Pandonesia Pandemics

Influenza Pandemic and its implications to Indonesia’s defense system and national security
1. Background

Traditionally for many years, the concept of security has been narrowly defined and interpreted as the preservation of the state from physical threats, mainly from external ones. Such narrative remains valid in many nations up until today. Following the cold-war era, the rise of more non-traditional threats, such as terrorism, ethnic cleansing, diseases and illegal drugs pose a new challenge to global and national security. These new threats have in some ways required many nations to redefine their perspective on national security. Globalization has also driven the community of nations to recognize the need to reassess the state of
affairs in search of peace and security through a more sustainable solution that resulted in a new and more inclusive security paradigm. In 1994, the United Nations Development Programme (UNPD) issued its first edition of the Human Development Report, a publication that introduced a new concept of security, called human security.1 This new concept attempts to respond to a number of new challenges, mainly on the expanded non-military aspects, that are faced by the majority of the world’s population up until today.
The scale of dangers posed by a pandemic, such as Influenza, as demonstrated by localized outbreaks in the recent years (SARS, bird flu and last but not least, swine flu), has led the United Nations to frame pandemics as a global threat. More and more governments recognize pandemic as a national security issue due to its catastrophic implications. Influenza pandemic, if taken lightly, may well become the highest emergency risks to the global population. In the last century, the US National Homeland Security Council observed several major influenza pandemics2 that have resulted in more than 20 million casualties worldwide. A more detailed history is made available by the U.S. Department of Health & Human Services with an even higher estimation of more than 50 million casualties worldwide and many more infected in at least 4 different pandemic cases3 observed (The Spanish Flu in 1918-1919, a flu pandemic in 1957-1958, The HongKong virus pandemic in 1968-1969 and the latest one relates to the Avian Influenza and its strains in
2009-2011).
Table 1. Cumulative number of confirmed human cases for avian influenza (2003-2011)4 The government of Indonesia (GoI) officially declared the first cases of avian influenza in the country at the beginning of 2004. As the first human casualty took place in July 2005, investigations could not determine how the victim contracted the virus. Poultry death cases started to rise in the country and this immediately grabbed the attention of the government through the issuance of a series of regulations by different departments and institutions, namely Komnas FBPI5, Ministry of Health (MoH) and Ministry of Agriculture (MoA). As time progressed, human cases related to avian influenza have been detected in many more countries, with the majority of cases were caused by direct contact between humans and infected poultry or exposure to contaminated environments. Large clusters of human cases remain absent, although the risks of human-to-human transmission of the disease cannot be ruled out from some of the cases. Although, widespread human-to-human transmission is not yet reported, the risk of a pandemic remains at large due to the alarming spread of the virus in such a short window of time. As most of the world populations in major cities are reachable within 24 hours from any locations in the world, the risk of outbreak will inevitably be a reality.
2. State Defense System and human security principles

