President Bush today unveiled a strategy to combat the threat of an avian flu pandemic, calling for $7.1 billion in emergency spending to stockpile reserves of medicines and to press ahead with the development of a new vaccine.
While no cases of the H5N1 avian flu virus have been detected in the United States, more than 60 people have died from the virus, most of them in Asia, and 140 million birds have been killed to try to stop its spread. The virus has recently been found in birds in Europe.
Experts fear that if the virus mutates into a form that can be easily spread through human-to-human contact, the result could be a global outbreak, potentially including many deaths. About half of the estimated 120 people who have contracted the virus have died so far.
"This is a vital issue to the health and safety of all Americans," Mr. Bush said during a speech at the National Institutes of Health in Bethesda, Md. While there is no pandemic, the president said, "if we wait for a pandemic to appear, it will be too late to prepare."
The president's plan calls for building national reserves of antiviral medicines like Tamiflu and Relenza, which can help reduce the effects of the flu though they cannot prevent flu from occurring. The stockpile of antiviral drugs would be reserved for first responders, like police officers and health-care workers, as well as at-risk populations during the first stages of a pandemic, the president said. The Bush administration is seeking to have enough antiviral medication stockpiled for about 20 million people.
The plan also calls for the government to spend about $1.2 billion to purchase doses of flu vaccine that may provide some protection against the avian flu virus. An avian flu vaccine cannot be developed until a pandemic actually occurs, because researchers need samples in order to develop an antidote.
"It would not be a perfect match for the pandemic flu," said the president, "but would likely offer some protection."
The Bush administration has awarded two contracts worth a total of $162.5 million to two pharmaceutical companies to produce enough vaccine to protect 20 million people. Sanofi-Aventis, a company based in France that was awarded one of the contracts, has successfully tested a vaccine prototype against the avian flu virus, based on cases already seen in Asia.
Mr. Bush also said today that he would propose that Congress approve a $2.8 billion plan to accelerate research in cell culture, a technology that offers the possibility of finding a vaccine faster - and the ability to produce it in greater quantities more quickly - than does the current egg-based technology.
The goal, Mr. Bush said, was to have the capacity to "produce enough vaccine for every American within six months."
The president said that the government will also work with other nations to help identify outbreaks of the virus and to help stop its spread. In addition, about $100 million would be spent by the federal government to help states and local governments develop their own plans. The Senate has already approved an $8 billion plan to help hospitals and health agencies prepare for a pandemic.
A REGIONAL summit of counter-disaster experts yesterday agreed a mutation of bird flu would need to be controlled at its source to prevent a devastating pandemic.
But the meeting in Brisbane of officials from the 21 member states of the Asia Pacific Economic Co-operation group and international agencies including the World Health Organisation stopped short of backing a regional stockpile of anti-viral drugs.
Australian ambassador to APEC Doug Chester said dealing at the source with any human-to-human form of the disease would be the best defence against a pandemic.
Summing up the two-day conference, he said the 100-plus delegates had agreed that early detection and geographic containment of a human outbreak were common to the pandemic plans being developed by most APEC member states.
Second-line containment measures would include border closures, movement restrictions, development of a vaccine and use of existing anti-viral medications such as Tamiflu and Relenza, both of which are being stockpiled by the Federal Government.
"The level of commitment was quite heartening, quite positive," Mr Chester said.
But International Red Cross regional delegation head Leon Prop revealed there had been no advancement on earlier calls by some South-East Asian countries for a regional stockpile of anti-virals to quickly end any human outbreak.
There have been 65 known human deaths from the H5N1 bird flu virus, but none has been positively linked to human-to-human transmission.
Scientists, however, are concerned that the unchecked spread of the virus among poultry and wild birds in south Asia and now southern Europe had increased the chance of it mutating into a form that could be passed among people, triggering a flu pandemic.
In the absence of a vaccine, which could not be developed until a human strain of the disease emerged, the limited world supply of anti-viral drugs would be the only effective treatment.
"At the moment there is a limited number of countries which are stockpiling (anti-virals)," Mr Prop said. "But there is no intention of regional stockpiling".
Mr Chester said the APEC meeting had accepted the need for "openness and transparency" by member states to ensure that any human outbreak of an avian-like flu was quickly isolated and controlled.
As a result of the Brisbane talks, a meeting of APEC leaders in South Korea later this month would consider a recommendation for a "desktop" exercise to test regional preparedness for a pandemic.
This would also allow member states to self-assess their own pandemic preparations.
Mr Chester said while there was a need for such preparations to be made, some delegates to the Brisbane conference had expressed concern that the pandemic threat was being overplayed.
"While it is a serious threat, there is an element of scaremongering that is undermining effective planning in some economies and it is causing unnecessary economic damage to some economies," he said.
SYDNEY (DPA): Representatives of Asia Pacific countries meeting in Australia agreed Tuesday to coordinate their responses in the event of a bird flu pandemic and test their readiness to deal with it.
Delegates to the gathering in Brisbane pledged to come up with a "regional cooperation mechanism" through which an affected country could draw on the resources of less affected ones.
The two-day conference was attended by more than 100 disaster management specialists from the 21 countries linked in the Asia Pacific Economic Cooperation (APEC) forum.
Australian Foreign Minister Alexander Downer stressed the importance of countries being open and honest when a bird flu outbreak occurred and not trying to cover it up for fear of damage to the local economy. It was a point taken up by John MacArthur, the Bangkok-based infectious diseases adviser to theUnited States Agency for International Development.
"The message of transparency was clear across the table," MacArthur said.
Health Minister Tony Abbott, the host of the APEC gathering, said it was important that populations were mentally prepared for a virulent human strain of the bird flu virus.
Earlier this month Abbott canvassed the possibility that all 20 million Australians could be vaccinated against bird flu next year if a vaccine being developed locally is shown to be effective.
Modeling by the Health Department suggested there could be 13,000 deaths, 58,000 hospitalizations and 2.7 million people seeking medical attention if the pandemic reached Australia, Abbott said.
But a procession of speakers urged against panic, saying that all 21 APEC countries except Papua New Guinea had a pandemic preparedness plan in place. Fewer than 100 people had succumbed to the H5N1 strain of the virus, 40 of them in Vietnam.
