Many pharmacies and herbalists in Egypt prescribe their own 'wasfa' (secret drug or herbal elixir). Credit: Cam McGrath/IPS

By Cam McGrath
CAIRO, Aug 10 2014 (IPS)

Magda Ibrahim first learnt that she had endometrial cancer when she went to a clinic to diagnose recurring bladder pain and an abnormal menstrual discharge. Unable to afford the recommended hospital treatment, the uninsured 53-year-old widow turned to what she hoped would be a quicker and cheaper therapy.

A local Muslim sheikh claimed religious incantations, and a suitable donation to his pocket, could cure the cancer. But when her symptoms persisted, Ibrahim consulted a popular herbalist, whose wasfa (secret drug or herbal elixir) was reputed to shrink tumours.

“I felt much better for a few months and thought the tumour was shrinking,” she says. “But then I got much worse.”

When she returned to hospital the following year, tests revealed that the tumour was still there, and the cancer had spread to her lymph nodes. Moreover, the herbal mixture she was taking had caused her kidneys to fail.“Successive [Egyptian] governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery” – Dr Ahmad Bakr, Egyptian health care reform lobbyist

Egypt is a “minefield” of bad medicine, says paediatrician Dr Ahmad Bakr, a health care reform lobbyist. He says successive governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery.

“Our health care system is deeply deformed,” Bakr told IPS. “It’s not just a matter of low funding and corruption, ignorance (pervades every tier of) the health system, from government and doctors to the patients themselves.”

He says Egypt’s lax regulation and poor enforcement has created room for unqualified doctors to perform plastic surgery out of mobile clinics, peddle snake tonic on satellite television, and dabble dangerously in reproductive health.

It is estimated that one in every five private medical clinics in Egypt is unlicensed, and thousands of medical practitioners are suspected of using false credentials or having no formal training.

“There are a lot of so-called doctors who practise medicine in Egypt,” says Bakr. “They mostly work out of small clinics, but you’ll even find them in the most prestigious hospitals.”

The incompetency goes all the way to the top.

In February, Egypt’s military announced it had invented a device to remotely detect hepatitis C – along with acquired immunodeficiency syndrome (AIDS), swine flu and a host of other diseases. The device, which is said to work by detecting electromagnetic waves emitted by infected liver cells, is based on a fake bomb detector marketed by a British con artist.

The military also claimed that it had invented a revolutionary blood dialysis machine that can cure hepatitis C, AIDS and even cancer in a single treatment.

“I was shocked when I saw these incredible claims were being made with barely any clinical evidence,” says Dr Mohamed Abdel Hamid, director of the government-run Viral Hepatitis Research Lab (VHRL). “With any new medical treatment you should perform peer-reviewed, double-blind clinical trials before announcing it.”

Critics say Egypt’s government contributes to a climate of medical irresponsibility. State media routinely exaggerates health threats and feeds public hysteria, while the knee-jerk reactions of government authorities – including high-ranking health officials – are coloured by popular sentiment and political motives.

Reacting to the global swine flu pandemic in 2009, overzealous parliamentarians passed a motion to slaughter all of Egypt’s 300,000 pigs.

There was no evidence that pigs transmitted swine flu to humans, nor had the virus been detected in Egypt. But officials, swayed by the Islamic prohibition on eating pork, appeared to seize the opportunity of a like-named virus to rid the Muslim-majority nation of its swine.

“The pigs were kept almost exclusively by poor Christian zebaleen (rubbish collectors), who used them to digest the organic waste,” says Milad Shoukri, a zebaleen community leader. “Thousands of families lost their livelihoods to this absurd decree, which had no scientific basis.”

Global pandemics such as severe acute respiratory syndrome (SARS), avian flu and the latest contagion, Middle East Respiratory Syndrome (MERS), have presented golden opportunities for Egypt’s myriad quacks and swindlers to fleece the uninformed masses.

“With each health scare we see the same patterns,” says Cairo pharmacist Amgad Sherif. “People panic and throw science out the window. The low level of education and high illiteracy among Egyptians makes them susceptible to believe even the most ridiculous medical claims.”

When a swarm of desert locusts descended on Cairo, enterprising charlatans took out ad space in local newspapers offering a “locust vaccine” to anxious citizens.

Not surprisingly, the injected serum, which turned out to be tap water dyed with orange food colouring, offered no protection against “locust venom”. But it did leave duped households poorer, and at risk of blood contamination or hepatitis C infection from jabs with unsterilised needles.

“The people doing this only care about getting money from people who don’t know any better,” says Sherif. “They know nothing about medicine and do not follow even the most basic hygiene practices.”

In one popular scam, people claiming to be state health officials troll low- and middle-income neighbourhoods offering costly “preventative medicine” for infectious diseases. The fake medical personnel, dressed in lab coats and wearing official-looking badges, administer bogus vaccinations to unsuspecting families.

“Sometimes they give people injections – who knows what’s in them,” says Sherif.

Health officials say the sham physicians create confusion that affects legitimate health campaigns, such as Egypt’s national door-to-door polio eradication campaign.

Egyptian authorities have also found themselves in a cat-and-mouse game with thousands of “sorcerers”, whose superstition-based folk medicine draws desperate working-class patients suffering physical and psychological ailments. The self-proclaimed doctors and faith healers are particularly difficult to catch, say prosecutors, because they tend to work out of rented apartments and advertise mostly by word of mouth.

An Egyptian judicial official told pan-Arab newspaper Al Arabiya that despite attempts to prosecute sorcerers for swindling and fraud, most cases are dropped when the sorcerers reach a settlement with their victims. “There is almost one sorcerer for every citizen,” he concluded.

(Edited by Phil Harris)

By Dalia Acosta
HAVANA, Dec 2 2010 (IPS)

Margot Parapar gets plenty of laughs from the audience with this joke: “Now the human body is divided into five parts: head, trunk, upper and lower limbs, and condom.” Using his female stage name, Cuban drag queen, comedian and health promoter Oliver Alarcón includes HIV/AIDS prevention messages in his shows.

Transvestites and other artists at the Song for Life gala. Credit: Jorge Luis Baños/IPS

He took part in a gala titled “Canto a la vida” (Song to Life), in response to the global AIDS epidemic, at the Fausto Theatre in Havana Sunday.

The performance, one of the activities organised ahead of World AIDS Day, celebrated Dec. 1, was an initiative of the National Centre for Sex Education (CENESEX) and other cultural and health organisations working to promote health and respect for sexual diversity.

“Tailoring one’s language to each specific audience” is, according to Alarcón, the key to promoting, through art, the practice of safe sex. “The majority of the audience may sometimes be the gay community, or heterosexuals, or the elite. The main thing is to know at whom the message is aimed,” he said.

After joining the HSH-Trans (MSM-Trans – men who have sex with men and transgender persons) programme at CENESEX a year ago, Margot Parapar’s stage appearances never fail to include messages on sexual health, blended with large doses of humour. “You have to know all about an issue, even if your aim is to popularise it,” Alarcón said about the preparation involved.

MSM-Trans is a social network of transgender persons (transvestites, transsexuals and drag queens) and men who have sex with men (MSM), in several Cuban provinces, who are trained as health promotes by CENESEX.

On stage, in front of a rainbow flag as a backdrop, Margot states confidently: “I know everything: I am a protected oracle.”

Behind the scenes, the actor acknowledged the essential nature of doing research to face the global AIDS pandemic and recognise human diversity.

For his part, Leonardo León, garbed as his artistic persona Chantal, said it was important not to oversimplify issues when talking about them.

“Our message must be perceived as attractive, up-to-date and close to people’s hearts,” he said, stressing the need to use “these shows that attract mass audiences, with all their diversity,” for educational purposes.

Cuba began to adopt measures against the HIV/AIDS epidemic in 1983, although the first case on the island was not diagnosed until 1986. At present official statistics indicate that there are about 13,000 HIV-positive people on the island, which has a total population of 11.2 million, representing a prevalence of 0.1 percent, the lowest in the Caribbean region.

Most heavily affected are men who have sex with men, who make up 72 percent of all diagnosed cases, Rosaida Ochoa, head of the National Centre for Prevention of Sexually Transmitted Infections (STIs) and HIV/AIDS (CNPSIDA), told the press.

As part of their prevention and awareness-raising programmes, both CNPSIDA and CENESEX have trained voluntary health promoters, who carry out active prevention work with their peer groups as well as wider population groups, and also through local media.

The health promoters are “a key factor, because as volunteers, they give their efforts and spare time to prevent STIs and HIV/AIDS.” Malú Cano Valladares, founder and coordinator of the MSM-Trans programme, told IPS.

“They take their health messages to their usual meeting places, as well as to schools, communities and hospitals,” she added.

CNPSIDA has trained 1,700 MSM as health promoters, and CENESEX has more than 400 in the MSM-Trans group, focused on STI prevention. At both institutions, other communities with specific goals, such as the right to freedom of sexual orientation, also join in the prevention work.

The two youngest members of the Oremi group of lesbian and bisexual women, for instance, were distributing leaflets and condoms last Sunday in Havana’s Paseo del Prado. “People sometimes think that lesbians run no risk of contracting the virus, but they do,” said Yasmín de Robles, one of the activists.

With Anaylis Noa, her partner of nine years, this young blind woman advised people to stay in a stable relationship as a means of preventing HIV/AIDS. In her view, lesbians are also vulnerable, because of the low perception of risk, when they practise oral sex or use sex toys without protection.

A recently-created group, Hombres por la Diversidad (HxD, Men for Diversity), also linked to CENESEX, carried out its first health promotion activity Tuesday, on the eve of World AIDS Day, and to commemorate the International Day for the Elimination of Violence Against Women, celebrated Nov. 25.

According to Luis Enrique Mederos, a member of the HxD group and of the technical team working with a helpline for persons living with HIV/AIDS in Havana, promoting sexual health and facing AIDS in Cuba requires tighter “links between the Education and the Health Ministries,” especially in order to reach the teenage population.

In the view of Luis Rondón, another member of HxD and a volunteer with the MSM-Trans programme in Old Havana under the auspices of CNPSIDA, training more health promoters, “developing closer relationships of trust,” and expanding “the social influence exerted by the volunteers” are some of the improvements needed for fighting AIDS in this country.

“The orientation of sexual desire does not increase a person’s risk of contracting STIs or HIV, but unprotected sexual practices and behaviours do,” said a sign projected at the Fausto Theatre before the gala performance, echoing the views of institutions like CENESEX and CNPSIDA with regard to respect for sexual diversity.

Excerpt:

By Marwaan Macan-Markar
BANGKOK, Sep 7 2010 (IPS)

The World Health Organisation (WHO) is urging countries in Asia to remain vigilant about the spread of the H1N1 influenza virus, which the international body declared was no longer a pandemic a month ago.

“In the current post-pandemic period, we expect to see localised outbreaks of different magnitude, and some continuing ‘hot spots’ will continue to show high levels of H1N1 transmission,” said Margaret Chan, the director general of the WHO, on the opening day of a regional health conference in the Thai capital.

“The pandemic virus has not gone away,” she warned. “The virus is likely to continue to cause serious illness in a younger age group. Protecting high-risk groups and maintaining vigilance are recommended actions.”

Outbreaks of the deadly virus, which had killed over 18,130 people by May this year, have continued to be reported in India, New Zealand and Australia. At the height of this virus’s pandemic period, the WHO had reported cases in 214 countries and overseas territories.

Chan’s statement at the meeting of health ministers and public health officials from 11 countries in South and South-east Asia stemmed from the global health body’s assessment based on epidemiological data from around the world indicating that “the new H1N1 virus had largely run its course.”

The 28th Health Ministers Meeting and the 63rd Session of the Regional Committee for South-East Asia runs from Sep. 7-10.

The WHO’s downgrading of the deadly new virus was announced on Aug. 10, when Chan said: “Based on experience with past pandemics, we expect the H1N1 virus to take on the behaviour of a seasonal influenza virus and continue to circulate for some years to come.

“Globally, the levels and patterns of H1N1 transmission now being seen differ significantly from what was observed during the pandemic,” she had added. “Out-of-season outbreaks are no longer being reported in either the northern or southern hemisphere.”

It is a picture that contrasts sharply with the reality that emerged when reports of this lethal virus, which was also called ‘swine flu’, spread in March and April last year. Alarm bells were sounded in the wake of outbreaks of the new influenza virus that began in Mexico and rapidly spread through North America.

Growing concern by public health officials about the new virus, against which people had no natural immunity, was confirmed in June 2009, when the U.N. body declared that the world was facing a pandemic. The Geneva-based WHO estimated at the time that nearly two billion people – a third of the world’s population – could be infected with the new virus.

Parallels were also made with the last flu epidemic, the 1968 ‘Hong Kong’ flu, which killed about one million people, and the 1918 ‘Spanish’ flu pandemic. The latter killed over 50 million people globally, having begun as a mild outbreak in the spring of that year and then evolved into a more virulent second wave during the winter.

The fatalities from the ordinary flu, on the other hand, are much less. It reportedly kills 250,000 to 500,000 people every year.

In response to this global health challenge, the WHO triggered a race to mass-produce vaccines for the lethal virus. At one point, it projected a need of close to 220 million doses annually, “with a surge capacity that could reach 420 million vaccine doses” a year.

In July 2009, GlaxoSmithKline Plc, the British pharmaceutical giant, had been inundated with orders for 440 million doses from nearly 20 governments, according to media reports.

But while the pharmaceutical giants, who are mostly based in Europe, Britain, North America and Japan, were in the spotlight to produce – and profit – from this surge in demand for the new vaccines, the new pandemic also paved the way for flu vaccine production to emerge from Asia.

India, China, Thailand and Indonesia responded to the public health challenge to boost the global vaccine supply.

Yet the WHO admits that the world’s vaccine production centres are still unable to meet the spike in demand stemming from the outbreak of pandemics such as H1N1. “Current vaccine production methods are too slow,” said Gregory Hartl, a WHO spokesman. “It takes four to six months to produce a flu vaccine.

“Till then we will be constrained in having the same time line,” he added during a telephone interview from Geneva. “The H1N1 vaccine is probably the most closely scrutinised vaccine in history. The safety profile of this vaccine is as good as, if not better than, the safety profile of the seasonal flu vaccine.”

Such a clean bill of health about the H1N1 vaccine has done little to prevent criticism of the WHO, following revelations that a member of the WHO’s Strategic Advisory Group of Experts on Immunisation, which helps shape the WHO’s vaccine policy, had ties to a vaccine research programme of a pharmaceutical giant.

This scandal was revealed by ‘Information’, a Danish daily newspaper, in December 2009. The publication alleged that a Finnish member of the WHO’s panel of experts had been paid the equivalent of 7.8 million U.S. dollars for a vaccine research programme from a drug manufacturer.

The WHO’s Chan has rejected the allegations that the U.N. body’s decision to declare H1N1 a pandemic was influenced by pharmaceutical giants.

Excerpt:

By Adam Morrow
CAIRO, Nov 17 2009 (IPS)

As authorities consider suspending a whole academic year to check the spread of swine flu among school children there is a feeling that measures to contain the H1N1 virus – known to be less dangerous than the one responsible for seasonal flu – are going over the top.

“By all standards, the H1N1 virus in its current form is a weak one – comparable to seasonal influenza – with a fatality rate in Egypt of one percent or less,” Dr. Mohamed Awad Tageddin, professor of respiratory diseases at Cairo’s Ain Shams University, told IPS. “More than 99 percent of those who contracted the virus in Egypt have recovered.”

Authorities in this country – where the H1N1 virus first appeared in early June – have taken drastic steps to contain the virus, beginning with the delay of the academic year for all schools and universities by one week.

Also, in order to reduce congestion in Egypt’s crowded classrooms, school days have been split into three shifts. This has, however, shortened periods from 45 minutes to 30 minutes.

While these measures may reduce the chances of infection critics say could take a toll on the general state of education in Egypt.

“Students will get half as much classroom time,” Dr. Hamdi Hassan, a medical doctor and MP for the Muslim Brotherhood opposition movement, told IPS. “Such measures are sure to have a negative effect on the educational process in Egypt, which is already in shambles,’’ he said.

Wafaa Meneci, professor of environment at Alexandria University, agrees. “The overall level of education in Egypt can be expected to suffer as a result of these drastic precautionary measures against H1N1,” Meneci told IPS.

Concerned parents complain that reduced class-time will also add to their financial burdens.

“In order to pass the final exams, my children will need to have private lessons which, like everything else, have only become more expensive,” Nagle Badr, 37-year-old housewife and mother of two, told IPS. “All our income will end up going towards private lessons.”

According to a Nov. 13 health ministry statement, a total of 2,379 cases of H1N1 infection have been detected in Egypt to date, of which 2,180 have recovered. Of the rest 193 are currently receiving treatment, while seven people -none of them students – have reportedly died of the virus. So far, 862 cases have been registered in schools and 91 in universities.

If the academic year is suspended lessons would be broadcast via state television or the Internet and final exams conducted online.

Parents dread the prospect. “I can provide some lessons myself, but many parents in Egypt are illiterate – what are they supposed to do? It would be a disaster for education,’’ said Badr.

“Lessons on television or the Internet should be considered a supplement to, not a substitute for, classroom learning,” said Meneci. “Neither teachers nor students have been trained to give or take exams online.”

“We don’t even have Internet,” complained Badr. “Lessons may be broadcast on television, but if there is no teacher to answer questions or ensure students are paying attention, my 13-year-old son won’t be able to concentrate.”

“This experiment – conducting final exams online – is sure to be a total failure,” warned Hassan. “Some 40 percent of the population is illiterate, let alone have the ability to use modern means of communication technology like the Internet.”

Given the relatively low fatality rate associated with the virus, many critics see the measures now being mooted by the government as excessive.

“Only seven people in Egypt have died so far from H1N1,” said Hassan. “The lengths the government is going to – with the stated aim of combating the virus – seem to be out of proportion with its seriousness.”

Hassan’s assertions appear to be borne out by local medical authorities.

“H1N1 is a weak virus, the fatality rate of which is unlikely to exceed its current rate of 1.3 percent worldwide,” Dr. Hamdi Menaa, director of the government-run Al-Khazindar hospital in Cairo, told IPS. “In fact, it’s less deadly than seasonal influenza, which has a 3 – 4 percent fatality rate.”

“Those who are dying of H1N1 are either the elderly or very young children or were already suffering from chronic health problems,” Menaa added. “Most people are quickly recovering – usually in four or five days – often without any medical treatment.”

Menaa blamed the media for “exaggerating the crisis and causing unnecessary panic among the public.”

Tageddin, who served as minister of health from 2002 to 2005, said the H1N1 virus does spread faster than seasonal flu virus and tends to infect young people. “But its fatality rate in Egypt remains less than one percent.”

“The World Health Organisation declared H1N1 to be a ‘geographic epidemic,’ based on its geographic proliferation – not on the number of fatalities associated with it,” explained Tageddin. “The virus does not and will not represent a serious threat unless it mutates into something more dangerous.”

“Only a few people – and no student – have died from the disease, which doesn’t represent a real health crisis,” said Badr. “The real crisis will be if they end up suspending school because of it.”

