Bali bird flu drill tests pandemic preparedness

Indonesia, indeed the world, had never seen anything like it. In a sleepy Balinese village, panic flares as some 20 people are feared to have suddenly been infected with avian influenza. The village is quarantined as medical workers clad in full protective body gear swing into action. The military and police are drafted in to halt what could be the beginnings of a deadly and disastrous global human bird flu pandemic.

The three-day simulated exercise from 25-27 April, which included a drill at Bali's international airport aimed at preventing travellers from exporting the H5N1 virus, was held in the country most likely to be the epicentre of a significant human outbreak, if not full-scale pandemic. Indonesia has suffered 108 bird flu deaths, the highest toll anywhere in the world.

Fourteen deaths alone have occurred in 2008 as archipelagic Indonesia, which was initially accused of being slow to respond to its outbreaks, grapples with the virus now endemic in birds in 31 of the country’s 33 sprawling provinces.

Bayu Krisnamurthi, executive director of Indonesia's National Committee for Bird Flu Control and Pandemic Preparedness, said the simulation was just part of Indonesia's overall avian flu/pandemic preparedness strategy. He said more must be done in preparation for a possible pandemic. But he hailed the exercise, which it took around six months to prepare.

"It was very successful, particularly in terms of participation and the attention from international partners," he told IRIN, referring to the over 50 international observer groups who attended the massive drill.
 
The airport portion of the exercise drew bemused and baffled responses from some travellers, who were swamped by mask-clad workers and made to pass through scanners detecting body temperatures as part of the drill.

"Now we know where we have a lack of knowledge or skills. We know where the gaps are that must be improved in future - that's what simulations are for," Krisnamurthi said.

Photo: Brennon Jones/IRIN

Indonesia has suffered 108 bird flu deaths, the highest toll anywhere in the world. Fourteen deaths alone have occurred in 2008, alone.

Some of the lessons learned, which are to be analysed by Indonesian officials at a meeting in May, included the simple logistical difficulty of properly isolating a village and containing the disease’s spread, as well as communicating effectively on the ground between the many agencies coordinating the response.

"The understanding of a pandemic still needs to be improved,” Krisnamurthi said. “We need more training."

Some interesting hiccups emerged from the perspective of the international observers, Annu Lehtinen, the UN's Regional Avian and Human Influenza Coordinator, told IRIN. For example, the tropical heat of Bali meant that medical workers could not stay outdoors in protective gear as long as they might in other climates, a problem which needs to be addressed in improving the effectiveness of the response plan to a pandemic.

How much the Indonesians take on board after the simulation will be the real test of the exercise's success, said Lehtinen.

Lessons learned?

"I think the critical thing is how the evaluation results will be taken into consideration when revising the national plan and revising procedures,” she said. “It (the drill) was absolutely a step in the right direction... [but] it's not enough,” she told IRIN. “You need to carefully take into consideration what has been learned."

Subhash Salunke, head of the World Health Organization (WHO) in Indonesia, said that though the exercise was held in Bali - where only two bird flu deaths have been confirmed - it involved national agencies, so broad lessons relevant across the nation could be learned. It was also useful for the international community, he said.

"It was a wonderful exercise for training staff in other provinces and districts, as well as other countries... because no other country has done this," Salunke told IRIN. "It was very satisfying that the Indonesian government has undertaken this and they are planning now to extend it to other provinces,” he said. “This can't be a one-time exercise and then we forget about it."

The next step, the national commission's Bayu said, will be incorporating the gaps that were found through the simulation into Indonesia's national strategy, as well as holding more exercises in up to seven other provinces, with at least some in urban areas which would be, he conceded, "more complex".

Krisnamurthi said the simulations were helping to fine-tune Indonesia's overall national strategy: "It's learning while doing, and improving. We are building our ship while sailing it - it's not finished."

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