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September 13, 2005

FEATURE-Rich-poor divide hobbles Asia’s bird flu plans. (BIRDFLU-ASIA) 2005-09-13 08:00:13


FEATURE-Rich-poor divide hobbles Asia’s bird flu plans

By Stuart Grudgings

MANILA, (Reuters) - A few people in a poor farming village come down with what they think is a bad case of winter flu and try to sweat it out without calling for medical treatment that they can barely afford.

Weeks later, millions are infected and markets are crashing as the first human avian flu pandemic races around the world.

It is the scenario that health officials are dreading as Asia makes only patchy progress in plans for dealing with an outbreak, held back mostly by a lack of resources.

Asia, seen as the most likely epicenter of a human bird flu pandemic, had a wake-up call with the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 that raised standards of government preparedness and border control.

But a human outbreak of the more deadly bird flu would pose far bigger logistical and financial challenges in a region where millions live on a few dollars a day, health officials say.

“All the will in the world might be there, but they don’t have the manpower, they don’t have the expertise, they don’t have the funds,” the World Health Organization’s (WHO) spokesman in Manila, Peter Cordingley, said of Asia’s poorer nations.

“There are enormous differences all across Asia between who’s prepared and who’s not, and it’s not going to be difficult to predict who’s better prepared.”

The H5N1 bird flu virus, which surfaced in southern China and Hong Kong eight years ago, has killed more than 60 people in Asia since 2003 and forced the culling of millions of birds.

The risk is rising that it will mutate into a form that is easily transmittable between humans, triggering a pandemic that could kill millions and play havoc with the global economy.

The WHO’s Plan A in Asia is to stamp out an initial outbreak by rushing in medical experts and anti-viral drugs.

Officials estimate there would be a 21-day window of opportunity to stop the outbreak before it spreads too widely.

But in a country such as China, where reporting lines are slowed by poverty, bureaucracy and vast distances, that window may have passed long before the outbreak becomes apparent.

“I trust and believe the central government has very good intentions, but unfortunately, it is a very big country,” said Lo Wing-lok, an infectious diseases expert in Hong Kong.

“At the district, regional levels, the failure to communicate continues.”

China failed to inform Hong Kong about an outbreak of SARS in its southern province of Guangdong in late 2002 that later spread to about 30 other countries, killing around 800 people.


In an example of how SARS changed attitudes, outbreaks of bird flu this year in remote western China were widely covered in domestic media and reported quickly by the health ministry.

Officials say SARS forced governments to tighten lax infection control procedures and also helped draw doctors and researchers back to the previously unfashionable field of infectious diseases.

“Public health systems now, where there’s the money, are much, much better,” said Cordingley.

Yet the sheer scale of a bird flu pandemic could overwhelm even the best-prepared governments.

The WHO estimates that a full-blown pandemic could put two-thirds of a country’s work force out of action, raising questions such as how to maintain transport, policing and food supply.

The heat-sensing equipment at airports that enabled officials to detect suspected SARS cases would be mostly useless in preventing the spread of bird flu because the virus can be spread by patients before they display symptoms.

A dozen Asian nations agreed last month to build a regional stockpile of anti-viral drugs, which relieve the symptoms of flu and save lives but only have a limited effect in slowing the spread of an outbreak. There is no vaccine for human bird flu, although scientists believe they have the knowledge necessary to make one.

No timeframe for the stockpile was agreed, however, and supplies of the main drugs are getting tighter as bird flu spreads towards European nations.


Relatively wealthy countries such as Australia, Hong Kong and Singapore have begun stockpiling drugs and have comprehensive pandemic plans in place.

But some poor Asian nations, such as the Philippines, still have no stockpile of antiviral drugs and are unlikely to be able to afford one at prices of up to $180 per person.

“In other parts of the Asia-Pacific region the resources aren’t there, and I think we need to look at how we can address all of those issues on a region-wide basis more effectively than we’re doing at the moment,” Australian Foreign Minister Alexander Downer told reporters last month.

Vietnam, where bird flu has killed more than 40 people since late 2003, is working on an emergency plan with foreign agencies but lacks skills and resources, said Anton Rychener, the U.N. Food and Agriculture Organization representative there.

In Indonesia, which suffered its first human fatalities from the H5N1 virus in July, officials are still working on a preparedness plan and face a daunting surveillance task in the huge archipelago dotted with small farms.

Thai officials say they have a response plan in place that complies with international standards and the country has stockpiled several hundred thousand doses of anti-viral drugs.

Like many Asian countries, however, they are struggling to change centuries-old farming practices that raise bird flu risks.

Free-range birds are believed to contribute to the spread of the virus as they move around unchecked.

Even in wealthy South Korea, officials say more needs to be done. The government recently set out new plans to deal with a pandemic and will test preparedness by rushing 100 mock patients to selected hospitals without prior notice.

“There is a clear shortage of resources needed to tackle a major outbreak, ranging from medication to space at intensive care units and ventilators,” said Young Z. Hur, director of Epidemic Intelligence Services at the South Korean Center for Disease Control.

(Additional reporting by Jack Kim in Seoul, Tan Ee Lyn in Hong Kong, Karima Anjani in Jakarta, James Grubel in Canberra, Ho Binh Minh in Hanoi and Vissuta Pothong in Bangkok)

REUTERS Reut08:00 09-13-05

Copyright: (c) TWP, AP, Reuters, others as appropriate

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Posted by dymaxion at September 13, 2005 01:02 PM

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