The Indonesian government says it will take firm action to stop the spread of bird flu, including culling sick poultry and vaccinating birds near outbreak areas. But international experts warn the government must do more to stop the spread of the H5N1 virus, which has killed at least 19 people in Indonesia since July.
The Indonesian government said recently it will cull poultry within a one-kilometer radius of outbreaks of the deadly bird flu virus, and vaccinate birds within a three-kilometer radius.
While welcoming the news, Peter Cordingley, the spokesman for the World Health Organization in Asia, says Indonesia must be prepared to take more serious steps to stop the disease spreading.
"I think it's fair to say that Indonesia woke up late in the day to the threat that they had with this infection in their poultry," he said. "They responded pretty well of late but we do know that the virus now is completely embedded across large parts of Indonesia and it's going to take some pretty radical steps to get rid of it."
The country has had the largest number of confirmed human bird flu infections and deaths of any country so far this year. And of the 10 cases reported in the first two months of the year, nine were fatal.
In other countries, the bird flu survival rate is close to 50 percent. Cordingley says it is not clear why the death rate in Indonesia is so high. It could be, he says, because victims wait too long to seek treatment.
"It may also be that because of the late delay by the authorities in responding to the virus that it is, in fact, very, very deeply embedded in the environment. But basically, we've put this one, so far, in a box called 'We don't know,'" said Cordingley.
Since it resurfaced in 2003, bird flu has killed more than 90 people, nearly all of them in Asia. There have been about 170 confirmed cases in humans. In recent weeks the virus has spread to birds in Europe, the Middle East, Africa and India. It caused several human deaths in Turkey and at least one in Iraq.
While nearly all humans infected have caught the virus from birds - health experts warn it could mutate to a form easily spread among people, causing a pandemic that could kill millions.
In Indonesia, there have been clusters of bird flu - with several members of a family becoming ill. This worries health officials, who fear the virus is changing. Although the WHO says, so far, that does not seem to be the case, Robert Roder, a specialist in animal viruses for U.N.'s Food and Agricultural Organization, says health care professionals can not be complacent.
"You have to realize there's more avian influenza in Indonesia than any other country on earth. And while the virus continues to circulate in [bird] populations which have very close contact with people, then the risk of the virus jumping species to become able to transmit between people is high," said Roder.
To limit the spread of H5N1, WHO spokesman Cordingley says Indonesia must adopt the same tough measures used in Thailand and Vietnam. He credits Thailand's massive poultry culls and its efforts to make sure villagers report sick birds with containing the disease. In Vietnam, Cordingley says, strong surveillance procedures in villages helped prevent any human infections since November.
Both Vietnam and Thailand also have worked hard to tell people not to eat, sell or transport sick poultry, and to keep birds away from homes and children.
The WHO spokesman says it is clear what Indonesia needs to do.
"Surveillance is the number one step," he said. "The number two-step is public education. There is till too much inappropriate behavior all across the region, people interfacing with poultry, putting their lives at risk and putting their family's lives at risk. And then once they've identified an outbreak, they have to respond immediately, you have to get rid of it as fast as you can, through culling and through areas of limited movement of poultry and human beings."
Indonesian presidential spokesman Andi Mallerangeng says the government will begin an education campaign to go along with efforts to cull and vaccinate poultry.
"One of the things that's being discussed was making [the] public aware about symptoms of bird flu and also how to manage it at their own household and their own villages, including how to take care of the birds. And if you have symptoms, then where to go, which hospital that can be referred to, etcetera," said Mallerangeng.
International experts say nothing is certain about the behavior of the H5N1 virus, and they say all countries need to be alert, not only Indonesia, to prevent a human pandemic. The cost of delaying a response, they say, is a mounting death toll.