Excerpt:

By Marwaan Macan-Markar
BANGKOK, Sep 10 2009 (IPS)

The race to mass-produce vaccines for the lethal H1N1 virus has attracted contenders from Asia’s developing countries, confirming a noticeable expansion of a field that has been dominated by flu vaccine production centres in Europe and North America.

India and Thailand are among the countries working on such vaccine doses. The demand for immunisation measures comes at a time when public health authorities are warning that Asia, like other developing regions, is in dire need of vaccines to respond to the rapid spread of the Type A (H1N1) influenza pandemic.

“This is something new for these countries producing flu vaccines. But they have produced other vaccines,” says Dr Arun Thapa, coordinator for immunisation and vaccine development for the New Delhi-based South and East Asia office of the World Health Organisation (WHO). “India, Indonesia and Thailand responded to WHO’s request to help boost the vaccine supply.”

“All three countries have received the seed virus for vaccine production,” Dr Thapa said during a telephone interview from Kathmandu, Nepal’s capital, where the region’s public health experts are meeting this week to chart a response ahead of a possible winter surge in (H1N1) flu cases. “We expect this new vaccine to be ready in the first quarter of 2010. That is an optimistic scenario.”

The WHO, which has transferred technology and development funds to vaccine manufacturers in the three Asian countries, expects to have a “collective capacity of about 220 million doses annually, with a surge capacity that could reach 420 million vaccine doses annually,” states a press release by the Geneva-based health body.

Those numbers for Asia will also be boosted by another vaccine production centre – China. The region’s giant is reported to have moved ahead of India, Indonesia and Thailand, following an announcement early this month that experts from the country’s State Food and Drug Administration (SFDA) approved a vaccine candidate. It is expected to have vaccines for 65 million people by the end of the year.

“China is set to be the first country to mass-produce a vaccine against the A(H1N1) flu pandemic,” reported the state-owned ‘China Daily’ on its website at the beginning of September. “Only one shot is needed for inoculation.”

The vaccine, which was developed by the Beijing-based Sinovac, “would be appropriate for anyone aged three to 60,” the English-language publication revealed, quoting a vaccine expert from SFDA’s drug evaluation centre. “It is up to the international standard for safety and immunogenicity factors.”

Thailand, on the other hand, is still at the first phase of conducting clinical trials, said Dr Vichai Chokevivat, chairman of the Government Pharmaceutical Organisation (GPO), the state-owned entity that received funds and technology from the WHO for vaccine production. “We will be dividing 24 volunteers into two groups. One group will be give a low dose and the other a high dose.”

“We will move to the second phase, which will have 400 participants, after that. We will be testing the vaccines for efficacy and safety,” Dr Vichai told IPS. “The new vaccine should be available by December.”

This flu vaccine production initiative in the developing world began over the past three years, with six manufacturers joining the initial effort, followed, in May, by five more producers. They are located in countries such as Brazil and Mexico.

Yet the projected output is still far from meeting the number of vaccines the developing world will need, states the WHO following a recent assessment of the 25 H1N1 vaccine production centres across the world. The latter includes pharmaceutical giants Sanofi Aventis, GlaxoSmithKline and Novartis.

The WHO has requested vaccine manufacturers in the developed world to contribute at least 10 percent of their vaccine doses for people in the developing world. Two multinationals have reportedly responded to this WHO request: Sanofi, headquartered in France, has pledged to give 100 million doses and Britain-based GlaxoSmithKline has promised 50 million doses.

But just when those numbers can be reached still remains elusive, since the U.N. health agency notes that producing vaccines for an influenza virus takes time. “It takes approximately five to six months for the first supplies of approved vaccine to become available once a new strain of influenza virus with pandemic potential is identified and isolated,” said the WHO.

The WHO’s concern about vaccines for the developing world stems from countries in this poorer region having weak health systems to cope with a surge in the number of cases of this virus, which began in Mexico and rapidly spread through North America between March and April.

In June, the WHO declared that the world was facing a pandemic. It estimated, at one point, that close to two billion people – a third of the world’s population – could become infected with this new virus over the next two years.

This strain of the H1N1 influenza virus, also called swine-flue virus, has currently infected over 254,000 people, of whom 2,837 have died, according to the WHO. South and East Asia has recorded over 19,000 cases and 188 deaths.

The last flu pandemic was the 1968 ‘Hong Kong’ flu, which killed about one million people. The 1918 ‘Spanish’ flu pandemic, which killed over 50 million people around the world, began as a mild outbreak in the spring of that year and returned as a more virulent second wave during the winter.

The ordinary flu, on the other hand, kills about 250,000 to 500,000 every year. Close to 70 percent of the seasonal flu vaccines are produced in Europe and North America, “with further significant manufacturing capacity in Australia (and) Japan,” states the WHO.

Till the new vaccines are available in South and East Asia, patients have access to antiviral drugs when infected. Yet even that requires monitoring for “genetic mutation (of the virus) and drug resistance,” said Dr Samlee Plianbangchang, WHO’s South and East Asia regional director.

Excerpt:

By Cam McGrath
CAIRO, Aug 23 2009 (IPS)

Muslims marked the start of the fasting month of Ramadan Saturday, but the global H1N1 pandemic has put a damper on religious festivities throughout the Middle East.

"Everyone is worried about swine flu," says Anwar Mohamed, a Yemeni antique dealer. "We have been told to avoid crowds, but everywhere there are crowds."

Arab governments have taken measures aimed at reducing the spread and impact of the H1N1 virus, which has infected over 5,000 people in the region, and killed at least 30. Authorities have implemented border surveillance, quarantine procedures and swine flu awareness campaigns. They have also sought to restrict activities that draw large crowds, including religious gatherings and pilgrimages.

As Islam's holiest month, Ramadan is a time for prayer, fasting and communal activities. However, Kuwait's Ministry of Health warned last week that the traditional increase in the number of Muslims attending mosques, religious lessons and other gatherings during Ramadan could facilitate the spread of swine flu.

Kuwait has reported over 1,000 H1N1 infections and two fatalities, the second largest number of cases in the region behind Saudi Arabia.

The United Arab Emirates, which recorded its first swine flu fatality on Friday, is mulling a plan to minimise H1N1 infections by reducing the time people spend in enclosed spaces. One option, according to the General Authority for Islamic Affairs, is shortening the duration of Friday sermons in mosques.

Egypt, the most populous country in the Arab world, began taking measures in July to limit the attendance of certain local religious events in an effort to curb the spread of swine flu among its 80 million people. Health officials and municipal authorities have ordered the cancellation or shortening of local Muslim and Christian festivals called moulids, which celebrate the birthday of a holy person. More than 1,000 of these annual celebrations take place each year in Egypt – the largest lasting a week and drawing over two million people.

"Such gatherings are an ideal breeding ground for the virus," the semi- official Al-Ahram weekly newspaper quoted health ministry spokesman Dr. Abdel Rahman Shahin as saying.

There are also reports that health officials want to shut down the ever- popular khiyam (Ramadan entertainment tents) and mawa'id el-rahman (charity tables). But organisers insist the only standing orders they have received are that these traditional Ramadan activities be held in well- ventilated areas with no more than 500 people.

Arab health ministers meeting in Cairo last month agreed to ban individuals under 12 or over 65, pregnant women, and those with chronic medical conditions, from attending the hajj. The annual pilgrimage to Mecca in Saudi Arabia is one of the world's biggest religious gatherings, drawing about two million Muslims every year.

It is the duty of every Muslim with physical and financial means to undertake the ritual journey at least once in their lifetime.

Mohamed Abdel Aal, a retired Egyptian carpenter, was preparing to join the hajj, which takes place in November this year. At 71, his eyes clouded by cataracts and legs weakened with age, he feels this could be his last chance to make the journey.

"Of course I know about swine flu, but I am old and my time may come soon," he says. "It is my only wish to complete the hajj. How can they deny me this?"

Some Arab states have also imposed restrictions on the umrah, or so-called "lesser pilgrimage" which can be performed any time of year but is especially popular during the last ten days of Ramadan. Health officials have discouraged Muslim pilgrims from making the trip, which is recommended in Islam but not obligatory.

Egypt has restricted the age range of umrah pilgrims to between 25 and 65, made pre-flight health checks mandatory, and stopped issuing umrah travel permits. Iraq barred its citizens from visiting Saudi Arabia, following a similar decision by Iran earlier this month.

The new swine flu precautions have been generally well received, though some opposition has been reported. Last week, hundreds of pilgrims stranded at Cairo airport protested the cancellation of their umrah travel bookings. And when a local council in southern Egypt turned off a town's streetlights to snuff out a popular moulid celebration, the crowd simply moved to a neighbouring village, and the festivities continued.

Excerpt:

By IPS Correspondents
PESHAWAR, Aug 19 2009 (IPS)

A swine flu advisory issued by the Saudi government, banning the entry of pilgrims under 12 and over 65 years, is a blow for Hajj pilgrims as Muslims the world over prepare for Ramadan which starts this weekend.

Posters advertising Hajj tours in Peshawar Credit: Ashfaq Yusufzai/IPS

"The decision by the Saudi government is against Islam. I had arranged money this year but the decision has shattered my dreams," says Gul Anar Khan, 70.

Kamran Zeb chairman of the Hajj Oranganisers Association in Pakistan told IPS that about 160,000 people were expecting to perform the pilgrimage this year. However, 40 percent of them were over the age of 70, and will not be able to make the journey to Islam's holiest shrine.

The week-long Hajj pilgrimage occurs in the 12th month of the Islamic lunar calendar. Muslims believe every able-bodied believer must make the journey at least once in their lifetime if they can afford it.

"The first batch of pilgrims leaves for Saudi Arabia from Pakistan on Oct. 22, but there are no arrangements in sight to educate the people about the disease," says Zeb.

Arab health ministers decided to ban children below 12 and the elderly above 65 years, and those with chronic medical conditions from attending the annual Muslim pilgrimage to Saudi Arabia this year in an effort to slow the spread of swine flu in a meeting held in Cairo on Jul. 22.

Since the confirmation of the first swine flu HIN1 patient, by the federal minister for health, Mir Aijaz Hussain Jakhrani, the Pakistan government has been under pressure to control the spread of the highly contagious virus.

"About 25 suspected patients were screened for swine flu and the situation was under control, as all preventive measures had been taken in this regard," Jakhrani told the National Assembly on Aug. 12.

"All precautionary measures have been adopted at airports and seaports to monitor the disease. Suspected travellers at the international airports, seaports and border posts were being screened," he added.

On Aug. 17, a hospital in Faisalabad, Punjab province, discharged a 14-year-old boy who was diagnosed with swine flu. The Pakistani boy had arrived from Saudi Arabia where his father is working on Aug. 3. His mother is quoted in the newspapers here saying she had returned with her son after performing the Umrah (a lesser pilgrimage of Mecca).

As of Aug. 13, the disease had infected 182,166 people in 78 countries, including 1,799 deaths since April this year, according to the World Health Organisation (WHO). The WHO had declared the fever a pandemic on Jun. 11.

"In the light of an advisory issued by the Saudi authorities we have asked that elderly over the age of 65 and children under 12 years, pregnant women, people with chronic diseases, serious cardiovascular diseases, asthma, tuberculosis and other respiratory diseases, uncontrolled diabetes should postpone their participation in Hajj and Umrah this year," Pakistan's director health, Dr Rasheed Juma, told IPS.

The ministry of health was also planning to install thermal scanners at Pakistan's airports to detect cases and procure swine flu vaccines whenever it became available, he said in an interview.

Immediately, the ministry was developing special health education material for Hajj pilgrims, along with training films, to be disseminated and displayed in the special camps for departing pilgrims.

"The medical mission accompanying the pilgrims this year will include highly qualified and trained public health specialists, epidemiologists, infection control and laboratory specialists," Juma said.

In the wake of a number of deaths and spread of H1N1 in countries close to Pakistan, like India, the ministry has prepared a comprehensive national plan. India reported 1,728 cases and 33 deaths on Aug. 19.

In the Gulf and the Middle East area, the H1N1 virus has so far seen fewer cases than other areas of the world affected by the pandemic. Saudi Arabia and Egypt are the two most affected countries: Riyadh has declared 232 cases and six deaths and Cairo has reported 117 cases and one death. The majority of infected cases have a history of travel to Mecca or Medina in Saudi Arabia.

The WHO's Pakistan chief, Dr Khalif Mahmoud Bile, told IPS over the telephone that though the pandemic was evolving and risk factors for serious disease were not known definitively, factors such as existing cardiovascular disease, asthma and other respiratory diseases, diabetes, cancer and pregnancy were considered as high risk.

An editorial in Pakistan's authoritative Dawn newspaper, Aug. 12, paints a bleak picture. "The WHO warns that the number of cases will rise significantly … The rising figures have caused fears that the gathering of pilgrims in Saudi Arabia for Hajj this year will become a flashpoint for the spread of the virus. After some Muslim countries proposed a suspension of the annual pilgrimage, an estimated 7 billion dollar industry, Arab health ministers decided to bar individuals younger than 12 and over 65, and those with chronic illnesses," it said.

Excerpt:

By Ranjit Devraj
NEW DELHI, Aug 15 2009 (IPS)

While the swine flu pandemic has not hit India too hard, it has sorely tested the country’s ailing health delivery system and its plans to remedy the situation through ‘private-public partnerships.’

Much of the drama is playing out in the western Indian city of Pune where the death of a 14-year-old schoolgirl, on Aug. 3, following misdiagnosis at a private hospital where she was being treated, has led to charges in the media that the government was not doing enough contain the spread of the A(H1N1) virus.

Health authorities reacted to the death of the schoolgirl, Reeda Shaikh, by asking people who develop flu-like symptoms to report to designated government facilities for testing. That quickly resulted in panic and chaos with public facilities being swamped by people with flu-like symptoms.

In Pune, which now accounts for 12 of the 21 deaths reported since the first case surfaced on May 13, there was frenzied buying of face masks and antivirals, with large numbers of people seen queuing up to catch flights out of the city.

Confusion continued to reign in Pune regarding testing and treatment at private facilities, with the government reversing its initial order and several private hospitals defensively refusing to attend to patients suspected to be suffering from swine flu.

What happened in Pune tended to be replicated across several of India’s cities – the sense of panic and confusion as well as shortages of antivirals like ‘Tamiflu,’ spread by terse reportage on India’s numerous television channels.

It was not long before the government began to be accused of creating artificial shortages of antivirals by restricting the sales of Tamiflu and playing into the hands of the manufacturers of generic drugs and testing kits.

“It should have been obvious to the government that a few designated facilities would not be able to cope with the demand for tests and treatment,” said Amit Das Gupta at the Delhi Science Forum, a non-profit public interest organisation that is engaged in issues related to science and technology. “Even in the U.S. those sick with the virus are being asked to stay at home unless they need special care.”

“To put the number of deaths and infected patients being reported in perspective, it would be well to remember that some 36,000 people die in the U.S. alone every year due to ordinary influenza and related complications. As far as India is concerned it is well established that 42 percent of all deaths in this country are caused by communicable diseases,” Das Gupta said.

Das Gupta also dismissed the government’s claim to have contained the spread of the disease through surveillance. “Effective surveillance depends on the existence of well-developed public health delivery systems, and in India these are in disarray as a result of shrinking budgets for public health spending,” Das Gupta told IPS.

India currently spends less than one percent of its GDP on public sector healthcare, forcing the majority of people to take recourse in private medical care. Leading public health experts have for years been warning that the allocation is woefully inadequate, and Jeffrey Sachs, chair of the international advisory panel of India’s National Rural Health Mission, has suggested that the figure should be raised to around five percent of GDP.

In such a scenario the capacity of the government to intervene effectively when faced with a rapidly spreading virus like the A(H1N1) is severely limited. Experts believe that more than the precautions the government has taken – such as screening airport arrivals – India’s sub-tropical conditions may have put the brakes on the virus.

“It would have been best to let the epidemic run its natural course. Of course, extra precautions may need to be taken as winter approaches when the northern temperate areas of the country could become more vulnerable,” Das Gupta said.

On Jun. 11, the World Health Organisation (WHO) raised the pandemic alert level for swine flu to ‘Phase 6,’ indicating that community level outbreaks were occurring in different parts of the world. Margaret Chan, Director General of the WHO, then admitted that it was not possible to contain or reverse the spread of the virus.

However, it was not until this week that authorities in India admitted that it was more important to contain the panic rather than the virus, which, in any case, has manifested itself as being not too different in symptoms and virulence from ordinary seasonal flu viruses.

“As the virus spreads it will slowly create immunity among people and the number of new cases will start to drop,” R.K. Srivastava, India’s director general of health services, said Thursday.

But the government’s failings were exposed by a group of independent public health specialists at the Centre of Social Medicine and Community Health at the Jawaharlal Nehru University through a note, calling for “greater clarity in the management of and treatment of A(H1N1) so that the public is informed regarding the aetiology, treatment and management of swine flu.”

“The hysteria created by the media and the knee-jerk reaction from the ministry of health and family welfare are not conducive to rational and well- informed management of the situation,” said the note signed by Dr. Mohan Rao, Prof. Rama Baru, Dr. Rajib Dasgupta, Prof. Sanghmitra Acharya, Prof. K.R. Nayar, Prof. Ramila Bisht and Dr. Ritu Priya.

The JNU experts said that treatment should continue to be limited to designated public hospitals and that the government needs to set out guidelines regarding the stage at which presumptive cases, and not just laboratory confirmed cases, will be treated with specific antivirals.

Equally, they said, there was no need for the government to open up testing and treatment in the private sector, especially when the situation was ripe for unnecessary – and expensive – testing for swine flu and unnecessary over- diagnosis and treatment. “This will not only lead to resistance to the only drugs we have but widespread exploitation of people wrongly diagnosed to have swine flu,” the experts said.

As for the government’s plans to seek partnerships with the private sector, India’s biggest private facility – the multi-billion dollar Apollo Hospital in the national capital – simply refused to obey a government directive for private hospitals to help out on the grounds that treating swine flu cases could put other patients at risk of cross-infections.

In a press release Apollo Hospital said: “We cannot put our patients, many of whom are immune-compromised, at risk by exposing them to the infections. We are therefore not in a position to provide facilities for H1N1 flu screening, sample collection and inpatient treatment in our campus for fear of cross- infection.”

Excerpt:

By Dalia Acosta and Patricia Grogg
HOLGUÍN, Cuba, Jul 27 2009 (IPS)

The impact of the global financial crisis on the economy in Cuba was a major focus of a speech Sunday by President Raúl Castro, who confirmed that further “adjustments” will be made to this year’s budget.

Sign at Jul. 26 rally in Holguín: "Raúl, give Fidel a hug from his people". Credit: Jorge Luis Baños/IPS

The Council of Ministers will meet Tuesday to analyse “the second adjustment in expenditure in this year’s budget plan,” said Castro.

In the first few months of 2009, the government already cut the state budget by six percent.

The authorities also sharply revised their GDP growth projections downward from six to 2.5 percent, although economists consulted by IPS fear that growth could be under one percent this year.

In response to the reduced availability of foreign exchange, the government implemented a strict energy savings plan in June – including scheduled power outages and temporary workplace shutdowns – in an attempt to stick to the budgeted expenditure on fuel imports.

Castro also announced that the Council of Ministers meeting would be followed Wednesday by a plenary meeting of the Communist Party Central Committee, to discuss “vital matters related to the national and international situation.”

