In an interview with IRIN, Dr David Nabarro, the United Nations’ senior coordinator for avian and human influenza, says although global defences against avian influenza have been strengthened, there are still challenges ahead in limiting the damage should the virus mutate into a form easily transmissible between humans.
Dr David Nabarro, the
United Nations’ senior
coordinator for avian and
human influenza, said
governments around the
world must be poised to
aggressively contain any
localised outbreak of H5N1
influenza in humans and to
limit the fallout. He added
that in the event of a
human influenza pandemic
it will be vital to keep essential
Such work “parallels the thinking they have to do for major security outrages. It’s not an unreasonable thing to be doing,” Dr Nabarro said.
Yet global efforts to prevent, or limit, such a catastrophe will require huge resources – both financial and technical. Dr Nabarro estimates the battle against bird flu will require between $500 million and $1 billion of new funding each year over the next decade to help countries, particularly poor countries that are most likely to be first affected, to bolster their bird flu defences.
As one urgent measure, Dr Nabarro said many countries still had to strengthen their public health systems, particularly their surveillance capacities, to be able to quickly detect and contain an outbreak of avian influenza in humans and to prevent the virus from spreading widely throughout the population.
“Human health systems, if they do pick up a cluster of severe human flu-like illness, need to have the capacity to contain this virus and stop it from spreading,” he said.
“Containment means initiating actions where people’s movement is limited, where people are encouraged to not mix with each other in crowded places, and when sick to stay home and isolated as much as possible.”
When the H5N1 virus began to kill vast numbers of birds in southeast Asia in late 2004, regional governments were slow to recognise and respond to the threat, with some authorities even attempting to cover up the extent of poultry deaths. The denials and delays proved costly, allowing the virus to spread and take root, while also killing dozens of people in the region.
Subsequently, Asian governments embarked on aggressive campaigns to contain the virus, culling millions of birds. Yet the H5N1 virus is still circulating in parts of Indonesia, and also thought to be endemic in Vietnam, Thailand and China. The fact that some birds, including ducks and wildfowl, can carry the virus without falling ill or displaying symptoms has hampered efforts to stamp out the virus completely.
In 2006, the virus surfaced in many other parts of the world – including eastern Europe and Turkey; the Middle East and sub-Saharan Africa – having been carried by migratory birds and introduced into domestic poultry populations.
But authorities moved swiftly, helping to bring the virus under control, though it appears to be still circulating in certain parts of Egypt and Nigeria. Dr Nabarro also said governments and local communities could ill afford to be complacent since the virus could reappear at any time.
Specifically, governments and communities must be prepared when there is a new outbreak to rapidly restrict movements around affected farms, cull birds on affected farms and surrounding areas, and keep the area clear of poultry for a long time before restocking.
“Most countries in eastern Europe would be able to control any new outbreak now much more rapidly than they did at the beginning of 2006,” he said.
“In sub-Saharan Africa and the Middle East, “all these countries have got a much better functioning system than before, and that is a very good sign”.
Asian countries have also made “huge progress” in responding to outbreaks in birds and strengthening their animal-health systems. But developing countries, especially in Asia, face a long-term challenge of overhauling their poultry industries – partially by reducing the movement of live birds – to increase biosecurity, and reduce the risks of people contracting the virus from ailing birds.
“We’ve got a 10-year challenge ahead of us,” Dr Nabarro. “What was initially treated by some as an emergency is now turning into a long-term programme in which we are trying to upgrade animal health, with veterinary services, greater bio-security for poultry rearing, and more attention to the quality of slaughterhouses and markets.
“In Indonesia particularly, but also China and other parts of this region, we’ve just got to transform the way poultry are reared,” Dr Nabarro said.
“It will be a long haul and we are going to have to maintain focus on it.”
Such dramatic changes would also require “mass social mobilisation” through large-scale public-awareness campaigns targeting rural communities in Asia – an effort that has begun with money from Japan and the US, though Dr Nabarro said such initiatives still needed to be expanded.
“We need to move people from ‘shock-horror-fear’ to having a pretty clear idea of what actions they will need to take, their families will need to take, and their communities will need to take to limit the threat,” he said.
Public health professionals are trying to work out how to simplify the messages on bird flu to effectively communicate the most important points to the public, such as washing hands and keeping distance from animals.
“We’ve started to see the kind of investment in public information that is necessary, but it is still only scratching the surface,” he said.
“It’s tricky – we have to change public attitudes internationally because of a problem that still is not tangible to very many villagers.
“To encourage them to change the way they care for their poultry, or to pay more attention to contagion and hygiene, on the basis of a risk that is intangible to them is never easy.”
It’s not just villagers who feel little sense of urgency: Dr Nabarro said he is frequently asked whether the seemingly abstract threat of avian influenza is more hype than reality.
“People ask me all the time, ‘is this H5N1 really going to change its genetic make-up and become capable of human-tohuman transmission or is it just going to coexist alongside the human race and then fade out in due course?’ My answer is, I do not know.”
Yet even if avian influenza ultimately recedes as a threat and the worst fears about a devastating human illness are never realised, Dr Nabarro said the global efforts to beat the virus are valuable preparation for governments, and rural communities, to cope with other disease threats that may begin in animals and migrate to humans.
“Seventy per cent of the pathogens that are going to affect the human race in the future will come from animals,” he said.
“To have human health services, and animal health services, that are working together is extremely reassuring.
“To have a human health
service that is capable of
detecting strange new bugs
that may come from
animals is an extremely
good thing for the future of
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