IMF/ WB Annual Meetings 2006- Press Briefing: Avian Flu

Press Briefing: Avian Flu

Sunday, September 17, 2006

Suntec Singapore

P R O C E E D I N G S

MR. HAY:  Good morning, everyone.  Welcome to this avian flu press update.  We have got a very good panel this morning spanning both developing countries, the World Bank, and the UN systems, so I think that this will be quite an authoritative update.

Let's start very quickly with immediate introductions.  On my left is Jim Adams.  He's the Vice President for East Asia and the Pacific, and he is head of the World Bank's Avian Flu Task Force.  On his immediate left is Ian Porter.  Ian is the World Bank Country Director for the countries Cambodia, Laos, and Thailand East Asia and in the Pacific.

On his immediately left we are happy to welcome Dr. Dalaloy, the Health Minister from Lao PDR, a small country battling bird flu.  He will tell us something about the day to day reality of that.  On his left is Dr. Kumnuan, who is Director of the Bureau of Epidemiology for the Thai Government.

Welcome to Dr. Kumnuan, and David Nabarro, surely no stranger to anyone here, the U.N. Systems Avian Flu Special Coordinator.  So, let me ask Jim Adams to start with a couple of minutes of broad comments about the development challenge that is surely avian flu.

MR. ADAMS:   Thank you, Phil.

Just a couple of general points on where we stand with respect to avian flu.  Today, we have laboratory confirmed cases in wild birds or poultry in 55 countries, and the impact is we have estimated about 220 million bird deaths and significant damage to rural livelihoods as a result of this challenge.

Presently a number of  the number of deaths in the population stands at 144 deaths in the 244 infections which have been identified in 10 countries.  Virtually all the human cases have been traced to close contact with poultry, but even then I think we have been very fortunate in that infections remained relatively rare, considering that millions of people may have been exposed to the H5N1 virus.

Now, the international response to this over the past year has been broad and I think fairly forceful.  We began with a conference on the needs assessment in late 2005 in Geneva.  We went on to Beijing in 2006, where close to $2 billion was pledged by the international donor community to help developing countries carry out their avian flu programs to reinforce and strengthen both the animal and the human health systems.  We estimate today that about 1.2 billion has been committed to those programs.  I think this is an important behavioral change in the donor community in that money has not only been pledged, but committed, and we feel that the programs that are now being developed to use these funds can have and will have an important impact on avian flu.

We have done some estimates, and when we began the macroeconomic work a year ago, they were basically back of the envelope estimates where we talked about perhaps 800 billion in costs as the potential risks of a pandemic.  Recent analytic work based on the models that we have developed on the global economy have, in fact, if anything, increased the potential costs, and we estimate that a severe pandemic could now cost over 3 percent of the global economy of the GNP because of its impact on trade and economic activity.  We estimate this could cost, in fact, certainly over $1 trillion and perhaps as high as $2 trillion in the worst case scenario; so I think the threat, the economic threat, remains well real and remains substantial. 

On the Bank's side, we have been working in virtually all of the countries, developing countries, that have been affected by an avian flu outbreak, providing advice and financing in the development of projects to tackle the challenge.  Financing totaling about $150 million have been committed for projects in eleven countries:  Albania, Armenia, Azerbaijan, Georgia, the Kyrgyz Republic, Laos, Moldavia, Nigeria, Tajikistan, Turkey, and Vietnam.

Our emphasis in our work is on the development challenge; we're not trying to deal with the emerging immediate crisis, but to rebuild veterinary systems, to do the surveillance work that has to be done, and to put in place the strengthening of health systems to begin to put in place the capacity to deal with problems that emerge.

We are working in other countries, and right now, in fact just last week, the team from the Bank supported by Dr. Nabarro, was in Indonesia to work with the government on finalizing a $15 million grant on the Bank side, but this will be part of a much larger donor effort to put in place an effective program in Indonesia.

These programs have been fairly broadly based.  They have responded to the specific concerns of countries, but I do have to underline that the technical work underlying these problems is based on the very good technical work that was done by WHO and by FAO and by OIE, the animal health organization, to put in place technical responses which would be appropriate to the specific country concerns.

We will work and continue to work, and we have been working and continuing to work closely with the U.N., and subsequent in this discussion I'm sure David Nabarro will want to talk about some of the way that is working at the country level.  Thank you, Phil.

MR. HAY:  Jim, thanks very much.  Some of the numbers that Jim was referring to are in the background documents out there along with the donor flows and tables and the World Bank's pipeline.

Let me bring in Ian Porter.  Ian, it's very easy, I think, to underestimate the development impact of bird flu.  Increasingly, we hear talk that there is now  global fatigue with H5N1, but in terms of the countries you're familiar with, I wonder if you can give us a sense of how there has been a heavy price tag on this already.

