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  Today Online 8 Feb 07
Time to talk turkey on bird flu battle
 The west has failed to back up its rhetoric by helping countries that will be on the frontline of a pandemic

JUST when most of us thought it was safe to go back into the water (or at least eat chicken and turkey), H5N1 raises its black dorsal fin and reminds us that it has unfinished business with the human race.

The enigmatic avian flu--burning like a wildfire one season, going to ground the next--has resumed its mysterious and seemingly irresistible march with new human victims in China, Indonesia, Egypt and Nigeria, and a spectacular outbreak among English factory turkeys.

While the World Health Organization (WHO) is grimly mobilising to confront imminent worst-case scenarios, the proposed response remains the same as last year: Rely on local early-warning systems to quickly identify sustained human-to-human transmission and then squelch it with massive saturation of the exposed population with the antiviral Tamiflu.

This strategy is based on a dubious perfect-world model of pandemic emergence and medical response, and is overwhelmingly contradicted by the WHO's own recent experiences in the field.

In the first place, Roche's wonder-drug Tamiflu is no longer a magic bullet: Several recent deaths in Egypt have been attributed to a Tamiflu-resistant strain and this resistance is likely to spread through the larger population of H5N1 subtypes.

Second, the elaborate system of outbreak surveillance, immediate poultry slaughter, and isolation of human victims that has been painstakingly established in China, Vietnam and Thailand simply doesn't exist in many areas of recent outbreak, and will never come into being without a massive, urgent international effort.

Years of heroic work in Vietnam to contain an explosive H5N1 outbreak that most experts feared was the likely pandemic trigger have been more or less annulled by the rampant and preventable spread of the disease across Indonesia's thousands of islands over the past 18 months.

This has been a defeat for the WHO's containment strategy. For fear of losing their base of operations in the country, the WHO and other international agencies acquiesced in the Indonesian government's negligent failure to aggressively cull infected birds or to contain the early human outbreaks.

Critics of the disastrous and failed campaign were censored and, in the case of the most senior foreign expert on the scene, even purged for leaking details of the fiasco to the international science press.

As a result, H5N1 is ineradicably entrenched in Indonesian poultry and the human toll has steadily increased, with a number of suspicious "family clusters" that suggest limited person-to-person transmission.

The virus is killing people within Jakarta itself, where high population densities favour accelerated disease evolution. The recent flood abets the danger.

Be more worried, in other words, about the Java chickens than the Suffolk turkeys.

Yet, as pointed out by the Financial Times, the UK and US pump more money into their own domestic pandemic preparations than the total sum given by all rich nations to the developing countries.

The reluctance on the part of some western European countries to help their poorer neighbours in the European Union with a stockpile of flu drugs and vaccines is just a case in point.

It is no wonder then that Indonesia decided--at least temporarily--that it's not going to share its human bird flu samples with foreign laboratories. After all, any vaccines made would be too short in supply and costly for the country to benefit from.

Now that the threat has reared its head in England's own backyard, the richer countries should recognise that more solidarity is needed to stem a killer influenza that is more likely to reach London via Heathrow as a result of failed containment efforts elsewhere.

It's time these countries back up their rhetoric and put in genuine effort by diverting resources to their poorer counterparts in other parts of the world. Help them stock up on vaccines, and invest more to find ways of producing cheaper vaccines for all.

Vaccine manufacturers, the Financial Times suggested, can also implement a deeply tiered pricing to deliver their products at cost in poor markets.

The Guardian, Agencies
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