Is the USA wasting money to control international “bird flu?”

During the recently concluded three-day summit on avian influenza in New Delhi, India, the USA raised its financial pledge for prevention of a pandemic by 45 percent to $629 million. The annual meeting of experts encompassing specialties including epidemiology, virology, molecular biology and risk assessment convened under the auspices of the United Nations. The majority of funds will be allocated for contingency planning, stockpiling of chemotherapeutic drugs and preparations for a possible pandemic caused by mutation of H5N1 strain avian influenza to become pathogenic to humans.

Since the emergence of the infection in Thailand in 2003 and taking into account previous outbreaks extending back to the late 1990s in Southeast Asia, confirmed human infections have amounted to less than three hundred cases. The majority of diagnoses have been documented in Indonesia and Viet Nam although it is recognized that there is a lack of transparency in some nations and diagnostic capability and surveillance are deficient in the less developed countries of Asia and Eurasia. Despite the ongoing dire prognostications by international public health experts concerning the imminence of a pandemic from 2004 up to the present time, there is no indication that widespread extension has occurred from poultry to human populations or that the virus can be transmitted among humans.

Avian Influenza is now endemic in Southeast Asia, the Middle East, Eurasia, North and West Africa. All these regions have poultry industries based on subsistence and small-scale production with live bird marketing and frequently interspersed with commercial operations. The infrequent and isolated outbreaks of Highly Pathogenic Avian Influenza (HPAI) in Western Europe are attributed to contact between migratory waterfowl and non-confined commercial flocks or where egregious deficiencies in biosecurity have taken place. Eradication of exotic HPAI in Western Europe has been accomplished by rapid diagnosis and depletion of affected and contact flocks, quarantine and surveillance in accordance with World Organization for Animal Health (OIE) directives. In contrast it is impossible to eradicate HPAI in countries with live bird marketing. The most practical approach is to separate commercial operations from subsistence and backyard flocks as completely as possible by rigorous biosecurity. Effective vaccination of small-scale flocks and commercial breeder, egg and broiler units at risk of exposure is essential to reduce the proportion of susceptible birds comprising a nation’s poultry population. Depopulation of farms with infected flocks is possible but is only of benefit if implemented promptly and efficiently, with fair compensation to owners and with logistic support by a central authority similar to our APHIS. We should regard HPAI in poultry in the 2000s as analogous to panornitics of velogenic Newcastle disease from the mid 1900s onwards.

The question arises as to who is responsible for making hard decisions regarding restructuring of poultry industries to eliminate live bird movement and marketing and to implement preventive measures? The USA has provided diagnostic equipment, technical training and research resources to the international community above and beyond the contributions of affected nations or those at risk. The onus should be placed firmly on the affected countries to recognize their individual and collective responsibilities and reform their industries in the light of the realities and risks of HPAI within their own populations. Why should U.S. aid continue to recruit volunteers to undertake “projects” in countries with endemic HPAI? Why should we continue to subsidize the proliferation of laboratories and vaccine plants for individual countries when there is adequate manufacturing capacity and diagnostic capability in regional centers?

There are many experienced observers who feel that the USA and to a lesser extent other industrialized nations are being held to ransom by proponents of an imminent H5N1 avian influenza pandemic. Invoking parallels with the 1918/19 disaster, administrators, epidemiologists and economists affiliated to the World Health Organization (WHO) and national agencies have enjoyed liberal funding and unwarranted publicity since 2003. The need for contingency planning, more effective and rapid production of vaccines and chemotherapeutics are without question. What is of concern is the fact that few changes can be seen in response to the tremendous expenditure to date. The nations with endemic HPAI must do more to reduce the obvious risks inherent in the way they produce and distribute their poultry.