U.S. Bird Flu Mission to Southeast Asia Strengthens Cooperation

WASHINGTON, DC, October 24, 2005 (ENS) - "Microbes know no borders and they are no respecter of sovereignty," said Health Secretary Mike Leavitt upon his return from a 10 day avian flu prevention and control mission to Southeast Asia. Briefing reporters at the State Department Friday, he said, "If person-to-person transmission occurs anywhere, there is risk everywhere, and that's well characterized by the Southeast Asian area."

Leavitt characterized the world as a vast forest, and each incidence of bird flu as a spark. "If we are able to be where the spark ignites, we have the capacity to simply put it out. If it's allowed to smolder for a time, it can grow beyond containment in a rapid fashion," he warned.

His warning comes at a time when Indonesian officials have just acknowledged that incidents of avian flu were known for months but suppressed to please the poultry industry which feared a price crash if the disease were known. The World Health Organization (WHO) has recognized five human cases of avian flu in Indonesia, including three deaths.

Leavitt traveled through Thailand, Cambodia, Laos, Vietnam, Indonesia, Singapore and Malaysia with U.S. and international public health and animal health officials.


U.S. Health Secretary Mike Leavitt is welcomed by the owner to a chicken farm in Thailand. (All photos courtesy Office of the Secretary)
"Our purpose in going to Southeast Asia was, at least in my sense," said Leavitt, "was first of all, to begin developing a network of surveillance so we'll have the capacity to determine at the earliest possible moment when this virus or if this virus achieves a person-to-person transmission."

The delegation, which included WHO Director General Dr. Lee Jong-Wook and representatives of the UN Food and Agricultural Organization, and the World Organization for Animal Health, was seeking to develop relationships of cooperation and transparency with health and government officials in the countries that have had the greatest exposure to the deadly disease.

The H5N1 strain of bird flu is responsible for the deaths of more than 150 million birds and 63 people since the start of its most recent outbreak in December 2003. Health officials worry that this strain could mutate to become a new virus that is easily transmissible between humans, resulting in a global pandemic flu that could kill up to seven million people, the World Health Organization estimates.

Leavitt asked people to remember that such a virus has not yet become apparent. "Until such time as we see that kind of person-to-person transmission, we will continue to treat it as an animal disease," Leavitt said. "Now that doesn't mean it's not a serious matter and we're taking it very seriously, but it has not turned into a human pandemic disease. It is simply an animal disease at this point."

"We were focused on concrete actions designed to strengthen surveillance, preparedness, containment and rapid response and determine the needs especially of those countries that are in need of capacity building," said Under Secretary of State for Democracy and Global Affairs Paula Dobriansky, who traveled with the delegation.


Secretary Mike Leavitt (left seated) signs a Letter of Intent with the Vietnamese Health Minister Tran Thi Trung Chien. October 14, 2005.
"Decisions will be made rapidly," Leavitt said, "and, therefore, having those relationships and cooperative agreements in place will be of importance. And we also needed to achieve some level of situational awareness to have a chance to see what is actually happening on the ground."

Leavitt literally went to ground to gain some understanding of the human experience of avian flu, sitting on the floor with a Vietnamese family that had been ill.

"It's a family of five - wonderful people," Leavitt told reporters. "I sat on the floor in their living area and had them describe for me what had occurred. They count on the chickens that they have and some rice wine that they produce out of their fields to support their family."

"When the village leaders came to them and said, 'We've got to destroy your animals,' it was blow," Leavitt recounted. "They concluded that they would eat the chickens that hadn't been sick. And when they began to process the chickens, invited their friends and family over, so that it wouldn't be wasted."

"A week later, the father became ill. Two hours later, he became violently ill and he described it the ailment that attacked him. He said, 'It was like the cough I had - every time I coughed, it was like I was coughing my lungs up.' And it was a very serious experience."

"Two hours later, their little girl began to show the same symptoms. The wife described the worry she had. It was highly significant. She said, 'I was horrified at what was happening, but I was most concerned that their health care could continue because the only asset we had that could be converted to money were the chickens and they were already gone.'

Leavitt understood from that encounter that the Vietamese village where they lived was effectively under surveillance for avian flu.

"That village was knowledgeable about avian influenza," said Leavitt. "They have begun to cull birds and that was the reason that those birds were destroyed and the point at which he caught it. There was a small clinic in the village commune where a doctor had been notified of the symptoms to look for and fortunately saw them."

But the delegation learned that awareness of the influenza danger varied widely from place to place.

"In another Asian country," Leavitt said, "I got up very early in the morning and went off to a wet market where I walked around large cages of turkeys and ducks and chickens and pigs all in the same area."

"And I happened to wake a woman up who was sleeping there who was a pig farmer who had driven 600 kilometers (400 miles) the night before with her pigs on the top of her bus next to a group of chickens and was going to get up the next morning and sell them and return home. She lives in a very remote area where there isn't television or media," Leavitt said. "She had heard of avian influenza, but was not in a position to have had the same treatment as my friend in the village in Vietnam."

