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February 27, 2006

A Winning Strategy?

Unless we act now, bird flu may win is the title of a thought-provoking article in the International Herald Tribune  written by Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations and Pulitzer Prize-winning author of "The Coming Plague." Garrett argues that all of the billions of dollars being spent around the world will be wasted unless more drastic action is taken by the world community. She points out that nearly all of the activity taking place in the various countries, such as the culling of flocks and the stockpiling of Tamiflu, is reactive and defensive.  She concludes:

"Rather than waiting for a tide of H5N1 to wash over the world's birds, mutate, and then move in a tidal wave over humanity, we should create lines of defense that start with the wild animals, move next to protect poultry, and then rely on rapid screening of human beings to determine who is, and is not, infected with the virus.

In the absence of these sound footings, everything else is just wasted billions of dollars".

Until May of last year, Avian Flu appeared to have been limited geographically to East Asia where it was diagnosed in domestic poultry and a relatively small number of humans. Most scientists believed it was being spread through contact among domestic poultry  Then a large number of wild birds were found dead in a northern Chinese lake. Since then the spread of the disease has followed predictable flyway patterns of wild birds, first across Siberia and then into the Caucuses, across the Danube and now into western Europe and south into Africa.

Garrett predicts that it is just a matter of time before migrating wild birds reach North America either via Iceland and Newfoundland or down a Pacific flyway crossing the Baring Strait into Alaska and then south. When this happens, awareness of the virus's potential lethality will be no doubt greatly raised in Canada and here in the US.

Garrett is right in calling for a quick, sure, portable test.  Two or three days delays could be critical in stopping an outbreak. Interestingly, she did not call for a concerted campaign for a next generation vaccine, as advocated by Michael Osterholm of CIDRAP and others.

The spread of B2B (bird to bird) Avian Flu is already having enormous economic impacts around the world. However, we should keep our eyes on the real danger, and that remains, in our mind, the spread of the highly lethal virus in parts of the world where there is little public health infrastructure and where people live cheek to jowl with their poultry. This is most likely the cauldron in which a mutated virus that is geared to the ready transmission  from H2H (human tohuman) will appear.

Many of the countries where H2H is most likely to develop already have chronic problems in their domesticated birds.  We know from experience that humans get the virus from poultry yet we still hear about human cases in China, Indonesia and now possibly Malaysia that seem to come out of areas where we have gotten no prior reports of infected birds.  This indicates that the authorities are either uninformed about outbreaks among poultry in their districts or are purposely downplaying such events. Both conclusions are disturbing.

Recent events in Nigeria and now Niger seem to be following the same pattern. These sub-Saharan countries have even weaker public health and sanitary systems than does Vietnam, the weakest link in Asia.

We agree with Garrett that the situation is dire and calls for concerted action.  But it will most likely not be the wild bird flyways that spread the disease worldwide should an H2H strain evolve, it will be the network of commercial airlines that follow no such seasonal patterns and bring every corner of the globe in contact within hours. Detection is important but a Manhattan-like project to quickly develop an effective, next generation, innoculation program may in the end be the only possible winning strategy.

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Posted by dymaxion at February 27, 2006 05:50 PM

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