Asian bird flu threatens to trigger worldwide epidemic

By John Roberts
6 February 2004

The current outbreak of avian influenza—popularly known as bird flu—in a number of Asian countries is looming as a major international health crisis. It has potentially catastrophic human and economic consequences. While the full story is yet to be established, it is already clear that economic backwardness, government cover-ups and an inadequate system of international monitoring and response have all played a part in enabling the emergence and spread of the disease.

The World Health Organisation (WHO) was first notified of the disease by Vietnam in January. WHO reported that, as of January 27, the country had eight confirmed cases of infected people, nine “possible” cases and another 36 cases under investigation. The death toll was six but the figure has now climbed to 10. The epidemic has spread to 28 of Vietnam’s 64 provinces and, according to government figures, an estimated 740,000 birds have died and almost three million have been slaughtered.

Outbreaks of the disease in bird populations have now been confirmed in Vietnam, Taiwan, Thailand, South Korea, Japan, Cambodia, Laos, Indonesia, Pakistan and China. One of the most serious situations is in Thailand where the government initially denied that the disease was present. Five people have now died in Thailand bringing the overall regional toll to 16—most of them children. Thai officials have now confirmed that bird flu has spread to at least 25 out of the country’s 76 provinces and more than 10 million birds have been culled.

The disease has had an immediate impact on exports from the affected countries. Thailand, which is Asia’s largest exporter of poultry, has been hit with import bans by Japan, the European Union and other countries. Thai exports, half of which went to Japan, were valued last year at $1.25 billion. As well as large agribusinesses such as the Charoen Pokphand Group in Thailand, many small farmers throughout the region have been hard hit by the outbreak.

The farmers not only suffer economic hardship due to the loss of their stock but they and their families are most at risk of contracting the disease. Typically they live close to their poultry stocks, use primitive farming methods and have poor access to veterinary services. Among the first to die were a mother and her young daughter in the northern Ha Nam province in Vietnam.

While the human and economic losses are already substantial, health authorities are worried that a modified strain of the virus could emerge that is transmissible from human to human. At present, the human victims are all believed to have contracted the disease through direct contact with the faeces or other excretions of infected birds. But the longer the outbreak continues and the greater the number of human victims, the higher the chances of a modified strain that can be directly transmitted to other humans. Such an occurrence could trigger a global pandemic, which could result in millions of deaths.

The same strain of the virus, known as H5N1, emerged for the first time in a human population in Hong Kong in 1997. Its lethal character was demonstrated by the high death rate—of the 18 confirmed cases, six people died. In order to contain the disease and prevent a modified version emerging, Hong Kong authorities slaughtered the island’s entire chicken population of approximately 1.5 million birds in just three days.

The current outbreak, however, is not confined to a relatively small area. It has spread to several countries and to many areas where transport, communication and veterinary and other services are very limited. As a result, the danger of a modified virus emerging has multiplied significantly. Already two Vietnamese sisters, who died after nursing their infected brother, are under investigation as the first possible cases of human-to-human transmission. Medical experts warn that it would take at least four months to develop a vaccine to combat any new killer virus and far longer to produce and distribute the vaccine.

Government cover-ups

Health experts are still trying to understand where the latest outbreak of bird flu originated and how it was able to spread to a significant number of countries—apparently quite quickly. Government attempts, in Thailand and Indonesian in particular, to cover up the outbreak in order to protect business interests have only complicated the investigations. The consequent delay in warning the public and taking measures such as culling chicken populations has probably been a factor in enabling the disease to spread.

Thai Prime Minister Thaksin Shinawatra has been widely condemned inside Thailand for failing to acknowledge the outbreak of bird flu until January 23. Nimit Traiwanatham told a Thai senate committee that the National Institute of Animal Health had believed that avian influenza had been present in Thailand from November. The government, however, suppressed the information. Officials declared that the culling of some 850,000 birds was due to “fowl cholera”.