MR. PORTER:  Let me just say a few words to complement at the regional level what Jim Adams just said, and certainly I think within East Asia, which is, of course, where the problem first started, I mean, it remains a very significant health threat and already a significant economic burden.  Eleven countries in East Asia region have been affected so far and in five of those countries, Cambodia, China, Indonesia, Thailand, and Vietnam, there have been human cases, and I think the latest figures show for East Asia there have been now 209 human cases, 127 deaths, so I think that's over 80 percent of the numbers that Jim just gave in terms of the global impact.

So, clearly, from a health perspective, I mean, there is already a significant impact.  But from an economic perspective, there has clearly already been a very significant impact.  If we take the case of Vietnam, for example, between the end of 2004 and the early part of 2006, 44 million birds were culled.  This is at a cost of about $120 million.  In Thailand in a similar  over a similar time period, 60 million birds were culled, and, of course, in most cases these are small holder farmers basically that are having backyard poultry farms, so the impact from an income perspective on their livelihoods is very dramatic and, of course, that calls for a very important program in terms of government response and compensation and so on.

But more broadly, I mean, in the case of Thailand, for instance, there has clearly been an impact on the commercial poultry industry as well, and in that context a very significant impact on exports of poultry from Thailand.  So.  Even whilst the epidemic is still basically being contained and hasn't certainly got to the pandemic stage or anything like that, I think one is still seeing a very significant health impact and economic impact.  I think in most of the countries in East Asia, if not all of them, I mean, clearly the problem is now recognized.  The stock taking, the understanding of the nature of the problem and what needs to be done has been carried out, and in most cases now national plans are being put in place to address those issues, and I think those national plans are very much plans that are focusing on an integrated way on addressing the problems so there are plans that deal both with the animal health issues as well as with the human health issues and I think they also include a very important information, education, communications program because I think that's clearly critical to addressing this kind of issue.  And I think we will hear from Dr. Dalaloy in a few minutes what has happened specifically in the case of Lao PDR. 

And on the World Bank side, I mean in some countries, particularly those where there is less capacity, I mean, we are very much involved together with other parts of the UN system and bilateral donors in helping the government put in place these kind of programs.  In other cases we will hear from Thailand.  Thailand has been able on its own to put in place a very effective program, but there what we're helping to do is try and pass on the Thai experience and the lessons that Thailand is learning to other countries in the region.

So, I think we clearly see an important start being made in addressing this problem through national programs, and the Bank at the regional level is very much involved in helping finance those programs.  So, I mean, clearly now key to all of this is implementation, and we have seen in the last few months both  well, in Thailand and in Lao and in Cambodia.  I mean, there have been new outbreaks, so it's clearly absolutely essential not only that we have good national plans in place, but that we are all working hard together to implement those plans.  Thank you.

MR. HAY:  Ian, thanks very much.

Let's bring in Dr. Dalaloy from Lao PDR.  Minister, when we were talking before, you told me you had three veterinarians in your entire country.  Can you give us a sense of how Lao PDR is fighting off H5N1.

MR. DALALOY:   First of all, thank you for inviting our country to participate to this meeting.  Mr. Phil has just raised that our country, small, poor country, how we can fight so huge a problem and solve it appropriately.

As you know, our country is a small country, but we have five neighbors and more than 5,000 kilometers of frontier.  Small country, small population, but big initiative. So, the task for us to do that is very huge because our health system as well as the system of Vietnam is still at the low level, so the task is huge.

So, for overcoming this, I think the problem, the mostly important is to rise our awareness because our awareness is really important because the fighting against avian and human influenza is the task of the whole society, so the whole society have to be informed, educated, and for having the capacity to protect themselves and implement all task for surveillance, for reporting, for participating in mitigating the spread of the disease.

So, for here, I think the role of the mass media, the mass organization is really important, very critical, and for this we are implementing this, and now in our country we have the support of the World Bank, all international partners, but given that the task specifically to UNICEF.

So, for us, the last outbreak in our capital city, in the neighborhood of the capital city, in the farm and village, with the implementation arrangement that we have put in place with the organization that we have readjusted, we are able to stop very quickly by culling the surrounding country in the area in the Repsol, and we also immediately investigating in the animal and also for knowing how is the situation, and with all of that I think we have succeed, and so in the compensation, naturally carefully, but we have done it.

So, our case is a case which demonstrated that small country with many constituent can also participate and can also contribute to stop the spread.  Basing on the ownership, but also basing it on the partnership with all international communities.  That's why we like to express here our thanks to all partners who have support us, friendly.

