Knock, knock! It's bird flu at the door

18 Oct, 2005

This may be the biggest epidemic challenge we will face in our lifetime

BY JM
18th October, 2005

After hiding in South East Asia since its re-emergence in 2003, the deadly bird flu is now on its way to other parts of Asia as well as mainland Europe and the US. The disease has already led to millions of birds being culled in Asia since 2003, besides deaths of 60 people. The British health secretary was recently quoted as saying that a bird flu epidemic in the UK could kill as many as 50,000 people. Every winter, about 12,000 people die in UK due to flu. The only consolation, according to him, may be that it may not hit before winter.

STATE OF PREPAREDNESS
OTHER COUNTRIES	INDIA
Stockpiling antiviral drugs, ordering Tamiflu, getting face masks, preparing testing labs, getting isolation wards ready, prioritising drug distribution plan for an emergency, banning poultry exhibitions and exports, banning imports from affected countries, quarantining of the sick, regulating poultry markets	Setting up committee to look into legal aspects of patent laws, warning to Gujarat to look for potential virus carriers from SE Asia

There are several strains of bird flu and the one which spells fear among the nations of the world is the H5N1 strain, which spreads quickly among birds, and for which there is no cure.

Bird flu does not easily transmit from birds to humans, and most of the human cases where it was detected involved poultry farmers who interact with the birds on a continuous basis. There have also been rare cases where the deadly flu passed from the infected persons to those taking care of them in Thailand and Indonesia. Despite the rarity of these cases, the major worry is that the bird flu virus may mutate into a variant which can be easily transmitted from human to human.

Unlike ordinary human flu for which the human body has defences, the emergence of this deadly strain in humans has unleashed havoc, since the body does not have any immunity to the new strain. Besides, until the mutated virus is found and isolated, there is little chance of developing any vaccine to offset the disease either.

There have always been several versions of bird flu, but none has been as deadly as the H5N1 strain. Last week, birds infected with avian flu were found in Romania, triggering fears of a European bird flu epidemic. Romania, like other nations hit by bird flu, resorted to mass killing of birds to prevent the spread of the disease. The country has now claimed to have contained the flu. However, now Greece and Turkey have reported birds dying in isolated localities, sparking more fears. Poultry farmers in these countries have been requested to turn over the dead birds for testing to find if they died of the deadly flu.

In many of the South Asian countries affected by bird flu, containment itself has been a major problem since their economies bank heavily on poultry farming and exports. Thailand, for instance, is the world's second largest exporter of poultry, and the country cannot hope to eradicate bird flu from its territory without dealing a body blow to its own economy.

As of now, worried nations are relying largely on Tamiflu, a drug manufactured by Roche to treat the symptoms of bird flu. The patented drug is still in short supply, and Britain has ordered about 2.5 million dosages of Tamiflu, enough to treat a quarter of its entire population. The country is still waiting for many more consignments of the drug.

Two provinces in Eastern Russia have also detected bird flu. However, it is not clear whether this is the deadly H5N1 strain.

Bulgaria, which borders Turkey has also found dead birds in their territory, and tests are under way to find out if they died of H5N1. Romania is closely working with Moldova to tackle the spread of bird flu.

Roche Holdings, the Swiss company which makes the patented Tamiflu, has said that it was donating the drug to Turkey and Romania and was increasing production of the drug. Roche has already pledged three million packs to the WHO.

In India, generic drug manufacturer Cipla has announced that it will be making generic versions of Tamiflu. Generic versions are cheaper versions of the same drug, manufactured at lower costs. Though Tamiflu is still under patent, Cipla hopes to sell the drug in countries where it is off-patent. Besides, emergency legal provisions in many countries authorise their governments to waive the patent rules in a crisis situation. The Cipla generic flu drug will be available in 2006. However, it remains to be seen if bird flu will wait that long.

The US health secretary has voiced fears about bird flu, saying it could spread further. The US also said that no country in the world is fully prepared to tackle bird flu once it hits. US has already pledged $25 million to Southeast Asia, the flu's epicentre to fight the disease. Countries in the migratory path of birds are in the high-risk category for avian influenza. It is next to impossible to prevent the flu from entering a country, since infected birds carry the virus with them as they cross borders in their annual migratory movement.

According to the United Nations, the threat of a bird flu epidemic is the highest now in the last 35 years.

Singapore said that it is stockpiling anti-viral drugs and preparing isolation wards in hospitals to take on bid flu. The tiny country has a population barely over 4.2 million and is densely populated. An outbreak of human-to-human bird flu could prove disastrous here.

The German state of Bavaria has banned poultry exhibitions and markets in an effort to prevent entry of bird flu. In Germany, it is the responsibility of individual states to ensure food safety. Sri Lanka too has banned imports of chicken and other exotic birds from countries where the deadly flu was detected.

Chile has also announced contingency plans to take on bird flu. The plans include voluntary quarantining of the sick and sourcing of anti-viral agents. The health ministry is also preparing vaccination programmes.

The North African country of Morocco is also on a state of high alert over the possibility of bird flu crossing into its territory from Europe. The country has banned imports of live poultry and related products from countries affected by bird flu. The country has been monitoring outbreaks of bird flu since the beginning of this year. Morocco has not found any evidence of bird flu so far.

In Australia, where bird flu vaccine trials are under way, the government is considering vaccinating its entire population of over 20 million is the trials turn out succcesful. Australia has already stocked up 3.9 million doses of Tamiflu.

Saudi Arabia too has ordered large quantities of Tamiflu in a move to fight bird flu if it breaks in the country. Saudi Arabia is worried that an outbreak could be catastrophic, with the faithfuls converging in the holy cities of Mecca and Medina during Hajj. The country is also preparing its labs to test for suspected cases of bird flu.

France has already sent masks and medicines to its embassies across the world, in an anticipatory measure to protect its citizens abroad.

However, India has been one of the slowest-starters in the fight against bird flu. The country has just now reached the stage of setting up a committee to look into the aspects of compulsory licensing of patent-protected drugs. Meanwhile, other countries have raced ahead to stock huge quantities of Tamiflu. According to health minister Ramadoss, "we are working towards full-preparedness’." Contrast this with UN and US officials who have discounted any possibility of full-preparedness in any country, and you get the irony.

The centre has also alerted Gujarat about the possibility of three species of migratory birds which come to the state from South East Asia every year, which could be carriers of the disease. Needless to say, there is little to make of this alert, since shooting down suspicious migratory birds as they enter Gujarat's airspace is not a practical idea.

Currently, the only hope rests on the fact that human-to-human transmission of the disease is very rare. However, it may be only a matter of time before the virus mutates to a strain which can spread as fast as the human flu and with the destructive capability of H5N1. By then, setting up panels and shooting down birds may be a bit too late in the day. The time to wake up is now.

BY JM