HEALTH: Indonesia Outbreak Revives Race Against Bird Flu

By IPS Correspondents Reprint | | Print |

Marwaan Macan-Markaar

BANGKOK, Sep 21 2005 (IPS) - As Indonesia grapples with the spectre of deaths from bird flu, public health officials in the region are racing against time to put into place a pandemic prevention operation that comes down to one word-speed.

For, the fate of millions of lives in Asia hangs on the speed with which a patient, infected with a human-to-human transmission of a mutated strain of bird flu, is diagnosed and the speed with which the prevention measures are implemented.

”We will only have a 21-day golden period to stop the virus spreading and becoming a pandemic,” says Dr. Kumnuan Ungchusak, director of epidemiology at Thailand’s department of disease control and a key player in plans being mapped out to stall the virus ravaging South-east Asia. ”A longer delay, even a month, can be very fatal”.

The new urgency follows the deaths announced on Wednesday of two young girls, admitted in Jakarta hospitals, after they developed symptoms indicating bird flu. Five others are currently under treatment for suspected bird flu in Indonesia.

On Wednesday, Indonesia’s health minister, Siti Fadilah Supari, told reporters in Jakarta that she considered the outbreak the possible start of an ”epidemic” on the archipelago and that ”most definitely there will be others as long as we are not able to identify positively the sources”.

The pandemic prevention scenario is expected to follow two broad paths, she explained. The first is geared towards the immediate family of the patient diagnosed with the lethal virus. Each family member, who had come into contact with the patient, will be given a dose of ‘Tamiflu’ within two days of the patient showing symptoms of the disease.

This regime of ‘Tamiflu’, the only known drug capable of stopping the spread of a mutated form of the H5N1 avian flu virus, will be for a 10-day period, affirmed Kumnuan.

More challenging, though, is to provide medication for the second part of this pre-emptive initiative. ”It would require giving around 10,000 people, 100,000 people or even one million who live within the area where this human-to-human form of the virus has been diagnosed,” says the Thai epidemiologist.

It is this phase-a novel way to destroy a possible pandemic at its roots-that has the 21-day window. ”This is a very challenging concept, very new, and necessary if we have to save lives,” adds Kumnuan. ”Cooperation at every level and speed will matter the most”.

According to public health officials, South-east Asia needs to stockpile antiviral drugs to treat at least three million people if the deadly H5N1 virus mutates to one that could explode into a pandemic.

But meeting this demand is already proving to be a problem due to limited stocks for the developing world. The World Health Organisation (WHO) is due to receive one million doses from the Swiss pharma giant Roche, the producer of ‘Tamiflu’, by the end of this year and another two million doses by mid-2006.

To compound that delay, this region appears far from ready to meet the looming global health challenge that the WHO states could result in two to seven million deaths around the world.

Already, the region has had 63 fatalities from the H5N1 strain of the bird-flu virus since January last year. Of the 63 people who have died, Vietnam has had 43, Thailand,12 and Cambodia and Indonesia, four each.

These deaths account for over half the number of the estimated 119 people who have been infected with the H5N1 strain of bird-flu after having come into contact with poultry infected with the virus.

”Asia is still the weakest link in pandemic preparedness when compared with what is underway in Europe,” says Peter Cordingley, spokesman for the WHO’s Western Pacific regional office (WPRO) in Manila.

Earlier in the week, the head of WPRO said at a conference that there were still many gaps in the health surveillance systems, so pivotal to detect a new virus and mount a response within a limited span of time.

”At the national level we need to improve further the capacity for surveillance and virological investigation. In addition, we need greater cooperation in sharing specimen samples,” said Dr. Shigeru Omi, WPRO’s regional director, in New Caledonia, an island in the South Pacific.

”Vietnam is on par with Thailand in health surveillance, but poorer countries like Cambodia and Laos don’t have the capacity due to the lack of resources,” Cordingley told IPS. ”This is also too big for the WHO and FAO (Food and Agriculture Organisation) to handle. We need a lot of international help”.

The rising concern about a pandemic comes in the wake of revelations by researchers at the Rome-based Instituto Superiore di Santi that people can be infected with even bird flu strains considered low-pathogenic avian influenza. Hitherto, medical researchers have maintained that humans were only susceptible to the high-pathogenic strain of H5N1 influenza.

Since the winter of 2003, when the current strain of bird-flu began spreading through Asia, over 100 million birds have died, either falling to the disease or being culled. Russia became the 11th country recently to be struck by this spreading lethal virus.

The fear of bird-flu mutating into a virulent virus, that could easily spread from person to person, has kept pace with the appearance of the strain among Asia’s poultry and duck populations. That is because humans lack a natural response to fight the H5N1 strain of the virus.

Possible scenarios, mentioned by health authorities, is the 1918-1919 global influenza pandemic, which killed an estimated 50 million people. It was the result of a flu strain jumping from birds to humans.

For people like WHO’s Omi, it appears to be a matter of time before disaster strikes, since, in his view, the current bird-flu virus is ”resilient, unpredictable, unstable and extremely versatile”.