In Leavitt's view the trip was "helpful." The U.S. government entered into cooperative agreements with Cambodia, Laos and Vietnam during the 10 day trip.


Heath Secretary Mike Leavitt (left) with Lao Minister of Public Health Ponemek Daraloy after signing a memorandum of understanding on avian flu. In the white jacket at left is Dr. Julie Gerbarding, director of the U.S. Centers for Disease Control and Prevention. October 13, 2005
The federal government has allocated $25 million between Health and Human Services and USAID for direct investment on the problem of avian influenza in the next year in addition to what Leavitt called and "ongoing and a quite robust set of relationships that exist already."

The Bush administration will primarily be investing in laboratory capacity, in surveillance, and in training. There is a basis to build on, Leavitt said. The United States has military, naval laboratories in that region, and many of the personnel in the public health labs in that region have been trained either at the Centers for Disease Control and Prevention in Atlanta or at the National Institute of Health.

USAID Administrator Andrew Natsios told reporters at the briefing that he did not accompany the delegation on the trip but Kent Hill, who is the assistant administrator of the agency's Bureau of Global Health did.

Natsios said USAID has redirected $13.7 million from other programs into the effort to prevent and contain the spread of avian flu in Southeast Asia. He said $10 million came from the Emergency Supplemental Budget for the Tsunami and $3.7 million from other programs.

"So by the end of the last fiscal year, by September 30th," Natsios said, "we had moved: $3.5 million for Vietnam; $1.6 million for Laos; $2.2 million for Cambodia; $3.2 million for Indonesia; and $500,000 for China. And there's $2.7 million that we've committed now to support regional activities in that area."

USAID has already purchased and prepositioned personal protective gear in Southeast Asia for workers so that they do not get infected if they go out to destroy poultry or treat cases of avian flu among people.

And USAID has now begun to train and equip teams of people who will be responding to incidents.

A communications and public education campaign that Natsios calls "Social Marketing," will be designed to educate the public in terms of what bird flu warning signs to look for, and how to report in each of the countries what they see.

But in some countries, public education to prevent flu is running up against unsafe customary practices. "There's a custom of drinking poultry blood after they slaughter an animal, just as a sort of a traditional practice," said Natsios. "That is something that is not a wise idea under these circumstances because that spreads the disease. People need to know these things in order to protect themselves."

Natsios is assigning the responsibility for combating bird flu to the USAID mission directors in 80 missions around the world where there are Foreign Service officers on the ground. In another 40 countries private organizations are working with USAID. Natsios is asking them all to work together along with the U.S. Department of Agriculture, which has agricultural officers in the embassies, to begin preparation for the disease in a worldwide manner.

Leavitt said the countries they visited are taking the situation "very seriously" but are dealing with a "complex and difficult situation."


Leavitt speaks with a woman who sells livestock in Vientiane, Laos.
"In almost all of these countries," Leavitt said, "large segments of their economy are made up of small farms and a centuries-old cultural practice where animals and birds and people live in the same area. Most of these are subsistence farms. They average $600-$800 annual income a year. And the importance of the birds they have to their lives is highly relevant."

If and when a human virus that is easily transmissible emerges, vaccine manufacturing capacity becomes important, but Leavitt says there is "a global dearth of vaccine manufacturing capacity."

"We did have a chance to visit the laboratories where various of the countries are working on vaccines, Vietnam, in particular. We talked at length about how we could be helpful to them in creating clinical trials that would measure the effectiveness and the safety of their vaccine. But it remains for them, as it does all other regions of the world, a dilemma, should this become a person-to-person transmitted disease," the secretary said.

Dobriansky said the delegation's message of cooperation and common cause was "well received through out the region."

"While we are working with countries, in some cases that lack some capacity to prepare for and respond to a pandemic flu, I see a heightened understanding of both the problem and the need to confront it together," she said. "Countries realize that the cost of taking action is significantly less than the cost of a pandemic."

As the delegation traveled, Secretary Leavitt gave out copies of the "Great Influenza" by John Barry, a book about the 1918 influenza epidemic worldwide, and in the United States.

In the book, Barry argues that because of suppression of information, some of it by self-censorship by the news media in 1918, the fact that 50 to 100 million people died of the flu within a six-month period, it was not widely known until after the pandemic was over that this was going on.

Natsios commented that there is no similar suppression of information today. "You know you can't control the Internet, you can't control radio - people who listen to this stuff. That will discipline our public systems and will, I think, influence the behavior of people, even at the village level, if they understand the nature of the threat and how we have to combat it."

"Public information and communication, as long as it's accurate, it provides substantive information on actions that people should take, will have the effect of disciplining the world's system to be more open and more cooperative on this," Natsios said. "Systems don't naturally cooperate. There has to be some incentive to do that. And I think the news media by their way in which they report on this, could influence this in a positive way."