In addition, the legislature will be meeting on Aug. 1 to debate a draft law creating a comptroller-general’s office, whose oversight of government spending will contribute to stricter “compliance with regulations,” he said.

The 1953 attack on the Moncada barracks led by Fidel Castro – in which his brother Raúl also took part – was the first attempt to overthrow dictator Fulgencio Batista and is considered the start of the Cuban revolution.

Sunday’s anniversary was the third headed by Raúl Castro since his ailing brother stepped aside as president.

In a landmark speech given by Castro as interim president on this important holiday in 2007, he referred to the “extremely important need” to produce more food, since nearly half of the country’s arable land was idle or underproductive.

The announcement foreshadowed the first major reform of his government: a 2008 law distributing unproductive government land to private farmers.

Castro reported that some 82,000 of the more than 110,000 applications for land have already been approved, with 690,000 hectares – 39 percent of the idle land – distributed so far.

The president said it was top priority and a matter of “national security” to produce food that can be produced in Cuba but is imported at an enormous cost. According to official figures, 2.4 billion dollars went to food imports in 2008.

One-third of the land distributed so far – 225,000 hectares – has been planted, said Castro, who also alluded to plans for expanding urban gardening, in people’s backyards for example.

“If one day fuel is lacking in this crazy, fast-changing world,” food would be closer that way, he said.

Baptist pastor Raúl Suárez, a legislator, said the policy of land distribution and Castro’s emphasis on seeking “the best way” to get products from the farm to consumers, to avoid transporting them long distances, were “the right approach.”

“We are moving forward, with the limitations faced by our country because we don’t always have the infrastructure or resources. But we’re progressing, which I know firsthand because I have my own organoponic garden and I have had a very good harvest, to share with my family and others,” he told IPS.

The lawmaker also praised measures that have been adopted for conserving water and improving the efficiency of water distribution. “We are trying to get a leap on a crisis that inexorably lies ahead at a global level and for our country as well,” he said.

In his speech, Castro gave a brief rundown of investments made in Holguín, Santiago de Cuba and other eastern provinces to expand water supplies in drought-stricken areas.

“These are projects for the present and above all for the future, when water will be an increasingly scarce resource on a long, narrow island like ours, where the precious liquid quickly runs into the ocean and is lost,” he said.

Castro also mentioned the 10 billion dollars in damages caused in 2008 in Cuba by hurricanes Gustav, Ike and Paloma.

“Raúl, give Fidel a big hug from his people. We love you dearly” read a hand-written sign held by someone in the crowd Sunday in Holguín, where the president held the rally in recognition of the recovery efforts made by this province after it was hit hard by Hurricane Ike last year.

Excerpt:

By Marwaan Macan-Markar
BANGKOK, Jul 15 2009 (IPS)

Pattadol Piboonsak was gripped with fear last week when he fell ill with a high fever, displaying the usual symptoms of influenza.

"I thought I had fallen ill with the new [H1N1] virus," says the 27-year-old Bangkok resident. "I was [worried]."

But he was fortunate. He was diagnosed with seasonal flu, and by the weekend he had fully recovered.

The fear of falling ill to the H1N1 virus has not left him though. "I have started wearing a [surgical] mask whenever I go out to public areas," says Pattadol. "I am afraid I will get the H1N1 virus."

Like him, a female employee at a post office, have sought the protection of a face mask against the risk. "I have been wearing a [surgical] mask since May, when we heard about this new virus," says 28-year-old Sunanta, who opted against giving a last name. "I will continue to wear the mask when I go to work till this virus is gone."

In recent weeks, such fears have gripped a large number of Thais as an increasing number of people succumb to the new H1N1 virus. With over 4,000 reported cases, the country remains the worst hit by the pandemic in Asia. Across much of Bangkok, people are following the same personal measures of precautions. There is a steady increase in the number of surgical masks worn by passengers traveling in the elevated commuter trains that snake across Bangkok.

This week, the Bangkok Metropolitan Authority shut down 435 public schools, 200 nurseries and 13 occupational training centres. These centres of learning will remain shut for five days.

The concern about the H1N1 pandemic spreading across this South-east Asian country of 65 million people is understandable. In mid-May, when Thailand hosted a meeting of the region’s health ministers to draft measures to deal with the new virus, there were no reported cases here. The only four cases in Asia at the time were in South Korea and Hong Kong, with three cases being reported in the former.

Currently, 24 people have died out of the over 4,000 confirmed cases of the type-A H1N1 virus, according to public health authorities.

That works out to a 0.4 percent fatality rate, or four deaths out of 1,000 infected patients, which places it at a manageable Level Two, according to World Health Organisation (WHO) calculations. Countries are expected to shut their borders if the virus hits Level Five.

China, the regional giant, by contrast, had reported over 2,000 cases by the first week of this month, Japan had reported 1,790 cases, Philippines reported 1,709 cases, and Singapore reported 1055 cases, up to that period, according to the WHO.

In order to deal with the virus spreading further in Thailand, public health experts are prescribing measures that seek to slow the spread of the virus, rather than trying to stop it infecting people.

"This is not the time to contain the virus. All the effort should go to mitigation," says Dr. Somchai Peerapakorn, of the WHO’s Thailand country office. "Now you cannot stop the virus. We have to slow down the spread by protecting the population."

"This is a brand new virus. Nobody can say what will happen next," he explained in an interview. "Measures to deal with the virus should be proportional and rational according to each country’s situation."

The profile of those infected by H1N1 provides pointers to help shape mitigation efforts. "The picture of those infected here are pretty much the same as those infected internationally. They are children, young adults and working age people," says Dr. Supamit Chunsuttiwat, a specialist in preventive medicine at Thailand’s public health ministry.

Yet what remains uncertain for now in a country that has impressive public health facilities when set against its poorer neighbours such as Burma, Cambodia and Laos is the exact number of H1N1 cases. "The number of real cases may be much higher," Dr. Supamit told IPS.

That stems from the country being among the most open in the region, welcoming a steady flow of tourists, a factor that has made Thailand more vulnerable to the virus than those with less airline passenger traffic.

"The spread of the virus is because of our exposure," says Dr. Supamit. "We welcome so many tourists. Smaller countries with less exposure to tourists are having a less impact."

Thailand’s challenge to slow the spread of H1N1 comes at a time when the WHO confirmed on Monday that the new flu is "unstoppable" and recommended that all countries seek "access to vaccines."

The new virus, which was reported to have begun in Mexico and spread through North America between March and April this year, has now infected close to 100,000 people across the globe, of which 429 patients have died.

The speed at which the virus has spread from one corner of the globe to Thailand, on the other side, points to a new reality.

"In 2009, because of globalisation and the huge amount of international travel, the virus is taking six weeks to spread," says Dr. Somchai of the WHO. "In previous pandemics, it took six months to spread."

Excerpt:

By Marcela Valente
BUENOS AIRES, Jul 8 2009 (IPS)

These days, people in the Argentine capital are largely avoiding the traditional greeting: a peck on the cheek. Doctor’s orders, amidst the fast spread of the H1N1 influenza virus, otherwise known as swine flu.

The pace of life in this bustling city of 12 million has slowed down as schools have closed and other activities have been put on hold in the face of an epidemic that has so far claimed 60 lives.

Above all, the health authorities have recommended isolation to curb the spread of the flu, and people in the capital are trying to stay home as much as possible, unless influenza symptoms drive them to join the crowds flocking to hospitals and health clinics.

All public and private schools in Buenos Aires province have been closed for the rest of the month, basically extending the two week winter vacation.

Pregnant women working in both the public and private sectors have been given two weeks leave; public employees of the province of Buenos Aires with children under the age of 14 were allowed to take leave – 45,000, or 10 percent of the payroll, have done so; the winter judicial recess was moved forward and expanded by two weeks, to a full month; Congress has taken a prolonged recess; and theatres were closed for 10 days starting Monday.

Factory workers and people working in the service sector are demanding that their work hours be shortened.

“Demand is always much greater than normal at this time of year,” Dr. Juan Rodríguez del Sel told IPS. The Durand public hospital where he works in Buenos Aires is on the front-line of the battle against the swine flu epidemic, which first broke out in Mexico in late April and has now coincided with the southern hemisphere winter flu season.

“Most of the cases are not serious, but now we are getting cases that are not commonly seen: young people with severe acute respiratory problems who end up on artificial respirators within 48 hours of the appearance of symptoms,” said the doctor.

“These are people under 30, without prior health problems,” he said.

The Argentine Health Ministry estimates that 97 percent of people with flu symptoms today have the H1N1 virus, which would put the total number at around 105,000. Of that total, 90 percent are asymptomatic or mild cases, and only a small minority of cases are complicated by pneumonia.

Dr. Eduardo López, head of medicine at the Gutiérrez Hospital and a member of the government’s Crisis Committee, estimated Tuesday that there are currently 107,000 cases in this country of nearly 40 million, according to projections based on the way the disease has spread.

On Monday, the World Health Organisation (WHO) reported 60 deaths in Argentina and 16 in Chile, the two South American countries hit hardest by the pandemic.

The authorities decided Monday to expand supplies of anti-flu medication to all patients who show even mild symptoms. To that end, the state distributed more than 300,000 doses and expects to distribute another 500,000 – an indication of the extent to which health experts expect the flu to keep spreading.

This week, the health authorities of the centre-left government of Cristina Fernández received 270 million dollars in additional budget funds to purchase more respirators and medicine, in order to provide free treatment to at least half a million patients. There will also be extra money to hire additional medical staff and purchase other materials.

Juan Carr, a spokesman for the non-governmental Red Solidaria (Solidarity Network), which is working closely with the authorities in the current public health emergency, cited projections that four million people will catch the H1N1 virus in Argentina.

He said that in half of the cases, people will have no symptoms but will be contagious nonetheless. Of the rest, just 18 percent will be seen by a doctor or visit a health clinic or hospital, and only a tiny minority will develop severe complications.

But what people are worried about is the fact that it is not yet clear what kind of patients are at risk of severe problems. The only specific warning issued so far has targeted pregnant women as an at-risk group.

Experts in the Health Ministry point out that seasonal flu viruses normally kill between 3,000 and 4,000 people a year in Argentina, mainly among vulnerable groups: newborns, the elderly, and people with depressed immune systems or chronic respiratory problems, diabetes or cardiac conditions.

The current epidemic has caused alarm because most of the serious cases have involved healthy people who within two days of getting a fever and a cough end up in the intensive care unit fighting for their lives.

The decision to distribute anti-flu medication to everyone who has symptoms is aimed at preventing such cases.

Fear of the pandemic has slowed down the busy pace of life in Greater Buenos Aires. People are staying home as much as possible, and the city’s hospitals are only keeping up with demand thanks to an extraordinary effort by their staff.

Night and day, long lines of patients await their turn. “He has a fever, a cold and a cough,” Ada Martínez told IPS after waiting two hours for her three-year-old to be seen by a doctor at the Children’s Hospital in the northern Buenos Aires neighbourhood of San Isidro. Both she and her son were wearing face masks.

In the capital, where the service for pediatric home health visits tends to be efficient, delays of up to 48 hours have become common in the last few weeks, and health professionals have received training on how to determine which cases are most urgent, based on the description of symptoms over the phone.

Some schools closed last week and others did so on Monday, with parents going in to pick up homework assignments. Public and private secondary school students have received assignments and recommended reading by email or online.

The main haunts of teenagers – gyms and health clubs, discotheques, cybercafés and swimming pools – have been closed in many neighbourhoods. And although shopping centres, with their movie theatres and eateries, are still open, city officials in some districts have recommended that children under 18 stay away from such places, for their own safety.

Theatres in Buenos Aires, which had experienced a sharp decline in visitors, shut their doors for 10 days as of Monday. The owners of movie theatres, meanwhile, promised to sell fewer tickets to keep down the size of the crowds, and are offering alcohol-based hand disinfectants. But not many people are venturing out to the movies anyway.

Train and subway stations, which are normally packed at rush hour, are as empty as they are during holidays.

Because the public administration is short-staffed, authorities have recommended people to postpone anything but the most urgent business. Anyone whose driver’s license has expired is now eligible for an automatic 30-day extension.

Shopping centres have seen business decline by half, although in some sectors the drop was much bigger, such as recreational areas for children, which are considering closing their doors.

On the other hand, pharmacies, bookstores and video and DVD centres are doing brisk business, seeing a 30 to 40 increase in rentals and sales.

In pharmacies, not only flu medicine is flying off the shelves, but also face masks, tissues and alcohol-based hand rubs.

People are keeping social visits to a minimum, and instead of new reservations, party rooms are receiving cancellations.

The Asociación de Meretrices de la Argentina (Argentine Prostitutes Association), estimates the drop in demand at 80 percent and the owners of pay-by-the-hour hotels say business has plunged.

On Jun. 29, health minister Graciela Ocaña resigned over differences with the Fernández administration in the handling of the swine flue epidemic and a previous dengue fever outbreak.

Excerpt:

By Emilio Godoy
MEXICO CITY, Jul 2 2009 (IPS)

Health ministers and representatives of 43 countries and the World Health Organisation (WHO) began to meet Thursday in the Mexican resort city of Cancun to discuss a common strategy to curb the spread of the H1N1 flu virus.

“We have to review our history, what we did and how we did it, what we did not do and why, with all of us recognising the actions and the results achieved, in a mature, objective manner,” said Mexican Health Secretary Ángel Córdova at the high-level meeting on “influenza A(H1N1): lessons learned and preparedness”.

The H1N1 virus, popularly known as swine flu, emerged in Mexico in April and has caused 337 deaths and more than 80,000 confirmed cases in 121 countries, according to the latest WHO update.

The United States heads the list, with 21,449 confirmed cases, followed by Mexico, with 10,984 cases, including 119 deaths.

But the disease, which the WHO declared a full-fledged pandemic on Jun. 11, is now spreading fast in Chile, Argentina and Uruguay, fuelled by the southern hemisphere winter.

In her keynote speech, WHO Director-General Margaret Chan said “we have good reason to believe that this pandemic will be of moderate severity, at least in its early days.

“But we need to watch very carefully what happens during the current winter season in the southern hemisphere.

“We are still seeing a largely reassuring clinical picture. The overwhelming majority of patients experience mild symptoms and make a full recovery within a week, often in the absence of any form of medical treatment. Research published last week confirms that this pattern, in which most patients experience mild influenza-like illness, has also been seen in Mexico.”

“The fight against this influenza virus is a global challenge that requires a global response,” Mexican President Felipe Calderón said at the inauguration of the two-day meeting in Cancun, in southwestern Mexico.

In the sessions, participants are discussing questions like the state of the pandemic, epidemiological monitoring of people and animals, the capacity of hospital networks to deal with the pandemic, and international health regulations.

But the officials and experts are facing an uncertain outlook, because the exact physical origins of the virus are still unknown. Moreover, flu viruses can mutate, and become resistant to any vaccine that may be developed.

“What we know now is the same thing we knew when it first appeared: it’s a virus that arose from a new recombination of human, swine and bird flu strains,” Silvia Ribeiro, a researcher with the Canada-based Action Group on Erosion, Technology, and Concentration (ETC Group), told IPS.

“But there are still some unanswered questions, like why have so many people died in Mexico. There are also clear indications that the virus is related to industrial-scale livestock production,” she added.

The Mexican government has spent some 85 million dollars on medicines and other materials to combat the flu epidemic.

One of the demands that has emerged at the international meeting is for the hardest-hit countries to have access to an eventual vaccine, which is expected to be ready by the end of the year.

“The world is awaiting the H1N1 flu vaccine as a necessary social input for protecting global health,” said Córdova. “We will continue promoting actions in favour of equal access to and rational availability of the vaccine, and the widest possible coverage.”

Weeks ago, Mexico sent the WHO swine flu samples and clinical data, to contribute to the search for a vaccine.

“The vaccine is necessary, but it will not prevent the disease. Besides, it will be a huge earner for the drug giants,” said Ribeiro.

Countries where the flu is spreading have purchased millions of doses of the anti-flu drug oseltamivir, produced under the brand names Tamiflu and Zanamivir.

But two patients, in Denmark and Japan, turned out to be resistant to Tamiflu – an indication of the virus’s capacity to mutate.

Canadian Health Minister Leona Aglukkaq urged the meeting to reach an agreement with a view to tackling the challenge that will be faced when the northern hemisphere winter starts, in October. Experts predict a new outbreak in North America during the winter months.

Excerpt:

By Marcela Valente
BUENOS AIRES, Jun 26 2009 (IPS)

Doctors at the forefront of the battle against the H1N1 influenza virus in Argentina point out that the number of cases is far larger than the official figures reflect. But they also stress that the mortality rate, as a proportion of the much higher number of cases, is lower than people assume.

The Health Ministry is still issuing a daily report on the number of cases of what is popularly known as swine flu, and the number of deaths. The latest statistics are 1,488 confirmed cases and 23 deaths, representing a mortality rate of 1.3 percent.

The media seize on these numbers with alarm, comparing them with the statistics from other countries.

“As of 20:32 on Jun. 24 there are already 21 cases of H1N1 flu,” said the nightly news anchor for Channel 13 – one of Argentina’s leading TV stations – glancing at his watch.

The reporter emphasised that Argentina had the third largest number of swine flu deaths, after Mexico and the United States.

These reports strike fear into people’s hearts, prompting them to flock to health clinics and hospitals at the slightest symptom of the flu or the common cold, or even in the absence of symptoms, which has pushed the health system to the brink of collapse.

“There are people who come in to say they suspect a neighbour has the H1N1 virus,” one doctor told IPS after the tape recorder was turned off.

Infectious disease experts say the actual number of cases is much higher than the official statistics indicate – a fact that should calm people’s fears, rather than create further alarm.

Some say the official figures should be multiplied by a factor of 10, while others say that would still “fall short,” in the words of one expert who spoke to IPS on condition of anonymity.

“The official statistics do not reflect reality. Many more people are infected, which means the mortality rate is lower than people suppose,” said Dr. Daniel Priluka with the Argentine Society of Infectious Diseases (SADI).

The total of 23 deaths in Argentina since the outbreak began in late April does not worry experts, who point out that seasonal flu kills between 3,000 and 4,000 people a year in this country of 40 million, mainly individuals from at-risk population groups like the elderly, newborns or patients with chronic health conditions.

Because the immense majority of swine flu cases are mild, requiring no medical treatment, there is no need to confirm all of them, the experts explain.

That is in line with the recommendations issued by the World Health Organisation (WHO) when it announced earlier this month that it was raising the pandemic alert from level five to six, the highest.

“Countries with widespread transmission should focus on the appropriate management of patients. The testing and investigation of patients should be limited, as such measures are resource intensive and can very quickly strain capacities,” WHO Director General Margaret Chan said at the time.

Chan said “the virus is contagious, spreading easily from one person to another, and from one country to another,” and that the “spread in several countries can no longer be traced to clearly-defined chains of human-to-human transmission.”

But she clarified that “the overwhelming majority of patients experience mild symptoms and make a rapid and full recovery, often in the absence of any form of medical treatment.”

The southern hemisphere winter is just starting, which means that in Argentina, as in neighbouring Chile and Uruguay, the flu season is in full swing.

In Chile, the Public Health Institute now issues twice-weekly, rather than daily, updates. The latest, released on Tuesday, Jun. 23, reported 5,186 cases and eight deaths.