The conference was told that rich countries should not wait for a bird flu outbreak in their own populations but help poorer nations stop an outbreak spreading.
Delegates from Vietnam, Cambodia, Indonesia and other poor countries asked for money to buy stockpiles of anti-viral drugs. There was no immediate response to these requests.
THE threat of an avian influenza pandemic engulfing the Asia-Pacific region was serious, but the degree of concern was overblown and had become counterproductive to preparing for an outbreak, an APEC summit in Brisbane has warned.
"We need to be prepared for a pandemic, but the threat should not be overplayed," Doug Chester, an Australian APEC ambassador, said after the two-day summit.
"Whilst it is a serious threat, there is an element of scaremongering that is undermining effective planning in some economies and it is causing unnecessary economic damage."
His comments were backed by a report warning that a bird flu pandemic in Australia could cause tens of thousands of deaths, the collapse of essential services, mass panic and a deep and extended depression.
The report, by the Australian Homeland Security Research Centre, has told businesses to plan for a possible outbreak, warning that, like terrorism, a pandemic is probable, but the timing and consequences are impossible to predict.
"If a pandemic were to occur, the effects would be colossal," the report said. "In the worst case, it could result in a worldwide depression as international trade collapses, domestic confidence disintegrates and millions of people die.
"All critical infrastructure and other businesses need to plan for a pandemic as the issue will not be going away in the near future."
Mr Chester said a "vast majority" of the 21 APEC economies represented at the summit had response plans in place, although Australia's nearest neighbour, Papua New Guinea, had not.
Vietnam called for assistance, including $US50 million ($A67 million) of funding, more antivirals such as Tamiflu and technical advice.
There was a broad call from delegates for an assessment of the plans, with the APEC organisation agreeing to conduct an exercise early next year to test preparedness.
Mr Chester said delegates had agreed that the best response to a pandemic was early intervention, openness and transparency.
"The more open economies are, the better chance we as a region and as individual economies have of nipping it in the bud," he said.
He said the tourism and poultry industries were most affected. Bird flu has led to the deaths of 60 people and caused millions of birds to be destroyed.
The research centre's report said tourism, hospitality, retail, movie theatres, sporting events and labour or import-intensive companies would suffer "massive" declines in sales.
It said if the same casualty rate as the 1918 Spanish influenza outbreak were applied to today's population, the number of Australian dead would be 42,000, although the comparison may not be valid thanks to modern antiviral drugs, modern health care and less cramped living conditions.
Delegates to the Brisbane summit also discussed the economic impact of a pandemic and plans to keep essential services and business running or help them recover as quickly as possible.
Countries pledged to exchange information about foreign citizens caught in countries in the middle of an outbreak.
It was possible that the region could create quick-response teams to fly into countries to target an outbreak at the source.
The key points of the summit will be passed on to APEC senior officials in Pusan, South Korea, in two weeks.
The head of a Red Cross delegation at the summit, Leon Popp, reiterated the need for an early warning system.
He said there was "still a lot to be done" in co-ordinating countries and making them aware of the damage that a pandemic could cause.
A senior Chinese official today insisted that the country has learned the lessons of the Sars outbreak and promised complete openness in its fight against bird flu.
China was heavily criticised during the 2003 outbreak of Sars, or severe acute respiratory syndrome, for initially covering up the illness. Now Beijing says it is committed to quickly investigating and reporting possible bird flu cases to the public and world health groups.
"From Sars, we see that no ... information can be hidden," China's disease control director, Qi Xiaoqiu, said while visiting the United States. "We have policies to encourage farmers to report possible outbreaks."
China has reported three bird flu outbreaks among its 14 billion poultry - half of Asia's total - over the past month. Detection and treatment are a major challenge as more than half its birds are raised in small, scattered farms. No human cases have been reported as yet.
Mr Qi said China has provided subsidies for farmers who quickly report sick birds to authorities. Once a case is found, he said, officials kill all birds within two miles and vaccinate all birds within three miles.
At least 62 people have died of the deadly H5N1 strain of bird flu in south-east Asia since 2003, and concern is growing that H5N1 could mutate into a human flu virus that could spark a global pandemic.
Officials meeting in Australia said that countries across the Asia-Pacific region will stage a mock disease outbreak to gauge how well they would respond to a pandemic or other major health threat.
The exercise is expected to take place in the first half of next year to assess how effectively the countries' disaster officials work together in a crisis scenario and to identify major weaknesses, said Doug Chester, Australia's ambassador to the Asia Pacific Economic Cooperation (APEC) forum.
Mr Chester, who chaired the two-day meeting in Brisbane, did not elaborate on the specifics of the drill. No concrete plans for fighting emerging diseases were reached but the meeting allowed participants to exchange ideas and report back to their governments before a summit of the 21 APEC members in South Korea later this month.
Mr Chester said the delegates discussed establishing regional experts who can be dispatched to assist countries in need. He also said they wanted to develop a regional pandemic response mechanism to work alongside the United Nations to address issues such as trade, assisting citizens in foreign countries and keeping essential services and businesses running.
Further outbreaks of bird flu should be expected in Europe and the virus will most likely be found next in Greece and Ukraine, a World Health Organisation expert said today. Bernardus Ganter, of the WHO's European regional office, said the outbreak of the deadly H5N1 strain of bird flu in Croatia was predictable because the country is in the migration path of wild birds.
"We will see more outbreaks in the future in that area," he told reporters in Copenhagen. "I wouldn't be surprised if we detect cases in Greece and Ukraine next." The H5N1 strain has been found in birds in Croatia, Russia, Turkey and Romania.
Signs of another outbreak of bird flu were detected at a duck farm in western Japan, authorities said today. Tests on 10 ducks suspected of bird flu showed they were infected with an H4 strain of the virus, which has no history of human transmission, according to Katsunori Tanaka, an Osaka livestock farming official.
The latest case follows the announcement yesterday that authorities detected signs of bird flu at a farm in northern Japan and planned to kill 82,000 chickens. Japan was among the first countries to be infected by the current outbreak of bird flu.
Canadian officials yesterday revealed that nearly three dozen wild birds have tested positive for H5 influenza, but have also stated that it is unlikely that it is the H5N1 strain of the virus.
