Anticipating a bird flu outbreak

Michael Richardson, Singapore

As a feared strain of avian influenza reaches Europe after spreading across Asia, threatening to trigger a global flu pandemic that could kill millions of people, political leaders are scrambling to galvanize a more effective international response to the infectious disease threat.

The U.S. Health and Human Services Secretary Michael Leavitt visited Indonesia this week after committing US$25 million in aid from the United States government to create a more effective surveillance network to keep track of bird flu and stop it spreading from its epicenter in Southeast Asia. He was on the last leg of a regional tour with health officials from the United States and the United Nations. At every stop, Leavitt urged governments to work faster to prepare for what many epidemiologists now warn is likely, sooner or later, to become another world-wide influenza pandemic.

The deadly H5N1 strain of the bird flu virus was confirmed on Saturday to have reached Romania, making its first appearance in Europe following an outbreak in Turkey last week. European veterinary and public health officials held an emergency meeting to advise governments in the 25-nation bloc on measures to try to prevent the virus from infecting humans.

The Bush administration earlier this month hosted a two-day meeting in Washington of officials from more than 65 nations and international organizations concerned about preventing the spread of the H5N1 virus that scientists fear is mutating into a form that will pass easily from human to human.

The virus has resulted in the deaths of an estimated 150 million birds in 13 mainly Asian countries, causing $15 billion in losses to the poultry industry. The World Health Organization has confirmed at least 116 human cases of bird flu and 66 deaths in Vietnam, Thailand, Indonesia and Cambodia since late 2003.

The Washington meeting agreed on the need for quick and accurate reporting of potential bird flu outbreaks, donor support for developing countries that have been or might be affected, and a pledge to work closely on the issue with the WHO, the United Nations agency responsible for global health problems.

Late last month, UN Secretary-General Kofi Annan appointed former WHO official David Nabarro as senior UN system coordinator for avian and human influenza. Nabarro said at the weekend that as the H5N1 virus spreads, it could accelerate its mutation into an organism that passes easily from human to human. Australia will host a regional meeting of pandemic management coordinators and health and quarantine officials at the end of this month to discuss and Asia-Pacific response. Just a few days earlier, Canada is to hold a conference of high-level officials on bird flu. Meanwhile, the WHO and the World Bank have called a meeting in Geneva next month to muster funding.

The Association of Southeast Asian Nations recently agreed on a three-year plan to control and eradicate bird flu. China, too, issued a national preparedness plan in September, including guidelines on logistics and disease surveillance, a color-coded alert system and injunctions to local governments to draw up their own contigency plans to cope with a possible outbreak of avian influenza among humans within its borders.

But while the battle lines are being drawn up in Asia and other parts of the world, they still appear to be largely inadequate to the task. By the end of the first week in October, only 40 of the WHO's 192 member states had drawn up pandemic preparedness plans, according to Margaret Chan, the agency's top official in the area. She was the head of Hong Kong's health department in 1997, when bird flu first made the jump from poultry to humans. It does so only if people eat infected birds that have not been well cooked or live in close contact with them.

Only about 30 countries, mainly wealthy ones, have stockpiled or ordered antiviral medicines for treating bird flu victims. However, some of the drugs are being sent to epicenter countries like Indonesia that cannot afford large stocks. There are no effective vaccines against bird flu, although laboratories in the U.S. and other nations are racing to try to develop them. Concern has been heightened by a new research finding from Vietnam that the H5N1virus is showing signs of developing resistance to Tamiflu, the main drug used to treat human cases of infection.

Preparations to counter a global flu attack are also being complicated because intelligence is weak, and the shape and power of the enemy remains far from clear. "The pandemic risk is great, the timing is unpredictable and the severity is uncertain," Chan said on Oct. 6. "Early warning systems which are critical to get information and intelligence are very weak in most countries."

The WHO's regional office in Manila said on Friday that the international community need to raise about $260 million in the short term to right the H5N1 virus in Southeast Asia alone. So far, only about $20 million has been committed to help combat the infection in the four countries human bird flu deaths have been confirmed.

If the H5N1 virus changes so that it can pass easily from person to person, no-one yet knows what the infection and death rate will be. In its recent form, the virus kills about half those it infects. Of the three global flu pandemics in the last century, by far the worst was in 1918 when so-called Spanish flu killed just under 3 percent of those who got sick, or about 40 million people. Preliminary findings from recently published research in the U.S. show that the 1918 outbreak was caused by an avian flu virus. Because the virus is coming from animals, humans have no or low immunity.

Scientists and epidemiologists have made widely varying predictions of the death toll in any new bird flu pandemic. They range from fewer than two million to as many as 360 million. The WHO says the most likely outcome would be somewhere between two million and 7.4 million deaths.

A draft plan drawn up by Leavitt's health department to cope with a flu crisis has reportedly warned that a large outbreak that began in Asia would be likely to reach the U.S. within a few months or even weeks, carried by aircraft passengers or other travellers. Quarantine and travel restrictions would not be effective because of the contagious nature of the disease.

The final plan is expected to be released later this month. The New York Times, which says it had obtained a copy of the draft, reported recently that if such an outbreak occurred, hospitals would be overwhelmed, riots would engulf treatment clinics, and even power and food would be in short supply as people failed to report for work because they were ill or afraid of becoming sick.

The draft plan outlines a worst-case scenario in which more than 1.9 million Americans would die and 8.5 million would be hospitalized, with costs exceeding $450 billion.

The writer, a former Asia editor of the International Herald Tribune, is a visiting senior research fellow at the Institute of South East Asian Studies in Singapore.