Delegates from 111 countries met in New Delhi, India, the first week of December to assess the progress in combating avian flu and the preparations for a human influenza pandemic. Two of the public health officials leading that effort summarized the results of the conference at a news briefing in Washington. As we hear from Faith Lapidus, they reported progress, but said there was still a long way to go.
Since it was first diagnosed in Asia in 1996, the virus that causes avian influenza, or bird flu, has forced the destruction of millions of infected poultry flocks in nearly 60 countries. More than 200 people have died after contracting the so-called H5N1 virus.
Bird flu is a problem that will likely be with us for some years to come, according to David Nabarro, senior coordinator for avian and human influenza at the United Nations. But citing data on the spread of the H5N1 virus from 146 nations, Nabarro emphasized the positive. "The first thing to say is that the situation has changed, between 2004 and 2007, the rate at which new countries are being affected by H5N1 has reduced, we've got a bit of a plateauing [leveling out], the number of human cases, which act as a sentinel, has slightly decreased, and the human deaths have also decreased." He said that broad epidemiological evidence suggests that the H5N1 virus situation is not quite so serious.
The virus, however, is still being actively transmitted in at least six countries, and there are new reports (December 16) of human infection and death in Burma and Pakistan. At the Washington briefing, Nabarro stressed the importance of maintaining focus, funding and political will to keep H5N1 under control.
And John Lange, who leads the U.S. government's avian influenza program, told reporters that the global campaign to stop avian flu goes beyond dealing with individual outbreaks. "What we've really been trying to do, when possible," he explained, "is to build long-term capacity, both on the veterinary side and on the human health side, through increased levels of surveillance, training of veterinarians and epidemiologists, building up laboratories, etcetera."
And Lange observed that international cooperation on bird flu has already had a positive impact on overall public health preparedness. "If there were a new disease that just emerged tomorrow, but it was totally different from H5N1 — maybe something that came out and had the ability for sustained and efficient human-to-human transmission — the best entities able to cope with it in terms of the networks that have been built up would often be those that are now working on the avian and pandemic influenza threats."
Lange stressed the importance of those networks within governments, as well as between them. He pointed to Washington's integrated approach to dealing with a pandemic. It involves every agency of the government, Lange said, not just those responsible for public health, because a very serious pandemic will affect every aspect of society. "It will involve the difficulties you may have when you go to that ATM (automated cash dispensing) machine and it hasn't been filled with money because the people have been sick from work and couldn't fill it with money. It will affect our financial systems.
"It will affect the Internet. Everybody may be staying home from work for a while and swamp the Internet. There are all kinds of complications that occur that are far beyond the mandate of the Department of Health and Human Services or the mandate of the World Health Organization. And that's why," he concluded, "even though this is a human health threat, if the pandemic were to occur, it really requires much broader coordination."
And the U.N.'s David Nabarro added that because the impact of an avian flu pandemic would be so wide-spread, local communities, civic groups and public utilities must also play a role in preparing for it. "The ability to deal with these threats does not come just from the action of governments," he observed. "It comes from increasing resilience in communities so they can handle not just the disease threats from animals, but also that they are capable of maintaining continuity (of public services) under these conditions."
While acknowledging the threats posed by war and global warming, Nabarro insisted that the biggest danger mankind faces today is almost invisibly small. "It's microbes, particularly microbes that come from the animal kingdom, that represent one of the greatest threats to humanity and certainly even to its survival as we know it."
The discussion of global efforts to combat avian influenza will continue at an international conference in Cairo now scheduled for October.