And in Uruguay, the Public Health Ministry reported a total of 195 cases as of Tuesday.

In Mexico, where flu season is over, the spread of the disease has slowed. The total number of confirmed cases stands at 8,279, 116 of which were fatal. In the United States there have been 87 deaths.

When the outbreak was first reported in Mexico, Argentina temporarily suspended flights from that country.

“Now, samples are only taken to confirm the diagnosis of patients who have been hospitalised, but the number of people who have had the flu in their homes, with or without medical treatment, could easily be multiplied by 10,” Dr. Pablo Elmassián of FUNCEI (the Infectious Diseases Foundation), told IPS.

“It no longer makes sense to carry out the test, because the virus is here to stay,” he said. “What we have to do is carry out prevention and damage control efforts.”

Along those lines, he warned that “malnutrition is a risk factor,” and recommended that efforts be focused on prevention among the most vulnerable sectors of the population.

He added, however, that there is always a risk of complications in cases of influenza, even for healthy individuals.

But he underlined that the mortality rate is based on the total number of cases, and said that if it were possible to obtain precise figures for all cases, the rate would stand at 0.3 to 0.5 percent – the same as for seasonal flu.

Priluka, meanwhile, said it was “absurd” to continue publishing daily updates. “It makes no sense; the virus is circulating and many, many people must already be infected,” he said. He estimated that half of the youngsters missing school could be swine flu cases.

The experts say their aim is to neither dramatise nor minimise the problem, but to put it in proper perspective.

“We have the seasonal flu and the H1N1 virus. So, if normally between five and 15 percent of the population has the flu, and some of the cases are serious, we now have to add another proportion of patients with the new virus, and its own complicated cases,” said Priluka. As a result of the increase in cases, along with the swine flu fears, hospitals have been overwhelmed.

“The hospital beds are full, and that IS a health problem,” according to Priluka, who said a health emergency should be declared in the Buenos Aires metropolitan area in order to strengthen the health system and increase the number of doctors and purchases of respiratory care equipment.

Non-emergency operations have been postponed in the city of Buenos Aires and special wings have been set up for H1N1 influenza cases. In addition, entire hospitals have been dedicated to swine flu cases in populous working-class neighbourhoods and slums on the outskirts of the capital.

With respect to the most severe cases, Priluka said that in regard to both the seasonal flu and the H1N1 virus, they have mainly occurred among at-risk groups. He added, however, that complications also arise in other patients, and always have, but that now these cases are receiving much more attention.

In Priluka’s view, it is still much too early to determine whether many of the severe or fatal cases involve young, healthy adults, as was apparently the trend in Mexico.

Samples taken by disease monitoring centres will indicate how many cases there are and what proportion of the cases are serious, he said.

The infectious disease expert predicted that this information will show that the proportion of serious or fatal cases among people considered to be at low risk is smaller than currently believed.

Excerpt:

By IPS Correspondents
SUVA, Jun 23 2009 (IPS)

Fiji has become the second Pacific island nation to confirm cases of the H1N1 flu virus following two positive tests returned over the weekend.

According to the World Health Organisation (WHO), Pacific island countries are one of the most vulnerable areas for the new virus, popularly known as swine flu, as shown by previous pandemics.

Medical authorities in this country of 900,000 have moved quickly to assure the public that there is nothing to panic about, while strongly advising people to take the normal precautions.

On Monday, a major hospital in Fiji’s western division reported an increase in the number of patients seeking treatment for flu-like symptoms. Workers at some medical clinics have taken to wearing surgical masks.

On Tuesday, Fiji’s education minister, Filipe Bole, asked head teachers in schools across the country to be on the alert for signs of infection among students.

“Children observed showing signs of flu with high fever are to be sent home immediately,” said Bole in a press statement.

Samoa (population 220,000) confirmed its first case – a visiting Australian student – earlier this month. About 30 other students and six motel staff were quarantined with suspected swine flu in the capital, Apia.

Suspected cases in the Solomon Islands and Papua New Guinea were also sent for testing recently.

In an interview with a local newspaper this week, the WHO representative in the South Pacific, Dr Chen Ken, pointed out that the virus was already causing community-level outbreaks in Australia, New Zealand, South Korea, and the city of Los Angeles, California and the state of Hawaii in the United States, all of which had direct links with Fiji.

“The case in Samoa shows that even intensive passenger screening measures such as Samoa was doing cannot keep the virus out,” Dr Ken told the Fiji Sun newspaper. WHO’s Fiji representative Dr Jacob Kool said at the start of the outbreak in early May that island nations “have only a limited stretch of their health care systems and a limited stretch of their essential services like safe water, electricity, security and all that. We know that in the 1918 Spanish Flu pandemic the most severely affected countries were actually in the Pacific and some of them had quite a high mortality.” Papua New Guinea’s health minister Sasa Zibe, who was developing swine flu-like symptoms after returning from a ministerial forum in Australia last week, has placed himself under quarantine.

In Fiji, the first patient was a 39-year-old man who had returned from Australia the previous week and visited a doctor after suffering flu-like symptoms. Samples sent to a national testing lab returned positive, with the health ministry going public on Saturday, Jun. 20.

Health authorities believe the first sufferer had contact with and infected the person who recorded the second positive case.

Both cases were recorded in Nadi, which is home to Fiji’s major international airport and is the key tourism hub.

Fiji’s permanent secretary for heath, Dr Sala Sakete, said the patients and their family members had been quarantined and put on treatment.

Earlier, Dr Saketa had urged people not to panic, but to take the necessary precautions, including seeking immediate medical attention if they developed any of the symptoms associated with the pandemic.

With both Fiji and Samoa major tourism destinations in the South Pacific, there are concerns about the impact of the virus in their key source markets, Australia and New Zealand.

Australia, with 2,436 cases, has the fifth highest number of cases in the world. Authorities in that country are investigating whether the death of a 26-year-old Aboriginal man last week was due to the H1N1 virus.

The number of swine flu cases in New Zealand hit 300 this week. According to an Australian Broadcasting Commission report Monday, 45 more New Zealanders contracted the virus in the previous 24 hours.

According to the latest WHO figures, the United States remains top of the list, with 17,855 cases and 44 deaths, followed by Mexico with 7,624 cases and 113 deaths, Canada with 4,905 cases and 12 deaths, Chile with 3,125 cases and two deaths and Australia with 2,436 cases and one suspected death.

The toll now stands at 52,160 confirmed cases worldwide, including 231 deaths, in around 100 countries and territories.

Excerpt:

By Gustavo Capdevila
GENEVA, Jun 11 2009 (IPS)

The cautious tone taken by World Health Organisation (WHO) Director General Margaret Chan when she declared an H1N1 influenza virus pandemic Thursday was only modified when she expressed concern over the potential effects of the virus in developing countries, and among young pregnant women in particular.

“(P)erhaps of greatest concern, we do not know how this virus will behave under conditions typically found in the developing world,” Chan told the press. “To date, the vast majority of cases have been detected and investigated in comparatively well-off countries.”

Under the WHO’s six-level global flu alert system, the highest level, a full-scale pandemic, implies sustained community level outbreaks in different countries in several regions.

The word “pandemic” is derived from Greek, with pan meaning “all” and demos meaning “people”.

The virus is becoming stable in some countries, said WHO Assistant Director General Keiji Fukuda.

WHO experts underlined that the virus, a novel strain of influenza A popularly known as swine flu, is here to stay.

But neither Chan nor Fukuda identified the countries where community level outbreaks of the H1N1 virus have been seen.

Nevertheless, it is clear that the three countries of North America – Canada, Mexico and the United States – are on the list.

In Australia, another country with a large number of cases, community level outbreaks are localised.

Other countries with community level outbreaks are in Europe and South America.

The response of countries to the declaration of a global pandemic will depend on the situation in each one.

“Countries should prepare to see cases, or the further spread of cases, in the near future. Countries where outbreaks appear to have peaked should prepare for a second wave of infection,” said Chan.

Guidance for specific protective and precautionary measures has been sent to the health ministries of all 193 WHO member countries, she said.

“Countries with no or only a few cases should remain vigilant. Countries with widespread transmission should focus on the appropriate management of patients. The testing and investigation of patients should be limited, as such measures are resource intensive and can very quickly strain capacities,” Chan added.

As it has done since the epidemic was first detected in North America in late April, the WHO reiterated that it does not recommend travel or trade restrictions or border closures.

Chan did not refer to the effects of the pandemic alert on the world’s economic and financial markets.

A diplomat from the Caribbean who did not want to be identified told IPS that his government was keeping a worried eye on WHO policies because a restriction on travel could have a severe impact on the tourism industry, on which his country depends.

The WHO chief also avoided making any statement on an eventual freeing up of patents on anti-flu medication.

She added, however, that the WHO has been in “close dialogue with influenza vaccine manufacturers,” and that production of vaccines for seasonal influenza in the northern hemisphere winter will be completed soon, so “full capacity will be available to ensure the largest possible supply of pandemic vaccine in the months to come.”

But the vaccine against the H1N1 virus will not be available on the market until September, she clarified.

Chan said the WHO has sent anti-flu medication to 131 countries in the developing world.

One of the reasons for the specific concern about poor countries is that 99 percent of maternal deaths, a marker of poor quality care during pregnancy and childbirth, occur in the developing world, said the WHO director general.

Another reason is that roughly 85 percent of the chronic disease burden is concentrated in low and middle-income countries, she added.

And “Although the pandemic appears to have moderate severity in comparatively well-off countries, it is prudent to anticipate a bleaker picture as the virus spreads to areas with limited resources, poor health care, and a high prevalence of underlying medical problems,” said Chan.

One of the WHO’s arguments for raising the alert level is the unpredictability of the virus, which “writes the rules and this one, like all influenza viruses, can change the rules, without rhyme or reason, at any time,” she underscored.

Chan also stressed that the WHO has “good reason to believe that this pandemic, at least in its early days, will be of moderate severity. On present evidence, the overwhelming majority of patients experience mild symptoms and make a rapid and full recovery, often in the absence of any form of medical treatment.”

She also pointed out that the number of deaths worldwide has been small.

Excerpt:

On Mar. 28, one month before news of the swine flu outbreak headlined worldwide, a nine- year-old girl in Imperial County, California ran a fever of 104.3 degrees F.

She had not rolled up her sleeve for this year’s flu vaccine, but that day she opened her mouth and stuck out her tongue for a cotton swab that scooped up mucus samples from her throat. Her mucus arrived at the Naval Health Research Centre in San Diego where technicians tested it and classified the virus in it as “unsubtypable” influenza A – it was something new.

She recovered.

The lab forwarded her mucus to the Centres for Disease Control and Prevention in Atlanta, Georgia, where it arrived on Apr. 17, four days after Mexico confirmed its first case of swine flu. Embedded in the girl’s mucus was a strain of the virus that was already sweeping the globe.

As of late May, 55 countries had confirmed more than 12,000 swine flu cases, a global contagion that has proved less deadly than scientists feared at its onset.

The CDC discovered the virus is a mashed-up concoction of human, avian and pig flu genes – a kind of flu sausage. Some of it is from viruses that are common in North America, native to pigs that have coughed it onto each other since 1999. But some of the gene combinations have never been seen before in pigs or people.

For years scientists have speculated on the potential for a deadly hybrid virus to form in pigs. Now, the biggest swine flu outbreak in history may be the first evidence that this can happen. Over the last 10 years, new flu strains have been cropping up in pigs on farms and scientists don’t know why. However, they had predicted it years before it began.

“I have warned that there could be viruses originating in swine jumping to humans and creating pandemics,” says Juergen Richt, a veterinary virologist at Kansas State University.

Richt and his colleagues drew together a frightening array of studies of flu viruses extracted from people and a small zoo of animals over the past several decades.

They revealed their findings in January in a prescient paper called “The Pig as a Mixing Vessel for Influenza Viruses,” published in the Journal of Molecular and Genetic Medicine.

Pigs are flu sponges, capable of contracting both bird and human viruses that can jump across the species barrier, Richt says. The 1957 and 1968 Asian flu pandemics were caused by mixed-and-matched, reassorted viruses. Richt contends that the viruses jumped from birds to people and transformed inside their new hosts, or that they jumped from birds to a mammal, such as pigs, where they shuffled their genes and formed new flu viruses.

Pigs and people can swap mutations of the virus among themselves in a risky game of viral hot potato. For years the 1918 flu pandemic that claimed 20 to 40 million people worldwide was blamed on pigs. Then researchers conducted some clever genetic archeology that cast doubt on the swine flu theory. Scientists now suspect that birds infected us, and we, in turn, infected the pigs.

Pigs have infected people with mixed-up viruses before, even triple whammies made of pig, bird and human flu genes, Richt’s paper shows. If the innards of each pig are Petri dishes where genes are jumbled and dashed together, then possible pandemic flu viruses have been stewing on hog farms for decades.

“Everyone was looking at avian flu in southeast China and we said, ‘You guys forget it could happen in your own backyard,'” Richt said.

Not every flu virus can infect every animal. Birds, for example don’t have receptors for human strains of the flu. Two different strains can only mix inside a body that has receptors for both. Pigs are one such host for a flu virus – they can get sick with both avian and human strains.

To reproduce, the flu virus slips inside its host’s cells and makes copies of itself, explains Gene Erickson, a microbiologist at Rollins Animal Disease Diagnostic Laboratory in North Carolina. The virus’ genome has eight segments, each of which it copies and assembles into new viruses. When two viruses invade the same cell, they both begin to copy themselves.

At that point there are not just eight, but 16 viral segments on assembly lines, and the genes start shuffling together in a process called reassortment. In that way, “mixing is possible, resulting in a new type of virus, like the virus that is currently infecting people,” Erickson said.

If there are three different viruses in the cell, even more combinations are possible.

Until now, swine flu has been easy to ignore. Pigs don’t easily infect people, and when they do, the virus often fizzles in its new host, unable to infect other people. Once inside a person the infection from the pig hits a dead end.

According to a comprehensive study published in the journal Clinical Infectious Diseases, swine flu had infected only several dozen people in the world since it was first identified in 1930. As of 2006, only 50 cases were reported worldwide. Adding 12 cases that the CDC has documented since then (before the current outbreak) makes the total 62.

Then, in the last 10 years, something changed. Ever since the late 1990s, flu viruses have been reassembling themselves inside pigs at a heightened pace. Pigs began coughing new viruses into the air.

“The change we’ve seen is a different kind of change. In fact we’ve seen the creation of a new kind of virus through the process of reassortment,” said Christopher Olsen, a public health professor at the University of Wisconsin-Madison and co-author of the study.

“The viruses we’ve seen emerge in pigs are a mixture of the classical swine flu, avian flu and human flu,” he said.

Experts also witnessed the emergence of a new subtype in 1998. “We’ve not been able to determine any specific reasons for why that began to happen,” Olsen said.

At the onset of the current outbreak, Olsen was concerned. “This virus is substantially different from what we’ve seen in the past and it has the potential to spread from person to person,” he said.

For now, the virus’ apparently low death toll has assuaged some fears. This outbreak is a mostly scientific curiosity of mixed up genes – one that was quietly predicted in early warnings from the scientific community.

*Special to IPS from NYU Scienceline

By Gustavo Capdevila
GENEVA, May 19 2009 (IPS)

The first step towards a massive global health prevention mechanism, under which billions of people around the world could be vaccinated against the H1N1 influenza virus – while a handful of transnational pharmaceutical corporations raked in the profits – was taken Tuesday parallel to the World Health Assembly.

The World Health Organisastion (WHO) Strategic Advisory Group of Experts (SAGE) on influenza A vaccines estimated that if the current outbreak turns into a full-fledged global pandemic, 4.9 billion doses of a vaccine would be needed.

An approximate idea of the numbers involved emerges from a comparison with the price of the vaccine against the common seasonal flu, which costs around 10 dollars per dose in the United States, for example.

Under this initiative, United Nations Secretary-General Ban Ki-moon and WHO Director-General Margaret Chan sponsored an agreement with executives from 30 pharmaceutical companies for the production of a vaccine against the H1N1 influenza virus, popularly known as swine flu.

But only three or four laboratories are in a position to develop and produce a vaccine, because the pharmaceutical industry is one of the most highly-concentrated in the world, even more than the oil industry, the head of the Butantan Foundation of Brazil, Isaías Raw, who took part in the meeting between Ban, Chan and drug industry CEOs from around the world, told reporters in Geneva.

The Butantan Foundation is a non-profit corporation that works with the Butantan Institute, a biomedical research centre affiliated with the Secretariat of Health of the southern Brazilian state of São Paulo.

The WHO also said that it will take manufacturers at least until July to produce a swine flu vaccine.

Raw pointed out that the production capacity of pharmaceutical companies of the developing South is very limited.

Nevertheless, despite those limitations, the laboratories from developing countries taking part in the meeting announced that 10 percent of the swine flu vaccine that they produce will be distributed to United Nations agencies at prices just above cost.

Raw said he was in favour of patent waivers for swine flu vaccines and antiviral medications, and he defended the right of all countries to receive samples of the new virus strain, to carry out research.

The Brazilian scientist also advocated the creation of a global fund to support the development of research centres in developing countries.

The WHO director general said it was not easy to broker an agreement between 30 pharmaceutical companies from Brazil, China, Egypt, India, Indonesia, Iran, Mexico and Vietnam, as well as Austria, Belgium, France, Japan, the Netherlands, Romania, Russia, South Korea, Switzerland, the United Kingdom and the United States.

But Chan said the pharmaceutical companies from the industrialised and developing nations had committed themselves to working with the WHO. She also said she had “encouraged them to work with the global community to make sure that developing countries, poor nations would not be left behind because of a lack of means.”

“The world’s influenza vaccine manufacturing capacity has tremendously increased in the last few years, thanks to the efforts of the industry and also to investment by governments,” she said at a news briefing in Geneva, where the 62nd World Health Assembly is being held Monday through Friday.

The WHO chief explained that production capacity will depend on how many doses are needed – only one, such as in the case of the seasonal flu vaccine, or two, like in the case of the bird flu vaccine.

The H5N1 strain of the avian influenza virus, which first appeared in humans in Southeast Asia in 1997 and has become more virulent since 2003, has caused the death of 50 to 60 of every 100 people who fall ill, Chan pointed out, saying it was “the most toxic virus we have seen”.

But, she noted, “the new influenza H1N1 virus we are dealing with is having a totally different clinical picture. We see outside of Mexico mostly very mild and self-limiting disease. We hope this will continue.”

For now, the WHO wants drug makers to continue putting a priority on producing seasonal flu vaccines, for which there is currently a high level of demand in the southern hemisphere, as it moves into winter.

Experts close to the WHO expressed doubt with regard to the wisdom of a hasty initiative to create stockpiles of billions of vaccines for a flu strain that so far has been quite mild, as acknowledged by the WHO itself in its official reports.

“The common seasonal flu is much more aggressive, strong and mortal than the one we are seeing now, swine flu,” a scientific source told IPS.

Nonetheless, authorities in industrialised countries and the WHO itself only recommend the seasonal flu vaccine in the winter for people with respiratory problems or people over 60.

“In the case of this new flu, which up to now has been milder, are we going to produce a vaccine for the entire population of a country?” the source wondered. For three or four pharmaceutical giants, “this is the business opportunity of a century.”

