Infectious diseases continue to be a major cause of suffering and mortality in developing countries.  According to scholar Nicholas B. King, “there is nowhere in the world from which we are remote and no one from whom we are disconnected” (2002).  Currently, outbreaks of the avian influenza in Indonesia, among other countries, represent a grave danger and are highly likely to spread to more nations worldwide unless urgent steps are taken.  Any pandemic is likely to spring from developing countries, such as Indonesia, that have limited means to fight disease.  Outbreaks of the bird flu began in Southeast Asia in mid-2003 and have now spread to countries throughout Europe (World Health Organization, 2006, Countries Affected by Outbreaks in Birds section, para. 1).  International organizations, like the United Nations, are particularly worried about the spread of the avian flu in Indonesia because Indonesia has Southeast Asia’s largest population of both people and poultry (Sipress, 2005, p. A01).

Controlling the avian flu is for the worldwide public good.  Because mortality rates as a result of such outbreaks are substantially higher in developing countries, it is essential that this disease be addressed on a global level immediately.  In the following paper, I will define the problems caused by the avian influenza specifically in Indonesia, analyze the structural power relations of both control over credit and knowledge in this country, and present my conclusions in regard to the issue in this region of the world. 

In order to successfully eradicate the avian flu in Indonesia, the government needs financial aid from the World Bank (and the United States), and it needs to open straightforward communication both within its own government and abroad to stop the spread of the disease.

Avian Influenza as a Problem in Indonesia

In developing nations like Indonesia lack of funding hinders implementation strategies.  The transmission of the virus to the human population is difficult to detect due to a shortage of hospital diagnoses and lab analysis capabilities (Embassy of the United States- Jakarta, Indonesia, 2005).  Indonesia has an impoverished health care system that has deteriorated significantly since the 1997 Asian Financial Crisis and a weakened central government after the 1998 ouster of Dictator Suharto, two reasons why an outbreak of avian flu would be devastating to Indonesia (Sipress, 2005, p. A01).  Apart from being highly contagious among poultry, avian influenza viruses are rapidly transmitted from farm to farm by the movement of wild birds, people (especially when shoes and other clothing are contaminated) and contaminated vehicles, equipment, feed, and cages.  This swift transmission makes bird flu a high priority problem for the world. Avian flu also worries specialists because such highly pathogenic viruses can survive for long periods in the environment, especially when temperatures are low, making them particularly contagious and transmittable (World Health Organization, 2006, The Disease in Birds section, para. 7).  Control of the disease is especially difficult in Indonesia because poultry is the prime source of both food and income that cannot be wasted.  Households continue to consume poultry even when deaths or signs of illness appear, because Indonesians have no choice other than starvation.  Farm owners do not like to report deaths or signs of illness to authorities because there is a frequent absence of compensation to those farmers who do destroy their sick birds.  These Indonesian farmers also tend to live in close proximity to their poultry stocks, use primitive farming methods and have poor access to veterinary services, leaving them at high risk for contracting the flu. 

Most cases of the bird flu in human beings have resulted from direct or close contact with infected live or uncooked poultry or surfaces contaminated with secretions and excretions from infected birds, which characterize the general type of contact with poultry in Indonesia (Sipress, 2005, p. A01).   Health authorities fear the disease will mutate into a form that can leap between humans and sweep populations that are not prepared with significant vaccinations and/or immunity.  If such a sweep does begin, most countries in this region lack both basic agriculture safeguards to prevent the disease from spreading to humans and the health care systems that may be able to contain the virus if it does start spreading. 

The World Health Organization estimates that the H5N1 (avian flu) virus could infect up to 30 percent of the world’s population if the disease does mutate and beings to spread more rapidly (Lovgren, 2004, p. 2, para. 4).  This disease is a threat to human health and could have a huge economic impact worldwide; it is essential to alert governments of the steps that need to be taken to prepare for a possible pandemic.  The solutions to many of these problems can be remedied through access to credit and straightforward control over information by the Indonesian government. 

Analysis of Structural Power Relations

Structural power is divided into four sources: security, production, credit, and knowledge.  No nation can control all four at one time, hence why power is always contested.  There is a constant struggle and evolution of institutions resulting in bargains between individuals, states, businesses, and others to control the four sources of structural power.  Structural power as defined by Susan Strange in States and Markets is “the power to shape and determine the structures of the global political economy within which other states, their political institutions, their economic enterprises and not least, their scientists and other professional people have to operate.  There is always competition among individuals to wrest power from each other.  This competitive dynamic is what politics is about” (1988).

Here, structural power plays a central role in the gap between developed and developing nations.  Developed nations, like the United States, have been able to take advantage of the four sources of structural power to gain worldwide prominence, whereas the developing nations are struggling to control a single source of structural power.  Controlling a single source of structural power gives semi-periphery or periphery countries the ability to bargain with core countries.  Essentially, the Indonesian farmers and possibly large pharmaceutical companies stand to lose from the set of circumstances surrounding the avian flu in Indonesia.  