MR. HAY:   Thanks very much, indeed, for that.  The Minister's remarks are also out on the table, as you leave, the summary of his points this morning.

Let's go over to Dr. Kumnuan, who, as I was saying before, was the Director of the Bureau of Epidemiology for the Government of Thailand.  What's the experience of Thailand?  How are you combating avian flu, Dr. Kumnuan?

MR. KUMNUAN:   Thank you very much.  Good morning all media, professionals.  In Thailand, we have been fighting with avian flu for almost three years, and we acknowledge that this is not an easy job.  First we thought that it is very easy to eradicate avian flu, but time has proved that we are wrong.  We have to continue our fighting.  So far we have fought with avian flu in poverty, and we have 24 human cases, 17 cases in 2004, five cases in 2005, and this year, we already have two cases.  We cannot currently that we can totally control the avian flu, but we tried.  The Thai Government tried very hard.

I think first we admit that this is a national agenda, is so very important and Thai Government have laid out a national strategic plan.  The government allocate $120 million for a treatment plan starting in 2005, 2006, and next year.  In this plan, 60 percent of the money will be going to improve the veterinarian part, animal health, and another 40 percent go to the public health and pandemic program.

The second important thing is to get the people participation but people cannot participate if you don't have a transparent information for them.  They will not know what is avian flu, so in Thailand we stick to this transparency.  We try to inform the public whenever we are having this outbreak.

So far the government mobilize about 800 village, giving them training material, and then give them some training for them so that they can serve to inform the government officials.

The next step is that the government have to set up a rapid response team and take this as a public health emergency.  Whenever we are suspect of some human case or outbreak, this team will go out.  This year, we have 4,800 modifications, and all of these cases will be under investigation send a specimen to confirm whether it is specify or human influenzas, and last we are preparing for the pandemic.  This is a sensitive issue.  Sometime people don't want to see preparing and making alarming symbols, but it is necessary.  We have 76 province.  The aim is to have every province, 76 province take this table top exercise, so far we just finished 10, so we have a lot of things to do.

So I would like to conclude that complacency caused repeated outbreak and maintain political commitment is a very important thing.  Transparency can raise awareness of people and don't let down your guard.  So, Thailand is having a short term pain, but we believe that it will be a long term gain because with avian flu we can improve other public health structure and animal health structure.  Thank you very much.

MR. HAY:   Thanks very much, Dr. Kumnuan, from Thailand.

David Nabarro, let me bring you in here.  But let me just ask you right at the outset, what do you say to people who say that H5N1 has turned into the Y2K of the viral world?  And somehow we have been exaggerating this.

MR. NABARRO:  Listening to Minister Dalaloy and Dr. Kumnuan, and it's quite clear that they are struggling and continuing to struggle with H5N1.  And I will talk in a moment or two if I may about what I was doing in Indonesia over the last few days and also what's happening in different parts of Africa.  And I think the only difference between now and, say, six months ago is not that the problem doesn't exist, it is just that perhaps headline writers have got used to it, so what was causing headlines in newspapers, international newspapers, six months ago is not anymore, but it's certainly continuing to cause distress to communities and major concern to governments all over the world. 

Phil, with your agreement and the agreement of everybody here, I would just like to explain why my I have traveled from New York to come to Singapore really very much for this session today.  And it is because I wanted just to put on record with you all that during the last year, the year that I have been in this work, we have seen internationally a rather special partnership that has been working really well.  And for those of us who tend to get cynical about international partnerships, I just want to tell you a little bit about what's involved.  We have more than a hundred governments who are part of an international partnership on influenza who meet every six months at senior level and talk through the issues they are facing.  And they're doing this work in the knowledge that the whole of the international system, as we call it, is working with them.

I feel myself that the way in which it was described just now by Ian Porter, the World Bank being part of the international system is how it has been on this one.  There is no space between what the World Bank is doing and what the rest of the international system is doing.  We are working 100 percent together.

And in addition, the different parts of the United Nations are also working as one.  The World Health Organization, the Food and Agriculture Organization, and other UN agencies, and we have also brought in the World Health Organization for animal health.

And then also in there as well as UNICEF, which Dr. Dalaloy mentioned, we have the International Monetary Fund sitting here in this room with us also doing work, very important work with financial regulators and Central Bank managers.

This doesn't happen by chance.  It requires the commitments of the heads of all the different organizations.  It requires the continuous engagement of different people in government, and we have, I believe, got a quite unique international partnership that has been working during the past year.  And I believe we also have results to show for it.  I mean, I could look to Dr. Kumnuan or Dr. Dalaloy, and I could ask them, I'm not going to, but I could ask them, what's it like working with the international community with the Governors on avian influenza?  Do you find we are truly coordinated?  Are we working together?  And I hope they will answer, yes, on this issue you are working in synergy.

