World Health Expert Assigned to Prevent Bird Flu Pandemic in Humans

GENEVA, Switzerland, September 30, 2005 (ENS) - The United Nations Secretary General has appointed Dr. David Nabarro, one of the most senior public health experts at the World Health Organization (WHO), to lead coordination of the UN response to avian influenza and a possible human influenza pandemic.

The appointment is critical as the world is fast recognizing the risk of an imminent human influenza pandemic, and is taking steps to reduce the risk and to get prepared.

"The WHO has been very clear about the imminent threat of a human influenza pandemic. The world is responding, and is moving quickly to get prepared. However, coordination of these efforts is critical to ensure all stakeholders are giving the best of what they have to offer, and that countries receive the support they urgently require," said Dr. Lee Jong-wook, director-general of the WHO.


Dr. David Nabarro (Photo courtesy WHO)
Currently, the outbreaks of a highly-pathogenic avian influenza virus in poultry and other birds in several Asian countries pose the greatest threat of sparking a human influenza pandemic.

WHO warns that this animal virus (H5N1) could change into a form which spreads easily from person to person. As people would have no natural immunity, a new influenza virus could cause widespread death, illness, social and economic disruption.

Since the latest outbreak began in mid-December, the H5N1 virus has killed 63 people in Asia. Hundreds of millions of birds have been culled in an effort to halt the spread of the disease.

The Ministry of Health in Indonesia Thursday confirmed another fatal human case of H5N1 avian influenza. The patient, a 27 year-old woman from Jakarta, developed symptoms on September 17, was hospitalized two days later and died on September 26.

Confirmatory testing was conducted at a WHO reference laboratory in Hong Kong. Initial investigation has revealed that the woman had direct contact with diseased and dying chickens in her household shortly before the onset of illness.

As a result of intensified surveillance and heightened public concern, growing numbers of people with respiratory symptoms or possible exposure to the virus are being admitted to Indonesian hospitals for observation and, when appropriate, treatment. Until a conclusive diagnosis is made, these patients are classified by the Ministry of Health as suspect cases. While many do not have symptoms compatible with a diagnosis of H5N1 infection, screening of patient samples is being undertaken in national laboratories as part of efforts to ensure that no new cases are missed.

Laboratory testing to confirm human infection with H5N1 avian influenza is technically difficult; some tests produce inconclusive or unreliable results. To ensure a reliable assessment of the situation in Indonesia, authorities are, after initial screening, continuing to send samples from people considered likely to have H5N1 infection to WHO reference laboratories for diagnostic confirmation.


Inspection of chickens that died of avian flu at the Disease Investigation Centre in Jakarta, Indonesia. (Photo courtesy FAO)
According to the UN Food and Agriculture Organization, highly pathogenic H5N1 avian influenza is now endemic in poultry in many parts of Indonesia. As influenza virus activity in Indonesia may increase during the wet season, from November to April, human exposure to animal virus could be greater during the coming months. Further human cases can be anticipated, the Ministry of Health said.

The World Health Organization has sent all countries detailed guidance on actions they need to take. Implementing these actions requires coordination across UN agencies, countries, civil society, across sectors within countries and the private sector. Implementation also requires funding.

As Senior UN system Co-ordinator for Avian and Human Influenza, Dr. Nabarro will be responsible for ensuring an effective and coordinated contribution by the UN system to controlling the current epidemic of avian influenza that is particularly affecting countries in Asia.

He will also ensure that the UN system supports effective local, national, regional and global preparations for a potential human influenza pandemic - so as to reduce the human toll, as well as the economic and social disruption, that this pandemic could cause.

Dr. Nabarro, of the United Kingdom, has held several leadership positions in WHO, including on malaria, environmental health, food safety and most recently in crisis operations. His 30 years experience includes work in community and government health programs, particularly in Asia, in the administration of development assistance, as well as the management of scientific research, the building of development partnerships and engagement with nongovernmental organizations.

The global strategy for the control of avian influenza in animals remains largely underfunded despite important contributions pledged by some donors, The UN Food and Agriculture Organization (FAO) warned Monday.

"It makes sense to stockpile antiviral drugs to protect humans against a potential avian influenza pandemic, but at the same time we have to contain the virus at source, in animals, to reduce the risk to people," said FAO's Chief Veterinary Officer Joseph Domenech.

The Global Strategy for the Progressive Control of Highly Pathogenic Avian Influenza launched by FAO, the World Animal Health Organization and in collaboration with the World Health Organization in May, for control programmes in southeast Asian countries, has called for over $100 million for the next three years.

To date, donors such as Germany ($6 million), Switzerland ($4 million), the United States ($6 million) and Japan ($0.5 million) have pledged around $16.5 million. FAO will provide another $2 million from its own resources. The World Bank and the European Commission are also planning to heavily invest in controlling bird flu.


Livestock officers course on avian influenza, Denpasar, Indonesia, 2004. (Photo by Ian Douglas courtesy FAO)
In recent weeks, several countries have joined forces to coordinate preparation. The United States announced a new International Partnership on Avian and Pandemic Influenza at the World Summit in New York. The initiative is moving forward with several countries, with a planning meeting October 7-8 in Washington.

Canada is also hosting a ministerial meeting on October 25 and 26, to discuss a range of policy issues to support the work of the partnership.

On November 7-8 the World Health Organization is hosting a meeting of all partners to coordinate the funding needed.

All of these efforts aim to ensure countries are equipped with national influenza pandemic preparation plans, that efforts to stop the outbreaks of avian influenza are accelerated, and that health tools, such as a vaccine are available as quickly as possible.

Meanwhile, a Mexican farm official denied Tuesday Japan's suspicion that illegal bird flu vaccines from Mexico may have been linked to recent outbreaks of avian influenza in Japan.

"No one has virus to produce vaccine besides those we preserve in this office," Jose del Valle, general director in charge of animal health at the Agriculture and Fisheries Ministry, said. He indicated the ministry has strict control over production of vaccines, saying, "We have registered who produced vaccines, and all viruses used to produce vaccines in this country are property of the government."

In Europe, a series of recommendations to prevent the entry and transmission of avian influenza among bird flocks in Europe has been made by the European Food Safety Authority's Panel on Animal Health and Welfare (AHAW)

Contact between poultry and wild migratory birds that could carry avian influenza is a risk that cannot be entirely eliminated, the panel said, recommending that biosecurity measures, such as limiting movements and contacts of animals and people between farms, should be increased.

The panel also recommended more education of farmers about avian influenza, and structured cooperation between avian influenza epidemiologists and ornithologists who map migratory bird routes. Import controls concerning live birds and poultry should be further tightened.

The recommendations were presented at a meeting of the Chief Medical and Veterinary Officers on avian influenza at the European Commission on September 22. The participants recognized the need for consistent and coordinated actions by national veterinary and public health authorities in preparing for the event of an avian influenza outbreak.

More cooperation between public and animal health surveillance systems, epidemiologists and virologists is required, as well as more support for countries experiencing avian influenza outbreaks, the veterinary officers said. They stressed an "urgent need" to update avian influenza contingency plans and pandemic preparedness plans in all European countries.