1. Where did avian flu originate? Why is so much poultry being killed? Why do wild birds seem to be less affected?
Influenza viruses have existed for a long time in birds. This virus, H5N1, is a descendent of the virus responsible for an avian influenza epidemic in Hong Kong with some human cases in 1997. It then underwent several genetic exchanges with other influenza viruses until a particular genotype, known as “Z”, of the H5N1 virus emerged. What was totally unexpected was its geographical spread and virulence among certain domestic birds, which is why we are no longer talking about an epizootic but a panzootic.
François Le Gall, Lead Livestock Specialist for the World Bank, who is responsible for the veterinary aspects of the global response to avian influenza.
With globalization, pathogens circulate more quickly and travel greater distances, and they are subject to genetic exchanges which allow them to acquire new factors of adaptability or virulence, or both. Domestic animals, because of repeated crossbreeding for purposes of increased productivity, are of better quality but are increasingly fragile and susceptible to pathogens. The growing demand for animal products is putting pressure on countries to increase their production, and it is estimated that by 2020 production will have doubled and will come almost exclusively from the developing countries. This is what has been called the Livestock Revolution. When these three phenomena converge -- extremely virulent pathogens affecting dense populations of extremely susceptible animals -- we have similar effects to those now being observed with the highly pathogenic avian influenza, or bird flu.
Most wild birds have been only slightly affected, or not at all. They constitute the wild reservoir of the disease. No action can be taken at this point to deal with such a vast and mobile reservoir. Domestic poultry like chickens and turkeys -- but not ducks-- are a receptive and susceptible target. They show very high mortality rates, and it is not rare to observe rates of 100% in highly concentrated farms. A third category is represented by species which are only slightly receptive, such as humans, among whom relatively few cases have been recorded in view of the many contacts that exist between humans and susceptible domestic species. On the other hand, humans are very susceptible, given that out of the 191 cases recorded as of April 4, 2006, 108 died. So we are talking about a zoonose.
2. Apparently the disease is not easily transmitted to humans. What about the risk of mutations? What about the risk of a pandemic?
The virus is part of a particular family whose genome, or genetic material, contains eight segments, and when infections exist and the virus multiplies, or replicates itself, it exchanges segments with other viruses in the same group. This is called genetic re-assortment (frequency of 3 to 1000 times higher than traditional mutations). Thus, the virus can suddenly become subject to significant genetic modifications and acquire new characteristics. This virus also has the possibility of undergoing recombinations among its segments and, like many other viruses, genetic mutations resulting from misreading of the code during the replication process, but these events are less frequent. What the experts fear are re-assortments between highly pathogenic animal (avian) strains and highly contagious human strains (seasonal flu) simultaneously with cross-infections -- in humans or pigs -- which could result in a new, extremely pathogenic and contagious strain for humans, in other words, the famous pandemic virus.
No one can predict today when a possible pandemic will arise, but although the probability may be low, the repercussions would be such that it is preferable to prepare for one.
It is extremely important to understand that the more the virus circulates among the flocks, the more susceptible it will be to genetic modifications, and that is why it is crucial to tackle the disease at its animal source in order to prevent or limit this accumulation of genetic exchanges. (We will return to this topic when we talk about measures to be taken).
3. Is this what is known as a zoonose? Are there any others?
A zoonose is a disease common to animals and humans. There are hundreds of them, and about 150 are a serious public health concern. Some have been known since ancient times, such as rabies (this is a zoonose in the strict sense) or anthrax (which is a disease common to humans and animals that may be spread through contaminated soil). Most of the recently emerging diseases are of animal origin, and virtually all of them have a zoonotic potential. Severe acute respiratory syndrome (SARS), mad cow disease (BSE), West Nile virus, and the current avian influenza are a few examples. To give you an idea of the importance of zoonoses: 60% of human pathogens are zoonotic, 75% of emerging diseases are zoonotic, and 80% of pathogens that could be used for bioterrorism are zoonotic. A set of factors converge to create what scientists call a “pathogen storm,” with zoonoses at the eye of the storm. The effects of globalization will only tend to accentuate this phenomenon.
4. How far has it spread? Can one predict the evolution of the spread of the virus? What about the role of migratory birds? Are there other ways that the virus can be spread?