Jim Clark, of the Canadian Food Inspection Agency, said it would take at least a week to determine whether the flu found in 33 wild ducks from the provinces of Quebec and Manitoba is the deadly H5N1 strain that has ravaged Asian poultry farms.
Meanwhile, the secretary of state for environment, food and rural affairs, Margaret Beckett, yesterday announced details of a review of British quarantine procedures after at least one parrot died from the H5N1 strain last month.
The review will be led by Nigel Dimmock, emeritus professor of virology at Warwick University. It will examine avian quarantine arrangements and procedures for captive birds and make recommendations on any changes needed to policies or procedures.
Defra's current practice was criticised after it emerged the dead parrot, from Surinam, was likely to have caught bird flu from a consignment of Taiwanese birds while at a quarantine centre in Essex.
In one market near where I live in Hong Kong there's a vision of the future.
Preparations in Asia vary widely
It's a stall that sells the chickens the Hong Kong housewives like to buy still alive to ensure their freshness.
But the stall-holder and her birds are behind a pane of glass that stretches from floor to ceiling.
She is in effect encased in a large box.
She's almost completely separated from her customers. When they buy a chicken she kills it, plucks it and wraps it up before passing it through a small gap in the wall.
The customer's contact with her or her birds is reduced to a minimum.
These are the kind of measures the scientists say are needed throughout Asia if we're to have any realistic chance of protecting ourselves from bird flu - in addition to the stockpiles of anti-viral drugs like Tamiflu or the yet to be produced anti-bird-flu vaccine.
But in reality we're not going to see measures like that across Asia.
'A plane ride away'
While Hong Kong might be what the World Health Organization (WHO) describes as the 'gold standard in terms of surveillance and measures designed to prevent the emergence of bird flu', poorer nations in South East Asia just don't have the same kind of resources to throw at the problem.
That is the biggest issue facing Asian governments.
The bird-flu virus H5N1 has been circulating in this region for at least two years.
It has been detected in many parts of Vietnam and Indonesia and some parts of Cambodia, China, Thailand and, according to the WHO, possibly in Laos.
There have been human cases reported in Vietnam, Thailand, Cambodia and Indonesia.
And no matter how hard the more affluent parts of this continent like Singapore, Hong Kong, Korea or Japan try to protect themselves they know that they're only a couple of hours' plane ride from infected areas where if human-to-human transmission got under way, we might not know until it's too late.
Some scientific modelling has indicated that if a strain of bird flu with pandemic potential emerged, the health authorities would have three weeks to move in with anti-viral drugs and vaccinate everyone at risk.
The thinking is that this could stop the disease, or at least slow down the spread.
But the truth is that in many rural areas in Asia chickens roam the streets and back alleys of small homesteads and there is almost constant contact between humans and birds - and there is almost no surveillance at all.
People don't seek medical help in hospitals or clinics because of the cost.
Slaughter
"While the modelling may be sound, there may be a huge gap between theory and reality,' says the WHO's spokesman in the Western Pacific Peter Cordingley.
He said that, in the event of a global pandemic, "Hong Kong will be as vulnerable as Vietnam's Ho Chi Minh city".
The WHO says Asia needs $160m in the short term to build up laboratory capacity, training and improve surveillance, particularly in poorer nations.
That is in addition to the $100m needed for work on the animal front.
So far the organisation says it's been operating pretty well on a shoestring but it's confident that renewed concern about the problem among developed nations means that things will now improve.
But it's not just about finding the money for the medical response.
Most experts accept that in 1997 a global pandemic was averted after an outbreak of Bird Flu in Hong Kong killed six people because the authorities slaughtered every bird in the territory - around one-and-a-half million of them.
Not ready
Compare that with the situation in Vietnam today.
The New York Times reported recently that while two years ago when a case of bird flu was discovered every chicken within a radius of about 5km of the infected fowl would be slaughtered, today officials kill only those birds in an infected flock that do not die from the disease itself.
The reason, the newspaper says, is a lack of money to compensate the farmers.
And then there are the allegations of corruption in Indonesia which mean the country has to test its entire stock of bird flu vaccine because government auditors suspect companies have produced doses of inferior quality to inflate profits.
Or fears raised by opposition politicians in South Korea that the government doesn't have enough intensive care facilities to treat a mass outbreak of any kind of communicable disease.
So yes, Asia has woken up to the threat posed by this disease.
But is it ready? No, there's a lot to do.
Although in some places they're doing their utmost to take adequate precautions, this region is nowhere near a position to fight an outbreak in anywhere but the most developed or affluent areas.
"We are hoping the resources now being discussed in the West will now make it possible to protect the populations of the poorest countries," says the WHO's Peter Cordingley, but he warns "It's a slow business, and how long do we have?"
TORONTO = Nearly three dozen wild ducks have tested positive for the H5 bird flu virus in Canada, officials reported Monday, but they said it was unlikely to be the strain blamed for more than 60 human deaths in Southeast Asia.
Dr. Jim Clark of the Canadian Food Inspection Agency said it would take at least a week to determine whether the flu found in 33 ducks from the provinces of Quebec and Manitoba was the deadly H5N1 strain that has ravaged Asian poultry farms.
But it was unlikely to be the same strain because none of the wild ducks tested was ill, he said at a news conference.
"That strain in Asia has caused high mortality in those birds; the birds that tested positive in Quebec and Manitoba are all healthy," Clark said.
Clark said 4,800 samples had been collected from wild birds in seven Canadian provinces in a study begun before the recent spread of H5N1 from Asia to parts of Europe and Turkey.
He said it was not surprising to find a variant of the H5 virus in Canada. He said it can be present in at least 7 percent of wild birds in North America at any given time, but in less virulent forms than the H5N1 strain.
The spread of H5N1 across the Eurasian land mass has world health experts worried about the possibility of a human flu pandemic developing that could kill millions and cripple economies.
The more a bird flu virus spreads, the more chances it has to mutate into a form that can pass easily from human to human. So far, all the deaths attributed to H5N1 have come in people who caught it from a bird.
The World Health Organization says the H5N1 outbreaks in Southeast Asia have infected 121 people and caused 62 deaths in Thailand, Vietnam, Indonesia and Cambodia. Vietnam has been hardest hit, with more than 40 deaths and tens of millions of poultry destroyed.