The Indonesian farmers stand to lose because their poultry flocks either die from the bird flu or the flocks have to be culled in order to prevent further spread of the flu.  Either way the farmers lose a substantial source of both food and income and are rarely compensated for such a loss.  The pharmaceutical companies stand to lose if the World Trade Organization (WTO) follows through on its decision made at the Doha, Qatar conference that is, according to Frederick M. Abbott in the American Journal of International Law, “supposed to enable countries lacking manufacturing capability in pharmaceuticals to make effective use of compulsory licensing” (2005).  In other words, this agreement would permit all WTO members to grant patents to another producer to make the patented product without the patent holder’s consent.  This would benefit developing countries like Indonesia, but hurt large pharmaceutical companies in countries like the United States, Great Britain, Germany, Japan and Switzerland. 

These major pharmaceutical companies earn substantial rents from the exploitation of their pharmaceutical patents, yet such exploitation makes products unaffordable to many developing nations who need the products most.  From the pharmaceutical home-country standpoint, patent revenues are used for research that results in new medicines.  The United States would prefer to restrict patents and pharmaceutical flexibilities, the opposite of what developing countries like Indonesia want. 

Control over Credit as a Source of Structural Power

It is difficult for Indonesia to fight the avian influenza without significant funding, yet who controls and has access to such funding?  Solutions to the multiple problems proposed by the avian flu can be accomplished, but not without financial support from multinational organizations or even individual countries.  The poverty in many developing nations exacerbates the problem of emerging diseases like the avian flu, because the prime source of food, in this case poultry, cannot be wasted; households in Indonesia continue to consume poultry even when deaths or signs of illness occur in their flocks.  These habits carry high risk of exposure to the virus during slaughtering, defeathering, butchering, and preparation of the poultry meat for cooking, yet such daily activities have proved difficult to change. 

It is hard for developing nations like Indonesia to make high quality vaccines and to expedite the vaccination process to match human need during times of crisis without an influx of foreign capital.  One of the oldest yet most effective public health strategies is quarantining people and goods suspected of harboring the infectious disease, but even quarantining takes proper capital backed infrastructure with access to all available knowledge.  Many multinational organizations like the WTO promote access to medicine for everyone and access to the necessary technologies to obtain such medicines; however, the World Bank primarily dictates which developing nations receive funding to fight their problems.

The World Bank is a vital source of financial and technical assistance to developing countries around the world; it provides low-interest loans and interest free credit to those who need it most (2006a, para. 1).  Many of the aforementioned problems such as lack of compensation to farmers and preventative infrastructure can only be remedied through funding from the World Bank.  Some economic costs that need to be considered throughout Indonesia as a result of the bird flu are as follows:  first, the direct costs such as losses of poultry that impact not only farmers but those in “upstream and downstream sectors” like poultry traders, feed mills, and breeding farms need to be addressed.  In many Southeast Asian countries the size of the poultry sector in the national economy is about one percent of the total gross domestic product, meaning blows to the poultry are blows to the economy and the people as a whole (World Bank, 2006b, Avian flu in East Asia, para. 3).             

Second, Indonesian economic production has been largely undertaken by industrial and large commercial producers and the impact of the avian flu may be felt in the greater unemployment of wage laborers and in corporate bankruptcies.  Third, Indonesian tourism could also fall because of disease fears or travel restrictions.  Finally, the costs of prevention and control are high.  The costs to the government of purchasing poultry vaccines and medication and hiring workers for culling and clean-up are financial burdens that developing nations like Indonesia cannot afford.  These costs can only be addressed by those with control of credit outside Indonesia; therefore, those with the monetary power control the destiny of this nation.  It is especially important that governments, with the aid of institutions like the World Bank, face the need to compensate Indonesian poultry farmers for the loss of their flocks.  It is compulsory to induce owners not to conceal outbreaks which could instigate future pandemics. 

The Institute of Medicine and the World Bank have recommended expansion of and financial support for public health infrastructure in four principle areas: epidemiological surveillance of outbreaks of infectious diseases, training and basic research in molecular biology and virology, public and private development of vaccines, and lastly the strengthening of and coordination between local, national, and international public health institutions (King, 2002).  If all developing nations had the backing and credit to achieve these four things, the world, both developed and developing, would be much safer with regard to infectious diseases. 