Excerpt:

By Gustavo Capdevila
GENEVA, May 18 2009 (IPS)

World Health Organisation (WHO) Director General Margaret Chan issued a warning about the danger posed by the H1N1 flu epidemic, while health ministers from several countries recommended avoiding excesses when it came to remarks about a potential pandemic.

"This virus may have given us a grace period, but we do not know how long this grace period will last. No one can say whether this is just the calm before the storm," Chang told health ministers and other representatives of the WHO’s 193 member states at the inauguration of the 62nd session of the World Health Assembly in Geneva.

Chang’s tone contrasted with the position taken by the ministers of Brazil, the United Kingdom and Japan, who called for maintaining the current level of influenza pandemic alert, phase 5, without passing to the highest level, phase 6, which would mean a full-fledged worldwide pandemic was under way.

José Angel Córdova, the health minister of Mexico, where the first cases of the H1N1 influenza virus – popularly as swine flu – appeared in mid-April, told journalists that he backed the call issued by those three nations.

The WHO alert level is based on how fast and widely a disease is spreading. Phase 6 is characterised by sustained community level outbreaks in at least two regions.

So far, this kind of transmission has only clearly occurred in North America. Other suspected cases of sustained community level outbreaks have been ruled out, first in Britain and this week in Japan.

"I will follow your instructions carefully, particularly concerning criteria for a move to phase 6, in discharging my duties and responsibilities to member states," said Chang.

However, the WHO chief did not refrain from pointing to the potential danger posed by influenza viruses, which she described as "the ultimate moving target. Their behaviour is notoriously unpredictable. The behaviour of pandemics is as unpredictable as the viruses that cause them. No one can say how the present situation will evolve."

She added that "We have every reason to be concerned about interactions of the new H1N1 virus with other viruses that are currently circulating in humans," such as the avian flu virus, which has spread in countries of Asia and Africa since 2003, causing hundreds of deaths.

Chang’s most emphatic warning was directed to the developing world, "which has, by far, the largest pool of people at risk for severe and fatal H1N1 infections," she said.

Without ignoring the risks posed by the epidemic, representatives of non-governmental organisations said the current global economic crisis posed an even greater threat.

Amit Sengupta, a health analyst from India, told IPS that "I’m not undermining the importance of a globally coordinated response to the influenza pandemic as it really spreads."

But what civil society is saying, he added, "is that by all accounts, the global financial crisis is a much bigger threat."

"We may be entirely wrong, but the evidence that we have before us today, in terms of the possibility of the pandemic spreading and the evidence that we have today of the financial crisis actually having happened and escalating, would suggest that the response to the financial crisis should at least match if not exceed the response to the swine flu," said Sengupta.

"And that is unfortunately something that we do not see. And unlike the swine flu, and all influenza epidemics, which have a way of containing themselves over two or three years, the last global financial crisis that happened actually only contained itself by the Second World War," he noted.

During the WHO assembly’s first day of sessions, Mexico proposed the discussion of "the possibility of creating an economic contingency fund, supported by financial multilateral organisations such as the World Bank and the International Monetary Fund.

"The fund could be used to compensate those countries that notify in a timely and responsible manner" on events of international relevance for public health, "as a way to encourage transparency and international cooperation in public health matters."

Mexico, which reported a total of 3,646 laboratory-confirmed cases of H1N1 flu, including 70 deaths, estimates the losses caused by the outbreak there at around two billion dollars.

One of the first decisions reached by the assembly was to shorten the meeting to just five days, through Friday May 22. This was done "for a good reason," said Chang, who stressed that "health officials are now too important to be away from their home countries for more than a few days."

But Sengupta said the resolution was another show of alarmism.

WHO authorities have come in for criticism for supposedly exaggerating the dangers of the epidemic.

Excerpt:

By Fabiana Frayssinet
RIO DE JANEIRO, May 15 2009 (IPS)

The H1N1 flu virus has begun its southward march in Latin America, carried by passengers travelling from areas hit by the outbreak. But the mortality rate is much lower than in Mexico, and there are no signs of “sustained domestic transmission” in the rest of the region.

According to infectious disease expert Dr. Gabriel Levy at the Durand Hospital in Buenos Aires, who is the coordinator of the Infectious Disease Network in the Argentine capital, the new H1N1 influenza A virus – popularly known as swine flu – got off to a ferocious start in Mexico, but its impact has gradually weakened as it moves southward.

Brazilian President Luiz Inácio Lula da Silva drew angry reactions when he said the flu outbreak is serious, but it does not have the magnitude that it appeared to have at first.

In Brazil, eight cases have been confirmed so far, none of them serious.

Dr. Alberto Chebabo, an expert in infectious diseases, told IPS in Brazil that most of the cases involved young adults who had travelled to the United States or Mexico, while others had arrived from other infected areas, such as a woman who returned from Europe, where she had visited several countries.

Two of the patients did catch the H1N1 virus in Brazil. But Chebabo, who works at the Clementino Fraga Filho Hospital in Rio de Janeiro, said “there is no epidemic in Brazil,” pointing out that the two cases in question were the friend of one of the patients who had travelled to Mexico, and the patient’s mother.

Of the 34 countries around the world that have reported laboratory-confirmed cases, nine have involved “isolated in-country transmission”: Brazil, Canada, Germany, Italy, Mexico, Panama, Spain, the United Kingdom and the United States.

But only three of them have “sustained community-level human-to-human transmission”: Mexico, the United States and Canada.

The flu has behaved in a similar manner in other Latin American countries, like Colombia, where the Social Protection Ministry confirmed one new case, which brought the total there to seven.

The latest case is a man who had travelled to Mexico City, and “like the rest of the cases in Colombia, he has completely recovered,” the ministry reported.

Brazil, like other countries in the region, has stepped up airport controls, while putting an emphasis on follow-up of everyone who has come into close contact with the patients.

Neighbouring Argentina took a more radical approach, cancelling all flights from Mexico after the first, and so far only, case of H1N1 virus in Argentina – a man who returned from Mexico on Apr. 24 and has already recovered. Another 100 cases are under study.

Argentina lifted the suspension of flights to and from Mexico on Friday.

In Brazil, the cases have been relatively mild, with the exception of one woman who had pneumonia but is in stable condition, said Chebabo.

But the expert did not rule out the possibility of the virus evolving into a more virulent strain, which means the mortality rate could still rise.

In Costa Rica, the situation is similar to the rest of the region: there are nine confirmed cases and five “probable” cases still awaiting the results of the lab tests. The cases involved people who either travelled to Mexico or came into contact with people from Mexico or the United States.

Like in Brazil, health authorities in Costa Rica say there is no evidence of sustained community-level human-to-human transmission. However, one of the cases was fatal: a 53-year-old man who suffered from diabetes and chronic lung disease.

As of Friday, the World Health Organisation (WHO) reported a total of 7,520 laboratory-confirmed cases around the world.

Mexico, where the first cases appeared, had reported 2,446 confirmed cases, including 66 deaths; the United States, 4,298 cases, including three deaths; and Canada, 449 cases, including one death.

Costa Rica was the only other country that had reported a fatal case.

Mexico reported Friday that the number of cases there had risen to 2,895.

The Latin American countries where cases have been confirmed so far are Argentina (one), Brazil (eight), Colombia (seven), Costa Rica (eight), Cuba (one), El Salvador (four), Guatemala (three), and Panama (29).

Experts say the most vulnerable population group is young adults, and that there have been few cases among children or the elderly, although they admit that they cannot yet explain the phenomenon. In addition, they say, the virus appears to be mild but highly contagious.

“It is still early, but the virus would appear to be easily transmitted. On the other hand, the cases (in Latin America) appear to be less severe than what was initially observed in Mexico,” said Chebabo.

Outside of Mexico, cases “have been mild and the deaths were in patients who were at risk due to complications” and underlying health conditions, he added.

However, the experts have not ventured to predict what might happen. Virologist Marilda Siqueira with the Oswaldo Cruz Foundation, a Brazilian government institute, said the virus could continue to circulate simultaneously with seasonal flu viruses, “making the genetic exchange between them possible.”

“A milder (or more virulent) strain could emerge as a result of that combination. For example, the virus could circulate for a few months and later mutate into a more severe form, as has been observed on other occasions,” she said.

Chebabo said that more virulent strains of the virus have not been observed. But he did not rule out the possibility, “because the influenza virus undergoes frequent mutations which could lead the A/H1N1 virus to become more severe in the next waves of the epidemic.”

“For now it has been contained,” virologist Laya Hun Opfer, at the University of Costa Rica Microbiology Faculty, told IPS. But the flu virus is unpredictable, and could mutate into a totally new form, she acknowledged.

In any of the possible future scenarios, say experts, the important thing is not to let down the guard and to stay alert, for example by preparing the public health system for an eventual epidemic.

Keeping mortality down depends on other factors, such as the hospital network’s response capacity.

The question is whether the countries of Latin America, several of which are currently suffering from epidemics of dengue fever, and a number of which have health systems with serious shortcomings, would be able to deal with a severe flu outbreak.

Dr. Hun Opfer said that because Costa Rica has a “first world” health system, it will not see a mortality rate like that of Mexico. Besides, the virus “is being kinder” for the moment, she added.

The prevention measures taken by the authorities in Costa Rica have been praised by the WHO, she pointed out. The Costa Rican social security institute announced a 700,000 dollar investment in health equipment to confront the flu outbreak.

In addition, 3,500 government health agents are dedicated to searching out suspected cases in that small Central American country of 4.5 million people known as the “Switzerland of Central America”.

And in Argentina, said Levy, “the response capacity is strong; there is good information and organisation.”

Because of the swift response by authorities in Argentina, there should be no mortality along the lines of what has been seen in Mexico, he said.

In addition, “there is always a major impact at the start of an epidemic, but later the impact declines,” he added. Indeed, in Mexico, the infection rate has declined sharply since late April, he noted.

Chebabo, by contrast, has doubts with respect to the Brazilian health system’s response capacity.

“If the cases remain mild, like the ones seen so far, there won’t be major problems in care. But if the number of hospitalisations goes up, we will likely have problems, because the health network is already overburdened,” he warned.

According to the Brazilian Health Ministry, 800 beds have been set aside for H1N1 flu cases in 54 hospitals, and nine million doses of antiviral drugs have been stockpiled in this country of 189 million people.

Chebabo said that an overlapping of epidemics, like dengue fever and the flu, is unlikely. The mosquito-transmitted “dengue is more common in summer, and influenza is more common in winter,” he pointed out.

But the Health Ministry in Costa Rica is worried about such a scenario, with the arrival of the rainy season, which could bring other threats, like dengue or malaria, on top of the H1N1 influenza virus.

Another concern in Latin America is the availability of laboratories and materials to test suspected cases.

In Costa Rica and Colombia, for example, samples from suspected cases have been sent to labs in the United States up to now.

But according to authorities in Colombia, the test kits will arrive by the end of the month. And Costa Rican Deputy Health Minister Ana Morice reported Friday that her country had received a shipment of test kits that would soon be available for use.

In Brazil, the tests are carried out in three national laboratories with kits provided by the WHO. Other labs are interested in working with their own diagnostic kits, which have been developed on the basis of international protocols.

In Mexico, which accounts for more than 90 percent of the flu deaths, the last death occurred on May 10.

In Mexico City, people have largely stopped wearing surgical masks and “day-to-day life is returning to normal,” said Miguel Ángel Lezana, director of the National Centre for Epidemiological Surveillance and Disease Control. “But we insist that although the figures are positive, because of the reduction in the number of cases, we must remain on epidemiological alert as long as this new virus continues to circulate.”

“Everything is like it was before; luckily the paranoia has resided and business is rallying,” Jaime Cabrera, the owner of a small restaurant that serves typical Mexican food in the capital, told IPS.

In Brazil, all patients with possible symptoms are being tested so far, since the number of cases is still small. But, said Chebabo, if an outbreak occurs, “the routine will probably be like in Mexico and the United States, with random samplings or tests on seriously ill patients.”

* With additional reporting from Marcela Valente (Buenos Aires), Daniel Zueras (San José) and Diego Cevallos (Mexico City).

Excerpt:

By IPS Correspondents
NEW YORK, May 15 2009 (IPS)

While the swine flu virus does not appear to be as potentially devastating as first imagined, environmentalists and some public health activists argue that it should be considered a wake-up call to the public about the conditions in which much of our food is being produced.

The stressful environment in which the animals live makes them more susceptible to infections and illness. Credit: Baileynorwoodrocks

That farm is partly owned by U.S. pork processing giant Smithfield Foods, which notes on its website that investigators “have found no clinical signs or symptoms of the presence of North American influenza in the company’s swine herd or its employees at our joint ventures in Mexico.”

Patty Lovera, assistant director of Food and Water Watch, a U.S. consumer group, is sceptical of this claim. She told IPS that she wouldn’t be surprised if the virus originated at the so-called “factory farm” in La Gloria.

“The conditions on those factory farms are very good for viruses to develop,” Lovera said. “Those factory farms are definitely the right place to look.”

The transmission of dangerous viruses from animals to humans is hardly a recent phenomenon. Some of the most devastating viruses in history emerged from animal sources. During the Middle Ages, the bubonic plague – spread by rats – killed millions of Europeans. And many scientists now believe the HIV virus jumped from African primates to humans.

Most viruses have a host species that suffers no ill effects but acts as a vector, spreading the virus to other animals. Viruses can live inside those so-called host species for a long time.

But when a virus mutates and develops the ability to “jump species”, the new host does not have the necessary antibodies to defend against this unfamiliar virus. This could cause a human to get ill from a flu virus normally carried by pigs, for example.

“Every time a virus enters a new host, it can mutate,” Dr. Michael Greger, director of public health and animal agriculture at the Humane Society of the United States, explained to IPS. “On farms with a small number of animals, the virus might infect only 50 pigs. Therefore, it has only 50 chances to mutate.”

“But on a factory farm with over 5,000 pigs, the virus can generate more than 5,000 chances, thus increasing the chance for a rare mutation, one that might even infect humans,” he said.

Whereas diseases transmitted by contaminated water or poor community hygiene, such as diarrhoea and cholera, have been eliminated in large parts of the world, viral transmission from animals remains a risk in nearly every society.

Three-quarters of human infectious diseases classed as ’emerging’ are transmitted from an animal reservoir, according to a research paper from the University of Lyon published in January.

The rise and steady development of factory farms in the United States and Eastern Europe has kept the price for pork products artificially low, as demand keeps on rising. Some factory farms in the United States can house up to one million pigs in sties so small, even moving is impossible.

Wouter Uwland, the owner of a farm in the Netherlands with just under 2,000 pigs, compares the living conditions for pigs on these massive farms with the harsh conditions in refugee camps. When many humans or animals live together in a small area, disease outbreaks are likely to occur.

“In larger companies, one should always consider the idea of a disease breaking out more likely than in small companies,” he told IPS.

The stressful environment in which the animals live makes them more susceptible to infections and illness. “Just like humans, animals are more likely to get ill when they are stressed,” Dr. Greger said.

Although the flu has dominated the news over the past weeks, the risk of catching the virus is actually the least of the problems for communities situated near factory farms, according to Food and Water Watch.

“The biggest problem is the amount of waste that these pigs produce,” Lovera told IPS.

Pigs produce roughly three times more waste than humans. Some factory farms can hold up to one million pigs at a time, and thus produce the same amount of waste as a city of three million.

The rules and regulations for the disposal of animal waste are different throughout the world. In Europe, the animal waste has to be collected in concrete containers, before it is used as a natural fertiliser on the fields.

In the United States however, where the farms are larger than anywhere else, the animal waste is pumped into so-called ‘lagoons”. In these enormous lakes of waste, the animal excrement may be kept for over a year. Only a layer of clay on the bottom keeps the fluid from getting into the soil and the groundwater.

According to Dr. Greger, these lagoons attract flies that can pick up a virus and carry it for miles. “Studies in Asia have shown that the Avian influenza was sometimes transmitted from farm to farm by flies that picked up the virus and were then eaten by birds,” he said.

The high levels of precautionary antibiotics that the animals receive also find their way into the soil and ultimately the groundwater via the waste. The presence of these antibiotics in the ground and drinking water immunises the consumers for medicinal antibiotics they might take in the future.

Uwland doesn’t see an easy solution to factory farms. “In theory, biological farming [a sustainable, chemical-free method] could produce the same amount of pork. But in practice, there is just not enough grassland to feed all these pigs,” he said.

Furthermore, biological farming doesn’t bring in even two-thirds of the revenue that factory farms do. Especially in the United States, where genetic technology is used to increase the production of crops and herds, the difference between biological and factory farming is just too big, he said.

Excerpt:

By IPS Correspondents
BEIJING, May 14 2009 (IPS)

China is battling hard to contain the spread of the swine flu after stringent border checks and draconian quarantine measures of Mexican nationals failed to prevent the virus from entering the country.

Both China and Hong Kong confirmed their second cases of the virus, sending ripples of anxiety among a public that still remembers the scary days of the 2003 outbreak of severe acute respiratory syndrome (SARS).

“Watching the news about the virus in Mexico I first worried that air-travel would become a big bother,” said Wang Yu who shuttles between Hong Kong and Beijing for his consultancy job, “but now I’m worried about being exposed to the flu and getting sick.”

Judging by the coverage of the virus on state television and print media, the spread of swine flu is nothing less than a top national priority for Chinese leaders.

After the first case was confirmed in China this week, state television aired President Hu Jintao ordering officials at all levels to take all emergency measures to prevent the disease from disseminating among the population. He urged them to “strengthen our leadership and maintain our vigilance… sparing no effort to stem the spread of the epidemic.”

China’s main worry is that its vast territory where many regions have regular bouts of bird flu could emerge as a breeding ground of a new strain of virus that would be much more lethal that the swine flu. The main threat lies with a possible “re-assortment” of two flu strains, Hans Troedsson, head of the Beijing office of the World Health Organisation (WHO), told the media earlier this year.

Bird flu has a high rate of mortality but it is very rarely transmitted between humans. Experts say that although very contagious, the swine flu is relatively benign and causes few deaths. But the mix of the two could result in a new virus that is unpredictable, and perhaps more lethal.

“The reason people are so worried about the ‘second wave’ of the H1N1 flu is because the virus’ global spread this time resembles the 1918 influenza epidemic that remains the most severe in modern history,” says Bi Jinglun, life scientist at Shanghai Fudan University.

In stark contrast to their attempts to cover up the 2003 SARS epidemic, this time around health authorities are at pains to drum up awareness of the health scare, making sure all anti-flu measures are widely broadcast and developments are regularly updated. Calling for national vigilance over the transmission of the virus, they have embarked on a manhunt for all people that had come in contact with the two confirmed carriers of swine flu.

A 30-year-old student surnamed Bao, who recently returned from the U.S., was the first to test positive for the flu. He had travelled from the U.S. via Tokyo to Beijing where he boarded a domestic flight to Chengdu, the provincial capital of the Sichuan province. He was taken to hospital with a fever upon his arrival.

Within 24 hours of his case being confirmed as swine flu, some eighty percent of the air travellers who had been with him on the flights from Tokyo and Beijing had been tracked down and quarantined.

The State Council – China’s cabinet – held an emergency meeting on Monday to discuss further precautionary measures. Beijing announced tightening of anti-flu measures requiring all domestic travellers who have come from or visited flu-affected regions to report their health at airports.