The parents of one of the victims have blamed the government for their son’s death. The boy’s mother, Chongrak Boonmanuj, said doctors at the Siriraj Hospital confirmed her son had died of bird flu but told her not to say anything about it as they were forbidden to speak about the disease. The boy’s father, Chamnan, asked: “The government knew, so why didn’t they tell the public so that we could protect ourselves?”

The government’s actions allowed the country’s chicken exporters—notably the huge Charoen Pokphand Group, known simply as “CP” inside Thailand—to make short-term windfall profits as the price of poultry jumped to more than $2,400 per tonne from around $1,700-$1,800. Thai consumer groups have pointed to the close connections between CP and the government, noting that Commerce Minister Wattana Muangsook is the son-in-law of CP founder and chairman Dhanin Chearavanout.

The January 29 issue of the Far Eastern Economic Review reported CP executive vice-president Sarasin Viraphol saying: “There is still no evidence that we have avian flu in Thailand... We are likely to emerge a winner rather than a loser from this episode.” In the February 5 issue of the same magazine, Sarasin was forced to concede that his company and Thai livestock officials were aware of an outbreak of avian flu in Nakorn Sawan province as far back as November. He claimed that officials thought the outbreak was “localised” and “containable”.

In Indonesia, the Director-General for the Development of Animal Husbandry Sofjan Sudardjat insisted as late as January 24—in line with government pronouncements—that the avian influenza strain H5N1 was not present in Indonesia. The government claimed that the deaths of millions of chickens were due to the Newcastle Disease, which is not transmittable to humans.

On January 25, however, Sudardjat admitted that avian influenza had broken out on Java in late August and spread throughout the country. His statement confirms claims by veterinarians that the government had known of the presence of bird flu since at least November but had sided with poultry industry representatives in denying its existence.

Even after admitting the presence of the disease, Indonesian officials initially resisted any large scale culling of the country’s poultry stocks. On January 28, agriculture official Tri Akoso told a conference in Bangkok of Asian nations, the European Union and international agencies that the mandatory killing of birds was impractical.

WHO chief influenza virologist Klaus Stohr said in Geneva on January 23 there was “a window of opportunity here to control the disease before it takes global proportions”. The actions of the Thai and Indonesian governments have helped narrow that window.

Inadequate resources

In attempting to track and control the spread of the disease, WHO is also hampered by the lack of adequate resources both in the countries where the outbreak has occurred and more broadly internationally. Hundreds of millions of poor farmers and peasants live in close proximity with their flocks and depend on poultry production for their survival, often in remote areas. Unlike in the West where poultry production is largely concentrated in huge enterprises, the decentralised production in Asia countries poses enormous problems for controlling any outbreak.

Even in areas where the disease has been identified, inadequate protection for those involved in culling also poses dangers. WHO has warned that unless these workers are adequately protected by vaccinations against human influenza and protective clothing then the culling operation may well provide the human incubators for a deadly strain. WHO has asked southern hemisphere nations to surrender some of their stocks of influenza vaccines being assembled for the next southern winter so culling workers can be inoculated.

The response of the major industrialised countries has generally been muted. Chicken imports have been banned but few funds volunteered to assist more backward countries in containing and eliminating the disease. Agencies such as WHO are also under-resourced.

WHO spokesman Dick Thompson told the New York Times: “There are big holes in the global public health network to monitor the many animal diseases that have implications for humans. The world needs to understand how much of a stake it has in animal diseases in third world countries.” WHO studies some animal diseases but governments are not required to report outbreaks to the organisation.

According to the newspaper, “Experts say a number of steps are needed to improve surveillance of animal diseases. They include better laboratory facilities, less costly diagnostic tests and sharing more information among international health agencies.”

The end result of government cover-ups and the lack of adequate monitoring and research is the outbreak of a disease that has already claimed a number of lives and devastated the livelihoods of many small farmers. More ominously, it has the potential to trigger a worldwide epidemic that, as one expert warned yesterday, could be 1,000 times worse than SARS.

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