Since its origin in Asia, the disease has spread to three continents, including Africa. It is still expanding, and experts think that this progression will unfortunately continue and even reach North America in 6 to 12 months as a result of bird migrations. Migratory birds play a very important role in the spread of the virus, especially over very long distances. But you are right to ask about other possible means of spread, since the current pattern of evolution of the epidemic does not fit with the kind of contamination that is strictly linked to migratory birds. Uncontrolled or illegal movements of animals and their products are also responsible for spreading the virus. One can see how difficult it is to stop the spread without putting appropriate surveillance measures into place.
5. What measures are contemplated to prevent the introduction of the virus, or its propagation once it has reached a country? Can you tell us more about the slaughter and vaccination of the animals?
These mainly consist of veterinary measures implemented by the veterinary services of the various countries. The measures in question, which are directly linked to the epidemiology of the disease, are very precise and standardized; the OIE has established international norms which, when strictly applied, can prevent or limit, in the best possible conditions, the progression of the disease. Wherever possible, sanitary prophylaxis is advocated, with surveillance of at-risk zones, and when an outbreak is detected, control measures need to be taken. These include confinement, slaughter/culling of infected and suspect animals, disinfection of buildings, strict control of movement (of humans/animals/products/material), biosafety measures on farms and markets, and possible vaccination of healthy animals on the periphery of the outbreak. This is by far the best way of containing the outbreak and focusing on eradicating the virus in the poultry flocks. Where this is no longer possible, medical prophylaxis measures are taken. In the case of avian flu and in situations where the outbreaks are out of control and the disease is progressing or, even worse, in an endemic situation, mass or targeted vaccination of bird at risk must be used in order to limit the viral load in the environment. It is important in this case to set up post-vaccination epidemiological surveillance to follow up the evolution and circulation of the wild virus (as opposed to the vaccine virus). Once the situation is under control, the sanitary measures can be resumed. After a period of time, if no new outbreak has been reported, the country can be declared disease-free, a crucial step for countries that export their products. So it’s not just a question of slaughter or vaccination but of deciding what steps need to be taken based on the disease, its evolution, and the capacities of each country. This may seem a bit complicated, but, as I said, these measures are extremely well codified by the OIE on the basis of rigorous scientific data, and it is strongly recommended that the OIE be consulted whenever there is any doubt about the procedure to be followed.
The key message is that everything depends on early detection and rapid response. Every minute counts. The sooner the disease is detected, the sooner the recommended measures can be put in place and the better the chances of containing the disease. This depends essentially on a single chain of command within the official veterinary services. The early warning mechanism begins when the farmer, who need to be well trained and informed about the symptoms of the disease so that he/she can recognize it and who need to know that he/she will be fairly compensated for the loss of his livestock, contacts the nearest public or private veterinary services for an analysis of the situation. In suspicious cases, the latter will contact the veterinary authority, which will send a team to the suspected outbreak; the team may declare a quarantine zone and implement emergency measures. The confirmation will come later, once the laboratory results are in. An equally essential step is the reporting of the disease to the OIE, which has a global early warning network to inform all countries about reported outbreaks. This network is linked, in the case of zoonotic diseases, to the World Health Organization (WHO) network known as the Global Livestock Early Warning System (GLEWS).
6. You have mentioned compensation for poultry farmers -- is this the financial compensation everyone is talking about? Does it mean giving assistance to the affected farmers?
Yes, that’s right. I mentioned compensation for the farmers whose animals had to be culled in an emergency situation. This is an essential element because the farmers, who are the first sentinels of the surveillance mechanism, cannot be asked to voluntarily report their sick animals unless we can assure them of compensation for the slaughter of those animals. This is fundamental, and we cannot disassociate culling from compensation. But compensation raises many difficult points. We have to establish a rate which is neither too low nor too high in relation to the replacement value of the animals; otherwise, all kinds of distortions may arise. We must be able to communicate the message in a way that it will be well understood by everyone. We must take follow-up measures to ensure that the money actually reaches those who honestly report the disease. And we must encourage early reporting. Much remains to be done and learned in this area, since the models -- which are far from perfect -- come from developed countries, which do not have the same constraints as those affecting the countries we work with.