But the second confirmed case presents more difficulties for Beijing because the carrier travelled by train. A native of the eastern province of Shangdong, this 19-year-old student surnamed Lu had just returned from studying in Canada. He arrived in Beijing where he developed a sore throat and headache but nevertheless boarded the train to Jinan in Shangdong.

While on the train he reported his fever to the health authorities and upon arrival was immediately taken into quarantine. But, local media has reported that because of a lack of communication between health experts from the local disease control and prevention bureau and the railway authorities, the majority of passengers who shared a carriage with Lu are unaccounted for.

In the absence of a passengers list, health authorities are now left with the option of having to appeal publicly for those passengers to come forward.

“This is not simply an issue of lack of communication between government departments, it is dereliction of duty,” Xue Lan, dean of the School of Public Policy and Management at Tsinghua University in Beijing was quoted by the China Daily.

Beijing has already warned that it would punish any failures to monitor or report the spread of the disease. “An outbreak must be accurately reported to the higher authorities. Delays, cover-ups or overlooking [items] when reporting is strictly prohibited,” a statement issued after the urgent meeting by the State Council said.

Central authorities have allocated a 5 billion yuan (735 million U.S. dollar) war chest to prevent and control the disease – demanding that local government set aside special funds too to fight the epidemic.

Premier Wen Jiabao has also ordered that mainland health authorities work more closely with agencies in Hong Kong, Macau and Taiwan on information- sharing, scientific research and preventive measures.

Hong Kong reported its second swine flu patient this week – a local resident who had returned from San Francisco – and called on the U.S. to screen outgoing air passengers to avoid exporting the virus.

“As a responsible global citizen, we are mindful that every country has a duty to reduce as much as possible the probability of travellers spreading infectious pathogens as a result of our interconnectedness,” a letter sent by Hong Kong Secretary for Food and Health York Chow Yat-ngok to the U.S. health authorities said. “This is indeed the very spirit of the WHO International Health Regulations promulgated in 2005, of which your country is a signatory.”

Excerpt:

By Fabiana Frayssinet
RIO DE JANEIRO, May 12 2009 (IPS)

Several weeks of unusually heavy rainfall and flooding that has affected nearly one million people in 10 of Brazil’s 26 states have revealed a problem that only becomes news when tragedies occur: the lack of public investment in disaster prevention, experts warn.

The worst flooding in at least two decades has claimed at least 44 lives, left over 300,000 homeless and evacuated, washed out bridges and roads, destroyed hundreds of homes, and caused huge losses for agriculture in northeastern Brazil.

Ercilia Torres, a geographer who specialises in climatology, told IPS that the disastrous consequences of these climatic phenomena could be greatly reduced with proper planning and the necessary infrastructure works.

Flooded rivers and landslides caused by the heavy rainfall that began in early April have led to the collapse of houses and destroyed crops in 320 municipalities.

Television images show rooftops under water, people moving around their towns in canoes and boats, and overcrowded emergency shelters – reminiscent of the scenes broadcast last year when intense rainfall caused a similar tragedy in the southern state of Santa Catarina.

“The important thing is to plan,” said Torres, from the University of Brasilia Department of Geography. “Zoning and urban planning are needed, and must take climatic aspects into account.”

She referred, for example, to planning of low-cost housing to keep units from being built in areas at risk of landslides or flooding, and to the construction of dams and drainpipes.

“These works are costly, but they can prevent greater tragedies,” said Torres.

According to a United Nations estimate, for each dollar invested in the prevention of natural disasters, 10 dollars are saved in disaster response costs.

The head of the Civil Defence Secretariat, Roberto Guimarães, agreed that disaster prevention, zoning and urban planning are needed, but said that Brazil has a “cultural tradition” of taking measures after, rather than before, disasters.

During emergencies, the Civil Defence Secretariat distributes food aid, medicines, clothing and blankets, clears roads, and rescues and evacuates local residents.

After flying over flooded areas, President Luiz Inácio Lula da Silva blamed state and municipal governments for failing to take preventive measures, like averting the construction of homes along rivers.

But the press later reported that many of the flooded homes had been financed by the Caixa Econômica Federal, a government financial institution.

Local authorities, meanwhile, have complained about the central government’s delays in releasing funds to finance disaster prevention and infrastructure works.

Torres said it was a combination of both factors. On one hand, there is the “bureaucratic question” when it comes to the disbursement of funds, and on the other “a lack of political will.”

“The need for these funds is only remembered when tragedies happen; later it’s forgotten,” she said.

Lula said he would send Congress a provisional measure to help states with the rebuilding and recovery efforts. According to preliminary estimates, economic damages amount to at least 500 million dollars, without counting the losses in agriculture, which have not yet been assessed in all of the flooded areas.

No prevention despite warnings

“The rains did not take us by surprise,” said Torres. “Meteorological reports had forecast heavy rainfall.”

In February, Environment Minister Carlos Minc warned that the rains, which were already falling in northwestern Brazil, could continue to be heavy until June, the month when water levels are highest in the rivers of the Amazon jungle.

Manaus, the capital of the northwestern state of Amazonas, is facing its worst flooding since 1953. The water level in the Negro river has risen more than three metres, said Minc.

“We don’t want to be alarmist, but the way things are going, the situation is disturbing,” the minister said, adding that “this time they can’t say that this happened because there was no warning: we gave a warning 60 days ahead of time.”

The states hit hardest by the intense rainfall and flooding are Amazonas in the north and Maranhão, Ceará, Piauí and Paraíba in the northeast. But parts of Rio Grande do Norte, Bahia, Pernambuco and Alagoas, also in the northeast, have been affected as well, along with the Atlantic coastal region of Santa Catarina, in the south – despite the drought affecting most of that state.

Isimar de Azevedo, with the Department of Meteorology at the Federal University of Rio de Janeiro (UFRJ), told IPS that two national institutes had warned about heavy rains as far back as January.

According to the experts, the unusually intense rains have been caused by two simultaneous climate phenomena: La Niña, characterised by an atypical cooling of the surface waters of the Pacific Ocean, and the formation of a low pressure belt on land in the equatorial region, known as the Intertropical Convergence Zone, when hot, humid winds bring cloud masses and cause heavier than normal rainfall, usually in March and April, in northeastern Brazil.

With the meteorological tools that are available today, small farmers in the north who have lost their subsistence corn and bean crops because of the rains could have planted earlier, for instance, in response to the weather forecasts, said Azevedo.

According to the meteorologist, periods of intense drought frequently alternate with periods of extreme rainfall in northwestern Brazil. “But instead of paying attention to official meteorological information, farmers prefer to follow their own experience,” he said.

“They planted at the time when they normally plant, but if they had used the information that was available, they would have planted a little earlier, so the rains did not hurt the flowering of the plants, which was what caused the greatest losses in agriculture in the north, because in that period of growth, crops need less water,” Azevedo explained.

Agribusiness interests, on the other hand, “which grow fruit, not cereals, were not hurt because they made use of the available information,” he noted.

But meteorologists failed to predict just how intense the rainfall would be. Although the weather reports forecast heavier than normal rainfall in the Amazon region, “we were surprised by the actual volume, which we did not expect,” said Azevedo.

Rainfall in the northwest has been more than 50 percent above normal. In Amazonas, the increase was between 30 and 40 percent, and in some spots was more than 100 percent above average, said the UFRJ expert.

Azevedo did not go so far as to attribute the heavy rains to climate change, but he did say that such heavy rains had not been seen in the northwest in 10 years.

Meteorologist Carlos Nobre at the National Institute on Space Research told the local press that although there have been intense drought and rainfall in the north before, “these phenomena are more intense than what we have seen in the past.”

What is happening, he said, is “characteristic of a planet that is heating up.”

Dionísio Neto with the Environmental Network of Piauí does not rule out the possibility that the uncontrolled spread of monoculture crops like soy has had an influence on the water level in the Paraíba river, which runs through Piauí and Maranhão.

“This is a reflection of the destruction of the ecosystem,” said Neto, referring to this year’s historic flooding.

Flooding in the north, drought down south

At the same time, Azevedo blamed the drought that is plaguing Rio Grande do Sul and parts of Santa Catarina – whose Atlantic coast area is receiving heavy rain – on “a response by the atmospheric system to the rains in the northeast and the northwest, a kind of compensation.”

Like Torres, Azevedo underscored the need for “maximum possible interaction between the concerned entities, like civil defence, the government, cabinet ministries and local authorities.”

“It is very interesting that the public places more and more trust in weather forecasts, that there is a growing perception that meteorological forecasts have improved,” he said.

“Maybe this is a good time for more information to be shared among the institutions responsible for civil defence and food production and the meteorology institutes, to prevent further damages,” he said.

A prolonged drought is affecting around one million people in southern Brazil, where 96 municipalities have declared a state of emergency due to the damages caused to soy, maize and beans crops, pastureland, and water supplies for human and animal consumption.

The Agriculture Ministry expects smaller than normal harvests of crops like wheat in the south, due mainly to the lack of rainfall.

The drought has delayed the planting of wheat in some regions of Santa Catarina and Rio Grande do Sul and in parts of Paraná, which could hurt the southern hemisphere winter harvest, said Agriculture Minister Reinhold Stephanes.

National wheat production in the last harvest was six million tons – the highest output since 2004. The official forecast for the 2008-2009 season is 5.5 million tons, which would be a nine percent drop.

Livestock have also sustained damages. The flooding and the continuous moving of animals back and forth in search of dry land and better pastures in the northeastern state of Ceará has caused losses of 50 percent there.

Productivity in the dairy industry is also down, with a 40 percent drop in milk production in some regions.

Another problem has been added to the drought and flooding: the arrival of the new H1N1 flu virus, popularly known as “swine flu”. Lula urged health authorities to redouble efforts to contain the spread of the H1N1 virus, of which there were eight confirmed cases in the southeast as of Tuesday.

Excerpt:

Scientists around the world are trying to decipher the influenza H1N1 virus in order to develop a vaccine, while others are tracking its origins to fight its spread more effectively.

Surgical masks have become part of the Mexican police uniform. Credit: Marcos Ferro Tarasiuk/IPS

Laboratory tests show that the virus strain initially believed to be swine-based is actually a subtype of influenza virus A that contains genetic material from swine, human and avian strains. It easily mutates and recombines, which is what makes it potentially so dangerous.

The microbiology laboratory at Canada’s Public Health Agency took a step forward in announcing May 6 that it had decoded the genetic sequence of three samples of the H1N1 virus collected in that country and in Mexico.

“This virus already existed. It has been mutating and will continue to mutate. My hypothesis is that we are faced with several subtypes of A/H1N1,” pulmonologist Fernando Cano, former director of Mexico’s National Institute of Respiratory Disease (INER), told Tierramérica.

There have been several documented cases of swine flu in humans, including a non-fatal contagion in 2007 that affected 12 people at a rural fair in the midwestern U.S. state of Ohio, said Cano, who is coordinator of the bioethics and clinical medicine faculty sponsored by UNESCO (United Nations Educational, Scientific and Cultural Organisation).

The people affected by that outbreak were tested and it was found that 60 percent had antibodies to fight that flu strain, added Cano, former director of the Autonomous National University of Mexico (UNAM) medical school. According to Cano, the Ohio virus is likely to be an ancestor of the current strain.

In a Tierramérica interview, Eduardo Sada, INER head of microbiology research, pointed to reports from 1957 and 1977 on swine flu in humans. “Undoubtedly the original virus and the current one circulated at a low volume for several years” until “something that we haven’t discovered yet” triggered the epidemic, he said.

To assert that this H1N1 subtype originated in Mexico at this point is just speculation, agreed Cano and Sada. The virus has now been detected in more than 20 countries.

The first confirmed case of the new virus was in the small, impoverished community of La Gloria, in the southeastern Mexican state of Veracruz. From mid-March to early April, a rare outbreak of flu affected 600 people in the town, located some 10 kilometres from a pig farm.

Medical samples from the sick individuals in La Gloria were sent to laboratories in the United States and Canada. One of them, from a five-year-old boy who presented symptoms on Apr. 1, contained the new virus, said a report released on Apr. 23.

The same report, from Canada’s National Microbiology Laboratory, in Winnipeg, confirmed that a woman who died of pneumonia on Apr. 13 in the southern Mexican state of Oaxaca, and who apparently had no contact with La Gloria, had also contracted the virus. But they weren’t the only early cases. In the city of San Diego, California, near the Mexican border, a boy fell ill on Mar. 30 with an “atypical” respiratory illness. A similar case occurred shortly afterwards, involving a girl in the nearby town of Imperial.

The U.S. Centres for Disease Control and Prevention (CDC), in the southeastern U.S. city of Atlanta, analysed samples from both cases and confirmed the presence of the new H1N1 virus.

In 1999, young people and pigs died of a strange virus in Malaysia. It was believed to be “Japanese encephalitis”, which is transmitted by mosquitoes that feed on both humans and pigs.

After several months of research and the slaughter of hundreds of pigs, the scientists discovered that the problem originated at a farm where some of the animals had eaten fruit remnants that had been contaminated by bats, which are asymptomatic carriers of the virus. Further, it was determined that transmission to humans occurred through pig saliva.

With that information, the authorities were able to stop the spread of the virus, which was dubbed Nipah, although they were not able to eradicate it.

Teams from the World Health Organisation (WHO) and researchers from several countries are trying to track down the origins of the new influenza, popularly known as “swine flu”. But they agree it will be difficult to determine where it originated.

Cano believes the deaths caused by the H1N1 virus, nearly all of which have occurred in Mexico, are related to delays in medical attention or inappropriate treatment, but does not rule out the possibility that the severe cases may have been caused by variants of this virus strain. “In any case, the new virus is generally not very lethal, and that is fortunate,” although it should not be forgotten that it could mutate and generate a severe pandemic in the future, he warned.

On Apr. 23, Mexico decreed a health emergency after confirming the presence of the new virus. On Apr. 24, the WHO also declared a public emergency. It then elevated its epidemiological alert from phase three to four, and later to five (out of six).

On May 4, Mexican authorities announced the stabilisation of the epidemic, calling for the gradual return to normal school and business activities, which had been largely paralysed since Apr. 23.

Every year, between 250,000 and 500,000 people around the globe die from the various strains of seasonal influenza that usually present during the colder times of year, says the WHO.

At first, the appearance of the H1N1 virus confused the scientific community, because the strain circulating mostly affected young adults. However, of the more than 1,000 cases confirmed in Mexico, nearly half were people 19 and younger.

Another issue to be clarified is why the people who died from the virus have nearly all been Mexican, and why some of the infected are able to recover without complications or pharmaceutical treatment, while others end up in the hospital.

For now, there are more questions than answers about the traits of the new virus, its origin and its mutation profile, after Canada confirmed that some pigs had contracted the virus from a sick farm worker.

Cano recommended that people continue to get vaccinations against seasonal flu, which even if it does not specifically target the new strain, does provide additional protection.

The H1N1 virus, which is spread in the same way as any other influenza virus, reacts well to antiviral medications if they are administered in a timely manner, though scientists fear new mutations could mean the pharmaceuticals will become less and less effective.

The first analysis by a multidisciplinary team from UNAM and the National Polytechnic Institute, set up to study the virus, confirmed that it has a great capacity to mutate, said microbiologist Antonio Lazcano, who considers it highly probable that there are different varieties of H1N1 circulating in Mexico alongside other flu viruses.

(*This story was originally published by Latin American newspapers that are part of the Tierramérica network. Tierramérica is a specialised news service produced by IPS with the backing of the United Nations Development Programme, United Nations Environment Programme and the World Bank.)

By Marwaan Macan-Markar
BANGKOK, May 11 2009 (IPS)

Researchers at a prestigious university hospital in Bangkok have been able to cut by 14 hours the time it takes to detect the lethal strain of the swine flu virus, which has infected thousands across the world.

It took the staff from the faculty of medicine at Chulalongkorn hospital’s centre of excellence in clinical virology just four hours to identify if a patient has the deadly strain of the H1N1 virus, down from 18 hours before, according to ‘The Nation,’ an English-language daily.

“The procedure has become much quicker because we received ribonucleic acid or the genetic material of the influenza prototype for analysis,” Yong Poovorawan, the head of the medical faulty, was quoted as having told the paper.

The news came on the eve of a meeting here of health ministers and senior public health officials of the 10-member Association of South-east Asian Nations (ASEAN) last week. ASEAN members include Brunei, Burma, Cambodia, Indonesia, Laos, Malaysia, Philippines, Singapore, Thailand and Vietnam. The latter were joined by health ministers and public health officials from China, Japan and South Korea to unveil a blueprint for action to respond to the swine flu outbreak that is threatening to evolve into a global pandemic.

Yet even as they drafted plans to protect their citizens, health officials admitted that they were grappling with many unknown factors surrounding this new strain of the H1N1 virus. Why, for instance, have younger people been infected – and died – in Mexico, the epicentre of the current outbreak swine flu?

According to the World Health Organisation (WHO), those sickened by H1N1 have been “generally younger people less than 50 years old, [which is] not typical of the seasonal influenza. [The] median age is 20, with males and females equally affected.”

“We have learnt by observation of the cases in North America that those affected were mostly young people; the elderly are not infected as much,” Supamit Chunsuttiwat, a specialist in preventive medicine at Thailand’s health ministry, told journalists. “But we don’t know why. Within weeks we will have a better explanation.”

What is known, however, is that the incubation period for this mysterious virus passed from human-to-human is “two to seven days,” he added.

The possibility of the new virus following the route of the 1918 ‘Spanish’ flu pandemic was mentioned during this week’s meeting of leading health officials. That virus, which killed over 50 million people worldwide, began as a mild outbreak in the spring of 1918 and returned as a more virulent second wave in the winter of that year.

“This is an issue of human security, this is an issue of solidarity, this is an issue of countries having to put up a common defence,” said Surin Pitsuwan, secretary general of ASEAN.

“We cannot let our guard down. A pandemic remains a formidable challenge to the region,” he warned. “A common defence through cooperation is the only way to deal with this threat.”

Part of that defence is to increase the antiviral drug stockpiles, share essential supplies, to help with technology transfer and tighten surveillance against the H1N1 flu virus.

For now, ASEAN has a stockpile of 500,000 courses of antiviral drugs in Singapore, and another 500,000 drugs distributed among its members.

In addition, the regional bloc has 750,000 personal protection kits ready to be sent when a “red alert” is declared, Surin disclosed.

But the health ministers of ASEAN expressed worry about the lack of access to life-saving vaccines, most of which are developed in the industrialised European nations and North America.

The final ministerial statement expressed concern “that most of the global vaccine production capacity is located in Europe and North America, and it is inadequate to respond to [a] global pandemic… Access to effective pandemic vaccines is a major problem in this region.”

That ASEAN is not leaving anything to chance stems from the impact and the lessons it learnt grappling with two other lethal illnesses that swept through the region in recent years. In 2003, Southeast and Northeast Asian countries grappled with the outbreak of severe acute respiratory syndrome (SARS), which killed 774 people out of the 8,000 who were infected in over 20 countries. The SARS outbreak began in Asia and then spread to Europe and the Americas.

