Bird Flu: Major Threat or Chicken Little?

Howard Markel, MD, PhD

Disclosures

August 09, 2006

Want some free medical advice? Don't start swallowing Tamiflu tablets right away. When it comes to avian influenza, the sky isn't falling. Yet. Since 2003, over 200 people have been stricken by bird flu; more than 100 have died as a result. Most of these unfortunate people contracted the disease from chickens they butchered or were living with in close proximity. No cases have yet been detected in North America -- among birds or human beings. If you live in the United States or western Europe, you have a much better chance of being struck by lightning than contracting this potentially devastating scourge. But, at least for birds, it does remain a threat in places like Vietnam, Indonesia, China, and Africa, even though relatively few new cases of bird flu have been reported this year.

So can we take a deep breath and relax? The best medical answer is a qualified "maybe."

Flu viruses reassort or mutate, readily jump species, and can easily spread among humans in the simple acts of sneezing, coughing, and even breathing. The viral variants that are new to our collective immune systems are especially infamous for wreaking contagious havoc. That's precisely what happened in 1918, when an influenza strain containing genetic components of avian flu stalked the world with a vengeance, claiming over 40 million lives. Most public health experts understandably worry that we are way overdue for a new pandemic.

The current wave of bird flu first emerged over 2 years ago in Indonesia, a nation that boasts Southeast Asia's largest populations of people and poultry. Many of the poorest people there raise their own chickens and live very close to these birds. Indonesia also suffers from one of the most understaffed healthcare systems in the world. All these factors could conspire to fan and spread the flames of a pandemic. Indonesian officials knew about the avian influenza problem among domestic chicken flocks since mid-2003. Succumbing to intense lobbying by its local poultry industry, at best the Indonesian government's public health polices can only be described as ostrich-like. It was not until July 2005, that Indonesian president Susilo Bambang Yudhoyono exhorted his fellow citizens to come clean on bird flu, and finally requested help from the World Health Organization (WHO).

Sadly, recent reports from the region suggest that avian flu is all too common among the many backyard flocks of chickens that make up a major food source for those living there and is killing more and more birds each month.

When a similar outbreak was discovered in Hong Kong in 1997, the orders were clear, transparent, and immediate: All domestic chicken flocks were quickly destroyed -- no ifs, ands, or buts. Disaster was temporarily averted. We may not be so lucky this time because of Indonesia's concealment and delay.

In other parts of Asia, there is encouraging news that Vietnam and China are making great strides in the culling of diseased poultry and surveillance of migratory birds in 2006. But no one should assume that the problem has simply flown the coop -- especially when it comes to the rather decentralized governmental structure of Indonesia and the inability of health officials to get provincial governors to take serious steps toward eradication.

More effective than sneezes in spreading germs is the chaos that results when a particular nation conceals early but clear signs of impending contagious crisis for financial, political, or any other reason. Think only as far back to the SARS scare of 2003. China's failure to act definitively or openly in cases appearing in the Guangdong province in late 2002 led to an epidemic that threatened to spread globally and cost the world economy billions of dollars.

If bird flu were to become a true pandemic today, the costs in lost revenue, healthcare, reduced productivity, and markets would amount to hundreds, if not thousands, of billions of dollars. The global death toll could exceed tens of millions or more.

But even if we are lucky enough to come through next year -- or the year after -- unscathed, despite our disorganization and poor planning, this problem will not go away. And if bird flu does not become a human problem, rest assured that another virulent form of influenza or some other emerging infectious disease will inevitably take its place as the threat du jour.

Last summer, the WHO sent every nation's public health ministry or department a detailed plan for responding to an avian flu pandemic. The plan includes recommendations for veterinary and/or agricultural means of detecting and handing domestic bird outbreaks, human surveillance, transparent international communications that feature reliable early warning systems, quarantine plans, and vaccine or antiviral development and distribution. So far, relatively few countries have instituted their own preparedness plans. Even among those that have plans, most are not quite ready to be reality checked.

Maybe that's why so many medical experts are screaming that the sky really is falling. When it comes to epidemics, we can never let our guard down or -- when they do not appear in a given year -- assume that the problem has resolved. It hasn't and it won't. That's why we need to plan -- and replan -- for the worst case scenario, far in advance.

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