And so I would like in a way to send this message to the taxpayers of the world who fund organizations like the World Bank, who fund the World Health Organization, the Food and Agricultural Organization.  What we have done in relation to avian influenza is we have shown that the organizations that you are funding with your taxes can work in coordinated support of countries.

Part two.  I said I have been doing this work now as U.N. Systems Coordinator for about a year, and I just to want give you my stock take of what is necessary to get success at the country level.  There must be sustained political commitment from the top, from the President, from the Prime Minister, bringing together the Ministers of Health and Agriculture, Economy and the Interior to make sure that everybody works together.  There must be the capacity to scale up the program, to do what Dr. Kumnuan just described, to be able to send out a team of health and agricultural experts to go to the villages where there is trouble, with cash, with the necessary equipment, with particularly protective equipment so that the people working with the birds, their health is looked after.

There must be full engagement of the private sector and civil society.  By that, I mean Red Cross, I mean local community organizations, I mean religious groups, because without the engagement of the civil society and without the involvement of the private sector, we don't get it working.

We have got to have also very open information going to the public.  The countries that are doing best on this are using the media to convey the truth.   They're not hiding stuff.  They're not doing work behind closed doors, and I know it's sometimes tempting to say, well, we mustn't tell the public what's happening because it will frighten them, but the experience, particularly from Thailand, from Laos, from Vietnam, and, indeed, more and more from Indonesia is that you have to actually let people know what's happening because then they're part of the response.

And then perhaps very importantly as well, and it came out in the words you have just heard, when people lose their birds, their livelihoods are badly affected.  The laborers who work on the chicken farms are suddenly out of work.  The people who are involved in the processing of the meat in the markets are out of work.  We must pay attention to livelihoods and compensate.

Lastly, you usually hear people like myself talk about money, and the need for money; and, yes, there is a shortage of funds in some of the countries that really are fighting an uphill struggle to control avian influenza and also to prepare for the pandemic.  But I would also like to say to you that what we need to do as well as requesting money is to focus on the fact that we now have got in countries good ways of spending resources so we get results.  You have heard about it in Laos and Thailand, but we have also seen it in many African countries, Eastern Europe, and the like, and towards the end of the year in Bamako, we're going to meet together again and review progress in Africa, in Asia, in Eastern Europe, and in the Indian subcontinent, and I think what we will be able to say to the international community, particularly to the donors, is we are well able to spend your money to get results, so we are not just asking for cash, but we are saying, we have got good investment opportunities for you.  Please make sure that Africa, that Indonesia, and that other countries with great needs do manage to access the resources they require.

Because 75 percent of the new dangerous pathogens that reach the human population are going to be pathogens that come from the animal kingdom, and what we are doing is we are not just preparing for a pandemic or helping to deal with avian influenza, we are actually building that part of the security for the human race that helps to protect us from pathogens that come from animals, and we must make sure that our defenses strong not just now, but for the foreseeable future.

Thanks very much.

MR. HAY:   David, thanks very much, indeed.  Let's take questions for our panelists.  If you would just let us know who you work for, what your media outlet is, we will be glad to take them.

The lady down here with the red hair in the front, and then we will go to the gentleman with the camera.

QUESTION:  I would like to see if somebody could tell me how big is the risk of pandemic right now.

MR. HAY:   Okay.

Let's take the gentleman here as well so we can actually get a couple of questions and get us off the mark.

QUESTION:   As you heard, Indonesia is one of the most severe countries infected by the avian flu, but there are many critics that the move of foreign government to respond to this issue is very slow, and is there anything that the World Bank can do about this in term of supervision of the implementations of the programs that you assist?  Thank you.

MR. HAY:  Thanks very much. 

Let's take one more.

QUESTION:   To what extent is the global effort to fight bird flu and to prepare for a pandemic underfunded at this point?

MR. HAY:  Okay.  Let's parcel out these questions.  David, will you take the question about where we are up to with the potential for a global flu pandemic.

MR. NABARRO:  Thank you very much.  There will be another influenza pandemic one day, but we don't know when.  The H5N1 virus is capable of causing disease in humans.  It's also a virus to which humans do not have immunity, and it's a virus which is all the time undergoing genetic change.  And so, we remain concerned that this H5N1 virus could mutate to a form where sustained or continuous human to human transmission becomes possible.

Unfortunately, we cannot predict when this might happen.  We cannot predict how it will happen, and so we encourage communities, governments, and private entities to get prepared for a pandemic that might start anytime, despite the fact we cannot be certain when it will happen.

I hope that is clear enough answer to your question.

MR. HAY:   Jim Adams, let me bring you in on the question about Indonesia and the extent to what the World Bank can do.

