Anticipating a bird flu outbreak<\/p>\n
Michael Richardson, Singapore<\/p>\n
As a feared strain of avian influenza reaches Europe after
\nspreading across Asia, threatening to trigger a global flu
\npandemic that could kill millions of people, political leaders
\nare scrambling to galvanize a more effective international
\nresponse to the infectious disease threat.<\/p>\n
The U.S. Health and Human Services Secretary Michael Leavitt
\nvisited Indonesia this week after committing US$25 million in aid
\nfrom the United States government to create a more effective
\nsurveillance network to keep track of bird flu and stop it
\nspreading from its epicenter in Southeast Asia. He was on the
\nlast leg of a regional tour with health officials from the United
\nStates and the United Nations. At every stop, Leavitt urged
\ngovernments to work faster to prepare for what many
\nepidemiologists now warn is likely, sooner or later, to become
\nanother world-wide influenza pandemic.<\/p>\n
The deadly H5N1 strain of the bird flu virus was confirmed on
\nSaturday to have reached Romania, making its first appearance in
\nEurope following an outbreak in Turkey last week. European
\nveterinary and public health officials held an emergency meeting
\nto advise governments in the 25-nation bloc on measures to try to
\nprevent the virus from infecting humans.<\/p>\n
The Bush administration earlier this month hosted a two-day
\nmeeting in Washington of officials from more than 65 nations and
\ninternational organizations concerned about preventing the spread
\nof the H5N1 virus that scientists fear is mutating into a form
\nthat will pass easily from human to human.<\/p>\n
The virus has resulted in the deaths of an estimated 150
\nmillion birds in 13 mainly Asian countries, causing $15 billion
\nin losses to the poultry industry. The World Health Organization
\nhas confirmed at least 116 human cases of bird flu and 66 deaths
\nin Vietnam, Thailand, Indonesia and Cambodia since late 2003.<\/p>\n
The Washington meeting agreed on the need for quick and
\naccurate reporting of potential bird flu outbreaks, donor support
\nfor developing countries that have been or might be affected, and
\na pledge to work closely on the issue with the WHO, the United
\nNations agency responsible for global health problems.<\/p>\n
Late last month, UN Secretary-General Kofi Annan appointed
\nformer WHO official David Nabarro as senior UN system coordinator
\nfor avian and human influenza. Nabarro said at the weekend that
\nas the H5N1 virus spreads, it could accelerate its mutation into
\nan organism that passes easily from human to human. Australia
\nwill host a regional meeting of pandemic management coordinators
\nand health and quarantine officials at the end of this month to
\ndiscuss and Asia-Pacific response. Just a few days earlier,
\nCanada is to hold a conference of high-level officials on bird
\nflu. Meanwhile, the WHO and the World Bank have called a meeting
\nin Geneva next month to muster funding.<\/p>\n
The Association of Southeast Asian Nations recently agreed on
\na three-year plan to control and eradicate bird flu. China, too,
\nissued a national preparedness plan in September, including
\nguidelines on logistics and disease surveillance, a color-coded
\nalert system and injunctions to local governments to draw up
\ntheir own contigency plans to cope with a possible outbreak of
\navian influenza among humans within its borders.<\/p>\n
But while the battle lines are being drawn up in Asia and
\nother parts of the world, they still appear to be largely
\ninadequate to the task. By the end of the first week in October,
\nonly 40 of the WHO's 192 member states had drawn up pandemic
\npreparedness plans, according to Margaret Chan, the agency's top
\nofficial in the area. She was the head of Hong Kong's health
\ndepartment in 1997, when bird flu first made the jump from
\npoultry to humans. It does so only if people eat infected birds
\nthat have not been well cooked or live in close contact with
\nthem.<\/p>\n
Only about 30 countries, mainly wealthy ones, have stockpiled
\nor ordered antiviral medicines for treating bird flu victims.
\nHowever, some of the drugs are being sent to epicenter countries
\nlike Indonesia that cannot afford large stocks. There are no
\neffective vaccines against bird flu, although laboratories in the
\nU.S. and other nations are racing to try to develop them.
\nConcern has been heightened by a new research finding from
\nVietnam that the H5N1virus is showing signs of developing
\nresistance to Tamiflu, the main drug used to treat human cases of
\ninfection.<\/p>\n
Preparations to counter a global flu attack are also being
\ncomplicated because intelligence is weak, and the shape and power
\nof the enemy remains far from clear. \"The pandemic risk is great,
\nthe timing is unpredictable and the severity is uncertain,\" Chan
\nsaid on Oct. 6. \"Early warning systems which are critical to get
\ninformation and intelligence are very weak in most countries.\"<\/p>\n
The WHO's regional office in Manila said on Friday that the
\ninternational community need to raise about $260 million in the
\nshort term to right the H5N1 virus in Southeast Asia alone. So
\nfar, only about $20 million has been committed to help combat the
\ninfection in the four countries human bird flu deaths have been
\nconfirmed.<\/p>\n
If the H5N1 virus changes so that it can pass easily from
\nperson to person, no-one yet knows what the infection and death
\nrate will be. In its recent form, the virus kills about half
\nthose it infects. Of the three global flu pandemics in the last
\ncentury, by far the worst was in 1918 when so-called Spanish flu
\nkilled just under 3 percent of those who got sick, or about 40
\nmillion people. Preliminary findings from recently published
\nresearch in the U.S. show that the 1918 outbreak was caused by an
\navian flu virus. Because the virus is coming from animals, humans
\nhave no or low immunity.<\/p>\n
Scientists and epidemiologists have made widely varying
\npredictions of the death toll in any new bird flu pandemic. They
\nrange from fewer than two million to as many as 360 million. The
\nWHO says the most likely outcome would be somewhere between two
\nmillion and 7.4 million deaths.<\/p>\n
A draft plan drawn up by Leavitt's health department to cope
\nwith a flu crisis has reportedly warned that a large outbreak
\nthat began in Asia would be likely to reach the U.S. within a few
\nmonths or even weeks, carried by aircraft passengers or other
\ntravellers. Quarantine and travel restrictions would not be
\neffective because of the contagious nature of the disease.<\/p>\n
The final plan is expected to be released later this month.
\nThe New York Times, which says it had obtained a copy of the
\ndraft, reported recently that if such an outbreak occurred,
\nhospitals would be overwhelmed, riots would engulf treatment
\nclinics, and even power and food would be in short supply as
\npeople failed to report for work because they were ill or afraid
\nof becoming sick.<\/p>\n
The draft plan outlines a worst-case scenario in which more
\nthan 1.9 million Americans would die and 8.5 million would be
\nhospitalized, with costs exceeding $450 billion.<\/p>\n
The writer, a former Asia editor of the International Herald
\nTribune, is a visiting senior research fellow at the Institute of
\nSouth East Asian Studies in Singapore.<\/p>",
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