Since the winter of 2004, the region has had to deal with the deadly avian influenza virus, H5N1, which began in Asia and then spread to other continents. It has killed 257 people out of a reported 421 cases, with Indonesia being the worst affected, where 115 people have died out of 141 infected.

ASEAN’s small antiviral stockpile, which was created in the wake of the H5N1 virus, will be insufficient if the lethal swine flu virus strikes the region. Yet there are no international guideline as to how much antiviral drugs each country should have in its preparedness plan.

According to the WHO, each country can create its antiviral stockpile based on its own situation and its capabilities. But if there is a full-fledged pandemic, the WHO estimates that between 25 percent and 45 percent of a country’s population could fall ill.

For now, the swine flu outbreak is far from reaching such a disturbing spread. The WHO has reported that there were 2,371 laboratory-confirmed cases of the H1N1 virus and 44 laboratory-confirmed deaths as of last week.

Outbreaks have been reported in 24 countries, with Mexico, which first went public about its swine flu patients and deaths, being the worst hit. It has recorded 1,112 cases and 42 deaths, according to the WHO.

Asia has only four cases of H1N1 on the WHO’s list, with three cases in South Korea and one in Hong Kong.

Excerpt:

By IPS Correspondents
MEXICO CITY, May 7 2009 (IPS)

The Mexican government is complaining about measures taken by other countries to protect themselves against possible contagion from the new H1N1 flu virus, which is widely seen as having originated in Mexico. But some Mexicans complain about stigma at home, as well as medical negligence.

Mexico has been loudly protesting the treatment received by Mexicans abroad since this country declared a health emergency on Apr. 23 because of the new influenza virus, popularly known as “swine flu”, of which there were 1,204 laboratory-confirmed cases in Mexico by Thursday, 44 of which were fatal, according to official figures.

Argentina, Cuba, China, Ecuador and Peru suspended all direct flights from Mexico, and several Mexican travelers have complained about the treatment they received in China and other countries.

But mistreatment has not only been received abroad. In towns near the Mexican capital, where most of the flu cases have been reported, stones have been thrown at cars with Mexico City licence plates.

Meanwhile, patients and their families have complained that they have been turned away from hospitals or have received inadequate, hostile treatment.

One such case would appear to be that of Blanca Esther Muñoz, 39, who reportedly died of influenza on Apr. 29 in the city of Tlaxcala, north of the capital, two days after giving birth to a premature baby. Although she felt sick before the birth, the doctors did not detect that she had the flu.

In their hometown of Papalotla, not far from Tlaxcala, Muñoz’s family complained that they have been shunned by their neighbours, and that they suffer discriminatory treatment when they visit the baby at the hospital.

According to her death certificate, Muñoz died of septic shock and pneumonia.

Her family members say the doctors never told them she had influenza, as health authorities now claim, and they say no one has checked the health of those who were by her side, holding her hand and kissing her.

The protocol for dealing with an epidemic includes identifying those who were in contact with the infected person, in order to prevent new outbreaks. This is especially crucial in the case of influenza, which spreads easily from person to person through breathing, coughing and sneezing.

The doctors say Muñoz’s baby daughter does not have the flu. She is in a special ward at the Tlaxcala Hospital of Gynecology and Obstetrics, because she requires special care, like any premature infant.

The baby is “a source of infection; I wish they would take her out of here,” a woman named Lilian, who did not want to give her last name, told IPS.

“Her mother died of influenza, so she’s a source of infection, right?” Lilian said by cell-phone from outside the hospital, to which her sister was admitted. “Influenza can be tricky; that’s why I think the baby should go to another hospital.”

A few kilometres to the south, at the Mexico City airport, the wife of President Felipe Calderón, Margarita Zavala, gave a hero’s welcome Wednesday to 136 Mexicans who returned on a government-chartered jet, after they were quarantined in hotels and hospitals in China even though they did not have any symptoms of the flu.

Fernando Cano, the secretary of the Institute of Respiratory Disease, a government body, told IPS that several of the influenza deaths in the last few weeks might be related to delays in receiving treatment or to substandard medical care.

Besides the 44 confirmed deaths caused by the H1N1 virus, 77 other people have died of similar symptoms in Mexico since late April. However, it is impossible to determine what killed them, because tissue and fluid samples were not taken before their bodies were buried or cremated.

Among the hundreds of Mexicans who have gone to hospitals fearing they had flu symptoms, there have been a number of complaints of poor treatment.

Four-year-old María Fernanda Meza died after her parents took her to two health centres in the capital.

Her parents say they took her in for treatment in a timely manner, but that she was sent home twice with anti-fever medication. One doctor even said she was feeling poorly because of a broken bone in her leg. The little girl died at home, of respiratory failure.

Gustavo Terán, 25, went to a Mexican Social Security Institute hospital with typical flu symptoms: fever, a runny nose, a very sore throat and general body ache. He was diagnosed with HIV, although it was later confirmed that he had the flu.

“They didn’t treat me for the flu because I didn’t have all the symptoms,” a woman who did not give her name told a local radio station. “I went to two hospitals and they sent me home with anti-viral medication. I’m ok now, but I never found out in the end whether I had influenza.”

There are those who blame the shortcomings in care given to some patients and some of the alleged medical errors on Mexico’s decentralised health care system.

Each of the 32 states in this country of 106 million people has its own health authorities that depend on the state governments.

Mexico accounts for 44 of the 46 confirmed deaths caused by the H1N1 virus, of which there are a total of 2,371 cases in 24 countries, according to the World Health Organisation (WHO).

The reason for that may be linked to “the negligence of some governors, who preferred not to report (cases) for their own reasons, thus delaying the necessary federal response,” said Luis Rubio, director of the Centro de Investigación para el Desarrollo (CIDAC – Development Research Centre), a non-profit think tank in Mexico City.

Excerpt:

By Gustavo Capdevila
GENEVA, May 5 2009 (IPS)

Poor countries facing the greatest threat from the spread of the H1N1 flu virus – popularly known as “swine flu” – will begin to receive shipments of Tamiflu, the World Health Organisation (WHO) announced.

The global health agency, which reported last week that it planned to provide poor nations with 2.4 million doses of the flu medicine, said Tuesday that it had dispatched Tamiflu from the United Arab Emirates, the United States and Switzerland.

So far, most of the cases of the new H1N1 flu have been reported in North America, although the epidemic is still in a “very early” stage, said acting WHO assistant director-general Keiji Fukuda.

“We have concerns about the infection traveling to the southern hemisphere, because that part of the world will be heading into the winter months, and the winter months are when influenza viruses usually thrive,” he told a news briefing in Geneva.

“If a deadly pandemic were to develop, there would be a desperate fight over limited supplies of anti-viral treatments and vaccines,” said Sangeeta Shashikant, a researcher with the Malaysia-based Third World Network, an independent non-profit international network of organisations involved in development issues.

In that fight, “developing countries will be at a vast disadvantage,” Shashikant told IPS, adding that “an urgent matter is the adoption of a framework establishing a fair and equitable global system for the sharing of the flu vaccines as well as anti-viral treatments.”

Developing countries, which face a broad range of public health challenges, don’t have the financial resources to purchase costly flu medicines and vaccines, she said.

Transnational pharmaceutical companies are offering anti-viral drugs like oseltamivir – patented under the Tamiflu brand name by Switzerland’s Roche – at 16 dollars per treatment.

“To treat millions, that cost is really quite high” for a poor country, said Shashikant, who works at the Third World Network offices in Geneva.

By contrast, generic anti-viral medicines produced in countries like Brazil, China and India can be purchased for 10 dollars per treatment.

None of these three countries are on the list of 72 nations to receive Tamiflu from the WHO.

But Mexico, the country hit hardest by the outbreak, is on the list, even though it is a member of the Organisation for Economic Cooperation and Development (OECD), known as the “rich nations’ club”.

The adoption of a distribution system will be discussed by WHO at its May 15-16 “intergovernmental meeting on pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits”.

The question of the sharing of flu viruses came to the forefront in 2003, when Asian countries hit by outbreaks of avian flu became embroiled in a controversy over the sharing of bird and human flu virus samples with drug companies.

At that time, Indonesia discovered that its viruses had been used to produce vaccines without its permission, and temporarily suspended sending flu samples to WHO collaborating centres, until an agreement on setting up a more equitable system was reached.

In the case of a swine flu vaccine, once it has been developed, the distribution system should recognise the principle of free access for developing countries, said Shashikant.

The reference to “other benefits” in the name of next week’s WHO meeting alludes to technology and the know-how on its appropriate use, said the expert.

Today, many of these scientific resources are protected by laboratories by means of patents and trade secrets, she added.

The incidence of the H1N1 flu virus is highest among adults under the age of 60. “The average age seems to be people in their mid-20s,” said Fukuda.

By Tuesday, there were a total of 1,490 laboratory-confirmed cases, including 822 in Mexico, where 29 deaths have been confirmed so far. There have also been two deaths in the United States.

Fukuda said it was not yet clear why there was a higher incidence among young people, and said that perhaps it was because younger people travelled more and were thus more exposed to the virus, or because older people had developed greater resistance than young people. “With influenza, oftentimes we see the infections go to younger people first and then go to older people later,” said the WHO expert.

But he clarified that males and females have been infected at the same rate, and said the viral samples taken in different regions are still very similar.

And the diarrhea suffered by some patients in Mexico was also a symptom seen in patients in the United States, Fukuda added.

He said that although a number of countries in Europe have reported cases, there is no evidence yet of community-level transmission of the virus there, and that in the two European countries with the largest number of cases – Britain and Spain – the virus was not apparently spreading beyond institutions like schools to the community at large.

“We don’t believe we are seeing community transmission in the same way we’re seeing it in the U.S. and Mexico,” he said, noting that most of the cases in Spain were travel-related, and that in Britain transmission was occurring in schools and related to travel.

That is an important aspect because the highest level on WHO’s six-phase influenza pandemic alert system is triggered by sustained community-level outbreaks in at least one other country in another WHO region, on top of the criteria for phase five (human-to-human spread of the virus in at least two countries in one WHO region), which have already been met.

A declaration of a phase six alert would indicate that a global pandemic was under way.

But, Fukuda added, “I don’t believe that all travel-related cases are related to travel just to Mexico.” He said WHO had learned of one such case related to travel to the United States, and stated that “If people are moving around, of course we will expect to see travel-related cases from different countries.”

He concluded, as other WHO officials have in the last few days, that “we don’t know how this will evolve.”

Excerpt:

By IPS Correspondents
BEIJING, May 5 2009 (IPS)

Rebuked in the past for its sluggish response and attempts to cover up the 2003 outbreak of severe acute respiratory syndrome (SARS), China’s measures to curb the spread of the swine flu virus are earning opposite marks of being extreme and "unjustified."

The country’s health authorities have been accused of discriminating against Mexican nationals by singling them out for forced isolation amid fears that the world’s most populous nation may be exposed to the spread of the flu. Beijing suspended flights with Mexico – the country hardest hit by the current outbreak of H1N1 flu – after health minister Chen Zhu warned the virus would very likely enter mainland China.

Beijing has now shifted into a defensive mode, attempting to stem the diplomatic row caused by its decision to quarantine more than 70 Mexicans across the country, even though many of them were not at risk for the virus.

Mexican Foreign Minister Patricia Espinosa has called China’s actions "unjustified" and has warned Mexicans against travelling to China.

China denied the charge and called on Mexico to "address the issue in an objective and calm manner." "The measures are not targeted at Mexican citizens and are not discriminatory. This is purely a question of health inspection and quarantine," said foreign ministry spokesman Ma Zhaoxu.

Chinese health experts have also hit back reminding the international public that in 2003 during the outbreak of SARS – which originated in southern China – some parties demanded a ban on all Chinese flights and a full quarantine.

"We have the right to ask of other countries what was once demanded of us," Zeng Guang, chief scientist of China Disease Prevention and Control Centre told the Southern Weekend newspaper.

Zeng argued Mexico had a responsibility to the global community to curb the spread of the virus by quarantining all infected people and those who had been in touch with them even if they did not exhibit any symptoms. "Each country where the virus spreads should react in this way," he said.

A 25-year-old Mexican man who is now ill with human swine flu in Hong Kong travelled via Shanghai aboard an AeroMexico flight from Mexico. Chinese health officials have been rounding up all passengers who travelled on that flight, but also all Mexican passport holders whether or not they had been in Mexico.

On the Internet, the public has rallied in support of the quarantine measures, according to media reports. A survey conducted by major Internet portal Sina.com showed that more than 92 percent of 4,263 online users thought the quarantine was a "necessary preventive method" and had nothing to do with discrimination, the China Daily reported.

After coming under criticism for trying to cover up the extent of its SARS epidemic and thus allowing it to spread around the world, China has been at pains to demonstrate new openness and preparedness to fight future outbreaks.

The 2003 SARS epidemic resulted in some 700 deaths worldwide, more than 300 of them inside China. Beijing was one of the hardest hit places, and the city was gripped by a sort of hysteria after its stunned residents realised the extent of the danger they had been living with while the cover up lasted.

The fresh strains of flu viruses that sweep the world every winter are frequently traced to China. Scientists suspect the strains develop easily in China because of its huge population where some communities live in close proximity to livestock.

The virus that caused the 1918 influenza epidemic and killed millions of people is said to have originated in China. So also were the dangerous "Asian flu" outbreaks in 1957 and 1968.

But China begrudges its reputation as a breeding place for killer viruses. The government has battled accusations that the current flu originated in China, rejecting as "groundless" reports that dead pigs found in Fuqin in the eastern province of Fujian were the source of the outbreak in Mexico. The Ministry of Agriculture said the pigs had died of swine dysentery and dropsy, which it said was common among young pigs.

Suggestions by the World Organisation for Animal Health that the new disease be labelled "North American influenza" in keeping with a long tradition of naming pandemics for the regions where they were first identified were met with obvious discomfort.

Then commentators in the official press universally greeted the World Health Organisation’s decision to refrain from using any geographical pointers and change the name of the current streak of virus from "swine flu" to the scientific H1N1.

"What is in a name?" asked an editorial in the Beijing Youth Daily. "Nothing less than a promise that all quarrels between countries are avoided and that they work together to fight the common threat," it said.

China was the first country to offer aid to flu-stricken Mexico, dispatching four million dollars worth of medical supplies and offering one million dollars in cash.

Photos of Mexican president Felipe Calderon receiving the Air China chartered flight with supplies in person last week featured prominently on the front pages of mainland newspapers.

Beijing announced that it had reached an agreement with Mexico to exchange chartered flights to repatriate nationals stranded by the flu outbreak to their respective countries.

With the diplomatic row seemingly resolved, the government is beginning to focus on winning the public relations battle at home. Despite assurances to the fact that pigs are not to be blamed for the epidemic, sales and consumption of pork in China – the world’s largest breeder and consumer of live pigs – have dropped dramatically.

Media reports have spoken of the "bursting of the pig bubble" while agricultural experts have expressed concern about the fortunes of thousands of pig farmers who have seen their income steeply reduced.

A survey by the China Times newspaper in several provinces where pig-breeding is regarded as a pillar industry found that prices of pork have dropped by about a quarter this year.

Beijing worries that steep declines in pork prices could add to deflationary pressures and impede the country’s economic recovery. Two years ago, China experienced the opposite: the spread of blue ear disease among live pigs reduced the country’s reserves of pork, prices surged and led to a new round of food-driven inflation.

Excerpt:

By Emilio Godoy
MEXICO CITY, Apr 30 2009 (IPS)

Esther de Anda has stopped eating pork since the appearance of swine flu in Mexico. “They say there’s no problem in eating it, but for now I prefer fish or chicken,” the homemaker told IPS.

Her response was typical of many consumers in Mexico, where the pork industry has come under scrutiny since the outbreak of the flu epidemic on Apr. 24, which so far has officially infected 97 people and killed seven in Mexico, although some 1,300 patients are under observation.

Mexico’s Secretary of Agriculture Alberto Cárdenas gave assurances that consumers can safely eat pork, which does not transmit the virus.

Nevertheless, China, Ukraine, Russia and other countries have banned imports of pork from Mexico and parts of the United States – where 109 cases of swine flu, most of them mild, have been confirmed.

The World Health Organisation (WHO) raised its pandemic alert level to phase 5, the second-highest level, on Wednesday.

The total worldwide cases of swine flu had climbed to 257 in 11 countries by Thursday, according to WHO.

Veratect Corporation, a two-year-old U.S. company that monitors disease outbreaks worldwide, claims it identified the first case of the new virus on Mar. 30 in the municipality of Perote, in the southeastern Mexican state of Veracruz, 800 km from the Mexican capital.

The Seattle, Washington-based company says it reported the cases to the World Health Organisation (WHO), the U.S. Centres for Disease Control and Prevention (CDCs) and the International Federation of the Red Cross (IFRC) in early April.

A pig factory farm run by Granjas Carroll, a subsidiary of the U.S.-based Smithfield Foods – the world’s largest pork producer and processor – operates near the Perote village of La Gloria.

Mexico’s health ministry confirmed Wednesday that the first case in Mexico of swine flu – which is a new mix of pig, bird, and human viruses – occurred in Perote, although the first person to die of the disease in this country was an employee of a national tax office on Apr. 12 in the southern state of Oaxaca.

Researchers and activists point to intensive pig farming as a perfect breeding-ground for new viruses.

Silvia Ribeiro, a researcher with the Canada-based Action Group on Erosion, Technology and Concentration (ETC Group), says the roots of the current epidemic lie in the pig farming industry dominated by transnational corporations.

The industry rejects such allegations. Alejandro Ramírez, assistant director of the Confederation of Mexican Hog Farmers, denied that pigs were the cause of the epidemic.

He also said that although pork does not transmit the virus, consumption of pork in Mexico has fallen 80 percent. Annual per capita consumption of pork in this country is approximately 13 kgs.

“This is a critical situation, and we are seeking solutions,” he told IPS. “We need to decide what to do with the meat that is not being sold.”

After a Jun. 30, 2007 inspection of Granjas Carroll, the federal environmental protection agency, PROFEPA, reported that the company – the largest pork producer in the country – had committed irregularities in waste disposal that posed a threat to the soil, air, water and underground water sources.

PROFEPA set a Jun. 30, 2009 deadline for the factory farm to bring its operations up to the country’s environmental standards, in order to obtain the environment ministry’s “clean industry certificate.”

Some 6,000 pork producers with 14 million hogs produce more than one million tons a month of pork in Mexico.

Hog farmers in Mexico and the United States pressed for the name of the disease to be changed.

On Thursday, WHO spokesman Dick Thompson said the agency would stop using the term “swine flu,” in order to prevent confusion over the danger posed by pigs. Instead, he said, it would “stick with the technical scientific name H1N1 influenza A.”

In a preliminary analysis of the new virus, researchers found that it arose from North American swine flu strains first identified in 1998 at a hog factory farm in the U.S. state of North Carolina, where a similar new human-pig hybrid virus had killed hundreds of animals.

In a report based on a 2.5 year investigation, which was released in April 2008, the U.S.-based Pew Commission on Industrial Farm Animal Production concluded that industrialised animal agriculture posed “unacceptable” public health risks, as well as threats to the environment.

“Due to the large numbers of animals housed in close quarters in typical (industrial farm animal production) facilities, there are many opportunities for animals to be infected by several strains of pathogens, leading to increased chance for a strain to emerge that can infect and spread in humans,” warns the report “Putting Meat on The Table: Industrial Farm Animal Production in America”.

