World Health Officals Agree on Bird Flu Urgent Action Plan

GENEVA, Switzerland, November 10, 2005 (ENS) - Health officials from more than 100 nations have outlined the key elements of an urgent $1.35 billion global action plan to control the H5N1 avian influenza virus which is now circulating in animals in Asia and has been identified in parts of Europe. Limiting the threat of a flu pandemic in humans depends on prompt and effective control of the disease in animals, delegates agreed.

The World Health Organization (WHO), the Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE) and the World Bank co-sponsored the meeting from November 7 to 9, at WHO headquarters in Geneva.

WHO Director-General Dr. Lee Jong-wook said, "The world recognizes that this is a major public health challenge. WHO is ready to focus its resources to reduce the risk of a human pandemic. We have plans on paper, but we must now test them. Once a pandemic virus appears, it will be too late."


Poultry market in Yogyakarta, Indonesia. (Photo courtesy FAO)
The first line of defense is control at the source, in birds, the health officials agreed, by improving veterinary services, emergency preparedness plans and control campaigns including culling, vaccination and compensation. More than 150 million birds already have died through the disease or culling to contain its spread.

The next step is strengthening early detection and rapid response systems for animal and human influenza, by building and strengthening laboratory capacity.

Then, once the dangerous virus is detected, rapid containment is essential. Health officials agreed that effective containment depends on support and training for the investigation of animal and human cases and clusters, as well as planning and testing rapid containment activities.

Should the virus mutate to a form that spreads easily among humans, millions of people across the world could die of the disease, WHO warns. The global action plan comes as the number of H5N1 human infections is rising.

On Wednesday, the Ministry of Health in Vietnam confirmed that a 35 year old man from Hanoi died of the disease on October 29. A total of 125 human cases have been recorded, 64 of them fatal. All the human cases of the disease have been reported in four nations so far, Vietnam, Thailand, Indonesia and Cambodia. Vietnam, with 92 cases, has the largest number of human cases.


WHO Director-General Dr. Lee Jong-wook said, "The urgency of acting now is felt by us all." (Photo courtesy WHO)
Dr. Lee told delegates, "At present many governments are not ready to cope with outbreaks, still less a pandemic. Preparedness is vital in every country, in every region. Integrated country plans will build on and strengthen existing systems and mechanisms. They will be comprehensive, costed, and evaluated. Response mechanisms should be rehearsed through simulation exercises. These plans will include protection of vulnerable groups such as children, refugees and displaced populations."

The next part of the global action plan, delegates in Geneva agreed, is the building and testing of national pandemic preparedness plans, conducting a global pandemic response exercise, strengthening the capacity of health systems, and training clinicians and health managers.

Integrated national plans must be developed across all sectors to provide the basis for coordinated technical and financial support.

And finally, to support the entire plan, factual and transparent communications, in particular risk communication, is vital.

Senior UN System Coordinator for Avian and Human Influenza Dr. David Nabarro said, "We must use all our assets and skills to the best effect, avoid duplication, share expertise, learn from our experiences and tune up our ways of working. We must focus on support for existing country mechanisms and provide integrated global joint plans, programs and monitoring."

Jim Adams, World Bank vice president for operations policy and country services, says the Geneva meeting was designed to allow donors and the international organizations to sit at the same table as affected countries and identify needs at the country level.

Adams, who led the Bank’s delegation to the conference, says the aim is to begin work on putting country programs in place to deal with avian flu, which would then be eligible for funding.

Dr. Louise Fresco, assistant director-general of the Food and Agriculture Organization, said, "Many countries where the disease is endemic have already taken action but they are overwhelmed by the situation and require urgent assistance. Fighting the disease in animals is key to our success in limiting the threat of a human pandemic. We know that the virus is being spread by wild birds but we need more research to fully understand their role."


Duck farm in Thailand with newly installed net to keep ducks and wild birds apart, a measure against spread of the avian flu virus. Animal health experts say the virus is being spread by wild migratory birds. (Photo courtesy FAO)
The needs of affected countries could reach US$1 billion over the next three years, according to an analysis presented by the World Bank to the Geneva meeting. This does not include financing for human or animal vaccine development, for antiviral medicines, or for compensating farmers for loss of income due to animals which have been culled.

