The speed at which Indonesia has become the country with the most human bird flu deaths has experts worried, but they say the pace will continue until the problem is tackled at the source.
The country's 43 reported deaths in just over a year comes as the H5N1 virus spreads virtually unchecked among the billions of poultry in backyard farms throughout the vast archipelago.
Indonesia became the nation hardest hit by bird flu after local tests concluded a 16-year-old boy from Jakarta's outskirts succumbed to the H5N1 virus late on Monday. The tests were conducted by a typically reliable local laboratory, but have not been confirmed by a WHO-affiliated lab.
The country has racked up nearly a third of the world's fatalities in just one year, with the latest case surpassing Vietnam's reported 42 deaths, which occurred over a period of about two-and-a-half years.
Experts say the number of human deaths are a symptom of a much larger problem -- the rampant spread of infection among the country's poultry.
"When you have trouble controlling infection among the chicken flocks, you are naturally going to see continuing infections among humans," Anthony Fauci, the US National Institutes of Health's infectious disease said in a recent interview.
He said the more it spreads, the greater chance it has of eventually evolving into a strain that could cause a human pandemic.
"It's obviously a toll in human suffering, but it also continues to give this virus the capability of circulating," he said. "And the more it circulates, the more you have an opportunity."
Fauci, who visited Southeast Asia last year, said Indonesia has not shown the same aggressive approach as Vietnam and Thailand in tackling the problem in poultry.
Vietnam has not reported any human cases in nearly nine months and no poultry outbreaks this year, after launching a nationwide mass vaccination campaign in poultry last year.
Thailand -- which has reported 16 deaths and is currently experiencing a flare-up -- relied on strong village-based surveillance and mass slaughtering when outbreaks were discovered.
But in Indonesia many local governments have refused to carry out mass poultry slaughters and vaccinations have been sporadic. One of the main issues is a lack of centralized control in a very young democracy.
Many powers once held in Jakarta were given to regional and community governments after dictator Suharto was ousted in 1998. Funding and policy decisions are often at the whim of inexperienced officials, mayors and village heads.
The UN Food and Agriculture Organization (FAO) is working with the government at the village level to develop local outbreak detection teams to snuff out poultry outbreaks before they can spread.
But progress is slow with limited resources in a country of 220 million people spread across 17,000 islands.
"It's a disgrace. We have the biggest problem in the world with avian influenza in Indonesia and yet the world is still not investing in getting a systematic control program in place," said Peter Roeder, an FAO expert in Rome who has worked closely with Indonesia.
"What's Vietnam going to feel like if they get virus reintroduced from Indonesia?" he asked.
So far, about US$50 million has been committed to the WHO and FAO for work in animal and human health in Indonesia over the next 18 months, the World Bank says.