Scott McPherson's Web Presence

The Chinese authorities have ruled out SARS and H5N1 avian influenza as causes of the respiratory distress that forced the closing of all primary schools in Hong Kong this week. 

Three young children have died as a result of the outbreak of seasonal influenza, according to the World Health Organization.  That is the good news wrapped in the bad news about this year's epidemic.  Although the Chinese authorities claim this year's seasonal epidemic is no worse than in previous years, that rule is not holding true throughout most of the rest of the planet.

Hong Kong is not completely out of hot water, however.  Yet another bird -- this time, a peregrine falcon -- has tested positive for H5N1, making it the second such case in a month.  It was found sick on Ma Wan island and died the same day it was tested.  A heron was found dead in Hong Kong's Ocean Park aviary last month, and it too tested positive for H5N1.  Authorities closed the popular tourist destination's aviary for three weeks.  Wild birds in HK are now routinely testing positive for H5N1, and five such positive tests have happened since January. the link below takes you to the International Herald-Tribune story of last month, where a dead magpie tested positive for H5N1.  By the way, the magpie was found in a Hong Kong food market.   http://www.iht.com/articles/ap/2008/02/15/asia/AS-GEN-Hong-Kong-Bird-Flu.php.

This disclosure means that for all intent and purpose, H5N1 is regaining its endemic stature within Hong Kong's wild bird population (as if it ever truly lost that status).

Killer flu in Hong Kong not bird flu

 

The deaths of three children in Hong Kong from a virulent form of influenza has forced health officials to close all of the district's elementary schools.

The outbreak has caused alarm despite the government's insistence that SARS or bird flu is not implicated.

The World Health Organization has also confirmed that the outbreak appears to just be the common flu.

The concern over the outbreak and the three deaths has nevertheless prompted many to don face masks when they venture out in public to protect themselves.

More than 550,000 children are currently out of school because of the outbreak and as yet it has not been announced when the schools will reopen.

Pictures in the media of people wearing face masks, locked school gates and temperature tests are redolent of the SARS outbreak in 2003 which killed 299 people.

While the SARS crisis has not returned the seven-year-old boy who died on Tuesday of a respiratory infection was the third child to die of flu-like symptoms in the last two weeks.

Of the school's 700 students 35 have fallen ill with flu-like illnesses and six of them have been hospitalised.

Investigations into the exact cause of death of the children are still ongoing but authorities say are taking no chances and closing the schools had more to do with soothing the anxiety of parents than an impending health crisis.

Other measures employed involve the shortening of visiting hours for acutely-ill patients in public hospitals, daily announcements of outbreaks and a public education campaign.

Infection control measures at hospitals have also been upgraded as Hong Kong is in the midst of the peak flu season.

Thomas Tsang the controller of the Centre for Health Protection however says there is no evidence at this stage that the flu season was any worse than in the past two years.

Critics say health officials have failed to learn lessons from the SARS outbreak and preventive measures should have been taken earlier.

http://www.news-medical.net/?id=36252

The hallways of Hong Kong's schools are eerily silent today.  That is because in the wee hours this morning, the city's government ordered all schools closed early for the upcoming Easter holiday.

The reason:  Influenza, or something like it, has wrought havoc upon Hong Kong's students.  Severe outbreaks of respiratory virus have erupted in 25 of the city's schools in recent days, and several children have died. 

The situation is not any easier in Hong Kong's hospitals, as some 15,000 hours of overtime have been clocked by nursing staff alone within the past two weeks (hat-tip to ironorehopper of Flutrackers).

Newspaper accounts vary as to the source(s) of the illness.  Some call it flu, while others still refer to the malady as "flu-like". At any rate, this illness is now accompanied by another, possibly even more frightening disease:  Encephalitis.  The most recent HK death was a seven-year-old boy who died yesterday of encephalitis associated with flu-like symptoms.  The mention of the very word "encephalitis" among flubies strikes severe apprehension at the best and outright horror at the worst.  Encephalitis Lethargica, as you recall, was the "secondary pandemic" to the Spanish Flu pandemic of 1918-19.  Think "Awakenings" with DeNiro and Robin Williams. Encephalitis Lethargica existed from 1917 to 1928, when it mysteriously vanished from the planet.

Now here's the interesting latest item:  The nation's leading SARS and respiratory distress experts are being called in, apparently in an effort to pin down the origin(s) of the illness.  It makes one wonder:  If the BBC is saying (as recently as this morning) that this is a "mystery" flu, and the SARS gang is being called in, what in Sam Hill is going on in Hong Kong?