Adams said that experience from programs to date shows is that if governments provide proper compensation for culling programs, and identify outside of those culled areas, the areas that have to be vaccinated, then those programs are successful.

"Obviously for farmers, particularly poor rural farmers, this is their income," Adams said. "If they are properly compensated and paid an appropriate market price for their animals, culling programs will be successful. If they’re not properly compensated, experience shows, they’ll find another way of getting animals to market and the problem will expand."

"And experience shows if you get the animal side right, one substantially reduces the risk of a human pandemic," said Adams.

As a first step, the Bank is preparing to go to its Board with its own financing mechanism, worth up to US$500 million dollars, to help countries in the initial phase.

"We have the financial resources to move quickly," Adams says.

"Obviously one of the things we can do is provide funding to support these country programs – to supplement government resources, to strengthen the veterinary systems and to put in place culling and vaccine programs for animals."

Another component Adams says will be funding to strengthen the health systems of countries for surveillance, which must be integrated with the animal side.


A lab technician at the Disease Investigation Centre near Yogyakarta, Indonesia checks for the avian flu virus in samples taken from poultry. (Photo courtesy FAO)
Adams says the funding mechanism, similar to that used by the Bank for funding its AIDS programs in Africa, would allow low-income countries immediate access to grants and soft loans from the Bank’s lending arm, the International Development Association.

Adams says he expects the funding plan to go before the Bank’s Board of Directors, right after the Geneva meeting and if the plan is approved, funding could be available by the end of November.

The Bank is discussing with donors like the European Commission, as well as the WHO, FAO and OIE, the setting up of a multi donor trust fund with the specific aim of supporting country level activities to combat avian flu.

"The European community has taken the lead in this and we expect to meet in Beijing in January. By then we hope to have specific proposals for the structure of a funding mechanism," Adams says. "It may well be that some countries are prepared to commit funds before then. But we hope by early next year to have that trust fund available."

The meeting supported an urgent resource request for US$35 million to fund high-priority actions by WHO, FAO, and the OIE over the next six months.

Dr. Bernard Vallat, the director-general of the OIE, said, "The priority now must be to address the urgent needs over the next six months. OIE and FAO have identified the key priorities as evaluating and strengthening veterinary services, laboratory and surveillance capacity in affected countries and those most at risk."

Dr. Vallat said, "I urge you all to remember that we are talking about an international public good."

"Time is of the essence," said Dr. Margaret Chan, representative of the WHO director-general for Pandemic Influenza. "We must act now if we are to have the maximum possible opportunity to contain a pandemic."


Le Thi Yen holds a photo of her son Nguyen Duc Long, who died of avian flu in 2004, when he was four years old. The family, who live in the village of Giang Trieu, near Hanoi, Vietnam, had killed and eaten chickens that had the disease. (Photo courtesy FAO)
A pandemic of avian influenza among humans could cost the global economy US$800 billion a year, the delegates in Geneva were told by Milan Brahmbhatt, a senior economist with the World Bank's East Asia and Pacific region.

To get an idea of the kinds of economic costs that might arise, Brahmbhatt looked at disruptions associated with SARS that led to an immediate economic loss of perhaps two percent of East Asian regional GDP in the second quarter of 2003.

"Note that a two percent loss of global GDP during a global influenza pandemic would represent around $800 billion over a whole year," he said.

Brahmbhatt said aside from the immediate costs of disruption, hospitalization and medical treatment, a serious global flu pandemic could also entail a "sizeable loss of potential world output through a reduction in the size and productivity of the world labor force due to illness and death."

Brahmbhatt cited a 1999 U.S. study that calculated, based on disease patterns of post World War Two pandemics, that a new flu pandemic could lead to between 100,000 and 200,000 deaths in the United States.

There could be more than 700,000 U.S. hospitalizations; up to 40 million outpatient visits and 50 million additional illnesses.

"The present value of the economic losses associated with this level of death and sickness was estimated at between $100 to $200 billion for the U.S. in 2004 dollar terms," Brahmbhatt said.

In all high income countries, the loss could amount to $550 billion. Brahmbhatt said the global loss would be larger because of the impact in the developing world, where the health systems are weaker and mortality could be much higher than in industrialized countries.