7. What about antiviral drugs and vaccinations for people?
I am not an expert on the subject, but it is well known that antiviral drugs are not very effective, and they do not generally work well unless they are used at the very onset of the infection to treat the symptoms. Vaccination also raises many problems because mass production cannot begin until the pandemic virus appears which it hasn't done yet, fortunately.
Communication is absolutely crucial at all stages and at all levels-- political, sectoral ministries, rural communities, etc. It should be considered a necessary complement to prevention and control programs. With a good communication strategy, we can avoid needless deaths by informing the public, particularly children or those who pluck the infected birds, for example, about the risk of handling sick animals. We can also avoid causing the type of panic that occurred in Europe in the case of mad cow disease, and prevent all the attention and resources being directed to the production of human vaccines, to the detriment of veterinary actions.
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It is important to have a good communication strategy
9. What are the key institutions and their role? The World Organisation for Animal Health (OIE) is often mentioned; you yourself have referred to it, but this institution is actually not very well-known, is it?
Many partners are working together on this issue. First, there are the governments themselves, with their relevant ministries (agriculture/livestock, health, communications, finances, etc.) and their private and associative partners --not enough has been said, by the way, about the key role of farmers’ organizations. Then there are the United Nations specialized agencies (the Food and Agriculture Organization of the United Nations (FAO), the World Health Organization (WHO), and the United Nations Children's Fund (UNICEF), to mention a few), donors and non-governmental organizations (NGOs). But it is true that the World Organization for Animal Health (OIE) has a unique and I would say central role in this complex arrangement.
The World Bank and the international community have recognized that it is essential to have high-quality veterinary services, not only to control the current avian influenza crisis but also to rapidly detect the appearance of other emerging and re-emerging diseases and to intervene quickly. In addition, the rich countries have acknowledged the priority need to support veterinary services in the developing and transition countries, not only to promote international development but also to protect themselves against the global propagation of animal diseases and zoonoses. All this explains why the actions being taken by veterinary services are now recognized as a global public good. And the OIE has committed itself to devising international standards to ensure the quality of veterinary services and to helping its 167 member countries apply them.
In recent years, moreover, the OIE has considerably reinforced its partnerships with the specialized agencies (FAO, WHO), representatives of the private sector (such as the Safe Supply of Affordable Food for Everyone Everywhere (SSAFE) initiative), donors (the World Bank in particular), governments (through official representatives of member countries and Chief Veterinary Officers (CVOs)), and NGOs, and it has worked to strengthen collaboration between veterinary and medical authorities.
10. Who is in charge of coordination? Has the United Nations designated a coordinator?
I think the first thing that needs to be clarified is that we expect each country to make a concerted effort to unite all the stakeholders around a common objective, namely, to establish as quickly as possible a good communication and implementation strategy, detect and rapidly respond to animal disease outbreaks by means of the traditional veterinary actions I have mentioned, protect the exposed populations, and prepare for a possible pandemic. It is all the more important in this case because the measures to be implemented involve collaboration among several ministries, specialized agencies, donors, public and private sectors combined, and even the governments of neighboring countries, in view of the transborder nature of the disease. This does not mean it will be easy, especially in emergency situations where everyone resumes their good -- or bad -- habits of working in isolation.
At the global level, the United Nations has designated an avian influenza coordinator for the United Nations system; the Bank, which has also been asked to participate in international coordination, is of course working closely with this coordinator.
The World Bank cosponsored the meetings in Geneva and Beijing. It has prepared a global operational and financial framework in the form of a facility of US$ 500 million, with accelerated procedures for helping countries affected by avian influenza to prepare for financing of projects. The technical menu follows the recommendations of the three partners (OIE, FAO, and WHO). In accordance with the Geneva and Beijing principles, it advocates a country-led, multisectoral approach, with the countries being supported technically by the specialized agencies and financially by the donors.
The World Bank is actively involved with its partners in helping countries to prepare a comprehensive response plan to deal with avian influenza, which for some of them will lead to investment projects. But it is quite probable that regional support will also be necessary to take into account the transborder aspects of the disease and for reasons of economies of scale or regional integration. As I just mentioned, the World Bank will be managing the multi-donor trust fund known as the Avian and Human Influenza (AHI) Facility.