Now add to this discussion the recent words of Zhong Nanshan (see my recent blog post), and you have a lot of wringing of hands and gnashing of teeth in southern China right now.

Zhong Nanshan is on his soapbox again.  And the world would do well to listen to him.

For the uninitiated:  Zhong Nanshan is Director of the Guangzhou Institute of Respiratory Diseases.  Guangzhou is located in the Cradle of Global Infectious Respiratory Disease, Guangdong province, China.  Guangdong is just north of Hong Kong.  Guangzhou is a dynamic city to work in if you are a public health professional.  That is because they pretty much see everything there is to see in Guangdong.  Bird flu. SARS.  TB.  You name it, it either starts there or winds up there. 

Zhong is at the center of the storm, and that is metaphorical.  Not only is he at the center of the disease storm, but his outspoken nature also creates a bit of a storm when he gets his dander up.  I point to Karl Taro Greenfield's seminal work on the history of SARS, the book China Syndrome.  If you have never read that book, hit Amazon now and pick one up.  His work in the early stages of the disease, as well as his antagonizing of the old-guard ChiCom political leadership put him doubly in harm's way.  His ability to end (at least temporarily) the truth embargo may have helped facilitate the demise of that old guard.  For a brief history of Zhong Nanshan, you can read this article: Uncompromising doctor - Zhong Nanshan.

Now for today's news:  The same flu epidemic that is strangling American emergency rooms is apparently also choking its Chinese counterpart facilities.  This H3N2 derivative, which we suspect is Brisbane, has caused several deaths among Chinese children and led to the closure and decontamination of at least one Hong Kong school. 

Zhong has issued a stern warning to the Chinese people in particular (and to the world in general) that H5N1 is mutating (again) at a time when traditional, seasonal influenza is about to reach a peak this month in China.  His concern is straightforward:  These may be the most favorable pandemic conditions in southern China since the original Hong Kong outbreak of human H5N1 in 1997.

Here is the Reuters story:

Bird flu shows signs of mutation - China expert

Tue Mar 11, 2008 9:38am GMT

(Adds closure of Hong Kong school)

HONG KONG, March 11 (Reuters) - A Chinese expert on respiratory diseases says the H5N1 bird flu virus has shown signs of mutation and urged vigilance at a time when seasonal human influenza is at a peak, newspapers reported on Tuesday.

"When avian flu is around and human flu appears, this will raise the chances of avian flu turning into a human flu. We have to be very alert and careful in March," Zhong Nanshan was quoted by the Ming Pao newspaper as saying.

"People who were killed by bird flu last year and this year were too poor to seek treatment. If you happen to have high fever and pneumonia, you must seek treatment fast," said Zhong, director of the Guangzhou Institute of Respiratory Diseases in China's southern Guangdong province.

Experts are worried about seasonal flu, because it could get mixed up with a deadly novel strain, such as the H5N1 bird flu virus. Such a hybrid would not only become easily transmissible between people, but packed with great killing power.

"The bird flu virus has shown signs of mutation. If infected people don't get treatment in a timely manner, they can die easily," Zhong was quoted as telling reporters on the sidelines of the Chinese parliament's annual meeting.

Three Chinese have died this year of H5N1 bird flu and they were infected probably through contact with sick poultry. The World Health Organisation said there was no evidence of transmission between humans in all three cases.

In Hong Kong, the government shut a primary school early ahead of the Easter holidays after one of its students, a 7-year-old boy, died at noon on Tuesday. The boy was admitted to hospital last week with flu-like symptoms and authorities are still trying to determine the cause of his illness.

Thomas Tsang, controller of the Centre for Health Protection, said five other pupils at the school have been admitted to hospital for respiratory infection and their conditions were stable. Three samples have tested positive for influenza A, Tsang said, without specifying the strain.

"The school will close early for Easter from tomorrow ... to facilitate disinfection," Tsang told a news conference. But he said there was no reason to close all schools in Hong Kong, although they would monitor the situation closely.

Hong Kong, which lies at the south of China, is in the grip of a seasonal flu peak, with outbreaks reported in a growing number of schools.

A 3-year-old girl died last week of human H3N2 flu and authorities have ordered schools to conduct fever checks and advise those who are unwell to stay home.

