Pandemic preparedness: begin at the source

Farm surveillance, along with fair compensation for producers who have to kill infected fowl, is the essential front-line of defence against an avian influenza pandemic, agreed health ministers from 30 countries and heads of 8 international agencies, including the WHO, at a conference in Ottawa.

Avian flu is concentrated in developing countries where farmers can ill afford to kill their flocks; so far, 140 million ducks and chickens have been slaughtered in Asia, at a cost of $10 billion. Farmers are compensated in most countries, but not to the full extent of their loss, giving them little incentive to report the disease.

As of Oct. 26, Avian flu H5N1 had infected 100 people, killing 62, in 4 Asian countries; most died after direct contact with infected birds. But experts fear that with continued human exposure to infected birds the virus could mutate into a form easily transmitted among people.

We need to “double and redouble our efforts to stop avian influenza at its source, in animals,” said Jacques Diouf, director general of the Food and Agriculture Organization (FAO) at the Oct. 24–25 conference on Global Pandemic Influenza Readiness in Ottawa.

These efforts would include both fair compensation for farmers and science-based systems for raising poultry and marketing live birds.

“We must take prudent measures … to stop this disease in its tracks,” he said. “It can be done.”

No concrete initiatives stemmed from the 2-day meeting, but participants stated in a Communiqué that it was an “important step” toward a long-term sustained political and institutional engagement. They identified a huge number of needs, including a harmonized global approach to research and development, along with increased production capacity, access and distribution of vaccine and antiviral agents.

Mexico's call for developed nations to reserve 10% of antivirals for poorer nations was put aside. Instead, the ministers decided it might be more appropriate for the 10 or so countries that have adequate supplies of the drugs, including Canada, to develop a way to share, such as through the WHO stockpile.

Only about 40 countries are ready for a pandemic, said Dr. Jong-wook Lee, Director General of WHO. “We must help countries stockpile.”

Roche International, the manufacturer of oseltamivir (Tamiflu), has promised WHO 30 million capsules of oseltamivir to cover 3 million people; enough for 1 million has been delivered.

The best protection, Lee added, is an effective vaccine, but that can't be developed until a human strain emerges, after which a vaccine will take months to produce. There is also insufficient global manufacturing capacity to produce the quantities needed. “It's a huge challenge,” he said. “We need investment.”

Delegates also agreed that coodinated risk communications among countries and institutions is needed to avoid public panic.

It may already be too late. In the midst of the conference, Roche Canada decided to temporarily stop shipping oseltamivir to private pharmacies in face of an unprecedented demand and fears of dwindling stock. In September, about 4000 prescriptions for the drug were filled for Canadians, compared to 421 in September 2004.

A Nov 7–9 international meeting on avian and pandemic influenza will “bring concerns to the next stage,” said Lee.