Less virulent strains of the H5 virus have been found before in North America. Parts of Mexico have suffered through an outbreak of H5N2 bird flu in poultry operations for more than a decade.
Canada had an outbreak of bird flu in 2004, but it was the less harmful H7 virus, which isn't believed to pose a serious risk to humans. About 17 million birds in British Columbia were slaughtered in early 2004 in an effort to stamp out any spread of the virus.
One day after officials revealed wild birds carrying the H5 strain of avian flu virus have been found in Canada, the nation's chief public health officer is urging Canadians not to panic.
"The first thing to know is that it's a huge leap for a bird virus to become a human virus that spreads efficiently in people," said Dr. David Butler-Jones, appearing on CTV's Canada AM.
"That's just a tremendous leap and very difficult and we likely would actually be able to watch that with the surveillance and have better preparation for it," he said.
In fact, Butler-Jones said that avian flu viruses have been discovered before.
"This really just documents more clearly what we've known for a long time -- that there's a range of avian viruses and that we do see them in all parts of the world, including in North America."
"In terms of the one that most people are worried about, the H5N1 that we see in Southeast Asia, the Americans have been doing surveillance in Alaska -- that's where it would come across."
Meanwhile, a stakeholder is also reassuring that Canada is in a good position to stop an outbreak of avian flu in commercial poultry stocks.
The Canadian Press reported that Chicken Farmers of Canada General Manager Mike Dungate said Canadians learned lessons the hard way last year when testing indicated that the avian flu found on a goose and duck farm near Abbotsford, B.C. was not the H5 variety.
Instead, the 37,000 geese on the Fraser Valley Duck and Goose Ltd. farm were exposed to the H7N3 strain of avian influenza virus. The outbreak caused no major human health problems, but forced the culling of some 16 million poultry.
Dungate noted that the outbreak, which devastated the industry in the Fraser Valley, prompted the tightening of controls on biosecurity and improved communication with federal officials.
On Monday, the Canadian Food Inspection Agency announced that several wild waterfowl in Quebec and Manitoba have tested positive for H5 flu viruses. However, the chance of the strain being the lethal H5N1 type is "likely fairly remote," said Jim Clark of the CFIA.
Health officials in Winnipeg conducting tests on the H5-infected birds won't know whether they have H5N1 until mid-week.
Even if the Canadian birds are carrying the H5N1 virus, it does not mean they are necessarily related to the viruses behind the poultry outbreaks in Southeast Asia.
That strain is behind the avian flu problem growing in Asia, where more than 60 people have died of H5N1 infection transmitted from poultry.
With the strain crawling through Europe as migrating fowl fly westward, there are mounting fears that the virus could mutate into one that can easily spread among humans and thus prompt a global pandemic.
Ottawa - An avian flu in the same family as the virus that has spawned fears of a pandemic has been detected in ducks in Quebec and Manitoba but experts say it is likely a benign form of the disease that is commonly found in wild-bird populations.
Even so, there is some fear that the acknowledgment of the presence of an H5 type of influenza in Canadian birds could cause some countries to invoke trade restrictions.
"Some countries are very risk adverse and will take advantage of the situation to sever ties in normal trading relationships with Canada - or any other country for that matter - that would perform this kind of surveillance," Jim Clark, the director of the Canadian Food Inspection Agency, told a hastily called news conference yesterday.
That kind of protectionist measure could increase the likelihood of a pandemic because it could suppress reporting of outbreaks.
Just like human beings, birds are subject to infection from a variety of influenza viruses. So news that several wild birds in Quebec and Manitoba have tested positive for the H5 flu bug need not trigger public alarm.
Further tests are being done to determine if the flu found in 28 wild birds in Quebec, and five in Manitoba, is of the H5N1 subtype.
That is the strain of avian flu that has swept through Asia and into Europe killing more than 60 people. These victims, mostly poultry workers, evidently caught the bug directly from infected birds.
Experts worry that H5N1 may mutate into an influenza virus that is easily spread from one person to another. That could lead to a disastrous pandemic since humans would lack immunity to the new flu threat.
A similar virus is believed to be responsible for the great Spanish flu pandemic of 1918 which killed millions of people worldwide.
This potential menace must not be ignored. It is heartening to find that Canada's public safety sentinels are hard at work, checking hundreds of birds around the country in the hope of having an early warning of a deadly flu's arrival.
Vigilance marks this country's first line of defence. Domestic poultry producers would be wise to keep a close watch on their birds, especially in the wake of the latest findings.
But, having noted that, it is important to remember that the latest announcement, revealing the presence of H5 in a few Canadian birds, involves no risk to the public as of yet.
There is a very good chance that this virus is not the specific H5N1 strain causing havoc elsewhere in the world. A federal official yesterday said it was encouraging that Canadian wild birds carrying the H5 bug appeared outwardly to be healthy, unlike poultry that has been sickened by deadly bird flu.
Test results definitively showing which H5 virus strain is in these birds should be available in a few days. Until then, Canadians should refrain from undue worry and take confidence in a bird flu surveillance system that, by all accounts, is working as it should.
TORONTO -- Nearly three dozen wild ducks have tested positive for the H5 bird flu virus in Canada, officials reported Monday, but they said it was unlikely to be the strain blamed for more than 60 human deaths in southeast Asia. None of the ducks tested was ill.
The spread of H5N1 has health experts worried that a human flu pandemic could develop and kill millions. Canada's announcement was the closest report of anything resembling the deadly virus in Michigan's vicinity.
Dr. Jim Clark of the Canadian Food Inspection Agency said it would take at least a week to determine whether the flu found in 33 ducks from the provinces of Quebec and Manitoba was the deadly H5N1 strain that has ravaged Asian poultry farms.
But it was unlikely to be the same strain because none of the wild ducks tested in Canada was ill, he said at a news conference.
"That strain in Asia has caused high mortality in those birds," Clark said.
He said it was not surprising to find a variant of the H5 virus in Canada. He said it can be present in at least 7% of wild birds in North America at any given time, but in less virulent forms than the H5N1 strain.
When U.S. President George W. Bush recently and repeatedly voiced concern over the threat of an influenza pandemic, an issue that has been fuelling high anxiety among public health authorities and flu experts for quite some time spilled all over the popular press.