Although the H5N1 virus has infected only 368 people around the world since 2003, its mortality rate has been high, killing 234 of them. (Reporting by Tan Ee Lyn and Donny Kwok; Editing by Jeremy Laurence)

While I was flat on my back, wishing my local health people had a test for Ad14 that I could test (positive) for, a few seemingly random news stories came across my bedside table.  When treated separately, they just appear to be common news.  When looking at the Big Picture, however, they reveal a disturbing trend.

First up is the developing situation in Paraguay.  Paraguay is located in South America, and is bordered on the northeast and southeast by Brazil.  Brazil has experienced a few recent outbreaks of yellow fever in the interior of the country, resulting in several deaths.  This is no surprise; Yellow fever is endemic to Brazil's rural interior.  But the reaction of Brazilians to the new outbreaks was an interesting sociological phenomenon.  Literally hundreds of thousands of Brazilians began clamoring for yellow fever vaccine, and several medical centers were overrun by anxious Brazilians seeking shots.

From the Reuters story of last month, Millions seek shots in Brazil yellow fever scare:

The government has denied the country faces an epidemic of the mosquito-borne disease. But authorities are warning tourists traveling to Brazilian forests, national parks and rural areas to get vaccinated at least 10 days before their trips.

More than half of Brazil's 27 states are partially or entirely yellow fever risk areas, including the Amazon and Brasilia. Most of the coast, which attracts the bulk of tourists, is considered free of the disease.

As fears of an outbreak mounted, the Health Ministry gave states more than 3.2 million doses of yellow fever vaccines this month, more than three times the average monthly distribution in 2007.

On Sunday, people in Sao Paulo stood in line for more than four hours at an airport health station to get shots, according to local media. In Brasilia, hospitals temporarily ran out of vaccines last week as demand surged.
http://uk.reuters.com/article/homepageCrisis/idUKN15537481._CH_.242020080115

Now back to beautiful Paraguay, home to jungles, crops and former Nazis on the run: Paraguay is experiencing a similar resurgence of yellow fever, with one important distinction:  A case of yellow fever had not been reported in Paraguay in 34 years.  There have been more Mengele sightings than human yellow fever cases over the past three decades!  Suddenly, and despite the government's attempts at stamping out the disease, no less than five documented human cases occurred at the same time, at a central farming camp, according to AP:

Yellow fever outbreak strikes Paraguay

ASUNCION, Paraguay - Paraguay asked international health authorities on Thursday to supply 600,000 doses of vaccine for yellow fever after the first cases were detected in the country in 34 years.

Antonio Barrios, a public health official, said the government had 100,000 vaccine doses but wanted to bolster stocks as a "reserve measure" after five cases of yellow fever were detected this week in a central farming region.

Barrios said the request was being made to the Pan American Health Organization. An expert on vaccination issues at the Washington-based offices was not immediately available for comment.

Barrios said the five cases of the mosquito-borne viral disease were found in and around a town in rural San Pedro department some 240 miles (400 kilometers) from the border with Brazil. In January, Brazil reported eight deaths after an outbreak in rural areas.

No deaths from yellow fever have been confirmed in Paraguay, but health officials said it was awaiting pathologists' reports on two people who died recently of unknown causes.

"Pathologists are working in the laboratory to determine whether they died as a result of yellow fever or as a result of some other ailment," public health minister Oscar Martinez said.

The government has announced vaccination plans in and around San Pedro of all those between 1 and 60 years of age. Others were also seeking vaccinations elsewhere at public hospitals.

http://www.msnbc.msn.com/id/23058833/

Then, local residents began behaving like -- like, well, like Brazilians.  Also from the AP:

4,000 block Paraguay road, demand vaccines

ASUNCION, Paraguay - Some 4,000 people demanding vaccinations against yellow fever blockaded a highway near the capital Wednesday, a week after the disease made its first appearance in Paraguay in 34 years.

The blockade snarled traffic for hours on a major route near Asuncion before authorities negotiated a peaceful end to the demonstration, police officer Francisco Monges said. There were no reports of violence.

Paraguayan health officials last week announced five confirmed cases of yellow fever that originated in a remote farm community, but no deaths. The outbreak prompted South America's second-poorest country to urgently request 600,000 doses of vaccine from international health authorities.

Demonstrators complained the government had been caught short of doses and demanded a major vaccination campaign against the mosquito-borne disease. Hundreds of people lined up this week at hospitals around Paraguay, demanding vaccines that were unavailable.

Separately, Paraguayan health officials said they were preparing to rush in 50,000 vaccines on a refrigerated plane from Brazil. Peru also had pledged thousands of doses.

