With each day bringing fresh reports of bird flu outbreaks on Europe’s periphery, the British government’s chief medical officer, Liam Donaldson, warned that a human pandemic was “inevitable” and that it probably would kill at least 50,000 people in Britain alone.
But the European Union’s Center for Disease Control says, “The risk of infection for most people in Europe is close to zero.”
In August, when the threat of the deadly flu appeared on Europe’s horizons, the Dutch government ordered poultry farmers to move all their birds indoors. A month later, it changed its mind, mainly because the EU would no longer let Dutch farmers sell their chickens as “free range.”
Now the EU says all chickens must be kept indoors.
If the chickens are confused, pity the people of Europe. With outbreaks of the deadly H5N1 strain of avian flu now confirmed in Turkey, Russia and Romania, and with more suspected outbreaks in Croatia, Macedonia and Greece, Europeans have been bombarded with confusing and contradictory information from the governments and international agencies they look to for protection.
After an emergency meeting in Brussels on Tuesday, EU foreign ministers declared the avian flu outbreak a “global threat” and warned that Europe was not prepared to cope with the expected pandemic.
Newspapers in Britain reported on government contingency plans for up to 600,000 dead and painted an apocalyptic picture of troops being called in to prevent people from fleeing infected areas. Alarm grew over the weekend when a parrot that died in quarantine after being imported to Britain from Suriname checked positive for H5N1.
Public reaction has been predictable. There was panic buying of Tamiflu, an anti-viral drug used to treat bird flu. When pharmacies ran out, Tamiflu was offered on eBay, the Internet auction site, for nearly $200, more than six times the normal cost of a five-day course.
Two days after the foreign ministers’ summit, EU health ministers held their own emergency summit and sent a somewhat different message.
“The risk to the general population in Europe is very low indeed,” said Patricia Hewitt, Britain’s health secretary.
So whom to believe? According to public health experts, the claims from both sides are justified and not necessarily contradictory.
The H5N1 virus that first emerged in Hong Kong eight years ago is a global threat. It has resulted in the deaths of millions of chickens, ducks and other fowl across Southeast Asia. About 150 million birds have had to be culled. The virus has reached Europe, and experts say that because of the migratory patterns of birds, it will inevitably reach Africa and the Americas.
Since 2003, about 120 people in Asia have contracted the disease from birds; 60 have died. It is relatively difficult for humans to catch the H5N1 virus from birds, but what is reassuring to public health officials is that there are no confirmed cases of human-to-human transmission, which is why the World Health Organization and other bodies continue to emphasize that the risk of human infection remains low.
Viruses can mutate
But viruses such as H5N1 can mutate into forms that can pass from human to human, and human flu pandemics strike with regularity. The 1918-19 Spanish flu pandemic killed between 20 million and 50 million people, according to varying estimates, and clinical evidence suggests that if the H5N1 virus mutates, it would be deadlier.
Belatedly, the world is waking up to the danger. Last month, the U.S. Senate allocated $3.9 billion to start stockpiling anti-viral drugs. But manufacturing capacity is limited, and the United States will line up behind other countries that placed orders first.
The EU is attempting to coordinate preparations across Europe, but Ben Duncan, a spokesman for the European Center for Disease Control in Stockholm, conceded that “the front-line response will be handled at the national level.”
Thus far, that response has been uneven.
Vastly different approaches
France has ordered 50 million surgical masks to distribute to the general population, while Polish border guards stationed at Kaliningrad, a Russian enclave on the Baltic Sea, have been outfitted with protective suits.
The Poles also have drawn up list of quarantine locations that is being kept secret, even though most public health experts agree that quarantines will be useless if the virus starts spreading among humans.
Because there is no human strain of the H5N1 virus, there is no vaccine to immunize humans against it. If such a strain mutates from the avian version, then scientists should be able to develop a vaccine within six months. The problem then is whether pharmaceutical labs would be able to mass-produce it quickly enough to slow the development of a pandemic.
The politically attractive alternative, at least for the wealthier countries of the world, is to stockpile anti-viral medicines. These medicines don’t prevent or cure the illness, but they can lessen its effects.
The WHO recommends that countries stockpile enough anti-viral medicine, namely Tamiflu, to treat 25 percent of the population, the approximate percentage expected to fall sick if a pandemic hits. But some wealthy European countries have announced plans to buy twice as much or more, even though enough of the drug won’t be available for at least a year.
The immediate concern, according to health experts, is that if countries or individuals start using Tamiflu as prophylaxis, it could make the virus resistant to the drug and more difficult to control.
The deeper problem is that if a pandemic hits, it could pit rich countries against poor in the scramble for medical resources, turning what should be a cooperative effort in disease control into an every-man-for-himself catastrophe.
“No country can do it on its own,” warned EU Health Commissioner Markos Kyprianou. “A pandemic knows no national boundaries.”
At the moment, the Swiss pharmaceutical company Roche is the only maker of Tamiflu, and it has back orders of more than a year. Roche is coming under pressure to allow generic manufacturers in poor countries to produce low cost versions of the drug.
Sen. Charles Schumer (D-N.Y.) last week called on Roche to license Tamiflu production to American pharmaceutical companies and generic producers. If the Swiss company refuses, Schumer said he would introduce legislation to force the move. In response, Roche has offered to build a manufacturing facility in the U.S.
While European countries have been prepared to spend on stockpiling anti-viral medicine, comparatively little has been spent trying to control the disease at its source–among the birds.
More funds required
David Nabarro, the UN coordinator for avian flu, said $175 million would be needed to set up effective monitoring and control programs for domestic poultry flocks. Thus far, only $30 million has been pledged.
Nothing can be done to stop the spread of the disease among wild birds, but across Europe, zookeepers and park wardens have started rounding up and confining their flocks of ducks, geese, swans, peacocks and other birds.
Not everyone agrees on where to draw the line. Marek Kwiatkowski, director of Warsaw’s Lazienki Park, the city’s largest, has balked at an order from the Agriculture Ministry to catch and confine the park’s 200 ducks and 40 peacocks.
“We can’t catch them,” Kwiatkowski told a local newspaper. “Besides, these birds are not ours. They are wild. They only live here.”
The ministry has given Kwiatkowski a week to comply or face a 3-year jail term.
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thundley@tribune.com
