It’s the latest punch in a dust-up that has been running for months. It’s not actually about what the navy-run NAMRU does. It’s about politics, personalities and profit. US Secretary of Health and Human Services Mike Leavitt tapped the nail on the head in his extraordinarily candid and rather admirable blog.

The Indonesian Health Minister has used the sample-sharing debate and the negotiations over the status of NAMRU-2 in Indonesia to set herself up as an antagonist of the United States, a position I suspect helps her politically among the constituency of her party.

Ibu Siti was chosen as health minister in preference to a previously favoured candidate because Indonesia’s president needed a woman from an Islamic party to tip his precariously balanced cabinet back from the brink of secular technocracy. She makes no apologies for taking an anti-Western stand at every opportunity. Most famously, she’s stopped giving flu samples to the WHO for analysis. In fact that’s probably why NAMRU got caught in the mess — it’s a WHO collaborating center. Supari has published a book “It’s time for the world to change! The hand of God behind the flu virus” in which she essentially argues that bird flu is a conspiracy cooked up in US military labs. Leavitt again:

Minister Supari, recently published a book in which she asserts the U.S. military is using influenza samples to create biological weapons. Secretary of Defense Gates was asked about the Minister’s accusation when he was in Indonesia this past February; he replied, “That’s the nuttiest thing I’ve ever heard.”

Of course that is loopy, and meant only for domestic political consumption. But the Indonesian cardiologist is not entirely wrong about another issue. Supari doesn’t think Big Pharma should make tonnes of money out of vaccines developed with samples from Indonesia, without Indonesians getting anything out of it. This makes Leavitt cross. Big Pharma needs the incentive of big profits if it is to continue to invest in research and innovation, he appears to say. But refusing to provide samples to help them achieve those profits also achieves robbing Indonesians and other people of an effective vaccine and thus good health.

In truth, Supari has a point. Her mistake is to reduce the equation to cash. What Indonesians need first and foremost is free access to any vaccines that are developed. Leavitt acknowledges that this is an issue, but brushes it aside. He’s wrong to. Bird flu is different from malaria and dengue fever and most other infectious diseases that affect developing countries, in that it threatens people in rich countries, too (HIV is one of the few other exceptions). That gives poor countries a tool which they can use to scratch away at an incentive structure that is chronically biased against investment in prevention in general and in prevention of diseases that affect poor people in particular. If Supardi learned to use that tool like a scalpel instead of a butcher’s knife, she might actually do something useful for both Indonesians and the world.

An aside: NAMRU does make life rather easier for Supardi’s ilk than it needs to. It’s website borders on the jingoistic, as well as lying about relations with the Indonesian MoH. It’s a truly remarkable and wonderful institution, the cradle of many a wonderful Indonesian scientist, but it might want to hire some PR expertise. Any idea who might be good at this kind of trouble-shooting?

The Institute for Democracy in South Africa has recently published a massive tome, The Political Cost of AIDS in Africa which “reveals that the fledgling multi-party democracies in parts of the continent are being undermined by sickness, incapacity and premature deaths among elected leaders as well as within the electorate”. Well, well. Who’d have thought it?

By definition, when over one in four voters is infected with a fatal disease that kills prematurely, voters will be dying prematurely. Since testing negative for that fatal disease is not a condition of office, it seems inevitable that some of the people dying are also politicians (the study points out that HIV is never acknowledged as the cause of death for a politician, but then most non-politicians with HIV in southern Africa are not exactly trumpeting their HIV status, either). If dead voters undermine democracy, as the study suggests, then yes, HIV will undermine democracy in southern Africa. HIV won’t undermine democracy as much as the acts of some of the region’s elected luminaries, such as Robert Mugabe of Zimbabwe, of course, but hey ho…

Now reverse the question. Not “how does HIV make for bad politics?”, but “how have bad politicians made HIV?”. What is really shocking in southern Africa is that political leaders, starting with South Africa’s Thabo Mbeki, have fanned the flames of HIV with their denial, their prudishness and their lies. And those of the voters that are still alive have, for the most part, allowed them to do it. In other words, voters are getting leaders that reflect their own views. That’s democracy.