Paraguayan authorities had no immediate response to calls for a wider vaccination campaign. They initially said they were concentrating vaccination efforts on residents of the affected community of San Pedro, some 240 miles from the border with Brazil.

The last reported case of yellow fever in Paraguay was in 1974.

The World Health Organization says an estimated 30,000 people worldwide die annually from the disease. Symptoms can include fevers, vomiting, jaundice and bleeding from the mouth, nose, eyes and stomach.

http://www.msnbc.msn.com/id/23149574/

And wouldn't you know it, dagnabbit, but somebody forgot to go to the store and restock the Yellow Fever vaccine.  Hot off the presses today, from Reuters:

Global supply of yellow fever vaccine depleted-WHO

GENEVA, Feb 27 (Reuters) - The world's supply of vaccine against yellow fever, which kills tens of thousands each year, is under extreme pressure, a senior World Health Organisation (WHO) official said on Wednesday.

So there is a buzz (forgive the terrible pun) going round in South America about the reappearance of Yellow Fever.  Add that to the list of things steadily heading our way, along with Dengue fever and the spread of West Nile Virus in the continental US.  Here in Florida, attention is turned toward local government budget cuts, and one of the first things slated for elimination is:  Mosquito control.  Let me state again:  West Nile Virus is here.  Dengue is coming, maybe on the next flight from Santo Domingo to Miami.  And now, at this time, local governments want to cut mosquito control? 

It's not like we haven't been through a yellow fever disaster before in the United States.  I refer you to Molly Caldwell Crosby's excellent book The American Plague, which details the 1878 plague's effects upon the hapless city of Memphis.  An Amazon.com review of the book concludes:

Over the course of history, yellow fever has paralyzed governments, halted commerce, quarantined cities, moved the U.S. capital, and altered the outcome of wars. During a single summer in Memphis alone, it cost more lives than the Chicago fire, the San Francisco earthquake, and the Johnstown flood combined.

Now let's turn our attention to yesterday's AP story about the alarming spread of drug-resistant tuberculosis across the planet.

Drug-resistant TB spreading fast

LONDON - Drug-resistant tuberculosis is spreading even faster than medical experts had feared, the World Health Organization warned in a report issued Tuesday.

The rate of TB patients infected with the drug-resistant strain topped 20 percent in some countries, the highest ever recorded, the U.N. agency said.

"Ten years ago, it would have been unthinkable to see rates like this," said Dr. Mario Raviglione, director of WHO's "Stop TB" department. "This demonstrates what happens when you keep making mistakes in TB treatment."

Though the report is the largest survey of drug-resistant TB, based on information collected between 2002 and 2006, there are still major gaps: Data were only available from about half of the world's countries.

In Africa, where experts are particularly worried about a lethal collision between TB and AIDS, only six countries provided information.

"We really don't know what the situation is in Africa," Raviglione said. "If multi-drug resistant TB has penetrated Africa and coincides with AIDS, there's bound to be a disaster."

Raviglione said it was likely that patients — and even entire outbreaks of drug-resistant TB — were being missed.

Drug-resistant strain now in 45 countries
Experts also worry about the spread of XDR-TB, or extensively drug-resistant TB, a strain virtually untreatable in poor countries. When an XDR-TB outbreak was identified in AIDS patients in South Africa in 2006, it killed nearly every patient within weeks. WHO's report said XDR-TB has now been found in 45 countries.

Globally, there are about 500,000 new cases of drug-resistant TB every year, about 5 percent of the 9 million new TB cases. In the United States, 1.2 percent of TB cases were multi-drug resistant. Of those, 1.9 percent were extensively drug-resistant.

The highest rates of drug-resistant TB were in eastern Europe. Nearly a quarter of all TB cases in Baku, Azerbaijan, were drug-resistant, followed by about 20 percent in Moldova and 16 percent in Donetsk, Ukraine, WHO said.

High rates of drug-resistant TB were also found in China and India, the world's two most populous nations that together are home to half the world's cases.

Drug-resistant TB arises when primary TB treatment is poor. Countries with strong treatment programs, like the U.S. and other Western nations, should theoretically have very little drug-resistant TB.

That is not the case in China, however, where the government says 94 percent of TB patients complete their first TB treatment.

"There's a huge, gross discrepancy there if they are then reporting 25 percent of the world's multi-drug resistant TB cases," said Mark Harrington, executive director of Treatment Action Group, a public health think tank. "They are clearly nurturing a multi-drug resistant TB epidemic and failing to report XDR-TB at all." (bold mine)

With growing numbers of drug-resistant TB patients, there is concern some national health systems will soon be overwhelmed.