The objective of Indonesia’s national defense policy is stated in the Act No. 3/2002, which is to “protect and uphold state sovereignty, maintain territorial integrity of the Unitary Republic of Indonesia, and ensure the safety of Indonesian people from all forms of threats and disturbances.” The Defence White Paper issued in February 2008, elaborates further on the five main strategic goals that aim to achieve such objective, namely:
1. To deter all forms of threats to Indonesia and its people;
2. To defeat military aggression by foreign countries;
3. To overcome military threats that undermine the existence and interests of Indonesia;
4. To address non-military threats that might have adverse impacts on Indonesia’s sovereignty, territorial integrity, and safety of the people; and
5. To contribute to international peace and regional stability.
This paper attempts to highlight the pandemic preparedness issue in relation to the 4th and 5th goals as stated above, with the understanding that they are to be carried out by the Indonesian Defence Force (TNI), through war operations and military operation other than war. Through history, we learned how epidemic disease has greatly impacted the outcome of military conflict with devastating consequences. Thucydides describes that a disease has spread out among the Athenian population resulting in demoralization among the political leadership and the people. It has also weakened the army, hindering it from achieving key military objectives.6 History repeats itself when the biggest pandemic in history, commonly referred as ‘The Spanish Flu’, spread out towards the end of the First World War and hit all parties in conflict resulting in significant casualties within the population throughout Europe. These 2 events, 2300 years apart, support the argument that public health emergencies carry a significant impact in defense and security matters. During critical time, a pandemic can arguably lead to undesirable outcomes during conflict times. Although Indonesia has not been exposed to such threats, the prevalence of Avian Influenza in the country based on reported official cases and the low awareness of public health safety demonstrates the security risk posed by the occurrence of a pandemic. It is worth noting that Indonesia continues to be the country with the most reported H5N1 human cases up to today with the highest fatality rate (more than 80%) with outbreaks in poultry occurred in all of 33 provinces in Indonesia. These numbers alone should serve as an indicator for the government that taking preventive measures on Avian Influenza is critical to the national security interest of Indonesia as the reemergence of infectious diseases will carry significant implications as these diseases pose grave danger to our citizens as well as social and political risks through chaos and unrests. They will also threaten the continuity of government / public services and potentially limit the effectiveness of security forces deployment. Such situation will intersect with the argument of whether the concept of human security commands the same status as the more traditional view of state security7. The occurrence of a pandemic situation implies the possibility of massive chaos and disorder, pushing people to flee their homes and abandon their possessions; qualifying them as Internally Displaced People - IDPs, which warrant an immediate humanitarian assistance in order to prevent massive casualties and injuries.8 From the human security viewpoint, disaster management remains a serious challenge for GoI, specifically in the modalities to ensure the safety of its people (in this case, IDPs). The current procedures and practices are undoubtedly insufficient to ensure that some forms of preventive protection are present in such situation. The increasing frequencies of natural disaster occurrences in Indonesia recently, should serve as a key driver to influence the state’s defense policy on capacity and capability planning as well as on the protocols of deployment to support the civil defense structures when circumstances require. The concern remains that state security concerns have come to dominate the debate, at times overshadowing the legitimate protection needs of individuals.9

3. Preventive measures against pandemic situations Our total defense and security system (Sistem pertahanan yang bersifat semesta) emphasizes on the roles of the civil authority to serve as the main component in responding to threats to public safety in civil emergency situations.10 The function of ensuring public safety is multi-pronged in nature, and it directly relates to disaster management, pandemic diseases, transportation safety and displacement of population.
The presence of a coordination mechanism that integrates the roles of the various government agencies and non-governmental bodies under one command structure is imperative in responding to the threats on public safety. Early warning, mitigation and disaster management processes form part of the mechanism to respond to pandemic situations. Upon requests, TNI will be ready to provide assistance to the National Disaster Management Office (BNPB), given the logistical capacity as well as the availability of personnel and heavy equipments that are deployable during disaster situations.11 The involvement of TNI is intended to be of supporting role and will be focused on preventive actions, depending on the nature of the non-military threats and the operational requirements on the ground.12 There is a general agreement among the health experts that the Asia region, specifically Southeast Asia, carries the high risk to emerge as the epicenter of influenza in the future. Effective responses to pandemic situation in the region are limited and delayed. Such outbreak could cause massive casualties, destabilize the region, and eventually threatens the security of governments around the world, primarily the developing states, including Indonesia. The civil defense structure will not be prepared to cope with it. There is not enough vaccine or antiviral medicine readily available in-country to protect every citizen from contracting such a disease. Limited pharmaceutical industrial and supply chain challenges will hinder these medicines to be produced and distributed quickly. Isolation and quarantine zones will be instituted and the international communities will respond with travel bans to the country. Movement of general goods and supplies will be hampered with tighter controls. Health facilities will be swamped by infected patients, all demanding immediate attention as supply of drugs runs out very rapidly. With disruptions taking place in daily lives with markets and access to public facilities remain closed, chaos and public disorder are expected to occur as people demand access to basic necessities. These are examples of the scenarios played out in numerous simulation / training sessions over the recent years. Through a series of decrees, decisions and campaigns, the Indonesian government has introduced numerous monitoring and preventive activities domestically. Strategically, the GoI has implemented national plans for the control of influenza pandemic under the leadership of the MOA, MOH and coordinating bodies. At the operational level, Interventions reach to the district and sub-district levels and involve local government, the private sector, communities and consumer organizations. At the tactical level, poultry vaccination and disease detection tools, disinfestations within the vicinity of reported cases and intervention on poultry market chain have contributed to minimizing the number of avian influenza cases, particularly in dense urban areas. Based on Komnas FPBI’s publication13, the government recognized that in preventing the occurrence of an avian influenza pandemic, raising poultry is only a part of the problem.
The virus can easily spread during transportation, while it is at the marketplace or during the slaughtering and cooking process. Other related industries also pose the same threats. Feathers used for making shuttlecocks and the processing of chicken manure for fertilizers also exposed the virus to workers and there few controls over these informal industries. It is therefore crucial for all parties involved as well as common citizens to have a proper understanding and demonstrate proper behaviors for handling poultry and responding to diseases caused by it. Challenges remain on how to effectively contain / isolate the disease from spreading beyond an affected zone (village / sub-district) and in effective coordination and communication on the ground between the many agencies coordinating the
response. In order to prevent such crisis from happening in Indonesia, we must continue our efforts and operate within a framework that should involve the following:
Conducting public awareness campaign through community outreach in order to disseminate health care information regarding influenza prevention and treatment.
Increasing disease surveillance system, response capacity and continuous monitoring of traditional poultry markets, while instituting changes to the poultry market chain. All intended to strengthen the bio-security and hygienic farming management practices in the poultry industry.
Accelerating research on avian influenza vaccines and antiviral drugs
Implementing an incentive system that encourages communities to report cases of outbreak on a timely basis.
Planning on protection of essential public service staff and continuity of core public services during a pandemic
Stock positioning of antiviral doses in high-risk areas for the key health workers and the populations they serve.
4. Conclusions