MR. ADAMS:   Yes.  Indonesia  well, I won't discuss only the World Bank, but I do want to discuss the broad donor response and the government response in Indonesia because I think those two have to be taken together.

Indonesian Government has been working hard on putting together a program.  They have been involved in all of the conferences that we have had in terms of work on the program.  I think development of that program has taken some additional time, and there have been two special reasons for that.  First, the challenge in Aceh, and secondly the earthquake.  I think to be fair, Indonesia has had to deal with an unusual coincidence of challenges, and of course to the extent you're drawing on the emergency side, you're drawing on many of the same people.

So, having said it's taken time, I think what we have been impressed by is the very hard work over the last couple of months that the government has put in place.  We have had a donors conference.  David mentioned his trip with the Bank team to bring that together, and now we are fairly confident that we are going to move forward quickly with about $15 million of support.  That will be part of a broader donor program that we will get on the ground a more effective program in Indonesia.

One other comment because I think Indonesia is a good example of government responsiveness and change in behavior.  When the initial infections were identified, there was a sensitivity about openness.  That's changed dramatically now, and the government has worked very, very closely with the international system, and particularly with WHO when there have been human infections, in order to ascertain what the source of the infection was, what the spread of the infection was or was not, and ensuring that good technical work is done to understand the magnitude of the problem.

So, we see again, much as in Laos and Thailand, I think the government has moved with strong commitments, but has faced some special problems.

Now, on the question of do we have underfunding, I think overall the answer to that is we have been impressed with the international response, and a large percentage of the overall requirements have been met.  We feel we have in place at the country level both with the Bank support and with the trust fund we have access to significant resources which we can deploy. 

We are worried about two things, however, and partly, I think it's an issue of timing.  The first one is the African continent.  We were, I must admit, surprised at the quick spread to Africa that emerged originally in Nigeria, apparently through the imports of birds from another continent.  We have certainly been able to respond very quickly in Nigeria because of very strong support from President Obasanjo, but we are worried within the African continent that we don't have access yet to the same level of resources we have for East Asia and for Eastern Europe and so I think that is a problem.

Now we have focus on the meeting in Bamako that David Nabarro mentioned.

I think the second area has been a concern that in dealing with urgent crises, sometimes all of the resources weren't in the right place at the right time, and the one area we have been most concerned there has been to ensure that WHO has adequate resources to prepare the response team.  They have been working very hard over the last six months to what I would call make effective the commitments that were made, and so there has been progress, but it is important to have the capacity to respond to the specific crises to monitor what's going on, and WHO's role in that on the human side is key.

MR. HAY:  The $15 million figure Jim referred to for Indonesia will be a grant, so this is not a loan.  It will actually be a grant. Any of the other panelists want to weigh in on that?  Minister?

MR. DALALOY:  I would like to echo the comments of the question of the lady.  As the WHO had has said, it is difficult to say when pandemic will occur, but adding to that, I think our goal must be prepare for not having outbreak and for not having a pandemic.  Naturally, this need for heavy investment, but I think it is a good investment for preparing  for not having pandemic. 

Thank you.

MR. HAY:   Thank you, Minister.

A question here.

QUESTION:  Can anybody tell us anything about the efforts to develop a vaccination against this?

MR. HAY:   Let me ask David, with his medical background as well as his expertise in this, what the latest state of play is.

MR. NABARRO:  Thank you very much, indeed.

Unfortunately, we do not know what kind of virus will eventually be the one that causes the pandemic.  It's likely to have significant genetic differences because of mutation from H5N1, and so if we develop a vaccine against H5N1, it may not necessarily have the capacity to neutralize the pandemic virus.  That means that when it comes to developing a vaccine against the pandemic, we will need to take the pandemic virus and quickly enter it into vaccine production systems, and there will be a six month delay before we can, for example, have vaccines to make available to countries.

However, a number of governments are investing in the production of vaccines based on the H5N1 virus, using a number of modern techniques to make the vaccines particularly potent in the hope that these what some people call "pre pandemic vaccines" will reduce the susceptibility of key individuals to the pandemic virus when it arrives, and so there will be some H5N1 vaccines available that could be used at an early stage in a pandemic perhaps to provide protection or some degree of protection for workers, and we hope that the virus that does cause the pandemic will be responsive to these vaccines.

The quantities of anti H5N1 vaccine that are currently available are still currently small, although there have been some scientific breakthroughs in the last two months that may increase the availability.  I would be happy to talk more about this complicated subject in private afterwards.

MR. HAY:  Of course, the other side of the vaccination issue is that going on with infected poultry but also as a preventative measure.

Let me bring in Dr. Kumnuan and ask him, how much is vaccinating poultry helping you, for example, in Thailand stem the further spread of H5N1?

