Collaborations between global scientists to tackle the Wuhan coronavirus (2019-nCoV) have taken off at an incredible speed, with open access to the virus’s genetics. However, Indonesia is being left behind in this global scientific effort due to a lack of capacity and differing research priorities.
A country with a 270 million population – the world’s fourth largest – has yet to declare any confirmed cases of infection even though its neighbours Singapore and Malaysia have announced cases of coronavirus infection.
Many question Indonesia’s claim of no infections.
A study from Harvard University – not yet peer-reviewed – assessed travel intensities from Wuhan to various countries. The researchers concluded that it is shocking that Indonesia has yet to confirm any 2019-nCoV cases.
Media reports suggest the delay in acquiring specific 2019-nCoV testing kits is the reason Indonesia has not reported a single case.
Researchers also indicate that Indonesia’s labs are not yet on par with others around the world. This slows health research and renders the country unable to participate in the global scientific effort to tackle the coronavirus.
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The World Health Organisation (WHO) recently declared the Wuhan coronavirus outbreak a global public health emergency. So far about 42,000 cases of 2019-nCoV infection and 1,000 deaths have been confirmed in China alone. In addition, more than 350 infections have been confirmed in at least 25 other countries.
The virus’s gene sequences were made accessible in early January through a public access genetics bank. Since then, labs around the world have been scrambling to understand the virus – its symptoms, similarities to existing coronaviruses, how it spreads and how fast.
Research institutions in China, the United States, Japan and Europe have dominated these front-seat initiatives – very little seems to be coming from Indonesia.
Gaps in funding and capacity
Prior to obtaining specific 2019-nCoV testing primers last week, the Indonesian government had been using diagnostics that could only detect the general coronavirus family in patients. It then required additional gene sequencing to detect the new virus.
Reports say the two-step method could take up to six days for each diagnosis.
While foreign labs have used publicly shared 2019-nCoV genome sequences to develop specific diagnostic kits themselves, the government’s Eijkman Institute for Molecular Biology director, Amin Soebandrio, says Indonesia’s labs have struggled to follow suit.
“Our lab’s speeds are not as fast as our colleagues in more scientifically advanced nations with facilities and funding that are more flexible,” Amin said.
Currently, only three labs in Indonesia have the capacity to test and research the new coronavirus, including Amin’s institute and the Health Ministry’s biomedical research lab. Only the latter is actually authorised to run tests.
“We have not been able to make them [2019-nCoV diagnostic kits] ourselves for considerations related to speed and affordability,” Amin said.
When asked how much funding his institute received from the government, he declined to answer. However, he indicated funds were prioritised for containing the outbreak first.
This has left little for labs to conduct frontier research on the virus.
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“The government’s budget [for the coronavirus] is primarily allocated for the handling of the outbreak such as preparing containment facilities and installing large expensive thermo-scanners in airports,” Amin said.
Around the world, on the other hand, research teams have been able to access grants from alternative sources – something Indonesia has been heavily criticised for lacking – to boost research and diagnostics development for the 2019-nCoV.
The European Commission recently announced grants totalling €10 million (US$11 million). The Canadian Institutes of Health Research is offering C$1 million in grants to researchers developing counter measures – including diagnostics or vaccines – to the 2019 coronavirus.
The combination of limited capacity and funding might explain why Indonesia’s scientific community is unable to take advantage of the publicly shared coronavirus sequence to contribute to global research.
Looking at global efforts
Since the 2019-nCoV gene sequences were made available through GenBank, some labs have developed testing kits to specifically detect the 2019 coronavirus in suspected patients.
So far, six teams have publicly shared their molecular testing protocols with the WHO. These include researchers at Hong Kong University and the Charité Berlin University of Medicine in Germany.
The research team from Berlin, for instance, developed one of the first tests for the 2019 coronavirus as soon as news of the outbreak came out, due to their expertise in SARS-related viruses.
When the first release of the sequence came out from China, the team was able to use it immediately to perfect their molecular detection kit.
The team’s 2019-nCoV diagnostics protocol was announced more than a week before the first coronavirus case was confirmed in Germany.
Since the start of this year, over 90 international papers regarding the novel coronavirus have been made available in the popular biomedical research repository PubMed.
More than 50 of these were published in the last week alone.
Different priorities?
Anis Fuad, who researches epidemiology and population health at Universitas Gadjah Mada (UGM), offered an alternative explanation for Indonesia’s low involvement in global research on coronavirus.
He says it’s due to different research priorities for the country’s science community.
“There are still no confirmed cases of the novel coronavirus, so the materials available and incentive to study it are low,” he said.
“It’s a different case with diseases such as TB [tuberculosis] and malaria, which affect hundreds of thousands of lives every year.”
For instance, the latest reports estimate 800,000 to 1 million TB cases in Indonesia – the third highest after India and China. Indonesia’s economic burdens due to TB are among the highest in the world.
Anis himself is in the preliminary stages of conducting bibliometric research to understand how scientists are studying the coronavirus by looking at publications indexed in PubMed.
“There is a total of 9,700 entries related to the coronavirus in general, with average annual publications of around 300-400 papers since [the early SARS outbreak in 2002],” said Anis.
“But only 10 publications come from Indonesian researchers. This is the coronavirus in general, let alone the 2019 Wuhan variant.”
He suggests one way to prompt Indonesian scientists to focus more on the coronavirus is to link it with local phenomena that are more familiar to the Indonesian people.
“There are some researchers, such as those from IPB University in Bogor, West Java. They attempt to understand the variations of coronavirus in Sulawesi, where the consumption of wild animals [such as bats and snakes] is common,” he said.
“Studies from those locally-contextual angles can enrich the discussion surrounding the novel coronavirus. Data obtained from such research can also be deposited to GenBank so other scientists can take advantage of it, and vice versa.”