And with last month's discovery of birds infected with the worrisome H5N1 avian influenza virus in Romania and Turkey, and an unrelated discovery of several Canadian birds with an H5 strain that has yet to be identified, it seems the term "bird flu'' is on everyone's lips.
The heightened attention carries with it a lot of confusion. So The Canadian Press asked some experts on avian and human influenza for help explaining what these viruses are -- and are not.
The name game
First things first: It's catchy and it's easy to say, but influenza experts don't like and don't generally use the term "bird flu.'' At their origins, all influenza viruses probably came from certain species of wild waterfowl, so the term is too vague to be useful.
Recent developments in Colombia illustrate the problem.
An avian flu strain found there, an H9, bears no relation to the one plaguing Southeast Asia. It's a far milder strain that will cause economic problems for affected poultry farmers, but probably poses next-to-no risk to people at this point.
A rose is not a rose
Influenza A viruses are divided into categories or subtypes based on two genes they carry on their surface. To date, scientists have found 16 hemagluttinins and nine neuraminidases, the H and the N in a flu virus's name.
In theory there may be 144 different combinations, all of which could be called a "bird flu.'' But some Hs and Ns have never been found together, leading experts to hypothesize some combinations cannot be formed.
Most of the known combinations have shown no talent at infecting people.
"The vast, vast majority of these (avian) viruses wouldn't do anything in humans,'' says Michael Perdue, an avian influenza expert with the World Health Organization.
According to an article Perdue and co-author Dr. David Swayne published in Avian Diseases in July, human infections have been documented with only H5N1, a few H7s -- H7N2, H7N2 and H7N7 -- and H9N2 avian flu viruses.
H7N3 was behind the large poultry outbreak in British Columbia in 2004. Two people were infected, but they suffered only conjunctivitis and mild flu-like symptoms. One person died in an extensive H7N7 outbreak in the Netherlands in 2003, but the majority of the nearly 90 documented human cases there suffered mild symptoms too.
The Asian version of H5N1 is far and away the worst known avian flu virus when it triggers human infections. The official WHO count suggests there have been 137 human cases since 1997, when it first jumped into humans. Of those known cases, 67 have died.
Public understanding of the vast differences between the various subtypes is low, suggests Swayne, director of the U.S. Department of Agriculture's Southeast Poultry Research Laboratory in Athens, Ga.
"When they say: `I'm scared this bird flu's going to kill me.' Well, it's like: `Wait a minute. Here's a low path, economic issue of avian influenza in a chicken flock. It really has no risk for humans or very minimal risk for humans and it's not the same as the Asian H5N1.'''
High path, low path
The term "low path'' Swayne uses describes another important distinction between avian flu viruses. Most are what is known as low pathogenicity _ low path for short. When they jump into domestic poultry, they don't even kill chickens. Typically egg production drops off.
Only the H5 and H7 subtypes produce viruses that are high pathogenicity or "high path,'' explains Dr. Richard Slemons, an avian influenza expert at Ohio State University.
High path viruses wipe out poultry flocks. The Asian H5N1 everyone is so worried about is a high path virus.
But not all H5s and H7s are high path. Mexico has had a lingering low path H5N2 outbreak among poultry flocks for more than a decade.
Not all H5N1s are created equal
Even within a subtype, there is a lot of variation among viruses. There is no cookie cutter that punches out identical H5N1s.
"What's happened is we've taken this term, this term H5N1, and we have equated it to being for all viruses that have that terminology as being the same as the Asian virus. And it's not,'' Swayne says.
He likens it to looking through a phone directory and assuming that all the Joneses listed are related.
So when H5N1 viruses have been found in Russia, Turkey and Romania, scientists needed to perform genetic analysis on them to see how closely matched they are to the Asian viruses.
Unfortunately, they have been found to be closely related to that lethal virus. But they might not have been. For instance, Slemons found a low path H5N1 in a mallard in Ohio in 1986. It would not have posed a fraction of the threat to human health that the Asian H5N1 does.
Economics vs. Public Health
In fact, most avian flu viruses are a much great economic than human health risk.
These viruses don't cross into people very often. In their paper in Avian Diseases, Perdue and Swayne documented only 234 cases dating back to 1959 where people were shown to have been infected by avian viruses. (That figure was as of June 28; there have been additional H5N1 cases in Indonesia, Thailand and Vietnam since then.)
"The question might be: Out of all the billions of people that have been exposed, why so few have been infected?'' Slemons noted.
Science doesn't have the answer to that question at present.
But things are more clear cut on the economic side of the equation. Outbreaks can be costly and difficult to halt. At one point, farmers in British Columbia estimated it would cost $340 million to rebuild their battered industry after their H7N3 outbreak.
And if the outbreak is caused by a high path strain, poultry exports of an affected nation can find international doors slam shut on their products.
Where the threat lies
Still, the threat remains that an avian virus could mutate and start spreading easily from person to person. Because human immune systems have no antibodies to those viruses, that would trigger a pandemic. Just how bad a pandemic it would be would depend on how virulent the resulting virus was.
So the situation with H5N1 is a source of ongoing and significant concern. And while no one likes to see the strain increase its geographic reach, experts believe the threat remains greatest in Asia, where high concentrations of people, birds and virus could fuel the emergence of mutations that facilitate human-to-human spread.
"The casino for genetic roulette will still be in Asia,'' predicts Dr. Michael Osterholm, director of the Center for Infectious Disease Policy and Research at the University of Minnesota.
"It's not that it couldn't appear there,'' he says, referring to Europe. "But probability favours the drive towards the ... mutations resulting in a human-transmitted agent in Asia.''
Doctors think they have hit on a way to effectively double supplies of a drug that fights bird flu. Administering Tamiflu alongside a second drug that stops it being excreted in urine means that only half doses of the treatment would be needed.
Tamiflu (oseltamivir phosphate) is the main antiflu medicine recommended by the World Health Organization (WHO). The WHO suggests that, in anticipation of a flu pandemic, countries should stockpile enough for at least a quarter of their population. But although Swiss drugmaker Roche, the sole supplier, has quadrupled its production capacity over the past two years, the current supply is thought to cover just 2% of the world population.
Last week, Joe Howton, medical director at the Adventist Medical Center in Portland, Oregon, suggested a way to double supplies, after browsing basic safety data from Roche for a talk on avian flu.
