Are we capable of coping with the deadly bird flu?

Are we capable of coping with the deadly bird flu?

Andrio Adiwibowo, Jakarta

In the aftermath of the polio outbreak, we are faced with
grave doubts about our capacity to cope with the current outbreak
of avian influenza. The disease has claimed more lives in a
shorter period. Within three months, four deaths have been
confirmed and the number of patient is still increasing. That the
outbreak is centered in the capital city of Indonesia has shocked
officials.

Moreover, many researchers are extremely surprised about the
emergence of avian influenza in humans in Indonesia. They had
believed that avian influenza was restricted to animals and there
was only a very small possibility that it could infect humans.
However, the facts have proved otherwise.

Avian influenza is not a new disease, especially in the Asian
region. There was an outbreak in 2000, even though it was
insignificant. At that time, a small number of chickens in
isolated poultry farms in Vietnam were killed by H5N1, an agent
of avian influenza. International researchers had warned most
countries in this region, including Indonesia of the possibility
of the virus spreading.

Based on good evidence, the next great pandemic is not a
matter of if, but when and where. From 2000 to 2004, avian
influenza cases occurred sporadically, not frequently. The rarity
of this event has tempted us to underestimate the threat. During
that period, it seems that the virus has become stronger and more
virulent. Today the death toll is evidence of that.

Today, a wild bird population has been accused as the
reservoir of the virus. This may or may not be true. The
existence of viral diseases is common in nature. Nature has its
own mechanism to activate and turn off the disease. The purpose
of this mechanism is to maintain equilibrium. In the wild,
approximately 20 percent of a bird's population may carry a
disease.

However, these numbers are not a threat to the human
population at all. They only live in remote places that are far
from urban centers. The problem emerges when irresponsible act
alters the system. Many people in developing countries are
involved in hunting and trading wild birds. People snare the wild
birds and trade them, or in other words they have introduced the
birds along with their diseases to the human community.

Therefore, the rule of thumb is one sick bird that is kept as
a pet is more likely to infect human beings than tons of sick
birds that lived in their own habitat. Jakarta itself has some
large bird markets, and hundreds of wild bird-trading centers,
both legal and illegal. We can only imagine how many diseased
birds are circulating and the threats we are facing now.

Avian influenza is endemic and probably ineradicable among
poultry in Southeast Asia, and now seems to be spreading at a
pandemic velocity. Correspondingly, unhygienic poultry practices
in most developing countries also support the spread of the
disease. Current evidence suggest that intensive farming
practices, inadequate disease control, trade in live poultry,
mixing of avian species on farms and at live bird markets, and
poor bio-security in poultry production contribute much more to
the spread of the disease than wild bird movements.

Overcrowding of birds within intensive farming practices that
causes close contact with fecal and other secretions has resulted
in the transmission of the virus at a greater rate. Likewise,
lack of control on transported poultry products, including
infected poultry, along with high mobilization across the city
has also widened the transmission from farm to farm.

The current belief that avian flu occurs exclusively where
there is close contact between humans and poultry may prevent us
from encouraging greater awareness and attention to this disease.
It is naive to believe that human to human transmission could
only happen by chance and the probability is insignificant. It is
true that there is no evidence of human to human transmission to
date.

However, in the future, a strain might acquire the ability to
"jump species", either by mutation or by recombination of genetic
material with a human influenza virus and the ensuing virus would
then be highly pathogenic and transmissible causing an influenza
pandemic.

The up side of the story is that avian influenza is by no
means new and a cure is already available. Most developed
countries are already prepared, yet the effectiveness of the
vaccine is still in question.

First, there is no guarantee that the vaccine prototype, based
on a reverse-genetically-engineered strain of H5N1, will actually
be effective against a pandemic strain with different genes and
proteins. The epidemiological observations and sequencing
analyses of genes from avian and human H5N1 viruses "demonstrate
that the viruses are continuing to evolve and pose a continuing
and potentially growing pandemic threat.

Next, gearing up for larger-scale production will take many
months and production itself is limited by the antiquated
technology of vaccine manufacture, which depends upon a
vulnerable and limited supply of fertile chicken eggs. It would
also likely mean the shortening of the production of the annual
winter flu vaccine that is so often a lifesaver for many senior
citizens. Moreover, there is not enough vaccine or antiviral
medicine available to protect more than a handful of people, and
no industrial capacity to produce a lot more of these medicines
quickly.

At the least, developing poor country will suffer a lot more
than the developed world. The majority of the world, including
all the poor countries of South Asia and Africa where, history
tells us, pandemics are likely to hit especially hard, will have
no access to expensive antivirals or scarce vaccine. It is even
doubtful whether the minimal medicine to respond to an initial
outbreak are available adequately.

Correspondingly, immediate steps should be taken to improve
monitoring and assessing the risk for pandemic influenza in all
countries where avian H5N1 viruses are present. Measures to
reduce the threat of pandemic influenza including developing an
international stockpile of antiviral drugs and making a vaccine
available in affected countries in Asia should be mandatory.

The writer is a researcher in the Public Health and Virology
Department at the University of Indonesia, Jakarta. He can be
reached at andrio7897@yahoo.com.