New drugs needed
"We are totally off track right now," said Dr. Tido von Schoen-Angerer, executive director of Medecins Sans Frontiere's Campaign for Access to Essential Medicines. He said only 30,000 multi-drug TB resistant patients were treated last year.

Experts said new drugs are needed if the outbreak is to be curbed, along with new diagnostic tests to identify drug-resistant TB strains faster — current tests take about a month for results.

WHO said a new diagnostic test able to provide results within a day is being tried in South Africa and Lesotho. If successful, the test could be introduced across Africa in a few months, though new labs would be needed to run the tests.

"Multi-drug resistant TB is a threat to every person on the planet," Harrington said. "It's not like HIV, where you are only infected through specific actions. TB is a threat to every person who takes a train or a plane." (bold mine)

http://www.msnbc.msn.com/id/23356049/

Where did we ever get off thinking we had "conquered" disease?  Look at the data on XDR-TB, the most lethal form of the disease.  Look also at where these cases are multiplying:  China.  India.  Russia and former Soviet territories.  Did I mention China, home to the 2008 Olympics? 

I have heard statistics in the recent past rearding the number of MDR-TB (that's moderately drug-resistant) and XDR-TB (or eXtensively drug-resistant) in the former Soviet Union.  How about 200,000 new cases a year?

Please allow me to pull directly from the Website of the Woodrow Wilson International Center for Scholars:

The substantial success in controlling TB during the Soviet years has been lost, and TB deaths have skyrocketed in Russia over the past 18 years, particularly among working-age men. Much of this increase is due to overcrowding in urban centers, and in prison populations especially, explained Dr. Keshavjee. Globally, TB strains—including MDR- and XDR-TB strains—kill approximately 1.8 million people per year, he said, disproportionally affecting the poor and immunocompromised.

Worldwide each year there are approximately 400,000 cases of MDR-TB tuberculosis, strains that are resistant to the first-line and most effective TB drugs, and often select second-line drugs. Due to the relative weakness of second- and third-line drugs, effective treatment of MDR-TB often requires an 18-24 month course of rigorously managed, directly observed therapy. XDR-TB strains are only susceptible to questionably effective third-line drugs. Because of this, XDR-TB requires a longer course of drugs and often times surgery if treatment is effective at all. Russia has a 14 percent prevalence of XDR-TB among TB positive patients, one of the highest rates in the world. Particularly frightening, said Dr. Keshavjee, is the increase in person-to-person spread of drug-resistant TB: “At least 10 percent of new cases of TB in the [former Soviet Union] are MDR [strains] and 50 percent of re-treated cases are MDR.” 

...In addition to the extremely slow response to TB, mentioned earlier, it is also difficult to accurately determine how many people may be suffering from TB due to inadequate data collection systems within Russia. While Russian officials claim 120,000 new TB cases per year, the World Health Organization puts the number closer to 150,000-160,000, he said. MDR-TB rates are even more difficult to judge, with broad estimates for those receiving treatment ranging from 17,000 to 58,000. Feshbach emphasized the importance of remembering that Russian statistics only include first incidence of TB, so relapse and re-treatment are not included in the counting. There are also inaccuracies in counting deaths when both HIV and TB are detected. HIV deaths due to TB are counted as an AIDS death, not a TB death. (bold mine)
http://www.wilsoncenter.org/index.cfm?topic_id=116811&fuseaction=topics.event_summary&event_id=239772

We are aware of the American citizen who was in indefinite, judge-ordered lockup in a Phoenix, Arizona jail for months because he refused to treat his XDR-TB with the proper respect.

Anna Spector's Infectious Diseases Blog

Robert Daniels made headlines in the United States when he was put in solitary confinement in a hospital ward after disobeying a judge's order to wear a mask (he went to a 7/11). He was diagnosed with a kind of tuberculosis that is very difficult to treat, XDR TB. Daniels, whose mother is Russian, and father is American, had been living in Moscow, but decided that TB treatment would be better in the US, so he went to Arizona. After a year of forced hospitalization and the removal of one lung, Russia Today reports that Daniels is better, but that Arizona officials wanted him to continue treatment he thought was not necessary. So Daniels has fled back to Moscow.

Among the torture Daniels' lawyer says he was submitted to were 24 hour a day light, and no telephone calls or TV.

http://infectiousdiseases.about.com/b/2007/10/16/xdr-tb-causes-robert-daniels-to-flee-us.htm

Well, at least he is back with his droogs, eh?    Good luck to us all.