The technique was invented during the Second World War to extend precious penicillin supplies. Scientists found that a simple benzoic acid derivative called probenecid stops many drugs, including antibiotics, being removed from the blood by the kidneys. Probenecid is readily available and is still widely used alongside antibiotics to treat gonorrhoea and syphilis, and in emergency rooms, where doctors need their patients to have high, sustained levels of antibiotics in their blood.
Howton noticed from Roche's data that Tamiflu, like penicillin, is actively secreted by the kidneys, and that the process is inhibited by probenecid. Giving the flu drug together with probenecid doubles the time that Tamiflu's active ingredient stays in the blood, doubles its maximum blood concentration, and multiplies 2.5-fold the patient's total exposure to the drug (see graph, and G. Hill et al. Drug Metab. Dispos. 30, 13-19; 2002)1.
In other words, you could get away with using half as much Tamiflu to get the same therapeutic effect. "It dawned on me that the data potentially represented a tremendous therapeutic benefit," Howton told Nature.
Given that Roche published the probenecid data in 2002, has it considered this option? "It doesn't seem so," says Martina Rupp, a spokeswoman at Roche's headquarters in Basel. "It is an interesting idea, but we can't really say anything," she adds, claiming that there are insufficient data. The WHO and the US Food and Drug Administration declined to comment when Nature asked them about the idea.
Studies are being proposed that will look at safety issues relating to probenecid and Tamiflu, although doctors argue that there are already enough data for the drug combination to be used, even without specific approval from regulatory agencies. Grattan Woodson of the Atlanta Research Center in Decatur, Georgia, has prescribed probenecid for more than 25 years and says he prescribes drugs for such off-label purposes every day. "This is a perfectly acceptable and established practice," he says.
Peter Zed, a specialist in emergency medicine at Vancouver General Hospital in Canada, agrees. He has published studies of the safety of probenecid and antibiotic combinations. "There would be nothing unique about using probenecid with Tamiflu," he says.
Michael Osterholm, director of the US Center for Infectious Disease Research and Policy in Minneapolis, Minnesota, cautions that probenecid alone will not be sufficient to avert a flu pandemic. He points out that the most optimistic estimate of Tamiflu production capacity in the next five years gives enough to treat just 7% of the global population.
Coping with a pandemic will require "launching a worldwide Manhattan-like project for drug production, packaging and distribution today", Osterholm says. "It's not just about having a magic bullet; it's whether you can make it and find enough guns from which to shoot it." Still, doubling the doses available could be crucial for treating people quickly after an outbreak, and Osterholm says the idea definitely merits investigation.
"This is wonderful," agrees David Fedson, formerly a medical director of the vaccine company Aventis Pasteur, based in Lyons, France. "It is extremely important for global public health because it implies that the stockpiles now being ordered by more than 40 countries could be extended, perhaps in dramatic fashion." He suggests that capsules containing both Tamiflu and probenecid should be developed.
Like many scientists, Fedson is stumped by the apparent lack of interest from Roche, and the relevant authorities. "It's stupefying," he says.
References
Hill G., et al. Drug Metab. Dispos., 30. 13 - 19 (2002).
http://dmd.aspetjournals.org/cgi/content/abstract/30/1/13
MARK COLVIN: Countries of the Asia Pacific have backed a proposal for regional fast-response squads of bird flu experts to move in, in the event of a serious outbreak of the disease in the region.
High level officials from the 21 APEC economies and a number of observer nations have just completed a two-day meeting in Brisbane to discuss their readiness, should bird flu mutate into a human pandemic.
Melanie Christiansen reports.
MELANIE CHRISTIANSEN: After two days of closed door talks with health and disaster experts from across the Asia Pacific, Doctor John MacArthur from the US delegation was impressed.
JOHN MACARTHUR: I thought the meeting was very productive. The countries were very open and very collaborative. And I think that I walk away without any concerns whatsoever. I think that they're working together well and they're going to be moving forward.
MELANIE CHRISTIANSEN: There'll be no communique from this meeting, but recommendations will go the APEC leaders meeting in South Korea later this month.
The chair of this week's meeting, Australia's Ambassador to APEC, Doug Chester, says that'll include a suggestion for a regional flying squad of bird flu experts able to respond to any outbreaks of bird flu transmitted from human to human.
DOUG CHESTER: A consensus has emerged amongst APEC economies that a response mechanism that would draw on expertise from the region that was available, that that's something we should look at doing.
MELANIE CHRISTIANSEN: The meeting also backed a proposal for an exercise to test how well countries in the Asia Pacific are prepared to respond and cooperate with each other in the event of a bird flu emergency.
DOUG CHESTER: A number of economies have suggested that APEC should do some exercises to test the regional preparedness, and that's something that APEC senior officials will take on board, something along the lines of a desktop exercise to test the interaction between APEC economies should there be a human to human outbreak in the region.
MELANIE CHRISTIANSEN: And while it wasn't on the agenda, some of the developing countries in particular came to the meeting seeking international financial help to get their bird flu plans ready.
Vietnam has asked for nearly $70 million in overseas support. Indonesia's Herijanto Soeprapto says his country also needs help to pay for its bird flu pandemic plan.
HERIJANTO SOEPRAPTO: The plan we got is about $US 570 million. Of course we cannot afford all of them, we have to ask the assistance of the other countries, donor countries, like Australia.
MELANIE CHRISTIANSEN: And while countries like Indonesia seek financial support from Australia, the Australian delegation used the conference to stress the need for all countries in the region to be upfront about any new outbreak of bird flu so it can be quickly contained.
And the Indonesian representative was happy to give that commitment.
HERIJANTO SOEPRAPTO: I believe that for the transparency, we have in Indonesia open media, everybody can know about that, they can get the information exactly and accurately, we don't have anything to hide.
MELANIE CHRISTIANSEN: But the head of Thailand's emerging infectious diseases department, Doctor Danika Kingnate, says there's one crucial area where there needs to be more information sharing - concerning the movement of migratory birds, which could be carrying the disease.
DANIKA KINGNATE: One thing that we would like to have is that all the APEC countries put an effort into surveillance of migrating birds, so that we can have an early warning system.