MR. KUMNUAN:   Actually, in Thailand, the government policy is not promoting vaccination.  We want to learn more about this vaccination in campaign in Vietnam, in Indonesia, in China.  So far we are using culling as a main intervention to improve the biosecurity, but we are open to more knowledge on this.

MR. HAY:   Okay.  Any other questions for our panelists?  Yes, indeed, the lady just here.

QUESTION:   In terms of educating the populations  I'm based here in Southeast Asia  I had a couple of experiences with people in villages where they have been affected up in Kampangphet in Thailand when asked why they hadn't been concerned when all of their chickens had died, they said, "Well, they die every year, so we didn't think this was a problem."  In Vietnam, when a farmer was identified as having ducks that were infected, he simply released them to resolve his problem.

Just how difficult is it to sort of educate people at such a grassroots level, and how effectively do you think you have been able to do that so far?

CHAIRMAN:   Let me hand it back to you, Dr. Kumnuan?

MR. KUMNUAN:  Yes, that is a very challenging problem now.  At the first year, all of the avian influenza outbreak have been in a big scale economic sector, and it is very easy to notice, to observe, to notify.  But clearly, the epidemic move through to the backyard chicken, and it's very difficult for the relater to differentiate whether this is S5 or some other common disease in the poultry, so we tell them that when they see some bad in their poultry, don't think of other disease.  Try to think this is S5 and notify the officials so we can send a team to investigate.

MR. HAY:   Thanks, Dr. Kumnuan.

Let me bring now in Jim Adams just for a quick sidebar on that.

MR. ADAMS:  Yes, you identified a key problem because clearly the surveillance part that the doctor mentioned is an important aspect getting this information back, but the other part of it that's very important is that the farmers have to have confidence that if they report it that the system, in fact, is going to be able to do the testing and, more importantly, if there is a disease, that compensation will be provided.

Particularly what we see with the rural small holders is that this is their livelihood.  It's not just that they let birds go or they sell birds because they don't know.  It's also the fear that if they do know and there is no compensation facility, it has enormous impact on their income.

So, this is a key aspect to building government programs that can respond to this problem broadly and effectively.  It's a particular challenge, obviously, in the rural areas with rural small holders, but this is the development challenge that we are talking about because I want to underline the points David is mentioning because, when we look at history, what we see is a sequence of virus emerging from human animal contact, and we want to put in place stronger institutions both on the animal health side and on the human health side to ensure the development problem is effectively addressed, and I think this is an important response as well to this concern that this is another Y2K, that, in fact, the longer term problem is here in this area.  We know because of the heavy populations that East Asia has been a source of these outbreaks.  Government policy can't solve those basic elements in the short term, but government policy and government programs can help deal with them more effectively in the long term, and that's what we see ourselves, along with the donor community, trying to address with those programs.

MR. HAY:  Jim, you mentioned compensation there.  Let me bring in Ian Porter and just ask him a quick question.  What is the price of the market value of a bird you have got to offer farmers do you think to give them the incentive to hand over an infected bird and not to succumb to the temptation to sneak the bird into market under the cover of darkness?  In Vietnam it would seem it's roughly 70 percent.

MR. PORTER:  I think within most of the countries I cover sort of the market price of chicken being the equivalent of two or three U.S. dollars, and I think we certainly think  certainly they would need at least 50 percent and probably closer to 75 percent in terms of compensation, so you could see from the government's perspective, of course, these numbers add up very quickly in terms of very significant costs to the budget.  And a big part of the resources that Jim was mentioning that have been mobilized from the donor community and a part of the program, for instance, that we are putting in place to support the Government of Lao PDR, a big part of that program is to help not only strengthen systems, but also to help the Government address the compensation issue.

MR. HAY:   Lady over there on the side, and then we will come back, Jason, to you.  Yes.

QUESTION:  I was wondering if you could provide a breakdown of the costs of a pandemic.

MR. HAY:  We can do that.  Perhaps we could best do that afterwards.  It's one of these things you can best capture, I think, within the briefing paper.  Jason, did you have a follow up?

I'm happy to give you that, by the way, but it is probably best appreciated in text.

QUESTION:   Back in January, you were talking with the World Bank and some of the U.N. agencies were talking about the economic costs of avian flu in Asia estimated at 10 billion U.S. dollars.  Since January, I think 38 countries have reported initial outbreaks of avian flu.  I was just wondering if you could provide an updated cost estimate for avian flu globally, and also perhaps if you can comment on the microeconomic aspects of avian flu in terms of poverty and what it's doing to people in villages.  Thanks.

MR. HAY:   Let's go get Jim to respond to that, first, and then I think we also get some of the other panelists to chip in.

