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Bird flu spiraling out of control in Indonesia

While Indonesia discovered its first bird flu outbreak fairly late in comparison to some other infected countries, it has endured one of the fastest spreads, with 42 human H5N1-caused fatalities reported since the first case was confirmed a year ago.

Until the latest Indonesian death was confirmed yesterday, Vietnam topped Indonesia as the country hardest hit by bird flu with 42 deaths since 2003 -- but Vietnam has not had a single human case this year. The disease continues to rage out of control in Indonesia, and experts say it will only get worse.

"It's like trying to fix the roof while there's a storm going on," said Dick Thompson, a spokesman for the World Health Organization. "Until the animal situation gets under control, there's going to be this steady drip, drip, drip of human cases, and that's a problem."

Although H5N1 is still a relatively rare disease among Indonesia's 245-million-strong population --compared to Vietnam's 84 million people -- experts say the country's decentralized government is exacerbating the problem. Since the fall of the Suharto dictatorship in 1998, most regions of the country have moved to a system of self-government; a condition most prefer to the harsh central control of the previous government in Jakarta.

"Decentralized units get very wary when the center takes on emergency powers," said Dr. David Nabarro, chief pandemic flu coordinator for the United Nations.

The lack of communication and cooperation between the regions has assisted bird flu's spread. Commonly, the response to a bird flu outbreak in Indonesia consists of limited culling and a vaccination ring around the cull, a practice that has been largely ineffective compared to the repression methods in other infected countries. Thailand quickly stemmed the tide of their outbreak by culling millions of chickens, and Vietnam brought their infections under control with mandatory vaccinations.

Other issues assisting the disease's spread are the sheer prevalence of poultry in Indonesia, a lack of compensation for culled birds -- causing a lack of cooperation from farmers -- and even superstition. Members of one village refused vaccination for the infection because they believed it had been brought on by witchcraft.

Indonesia does have the potential to fight off bird flu, as it did when a polio outbreak hit last year. A lone case of the disease was reported in May of 2005, which quickly grew to 303 cases, but a countrywide immunization campaign reduced the cases to just two so far this year. But so far, the country has shown no signs of such organization against bird flu.