Anticipating a bird flu outbreak

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.