MR. ADAMS:  The additional work we have done has not been focused on that issue, so I have to apologize.  I can't answer that directly.  But what we have done in our modeling as a result of the work that we do generally on global development, is a focus on the risks of an avian flu pandemic.  And the reason why we have done that I think is to underline globally the importance of staying attention on the long term program.

This detailed modeling did result in an increase in that.  We looked very closely at the SARS epidemic and what that cost, and what we looked more broadly historically in the earlier experiences, particularly the experience in the early twentieth century with what some of the estimated costs, so those have been incorporated in the model, and that's what Phil would be glad to talk about.

In terms of the micro side, what we focused on mostly in the programs is ensuring that the programs that have emerged respond effectively to the specific problems the country has faced, and we now have programs where all that have been over the Central European countries are outbreaks either among wild birds or among limited populations of animals, and we found within those programs, the attention initially is on the animal surveillance side, rebuilding veterinary systems.  Obviously in the case of deaths and in the case of East Asia, we have moved towards much more stronger programs on the human surveillance side, and so we have tried to make sure at the micro level that the specific program responds to the problem, and there is a reason for that.  Both in terms of the fact that we resources are limited overall, these are programs that are additional to the budget programs that most governments have in place.  We have tried to respond to that with extensive grant funding.  We have had access in virtually all of the East Asian countries.  We have had access to a trust fund largely financed by the European community, which provided grant funds.  The Japanese government has made grant funds available to us that we provided, and that, of course, has the advantage that those are additional funds to the government budget that the government doesn't have to repay over time.  So, we have also tried to tailor the level of financing, the type of financing to the particular challenge.

So, we work very hard.  I think all governments have a broad interest obviously in mobilizing as much grant funding, but I'm pleased to say that we now have a couple of examples where the countries have sought access to resources on the harder side of the Bank, on the commercial side of the Bank, this is primarily in Eastern Europe.  A recent example is Romania.  The reason for that is again because they recognize the potential impact of this on the poultry industry, and they recognize the potential economic costs of not getting on top of the problem.

So, we have had I think a good response broadly.  We have had at the country level certainly challenges in terms of putting in place the implementation capacity to implement the programs, but that's a work in progress, and I think what we have been impressed by is how broadly developing countries have responded to say we are giving priority to put in place these programs, and we are going to give the priority in terms of implementation.

MR. HAY:  Jim, let me bring the Minister in just for a second there.  Jason, you were asking about whether bird flu would lead to more poverty at the country level.

Minister, has that been your experience in Lao PDR?  You already said yours was a small, poor, developing country?  What has been the impact?  Have you seen incomes falling and more poverty as a result?

MR. DALALOY:   Yes.  I can say that the avian influenza can cause more poverty in our country if we don't support them by compensation.

MR. HAY:   So, that has certainly been the experience of Lao PDR.

Second row on my left.

QUESTION:   China plays a very large role in all of this, and so far there hasn't been much talk about it.  I would like to hear an assessment of China's cooperation so far in this area.  And last week or the week before, there was some discussion about the sharing of samples and whether or not they were forthcoming.  I would appreciate some discussion on that.

MR. HAY:  Let me start off with Jim Adams, who is Vice President for East Asia and the Pacific, China, and then, David, I think we will go to you on the samples.

MR. ADAMS:   China has been an interesting case.  I mean, China has been an active participant in the program, hosted a very important pledging conference.  But from the beginning, China took the position that it was not going to seek resources from outside.  It was going to deal within its budget capacity, and it's done that.  It's provided significant resources for implementing a program.  But I have to say as part of that program, the Bank and the international community, particularly the U.N. system has had substantial technical interactions with the Chinese Government.  We have been very pleased on our side in terms of the work that has been done.  I mean, what the Chinese Government asked the Bank side was largely for advice and information on other programs, particularly some programs that have been implemented in developed countries.  As some of you may know, Japan and the Netherlands all had outbreaks which they dealt with very effectively, and so there our role has been primarily a knowledge function.  Indeed, China did make a commitment and has provided money for the Bank's trust fund, so it's actually in this respect a small donor to the overall program, and as I said, it decided not to seek access to anything beyond the international knowledge.

David, I think, will have more information on exactly what was done.  I think many countries face a challenge in terms of how you interact with the international side.  We have seen real progress in China.  Why don't you summarize, David.

MR. NABARRO:  Thank you.

You used the term China's cooperation, and I would phrase it a bit differently.  China is a participant, a very active participant in the global partnership in many different ways, but it wants to be participating in the same way that every other country is participating, and I would like to frankly commend the Chinese Government for the way in which they have been extremely active in working with other nations, both regionally and globally, on a variety of issues to do with animal vaccination, to do with virus epidemiology, and also to do with disease tracking and information provision. 

