Hera Diani, Jakarta – When avian influenza became a major global issue in 2006, some foreign health experts thought it was over hyped.

They said that people should indeed be cautious about the disease because influenza spread easily and called for global funding efforts to stop the disease. "But I think it's been over hyped. There is no indication or evidence that it will become a global pandemic," said a US HIV/AIDS researcher.

Other experts were concerned that fear of an avian influenza epidemic had caused other major health issues to be overlooked. So is the bird flu threat nothing to be worried about?

Maybe. But in the case of Indonesia, the hype surrounding it was seen as necessary to bring it to the serious attention of the people and the government.

According to the World Health Organization, bird flu remains essentially an animal disease, but one that has infected more than 250 people worldwide since late 2003, killing more than 150 of them.

In Indonesia, the first cases of bird flu in fowl were detected in 2003, and the first cases in humans in 2005. The country now has the world's highest number of human deaths from the virulent H5N1 strain of bird flu, with 75 people infected and 57 dead. Most of the infections were contracted from domesticated fowl. The most recent, on Jan. 7, was a 14-year-old boy in Tangerang, west of Jakarta.

The country is on the front line in the battle against the disease. No other nation has counted more deaths than Indonesia, where millions of chickens roam backyards freely.

Indonesia has attracted international criticism for not doing enough to stamp out the virus or to inform people of the danger. Many experts see it as the weak link in global efforts to ward off a possible pandemic.

To be fair, the avian influenza problem is very complicated in Indonesia. As a geographically big country with over 220 million people and billions of chickens and ducks, it requires a lot of resources to fight bird flu.

There are approximately 30 million homes which keep chickens in their backyards, and millions more birds out there, making widespread vaccination and mass preventive culling difficult.

The complexity of the problem has revealed how poor the nation's health system, animal health services and public awareness campaigns are. Only after bird flu surfaced did the country establish a pandemic preparedness commission.

Delayed treatment due to poor public awareness of the virus has led to the significant mortality rate. In many cases in West Java, even doctors and nurses have failed to take the problem seriously and immediately treat patients showing bird flu symptoms, while officials have been late to arrive at infection sites after the disease is reported.

The bird flu public awareness campaign run through the mass media has been of little help. People are still relaxed about the threat and there have been instances of farmers refusing to hand over their birds to the authorities despite being promised compensation.

In North Sumatra, farmers refused to have their poultry vaccinated, saying that they were healthy. The men drank the animals' blood in a protest.

In addition to halting the spread of the deadly disease, the government should use this time to improve the health system, animal health services and public awareness campaigns.

Observers have said there is a need for detailed and non-reactionary or superficial programs. The government's recent plan to cage fowls in residential areas to curb the spread of the virus, for instance, is likely to be futile unless people keep the cages and surrounding areas clean.

They have also said that it is vital that vets in each district stay on the alert for bird flu cases and respond to them, which means reliable vaccination programs, as well as the efficient killing of infected birds and compensation provision.

Such initiatives have been difficult to introduce, however, particularly because local administrations now have greater authority over internal matters. There is a need to increase the level of activity at the provincial and district levels.

The public awareness campaign needs to be more aggressive, as people will only follow the example if they see that there have been bird flu victims in their areas.

There is also a need for biosecurity awareness, involving educational institutions, places of worship and community groups.