Global Trends by Martin Khor

Monday 17 Oct 2005

Spread of bird flu raises alarm

New cases of bird flu in poultry in Europe in the past week have triggered renewed anxiety that a pandemic can emerge that will kill millions around the world.  Countries are now scrambling to stockpile the only known drug to treat the disease, but supplies are limited.


Fears that a  worldwide “bird flu” pandemic may emerge increased last week when the television and news media highlighted the first cases of the flu virus in poultry in Turkey, following earlier discovery of the disease in ducks in Romania.

The virus is believed to have been carried over from Asia to Europe by migratory birds. 

European health ministers met last Friday to discuss measures to reduce contact between wild birds and poultry to curb the spread of the virus.  Millions of poultry could be kept indoors to prevent contact with migrating birds.

Asia has been the region of origin of the lethal H5N1 variety of avian flu.  Over 160 million poultry that were or could have been infected have been culled in a bid to stamp out the disease.

What is worrying is that the infection from the virus has already crossed from poultry to humans, and the incidence of death is very high once people are infected. 

If the virus mutates so that it can be passed on from human to human, a pandemic is expected to take place, which could kill millions around the world.

So far there is no scientific evidence that the human-to-human form of bird flu has yet emerged.  But at a forum organized by the World Health Organisation in May in Geneva, a Thai health ministry official presented circumstantial evidence of a few Thais being infected through contact with family members. 

Last week, another major problem became evident.  The pharmaceutical drug, Tamiflu, can treat avian flu by reducing its severity.  Governments are now ordering the drug, but the sole company having the patent cannot produce fast enough.

There is concern that when the pandemic of bird flu in humans strikes, there won’t be enough quantities of Tamiflu to treat the infected patients.

The virus has been reported in birds and poultry in Hong Kong, South Korea, Vietnam, Japan, China, Thailand, Indonesia, Cambodia, Philippines, Russia, Romania and Turkey.

So far more than a hundred persons (all in Asia) have been known to be infected by the virus and 60 have died. Countries in which human cases have been reported include Hong Kong, Thailand, Vietnam and Cambodia.

While only a few human cases have been reported, experts and the WHO predict it is only a matter of time before a pandemic affecting millions will hit.  Asia will be the region first and perhaps mainly affected.

WHO's influenza programme coordinator, Dr Klaus Stohr, called for global and national pandemic preparedness as "we are on borrowed time".

An influenza pandemic could make 500 to 1,253 million people ill, require 6.4 to 28 million people to be hospitalized (if there were enough hospitals running at that time), and result in 2 to 7 million deaths, he told a WHO forum in Geneva in May.

Some experts think that is an underestimate.  Marc van Ranst, a virologist at Leuven Catholic University, gave 30 million deaths as a realistic figure should a pandemic arrive.

Stohr predicted that a pandemic would come in several waves, would affect community services and cause social and political disruption, with large economic losses. The present Asian avian flu epidemic was already predicted to cause $10-30 billion in losses.

He urged countries to establish a national pandemic preparedness plan, which should incorporate health services, pharmaceuticals (including stockpiling drugs), civil emergency response, communication and leadership and coordination.

Richard Nesbit, from the WHO Western Pacific regional office, said there was a concern that the virus could be adapting to humans and increasing the pandemic potential.

Dr. K. Ungchusek of the Ministry of Health, Thailand, reported a case in his country where a girl had died of pneumonia after being infected by the influenza virus, and her mother (who had taken care of her) had also died a few days later of the same type of ailment, while her aunt also fell sick (but did not die) from the disease.

He said that medical colleagues in neighbouring countries had also reported to him of family-based clusters of people contracting the disease, for example, three brothers at Thai Binh-Hanoi and five family members in Haiphong (both in Vietnam) and a brother and sister in Kampot province of Cambodia.

Meanwhile, there is a scramble to obtain the Tamiflu drug, as there is limited capacity by the company Roche to produce. It doubled production in 2004,doubled it again in 2005 and plans to double it again next year.

But demand is still far higher, as countries plan to stock up in anticipation of the dreaded pandemic.  The UK, for example, has ordered 14.6 million courses of Tamiflu but only 2.5 million have been delivered.

There is also a shortage of the herb, star anise, grown in China, which provides an ingredient for the Tamiflu drug. 

The fight by countries to obtain supplies to stockpile Tamiflu has also reignited the debate on the effects of patents on access to medicines.

There are increasing calls for relaxation of Roche’s patent on Tamiflu so that generic versions can be produced.  Nobel prize-winner Sir John Sulston (famed for his work on the human genome) last Friday called for reform of the drug patent system to allow faster stockpiling and wider access to Tamiflu.

Meanwhile, the Indian generic drug company, Cipla, has announced it would make a generic version of Tamiflu and make it available “at a humanitarian price” to developing countries.

But there are also warnings by experts not to consider Tamiflu as a wonder drug.  It is not a cure for flu, but can reduce the severity of a bout if taken within the first 48 hours of the onset of symptoms.