The international community pledged US $1.9 billion to fight the avian flu worldwide and to prepare for a possible human influenza pandemic.  These pledges were made at the International Ministerial Pledging Conference in Beijing, China.  The World Bank has already pledged almost US $500 million from a global funding program to fight the bird flu.  World Bank President Paul Wolfowitz said, “To prevent the spread of avian flu, we need leadership at the highest levels to deliver programs that address both animal and human health concerns, while also preparing for a possible human pandemic.” (World Bank, 2006c, para. 6)

The World Bank also expressed the necessity for significant financing to support culling of infected birds and compensation to farmers who surrender their sick birds.  A new World Bank funding program is designed to allow countries access to funding on short notice to strengthen their veterinarian and health services, which would deal with the avian flu outbreaks among animals and minimize the threat posed to people.  In addition, the new program allows poor countries immediate access to funding to carry out international programs to control bird flu.  Programs like these are essential in combating bird flu in nations like Indonesia.  According to the World Bank there have been “active discussions” regarding funding for Indonesia and its fight against the avian flu (World Bank, 2006c, para. 12).  Nations like Indonesia need access to both credit and knowledge to overcome obstacles like the avian flu.

Control over Knowledge as a Source of Structural Power

Control over knowledge is an obvious power tool in the world today, yet how can it affect the fight against avian influenza?  The Indonesian government knows how to control knowledge for its own benefit.  The government skewed information for their benefit, as Governor Sutiyoso denied that Jakarta city administrators were slow to manage the epidemic when in fact officials now know that Indonesia covered up the original outbreak of the avian flu.  Indonesian officials covered up and then neglected the spreading bird flu for two years until it began to sicken humans, posing a grave threat to people beyond the borders of Indonesia (Sipress, 2005, p. A01). 

Indonesia’s national director of animal health disclosed that officials had known that chickens were dying from the bird flu since the middle of 2003, but kept this a secret until 2005 because of lobbying done by the poultry industry.  Indonesia’s minister claimed that they did not “want to publicize too much about the bird flu because of the effect on [the] farms” (Sipress, 2005, p. A01). Owners of major poultry companies also feared the publicity of the avian flu would harm the sales of chickens and eggs.  It is here that multinational organizations like the World Bank need to use their power and control over knowledge to let the Indonesian governments know that they will help.  The act of holding back information regarding the avian flu from both the Indonesian government officials and the world health organizations was dangerous to the entire world.  If the Indonesian government knew that help from multinational organizations was coming, they may not have felt the need to cover up the outbreak of the bird flu for so long. 

At each step of the avian flu progression in Indonesia the government failed to take measures that could have broken the chain of transmission, yet government officials discouraged research into the outbreak.  Such misuse of information shows a failure of infrastructure and a need for a regulated control of knowledge by a truthful government.  The Indonesian government needs to win the trust and confidence of its population in order to minimize panic and disruption and to mobilize the public as a key partner in beating the disease.  Both Indonesian farmers and the general population need to be educated with regard to the dangers of the avian flu and the necessity of culling infected birds to prevent the spread of the disease.  With the effective use of knowledge in Indonesia, bird flu can be eradicated.

Conclusion

As the world gets smaller through the advancements of technology and transportation it is essential that the nations of the world work together to fight diseases like the avian bird influenza.  Although Indonesia did not handle its first outbreak of the bird flu correctly as government officials witheld information from the public, with funding from the World Bank it can handle future outbreaks in a more efficient manner.  Assuming the World Bank’s new program for quicker access to funding works, many nations should be able to take a stand against the avian flu and other infectious diseases.  With honest access to funding and information, Indonesia should be on its way to eradicating the avian flu.  Funding from multinational organizations and cooperation among governments are the key solutions to this problem.  Controlling the avian influenza now is essential to global security.

References

Abbott, Frederick M. (2005). The WTO Medicines Decision: World Pharmaceutical Trade and the Protection of Public Health. American Journal of International Law, Vol.99, No. 2. Retrieved January 29, 2006, from JSTOR.  

Embassy of the United States Jakarta, Indonesia. (2005). More Avian Flu Outbreaks in  Indonesia. Retrieved February 11, 2006, from http://www.usembassyjakarta.org/

King, Nicholas B. (2002, Oct-Dec). Security, Disease, Commerce: Ideologies of Postcolonial Global Health. Social Studies of Science, Vol. 32, No. 5/6. Retrieved January 29, 2006, from JSTOR.

Lovgren, Stefan. (2004, December 7). Is Asian Bird Flu the Next Pandemic. National Geographic.com. Retrieved Januaray 29, 2006, from http://news.nationalgeographic.com/

Sipress, Alan.(2005) Indonesia Neglected Bird Flu until Too Late, Experts Say. The Washington Post, p. A01. Retrieved January 29, 2006, from JSTOR.

Strange, Susan. (1988) States and Markets. New York: Basil Blackwell. 

World Bank. (2006a). About Us, Working for a World Free of Poverty. Retrieved February 18, 2006, from http://web.worldbank.org/

World Bank. (2006b). East Asia Update- Economic Impact of Avian Flu. Retrieved February 20, 2006, from http://web.worldbank.org/

World Bank. (2006c, January 31). International Community Pledges US$1.9 billion to Fight Avian Flu. Retrieved February 20, 2006, from http://web.worldbank.org/

World Health Organization. (2006, February). Avian Influenza “Bird Flu”- Fact Sheet. Retrieved January 29, 2006, from http://www.who.int/

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