My blogsite has been silent for the past few days, as I had to rush out of town and only now have returned to the Golden Keyboard.  My drive from Miami to Tallahassee was full of potentially whimsical and penetrating commentary regarding the recent book release from our favorite foreign health minister, Siti Fadilah Supari of Indonesia (pictured). 

All of this started with a phone call this past Tuesday from my good friend Sharon Sanders, founder of Flutrackers.com.  Sharon tipped me off regarding the release of the Supari book, which blames the United States military-industrial complex, the pharmaceutical cartel, President George W. Bush, the Andromedan galactic government, Lee Harvey Oswald, Britney Spears, steroids and global warming for the collective failure of her nation's government to contain H5N1. 

And just when I had penned a tome worthy of such a supremely ridiculous book premise, along comes the Indonesian government to sabotage my initiative by acting sanely!  Damn them, anyway!

You see, back in January, 2007, Indonesia stopped sending human H5N1 samples to the World Health Organization.  The government's reasons were locked in some strange logic vault, so it is hard to follow their line of reasoning (if reason factors anywhere in this argument).  Anyway, Indonesian leaders believed that if they withheld their native human bird flu samples from the rest of the world, the rest of the world would capitulate to their demands of free vaccine for all Indonesians!  Plus they would get two front-row seats for the American Idol finale, and ten box seats at Wrigley Field on the first base side (they get to bring their goat).

The WHO responded by saying not even they could get American Idol tickets, and they better look elsewhere.  Indonesia then sent samples from the suspected Bali H5N1 cluster cases that occurred in rapid-fire fashion in August, 2007.  But the government abruptly stopped again when they learned American Idol had been over since May, and Jordin Sparks had won.  They really liked that beat-box dude.

Of course, let us not forget the reason why the Bali samples were sent:  The December 2007 Global Warming Summit was coming to Bali, and with all those world leaders coming down, they didn't want Bali to be Ground Zero of the Next Pandemic.  So the Indonesian government lifted their self-imposed insanity -- er, moratorium -- and sent two samples (big deal) to the WHO.  When it became apparent that the Next pandemic would not start during the Summit, however, they returned to their pattern of withholding samples. 

So why the sudden and dramatic turnaround in governmental attitude?  Why is Indonesia now sharing H5N1 samples? Usually it means somebody wants something that is of greater value than what they possess.  According to Reuters, that "something" is the ironclad assurance that Indonesians will get vaccine by the thousands of liters if their sample turns out to be The Trigger of the Next Pandemic.

But I have my own theories.  Here they are:

1.  They saw that the current Northern Hemisphere vaccine protects against seasonal flu as well as it does against falling debris from a dead spy satellite, and they knew they were doomed anyway, so what the Hell?

2.  They believed the US gave Fidel Castro bird flu, and that is why he is too weak to govern, and they didn't want to wind up the same way old Fidel did.

3.  They did get those Idol tix from Fox!  Plus Supari gets to sing on the Season Finale.  With Blake Lewis. And Simon will be gagged.

Of course, none of these are the correct answer.  She will sing and dance with Paula Abdul. 

Seriously, what is clearly going on is this:  Indonesia has lost the handle completely on containment of H5N1.  As we all know, the disease is endemic in poultry, wild birds, pigs, cats, dogs, and possibly even certain villagers.  They also know -- or suspect --  their deal with Baxter is insufficient to protect the entire country from the disease.  So they have successfully negotiated a settlement with the WHO, and I am betting a good deal of that settlement was financially brokered by the Bill and Melinda Gates Foundation.  That is entirely speculative on my part, but it took someone with access to incredibly deep pockets to financially back that agreement, and the only entity that I am aware of with that kind of financial clout is the Bill and Melinda Gates Foundation. Senator Barack Obama's presidential campaign comes a close second, but they are too busy trying to fend off the "other Bill," as the prospective First Philanderer tries to buy Democrat delegate support even as Obama wins them.  It's the American Way!

But I gleefully digress.  Indonesia is throwing in the towel, and I strongly suspect they know something we don't.  Their people must have performed their own calculus and determined that H5N1 is beyond their capabilities, maybe even Baxter's, to solve.  So they have turned back to the WHO and the UN for help. 

Why in God's name they ever thought the US was capable of manufacturing a bird flu biological weapon is beyond me.  We can't even get a platinum record from a recent Idol winner.