12. What resources are available? Could you tell us something about the results of the conferences in Geneva and Beijing and the forthcoming Vienna conference?
The Geneva conference in November 2005 brought about an agreement on the general principles of intervention. I believe it was the first time that the three partners spoke with a single voice. The message was that the best way to prevent a pandemic is to tackle the virus at its animal source. The key is early detection and rapid response, and that involves effective veterinary services. At the same time, it is important to prepare for a pandemic. It was also pointed out that actions to prevent and control avian influenza are a global public good.
At the Beijing conference, the international community mobilized in support of the countries that were judged the most at risk at the time, and US$ 1.9 billion were committed to fight avian influenza. The World Bank pledged US$ 500 million and has been charged with the responsibility of managing a global trust fund. The Bank was also strongly urged to continue playing a role in the global coordination of assistance. The status of its commitments and the reevaluation of needs will be the subject of discussions at the Vienna conference in June.
To sum up, political commitment exists at the international level, and we have a well-established, consensus-based technical framework. Although coordination, which is essential, is not always easy, we are all working to make it more effective. Financially, the donors have been mobilized. But additional resources will be necessary as the epidemic progresses, particularly for Africa.
I think so, sincerely, and I'm not the only one. The multiplicity of crises on all continents, the impact of these crises -- in particular in terms of the increase in poverty and food insecurity in all the developing countries -- and their costs fully justify the view that the prevention and control of animal diseases should be considered a global public good and a means of attaining the Millennium Development Goals.
It is estimated that 200 million poor people in Africa depend on livestock for their survival. These poor populations are highly exposed to a multitude of animal diseases as a result of strong pathological pressures and a weak response capacity. These diseases may in turn expose the people to other economic, social, environmental, or even political risks. Given the importance of livestock for these poor populations and the threat to their livelihood from the repercussions of animal diseases on livestock productivity and human health, all programs aimed at controlling and eradicating these diseases, with their serious consequences for the poorest segments of the human population, will have a major and direct impact on poverty reduction.
The World Bank thus committed itself in Doha, in cooperation with its partners, to support programs aimed at building up the national capacities of developing countries. This commitment took the form of an agreement between the World Bank and the OIE to reinforce global health governance and study the framework for a durable, global financial mechanism for emergency and/or compensation funds. The creation of a global fund to assist countries in their efforts to respond quickly to outbreaks, and to provide compensation to farmers, would be of interest to all countries, including members of the Organization for Economic Cooperation and Development (OECD), which should see it as a way to protect their livestock and populations against epizootics and zoonoses originating in the developing countries.
Some experts fear a lasting infestation of avian influenza in Africa, which would create an enormous, permanent outbreak to the south of Europe. Thus, Europe has a dual responsibility to mobilize: out of a necessary humanitarian concern to promote scientific and medical collaboration in the event of the emergence of a pandemic, and as a measure to protect its own livestock. North-South solidarity has never been so critical. In addition to avian influenza, emerging animal diseases -- three quarters of which are zoonotic -- will be increasingly present on the world scene. The international community will need make increasing investments in a global system of prevention and control of animal diseases. Audio
First of all, as I said, it is the duty of the rich countries, and in their own interest, to support the poor countries in building or rebuilding sustainable veterinary systems based on effective administration and a dense, highly motivated network of private rural veterinarians and on well-trained and organized farmers in terms of knowledge about animal health. It is estimated that about 100 countries do not yet have veterinary legislation or appropriate administrative and financial structures to face such an epidemic, if necessary, without international scientific, technical, and financial support. The global cost of such a program will be much lower and the results more effective than the management of repeated global crises.
Finally, what must be done is to strengthen the global mechanism for veterinary governance by acting at the various geographical levels -- national, regional and international. The core of this mechanism is formed by the OIE, which has this very mission. We support it because we believe it is the best placed and most legitimate institution – given its terms of reference -- to play this role and guide its partners, through the joint arrangements it has put in place with governments, the private sector, universities, donors, and other specialized agencies such as FAO or WHO, to work towards a common objective, namely, global health security.
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