That's the best way, because even if we do our best in our country, the virus can come again, and if you let it go for a long, long time, then there is the risk of mutation, and the emerging of the new pandemic.
MARK COLVIN: The head of Thailand's emerging infectious diseases department Doctor Danika Kingnate, ending Melanie Christiansen's report.
Worries about bird flu have overtaken a regional economic summit in Bangkok this week by heads of government from Cambodia, Laos, Burma, Thailand, and Vietnam.
The five government chiefs' two days of meetings begin Wednesday as health authorities across Southeast Asia battle to contain a spreading bird flu outbreak. The virus has ravaged poultry flocks, and there are fears it will claim more human lives in the winter months ahead.
This week's summit is the second top-level meeting of the regional group known as ACSMECS. The organization focuses on economic cooperation and strategy. Its name is based on the three major river systems that flow through the area: the Ayeyawady, Chao Phraya and Mekong.
Thai Prime Minister Thaksin Shinawatra says fighting the avian flu virus will be a key topic at the summit. Thailand, Cambodia, and Vietnam have been hit the hardest by the H5N1 strain of bird flu that has killed more than 60 people in Asia.
Thai Foreign Ministry spokesman Sihasak Phuangketkeow says the leaders will be looking to improve cooperation in dealing with bird flu.
"That is the common challenge that we face - not just the countries within ACMECS but countries in the region and international community," he said. "Certainly we think it is time for us to work together, to pool our resources to deal with the challenge of the bird flu before it becomes a real crisis."
Avian flu virus carried by migratory birds has spread into Russia and Europe. Given the serious challenge the virus poses, Mr. Sihasak says regional leaders at the Bangkok summit hope to intensify their links with the international community.
Vietnam in particular is seeking more international assistance for its efforts to control bird flu.
ACMECS also has a wider role in promoting regional economic development. The five member states also are part of the Association of South East Asian Nations. But Vietnam, Laos, Cambodia and Burma, who are among ASEAN's newest members, face greater development challenges than Thailand, Malaysia or Singapore.
Mr. Sihasak says this week's meeting will further explore opportunities to bridge the gap between ACMECS and ASEAN nations. "ACMECS has as one of its principal benefits to reduce the development gap in the region, and this will help to move forward the integration within the broader ASEAN framework," he added.
Thailand is looking to increase trade in agricultural commodities, with an aim of developing contract farming programs with other member countries.
ACMECS is committed to strengthening regional trade and investment, agricultural and industrial cooperation, transport links, tourism, and human resources development.
COPENHAGEN, Denmark (AP) -- Further outbreaks of bird flu are expected in Europe and the virus will likely be found next in Greece and Ukraine, a World Health Organization expert said Tuesday.
Those countries are at risk because they are on the migration routes of wild birds traveling from countries where a deadly strain of the virus has been detected, including Russia and Croatia, said Bernardus Ganter of the WHO's European regional office. The disease has also been found in birds in Turkey and Romania.
"We will see more outbreaks in the future in the area," Ganter told reporters in Copenhagen, referring to Croatia. "I wouldn't be surprised if we detect cases in Greece and Ukraine next."
Greek health authorities on Saturday said final results of tests on a sick turkey found on a Greek island showed it had not been infected with the deadly H5N1 strain of bird flu.
Ganter said the virus was likely to be found in the migration routes of wild birds traveling south for the winter.
"The migration season is coming to an end soon and that may slow things down a bit, but we'll see next year when they come back," he added.
The WHO has said most European countries have preparedness plans in case the virus mutates into a form that can be easily passed to and between people.
The deadly H5N1 strain has decimated poultry flocks in Asia since 2003 and killed at least 62 people there. No human cases have been reported in Europe.
Ganter said that the best way to contain the virus was careful monitoring of migration areas.
"Surveillance is key and it's important to keep domestic poultry inside in those areas so they don't mix with wild ducks and geese and get contaminated," he said.
"It's important that people know to look out for dead bird flocks and report it and it's very important that people understand that this is something we can stop."
BANGKOK, Nov. 1 (Xinhuanet) -- Bird flu has been detected in three more locations in Thai central province of Suphanburi while another two sites in Northern province of Kamphaeng Phet and central province of Nakhon Pathom have been removed from the list of areas under strict surveillance for risk of the virus outbreak.
According to the Thai Livestock Development Department, lab tests have confirmed that the bird flu virus has spread into three more areas in Suphanburi -- Tambon Ban Don in U-thong district, where 4,500 free-range ducks have contracted H5N1 virus, Tambon Nong-phugnag in Samchuk district with 11 infected fighting cocks, and Tambon Nong-sadao in Samchuk district, where around 2,000 chickens raised for their eggs have been sick.
All the three spots have been declared areas needing close monitoring for 21 days. Livestock officials were sent to cull all poultry in the areas on Oct. 28.
However, a village in Tambon Wangcha-oan in Kamphaeng Phet's Bung-samakkee district and a village in Tambon Lam-phya in Nakhon Pathom's Muang district have been declared clean from the deadly virus as of Monday and removed from the list of locations under 21-day control.
Livestock Department chief Yukol Limlaemthong said that the bird flu-infected ducks in Suphanburi's U-thong district were illegally brought into the area. The department is taking legal action against those involved since the Ministry of Agriculture and Co-operatives earlier prohibited the movement of poultry.
"Over three to seven persons were arrested each day since the regulation went into effect", the Department Chief said.
Yukol said poultry smuggling still exists because smugglers, despite acknowledging the law, can make money by selling fowls at a price higher than usual because of limited supplies.
"They know the law. They know that moving poultry is illegal but they dare to take a chance," he said.
"There is no such entity as 'the public' ... the public is merely a number of individuals." - Ayn Rand
Several leftish bloggers have published their doubts that the alleged avian flu menace is anything more than another Bushevik distraction – and just in time to draw our attention away from Plamegate and the "Scooter" Libby indictments. (See, for example, Bill van Auken.)
Who can blame them? After all, as Keith Olberman recently pointed out, each of the Department of Homeland Security's thirteen color-coded "terror alerts" shortly followed some instance of Bush Administration bungling. And sure enough, the orange alerts took the embarrassments off the front pages and the TV newscasts.
Unfortunately, this time the threat is all too real.