But the issue of sharing samples is fraught with complexities because there will always be occasions when there is worry that a sample, when it is shared, is not just being used for scientific purposes  for example, for sequencing the genetic content of the virus  but it is also perhaps being used for commercial advantage, such as the production of diagnostic materials or biological reagents.  And I think that I can't give you a simple response on the extent to which sample availability is at the level that everybody wants in relation to any individual country because I know that each issue of sample release is subject to a great deal of negotiation and dialogue in relation to what is that sample going to be used for. 

And it's probably best that at a point, if you want to, you take this issue up with the World Health Organization who, as you know, have had quite a lot of challenges in trying to make sure that for each country the situation in which samples are shared is one that enables the country to be confident that that is being done in a proper way.

So, I'm not going to say any more on the specific case right now.  We could perhaps talk about it afterwards.

MR. HAY:  While I have got you there, David, let me just ask you about, we hear there are strains, new strains, of H5N1 in some of the resurgent countries in Asia, which prompts me to ask how much of a problem is  cross border smuggling of infected birds?

MR. NABARRO:  Well, that was an interesting question, Phil, and so my answer is, on smuggling, we just have to recognize that one of the major causes of the movement of this virus from country to country is through trade.  And this is, as was pointed out when Jim was talking about Nigeria, he was very precise, that the virus arrived in Nigeria through trade.  And a lot of work recently has suggested that the new instances that have been reported are due to trade, and that trade usually results from there being a commercial advantage to somebody who has got birds and shifting them across the border from one country to another.

This is a major issue, and it's one that my colleagues on my right are dealing with every day, and perhaps they might want to reflect on your question.  Are you interested to talk about smuggling?  "Um," he says, and you know why.

MR. HAY:  Okay.  Let's take the question there, and then what I will do is turn the proceedings over to both the Minister and Dr. Kumnuan, since they have come so far, just for a couple of final thoughts before we wrap up this morning.

QUESTION:   As you know, the U.S. and Latin American countries are the leading poultry exporters in the world, so my question is:  What are the chances for the avian flu to reach America as a continent, especially the Latin American countries, and how those Latin American countries are prepared for coping with a potential outbreak?

MR. HAY:  David, I think that's one for you and any of the other panelists who want to chip in.

MR. NABARRO:  Thank you very much.  There is, indeed, a continued view that Latin American countries will get H5N1 sometime either through trade or through introduction as a result of the movements of infected wild birds.

I am really impressed with the efforts being made by Latin American countries to get ready for the arrival of highly pathogenic avian influenza.  There have been a number of meetings and events often involving groups of countries to make sure their veterinary services are ready, and also there has been a high level of public communication.  I, myself, this afternoon am traveling to Mexico to spend a day discussing with both the private sector and governments in Latin America precisely on the issue you have described.

Of course, we will need to see what response is actually demonstrated when HP, highly pathogenic, avian influenza arrives, but I'm currently pretty positive about the level of preparedness.

MR. ADAMS:   Yes, just a quick response on the Bank side, so far all of the questions we have had have been on the technical side.  We have been terribly impressed with the way the industry has prepared itself on this question, to underline the point Dr. Nabarro has made.  And you know, we have been supporting both through the Bank's regular analytic work on the technical side, but also through the work of our private sector organization, the IFC side, that has been prepared to work with these industries to make sure they are ready for this challenge. 

And I think it is important that that work is being done, and I think we have been terribly impressed with the region not closing its eyes to this issue because it hasn't been hit, but actually getting itself ready as both of our colleagues from the countryside have emphasized, to make sure that this doesn't happen to the maximum degree possible, but if it does happen, to be prepared to deal with it.

MR. HAY:  Jim, thank you very much.  Time is tight, and we have got to leave the room, but just before we do, one very quick thought, Minister, from you.  What's the thought you want to leave here today, and then very quickly from Dr. Kumnuan.  Just a very quick thought, indeed.

MR. DALALOY:  My thinking is that we are on the right track for fighting, and I hope and I wish this will continue.

MR. HAY:   Thank you very much, Minister. 

Dr. Kumnuan?

MR. KUMNUAN:   Yes.  I think avian influenza, not a bad thing, has come and give us the opportunity to improve our infrastructure on public health, on animal health, and working together, and there are many good impacts in other health  example, you know, in Thailand, we have to fighting with other emerging diseases, but with this infrastructure, I think that it will be a good platform to control other emerging disease as well.

MR. HAY:  Dr. Kumnuan, thanks very much.  Let me thank all of our panelists.  If you want to have follow up questions, let's do it outside the room so the IMF can now come in. 

Thank you for coming.