Indonesia and its neighbouring countries will face more complex security challenges from internal, external as well as trans-national sources. These challenges are not merely physical violence / threats, such as border security or foreseeable threat of invasion, but rather non-military threats such as natural disasters and maritime security. In terms of threats related to natural disasters, a severe influenza pandemic will cost the lives of millions of people and will threaten the national security due to its severe implications. In recognition of such situation, the GoI has classified the threat of an influenza pandemic as a national security threat in its Doktrin Pertahanan Negara (state defense doctrine document published by Ministry of Defense in 2007). It is anticipated that the world’s poor population will suffer most from a pandemic situation. The Lancet recently predicted that if the next pandemic were at the scale of the 1918 Spanish Flu outbreak, more than 50 million deaths would occur in developing countries. Geographically speaking, this prediction is in line with the pattern of recorded avian influenza cases up to this date. The records show that Indonesia has the highest number of confirmed human cases of Avian Influenza with high fatality rates (more than 80%).14 Most Indonesians rely on poultry for food, and many rely on poultry for their livelihood as well. It is traditionally common that people’s lives are intertwined with the poultry chain, especially in the densely populated islands, such as Java and Sumatra. Although the virus is not readily transmitted among humans, it carries the possibility of evolving into a form more easily transmissible between humans and subsequently triggers a pandemic situation. The importance of strengthening pandemic preparedness through surveillance and monitoring, public awareness campaign, and hygienic intervention & disinfection along the poultry market chain, as well as training and education initiatives; all are intended to improve animal and public health with the objective to set a high barrier for the opportunities of a pandemic to occur in the country. The total defense and security system that Indonesia adopts are characterized by a number of attributes that will be advantageous during a pandemic situation, such as: crisis management capacities, ability to deal with varied tasks with extreme limitations, logistic resources, and nationwide presence in the country. TNI’s roles during a pandemic remain critical and could include: (1) taking national and regional command of the event, (2) assigning personnel to cover for essential civilian missions, (3) deployment of personnel to support the police force in maintaining public order and implementing public health measures such as isolation and quarantine. All these will have to be performed under the awareness that the primary role of TNI remains at defending the integrity of Indonesia from all possible threats, especially in times of global geopolitical changes caused by a pandemic situation.

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