And how might we know this? Certainly not because the mainstream media says so. We've been forewarned: if the Bush regime chooses to concoct another convenient "emergency," we can be sure that the corporate media will obediently do their part by sounding the alarm.
We can know that the bird flu is an oncoming disaster because the scientists tell us so. I count myself among the apparently declining minority of Americans who believe that science remains the most reliable source of factual information. Far more reliable than faith or George Bush's gut.
As a member of the American Association for the Advancement of Science (AAAS), I subscribe to its journal, Science, which has been warning of this menace for several years. (Most recently in the July 15 and October 7 issues.) And the AAAS is no friend of Dubya's "faith-based" anti-science administration.
In addition, the cover story of the October, 2005 issue of National Geographic, is "The Next Killer Flu: Can We Stop It?" For much, much more, Google "Avian Influenza," and you will find over two and half million hits. Leading the list are reports from the World Health Organization and the U.S Centers for Disease Control.
The 1918 influenza pandemic killed from 50 to 100 million people. The same proportion of victims, adjusted to the increase in population since 1918, would add up to 180 to 360 million. (National Geographic). Needless to say, such a catastrophe would devastate the world economy, causing millions more to die of starvation and other diseases, as vital services and the distribution of essential supplies would be paralyzed. The good news is that medical science has advanced significantly since 1918. The bad news is that international air traffic would accelerate enormously the spread of the pandemic. The worst news: scientists tell us that the outbreak is a virtual certainty – more likely sooner rather than later.
Much more might be said here about the biological and epidemiological aspects of this looming threat. But my space here is limited, and an abundance of scientific information about avian flu from qualified experts is readily available. Instead, I will confine my comments to the politics of the bird flu menace.
To put the matter bluntly: among recent U.S. administrations, the Bush regime is the absolute worst to be in power at a time when a global pandemic is about to break out. Bush's Health and Human Services Secretary, Michael Leavitt, admitted as much: "There have been many who foresaw this and urged the country to begin preparations sooner, and it would have been better if we had done so." (Newsweek, October 31, 2005).
But as Katrina demonstrated to us all, planned preparations for foreseen national emergencies are just not the Bushists' thing. Nor is it much the concern of the GOP Congress, which has slashed funding for emergency services, bio-medical research and the Centers for Disease Control. The request for influenza research this year was $119 million. Presumably, this is one of the "big government" programs that Grover Norquist and his gang would like to "drown in a bathtub." By way of contrast, the Congress readily appropriated $10 billion (with a "b") for anti-ballistic missile defense – a "defense" against a non-existent threat that does not, and arguably can not work.
The public apathy and lack of preparation in advance of the coming pandemic catastrophe must be blamed, at least in part, on the past PR manipulations by Bush's White House. In addition to the thirteen false terror alarms noted above, we've been told these demonstrably false Iraq/WMD warnings: "Simply stated, there is no doubt that Saddam Hussein now has weapons of mass destruction." (Cheney, August, 2002) "We know where [the WMDs] are. They are in the area around Tikrit and Baghdad." (Rumsfeld, May, 2003). "We found the weapons of mass destruction." (Bush, May, 2003). Add to that "the smoking gun in the form of the mushroom cloud," Saddam's bio-war "Winnebagos of Death" (Colin Powell to the UN, February 2003), the pilotless balsa-wood and bailing wire "aircraft of doom."
And now a flu pandemic? Yeah, sure! So what else is new?
Remember the fable of the boy who cried wolf? Here's the validation.
So what are we to do about the coming bird flu disaster? Research and development of a vaccine? Too little and too late. Emergency production of Tamiflu, the best available medication? No facilities in the United States – they've been "outsourced." The manufacturer of Tamiflu, Roche Holding AG of Switzerland, holds the patent, and we wouldn't want to violate its corporate rights now, would we – merely to save a few million lives? In fact, Roche is willing to license other facilities to produce Tamiflu. But all this falls short of the required massive production increase. Even so, the French now have 13 million doses of Tamiflu ready for their population of 60 million. But what would you expect: those poor souls have "socialized medicine." In the U.S., there are 2.3 million doses of Tamiflu on hand. Why not more? Because "many American drug companies no longer even make flu vaccines – because there is little long-term profit to be made in vaccine manufacturing." Three cheers for free enterprise!
Inadequate research and development. Insufficient supplies of medications and vaccines. Insufficient numbers of hospital beds and emergency equipment for the hundreds of thousands, perhaps millions, of pandemic victims. Will the Bush administration provide the funding for these necessary preparations for the pending emergency? No way. But Bush has another plan:
"Send in the troops!"
Thus Bush's pathological fascination with armed force comes to the fore. Katrina gave us a glimpse of what Bush might have in store for us for the next national emergency. In his speech to the nation from Jackson Square in New Orleans, Bush said: "It is now clear that a challenge on this scale requires greater federal authority and a broader role for the armed forces – the institution of our government most capable of massive logistical operations on a moment's notice." And at a White House press conference on October 4, Bush reflected: If we had an outbreak [of avian flu] somewhere in the United States, do we not then quarantine that part of the country? And how do you, then enforce a quarantine? ... And who best to be able to effect a quarantine? ... One option is the use of a military that's able to plan and move."
Nicole Colson elaborates:
Congress may already be helping Bush's wish become a reality. The Senate Armed Services Committee is reportedly considering proposals to increase the military's role in natural disasters by creating National Guard units specializing in disaster response--and clearing the way for active troops to engage in law enforcement activities on U.S. soil, something that's currently illegal.As the Katrina disaster abundantly demonstrated, George Bush presides over a government that does not believe in government – except, of course, as a device for gathering tax revenues from the masses and redistributing it to defense contractors and campaign contributors, and also for keeping dissenting citizens under surveillance and control. Otherwise, whatever the government attempts to do, we are told by the right-wing think-tank gurus, private individuals, private property, and "the free market" will always do better.Congressional aides recently told U.S. News and World Report that some senators are also considering introducing legislation that would allow the Feds, in "extreme circumstances," to take command of the National Guard without first getting approval from a governor.
The regressive right and its captive media have been pounding these doctrines of privatism and market absolutism into our heads since the heyday of Ayn Rand and the founding of Bill Buckley's National Review, fifty years ago - doctrines devoid of evidence and sound argument, contrary to both pra