Friday, February 25, 2005

Bird flu: a day late and a dollar short

The war in Iraq costs about $140 million per day. At a meeting of regional leaders in Ho Chi Minh City yesterday a UN Food and Agriculture Organization (FAO) official showed dismay that world governments have so far given a total of only $18 million to prevent bird flu from spreading and mutating into a devastating pandemic. Samuel Jutzi of the FAO said the attitude of donor nations like the US and others was that "[t]he problem is far away, so why should they invest in Indonesia or Vietnam.'' The virus is now endemic in the region so the costs of eradicating it are climbing.
Bird flu experts at [a] three-day meeting in Ho Chi Minh City say the virus has become so entrenched in parts of Asia that it will take many years to eradicate. The cost of a sustained effort to detect the virus, equip laboratories and vaccinate birds was now probably $300 million, Mr Jutzi said. (Reuters via Bangkok Post)
Even if the investment were made, it is not completely clear what strategy to employ. FAO and WHO are advocating campaigns that would in effect destroy the rural economies of the area and encourage large industrial poultry farms where modern "biosecurity" measures could be employed. Some believe this would have a devastating impact on the rural poor and stimulate the very conditions that allow Highly Pathogenic Avian Influenza (HPAI) viruses like the H5N1 strain to develop and spread. Bird vaccination is also debated since vaccines may produce enough protection to prevent disease but not enough to prevent infection. Thus the virus can circulate silently in the bird population and the usual tracking methods which look for antibodies to the virus will no longer work. The theory behind vaccination is that it greatly raises the dose needed to infect a bird and once infected the birds shed much less virus than unvaccinated birds. However there is some evidence that shedding can increase over time as the virus mutates. There is so little experience with vaccination as a means to control HPAI viruses that its use is a high stakes gamble. There is too much that we don't know at this point.

There needs to be a rapid and intense investment in closing important information gaps. That investment hasn't been and isn't being made. Currently some countries like Thailand are wary of vaccination because international regulations require the exporting country where vaccination is done to prove their birds are virus free, a difficult task if they have been vaccinated. Thus policy impedes vaccination. Now WHO is considering changing the regulations to allow export of vaccinated birds from special "disease free" zones (Reuters via MSNBC). This policy would encourage vaccination. Maybe this is a good idea, but one can envisage a future dilemma when we discover that the zones are not truly disease free (there will be strong disincentive to reveal infection) but the disease can no longer be detected.

Meanwhile, a possible Virus of Mass Destruction is gestating in southeast Asia, but our government isn't aware enough to invest the trivial sum (in Iraq War terms) that's needed.

We are indeed a day late and a dollar short. Or should I say, two years late and "two-days-of-the-War-in-Iraq" short.

Thanks for "keeping us safe," George.