The independent commission, whose 15 members came from the fields of veterinary medicine, agriculture, public health, business, government, rural advocacy and animal welfare, was set up in 2005 to study the impacts of the drastic changes in animal agriculture in the United States over the past 40 years.

The report emphasised the danger that “the continual cycling of viruses…in large herds or flocks (will) increase opportunities for the generation of novel virus through mutation or recombinant events that could result in more efficient human-to-human transmission.”

In 1965, there were 53 million hogs on more than one million farms in the United States, compared to 65 million animals in just 65,000 facilities today, half of which have more than 5,000 hogs.

A United Nations Food and Agriculture Organisation (FAO) mission headed by Animal Health Officer Moisés Vargas is currently in Mexico to study the role that pigs have played in the current epidemic.

“There is nothing to check, because the (pig) farms operate according to health standards and measures,” said the Confederation of Mexican Hog Farmers’ Ramírez. “The best solution is to start consuming pork again.”

The Egyptian government decided Wednesday to have the 300,000 pigs in the country slaughtered to prevent the spread of swine flu.

But the Paris-based World Organisation for Animal Health (OIE) released a statement Thursday advising ” members that the culling of pigs will not help to guard against public or animal health risks presented by this novel A/H1N1 influenza virus and such action is inappropriate.”

Acting WHO assistant director-general Keiji Fukuda said Thursday that “Good disease surveillance is now required in countries in the southern hemisphere, which is coming into its winter season when seasonal influenza tends to peak.

“It is possible that we will see outbreaks of the H1N1 virus occurring more frequently in the southern hemisphere than in the northern hemisphere. This is something we have to be on the watch out very carefully for,” he said.

Besides Mexico and the United States, cases of swine flu have been confirmed in Austria (1), Britain (8), Canada (19), Germany (3), Israel (2), the Netherlands (1), New Zealand (3), Spain (13) and Switzerland (1).

WHO continues to advise no restriction of regular travel or closure of borders.

Excerpt:

By IPS Correspondents
MEXICO CITY, Apr 28 2009 (IPS)

The swine flu epidemic has dealt a new blow to the Mexican economy, already weakened by the global recession, hitting small and large companies alike.

But there are also a few winners: pharmaceutical laboratories, pharmacies, doctors and private medical clinics, as well as the home entertainment industry.

Projections issued prior to the outbreak of the epidemic last week indicated that Mexico’s GDP would shrink this year – by 3.7 percent, according to the International Monetary Fund (IMF) and by 2.8 percent according to the government.

But the epidemic will increase the fall by between 0.5 and 1.5 percent, observers say.

The longer the health emergency lasts, the greater the impact on the economy will be, economist Ángel Vega, a business consultant, told IPS.

The new flu strain that began to draw attention in Mexico last week has so far claimed 152 lives out of a total of around 2000 cases of people showing typical flu symptoms: high fever, joint paint and runny noses.

The epidemic has spread to several countries around the world, especially the United States, which has reported 64 cases so far. Confirmed and suspected cases have also been reported in Canada, Costa Rica, France, Israel, New Zealand, South Korea, and Spain.

On Tuesday, World Health Organisation (WHO) spokesman Gregory Hartl said that "If we have a confirmation (of human-to-human transmission of the virus) from the United States or Canada, we could move to phase 5."

On Monday, the WHO raised the alert from phase 3 (sporadic cases of animal or human-animal influenza virus) to phase 4 (sustained human-to-human transmission).

Phase 5 involves sustained human-to-human transmission and community-level outbreaks in two or more countries in one region. It also reflects a strong signal that a pandemic is imminent

The new strain of influenza is a combination of swine, avian, and human viruses that experts say may have originated in a pig before jumping to humans.

And although scientists have given assurances that the consumption of pork poses no risks, China banned imports of pigs and pork products from Mexico on Monday, and several other countries have followed suit, or are considering doing so.

In addition, tourism, one of Mexico’s main sources of revenue, after oil exports, has begun to feel the impact, with thousands of foreigners cancelling flights and tours to this country.

"Mexico may begin to face trade restrictions and a perception abroad that business should be done carefully in this country, or should be reconsidered," said Vega.

Ramiro Tovar, director of economic studies and economic regulation at the Autonomous Technological Institute of Mexico, told the local press that to judge by what happened five years ago in the case of bird flu in Asia, the impact of the new epidemic could mean an additional 1.5 percent contraction in GDP in Mexico.

"This reduction would not be the result of a one or two week suspension of activities" in Greater Mexico City, but of the effect that the epidemic will have on the behaviour of consumers and investors throughout the year, he said.

In the last two days, the stock and exchange markets in Mexico have reflected the negative impact that the epidemic could have, if it continues to grow.

After the health emergency was declared in Mexico on Apr. 23, the government of President Felipe Calderón ordered the closure of cinemas, theatres, stadiums, museums, schools and universities, to prevent people from gathering in crowds.

After that, shopping centres, bars, discotheques and restaurants began to shut their doors.

As of Tuesday, all restaurants in the capital were expressly banned from serving customers, although they can provide home delivery.

The ban is the "coup de grace" for restaurants in the capital, which have already been suffering the effects of the global crisis, Francisco Mijares, president of the National Chamber of the Food and Restaurant Industry (CANIRAC), said Tuesday.

The city government measure left 450,000 workers from around 35,000 restaurants – 95 percent of which are considered small or micro-businesses – temporarily out of work.

Street food stands have also felt the impact. Four different street vendors in the upscale Mexico City neighbourhood of Polanco complained to IPS, saying their sales had plunged by more than 50 percent in the past two days.

Many regular customers of the food stands have not been going to work, while others are being especially careful about what they eat, afraid of getting sick.

Corporations like Coca Cola, Procter & Gamble, Volvo, Monsanto, Johnson & Johnson and Philip Morris, some of which have offices in Polanco, instructed many of their executive level staff to work from home.

Other employees received permission to stay home to take care of their children, since all schools are closed.

By contrast with the blows received by many sectors of the economy, pharmacies around the country have done brisk business selling surgical-style face masks – the use of which has been recommended by health authorities – vitamins, anti-flu medication and disinfectants.

Pharmacies and their suppliers have reported higher-than-average earnings.

The high demand for face masks, which most businesses have run out of, has led some street vendors to start selling them at prices up to four times what they fetch on the formal market.

Also benefiting are doctors and private clinics, which have been overrun with people worried that they have flu symptoms.

Many people continue to turn to the private health sector even though public health centres have been instructed by the government to treat any person with influenza symptoms for free. The order also applies to clinics and hospitals that usually treat only members of the military or the social security system.

Higher-than-usual profits have also been reported by video and DVD rental stores, as more than 33 million students have found themselves without classes, and the government has recommended that people stay home as much as possible.

Some private schools sent emails to parents with homework instructions for their children.

Universities, meanwhile, urged their students to do projects and papers, according to instructions they will receive by means of public communiqués.

"The situation in Mexico because of the epidemic is unprecedented, in fact I would say the world is facing an unprecedented situation, and you don’t have to be an expert to predict that our country will have economic problems as a result," said Vega.

Finance Minister Agustín Carstens said Monday that the epidemic would have an impact on the economy, but not a permanent one, to judge by similar experiences in China, Canada and Hong Kong.

Carstens said the hardest-hit sectors would be theatres, cinemas, discotheques, hotels and restaurants. But he added that it is too early to gauge the extent of the impact on the Mexican economy.

Excerpt:

By Marwaan Macan-Markar
BANGKOK, Apr 28 2009 (IPS)

When the World Health Organisation (WHO) raised the influenza pandemic alert from phase three to an ominous phase four warning this week, it went beyond the alarm associated with the killer avian influenza virus in Asia.

The global health body’s warning came as the outbreak of a lethal strain of swine flu has killed more than 150 people in Mexico – the epicentre of the virus – and has also been detected in parts of the United States, Canada, Europe, the Middle East and Asia.

The WHO warning for a possible global pandemic emerging from avian influenza always remained a “phase three alert,” says Peter Cordingley, spokesman for the WHO’s Western Pacific division. “The difference now is that we have raised the pandemic alert to phase four.”

“This is WHO’s way of saying [the lethal virus] has edged close to a pandemic situation,” he added during a telephone interview from Manila, where the WHO’s regional office is based. “It can spread internationally.”

A phase four alarm is often sounded when there are reports of “community- level outbreaks,” which has been the case with the recent strain of the H1N1 strain of the swine flu virus, but not so with the cases of human-to-human transmission of the H5N1 strain of bird flu virus across Asia.

According to the WHO, a phase five alert is sounded when there is human-to- human transmission of a deadly virus “into at least two countries in WHO region.” And the final phase six alert is declared when the virus enters the “pandemic phase,” where community level outbreaks are detected in “at least one other country in a different WHO region in addition to the criteria defined in phase five.”

It was fear of the avian influenza virus mutating and re-assorting itself with other viruses and emerging as a global pandemic that promoted the WHO to first sound the alarm in early 2004 that the world was on the brink of a public health crisis. At the time, grim pictures were painted, including mention of the 1918 “Spanish” flu pandemic that killed over 50 million people across the world.

But when and where such a lethal virus would emerge remained elusive.

“The current situation was, at least technically, what we were worried about at the height of the avian influenza scare,” says Cordingley. “It was a situation we were always worried about: the virus going through pigs – the mixing vessel – and emerging as a new virus, infecting humans.”

Such a scenario is behind the current lethal virus that is spreading between humans. “There has been a re-assortment of genes from poultry, swine and human virus strains,” says Subhash Morzaria, regional manager of the Bangkok-based emergency centre for trans-boundary animal diseases at the Food and Agriculture Organisation (FAO). “It has been confirmed that human and poultry viruses infected swine and got mixed.”

“This combination is not rare. Re-assortment of viruses in swine is frequent,” he told IPS. “But the re-assortment of the virus we have now is new; we have not seen this before.”

Worries that the new virus is more potent than the bird flu virus are not out of place. In the over six years since the H5N1 strain emerged in Asia and then spread to other corners of the world, there have been 257 reported deaths out of 421 cases. The worst affected country has been Indonesia, where 115 people have died out of the 141 infected.

Even the 2003 outbreak of severe acute respiratory syndrome, or SARS, which prompted concern in the region, did not trigger a pandemic alarm with the speed that the H1N1 virus has. SARS spread to humans from animals and was associated with flu-like symptoms, such as high fever, headaches and respiratory problems.

By the time it was contained, SARS had killed 774 people out of the 8,000 who had been infected in over 20 countries in Asia, Europe and the Americas.

Yet as Asian countries take preventive measures to respond to the latest threat of a global pandemic, the region’s experience – having combated SARS and contained bird flu – sees it at a better level of readiness. The Association of South-east Asian Nations (ASEAN), a 10-member regional bloc, reflects this confidence.

“ASEAN member states are better prepared now following the experience from recent SARS and avian-influenza outbreaks,” states the regional grouping, which includes Brunei, Burma, Cambodia, Indonesia, Laos, Malaysia, Philippines, Singapore, Thailand and Vietnam. “ASEAN has the existing mechanisms and networks for strengthening preparedness and response to a possible pandemic.”

Such resources include “500,000 courses of antivirals stockpiled in Singapore, while 500,000 more courses have already been distributed,” reports ‘The Nation’, an English-language daily in Thailand. There is equipment that “is readily available for ASEAN countries for rapid response and containment of outbreaks that may occur in the region.”

The picture is also true for most of Asia, confirms the WHO’s Cordingley. “Each country has committed resources to strengthen their health systems. Doctors and nurses have been trained and hospitals have been improved.”

“The health systems in Asia are vastly different than in 2003, when SARS struck,” he added. “Now they will have to monitor the virus. We don’t know what this virus will do.”

Excerpt:

By IPS Correspondents
MEXICO CITY, Apr 27 2009 (IPS)

The deadly new influenza strain that originated in Mexico has led to the closure of schools, universities, museums, libraries, cinemas, theatres and churches here, while it continues to spread to other countries.

So far there is insufficient data to predict when the outbreak will ease or whether the measures adopted to fight its spread will be effective, experts say.

By Monday, four days after a health emergency was declared in Mexico, the number of people killed by the virus had climbed to 149, out of a total of around 2,600 cases, mainly in the capital.

The government of President Felipe Calderón expanded the closure of schools, which was only in effect in the capital and the states of Mexico and San Luis Potosí, to the entire country.

If the disease does not stop spreading, Mexico will close its borders, Health Minister José Córdova warned.

On the streets of Mexico City, the use of surgical face masks is becoming widespread, after news and alerts about the swine flu epidemic multiplied over the weekend. On the bus taken by IPS on Monday, most people were wearing masks, which were handed out for free by government employees at different points around the city.

“This is like a bad movie; God willing it will end soon,” said Marisol Menéndez, an office worker riding the bus.

“They should give us the day off; our kids are not in school and are home alone,” said her friend Margarita Ortiz.

The Mexican capital, a city of 20 million, was unusually quiet on Monday. Many restaurants were closed, and some offices were working at half-steam, in line with instructions from the Labour Ministry, which asked bosses and owners to be lax with regard to absenteeism, especially for workers who may have flu symptoms or who have to stay home to take care of their children.

The World Health Organisation (WHO) reported that the epidemic that broke out in Mexico is a new subtype of swine influenza A/H1N1 “not previously detected in swine or humans,” with characteristics of avian and human flu viruses.

The WHO Emergency Committee meeting in Belgium reported Monday that it had raised its pandemic alert level from phase 3 (low risk of a pandemic) to phase 4 (person-to-person transmission in a limited geographical area), on a scale of 6.

The 15-member committee had planned to meet on Tuesday, but after the first case of swine flu was reported in Spain, it moved the meeting forward to Monday.

WHO spokesman Gregory Hartl said in Brussels that “it is a rapidly evolving situation,” and WHO Director General Margaret Chan said it has “pandemic potential”.

The countries affected by the virus – but without any fatal cases – include the United States, with 40 confirmed cases, Canada with six cases and Brazil and Spain with one each. Suspected cases are also being tested in Colombia, France, Israel, Italy and the United Kingdom.

A number of countries are on the alert and are following disease prevention protocols.

It is too early to know whether the disease is still on an upward spiral, Dr. Mario Castellas, an infectious disease specialist at a private hospital in the capital, told IPS. He said two or more incubation periods (five to seven days in this case) are needed before any projections can be made.

“It’ll take time, around five or six more days, to know if we have managed to curb the epidemic at least in Mexico,” said Castellas.

Local health authorities say the new virus is not fatal if the patient receives treatment promptly, within 24 to 48 hours of the appearance of the first symptoms

Despite that clarification, rumours are spreading in Mexico City that the flu kills within five hours of infection.

Radio and TV stations are repeatedly broadcasting government messages urging people not to shake hands or greet each other with a kiss, and to wear face masks, seek medical treatment at the first sign of symptoms, and stay away from crowded places.

A 2008 Health Ministry report on Mexico’s response to a flu pandemic warned that the conditions were in place for a pandemic to occur at any time.

The report was drawn up to prepare the country for the hypothetical scenario of an influenza pandemic, but with the avian flu epidemic in mind.

The study says that in a moderate scenario, 15 percent of the population would fall sick and the outbreak would have a cost equivalent to 0.5 percent of GDP; in a moderately severe scenario, 25 percent of the population would be infected, at a cost of one percent of GDP; and in a severe scenario, 35 percent of the population would catch the disease, with an economic impact of 3.7 percent of GDP.

The origin of the new strain of swine flu is still unknown. Spokespersons for Veratect Corporation, a U.S. company that monitors disease outbreaks worldwide, told the Mexican newspaper Reforma that it was the first to detect the current outbreak, identifying the first case on Mar. 30 at a pig factory farm in a rural area near the town of Perote in the Gulf of Mexico state of Veracruz.

According to the source, the factory farm is owned by Granjas Carroll, a subsidiary of Smithfield Foods.

But company spokeswoman Jazmín Jiménez told IPS by telephone that the report was “totally false.”

“We have 970 employees, and not one of them, and none of their family members, have the flu or anything like it,” she told IPS.

Cases of respiratory infections, “but not the flu,” occurred in late March in La Gloria, a neighbourhood located eight km from the factory farms, but they were due to a lack of sanitation and clean water in the area “according to what the health authorities told us,” said the spokeswoman.

“There is nothing strange here, and we haven’t heard of anyone who is sick,” Irene Argüello, who works in a construction materials store in Perote, told IPS by phone. “I don’t know why they are saying the disease started here; we would be in a state of emergency if that were true.”

Health Minister Córdova said the virus may have emerged somewhere in Europe or Asia, “given that part of its genome matches the common pig,” before it mutated and transferred to humans.

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By Marwaan Macan-Markar
BANGKOK, Jan 20 2009 (IPS)

Thailand’s plans to contain the spread of the deadly avian influenza virus must involve the tens of thousands of Burmese migrant workers employed in this country’s poultry industry, say experts.

‘’They form the frontline of Thailand’s defence against the spread of bird flu,’’ Jasper Gross, research officer for the International Union of Food, Agricultural, Hotel, Restaurant, Catering, Tobacco and Allied Workers’ Associations (IUF), told IPS. ‘’The industry has to protect these migrant workers, give them proper information, equipment and provide a reporting mechanism.’’

The call for such a programme comes in the wake of the International Labour Organisation (ILO) attempting to drum up attention to help poultry workers and farmers in small and medium-sized chicken farms across South-east Asia. The Geneva-based body is pushing for workers to take on a greater role in detecting and stopping the spread of the deadly H5N1 virus.

‘’If these workers are properly trained, they can help reduce risk of avian influenza spreading,’’ says Tsuyoshi Kawakami, senior specialist on occupational health and safety at the ILO’s regional office in Bangkok. ‘’Workers have expressed some anxiety about how they will be affected. Slaughterhouse workers, meat-processing workers are worried.’’

‘’We cannot discriminate against migrant workers,’’ he told IPS on the sidelines of a meeting held here to share progress of the ILO’s work in Thailand since 2007 and at raising awareness on responding to avian influenza (AI) in the workplace and a possible human pandemic.

Labour rights activists reveal that the information available for Burmese migrant workers to cope with and respond to bird flu is limited to some material produced in Burma. What is missing, they say, are translations of information with Thai-specific situations that are available to Thai workers who handle poultry in the industry.

Currently, migrant workers from Burma make up the largest chunk of the estimated 100,000 people employed in factories across central Thailand and in areas around the capital Bangkok. The Burmese workers, along with those from Cambodia, account for up to 80 percent of the labour force in commercial food factories.

In some of the smaller factories, a few hundred Burmese workers dot the assembly line, performing monotonous tasks such as handling freshly killed chicken. In the larger ones, up to 8,000 workers may make up the labour force.

Thailand’s poultry sector is steadily regaining its health after taking a beating following the current outbreak of the deadly H5N1 virus, which began in January 2004, affecting many countries in South-east Asia.

Before the current outbreak, the country was exporting 500,000 tonnes of cooked and raw chicken, earning 1.2 million U.S. dollars annually. The outbreak of avian influenza (AI), which resulted in millions of chickens culled and dying due to the virus, saw exports plummet to 27,000 tonnes.

Presently the Thai industry exports 400,000 tonnes of cooked chicken, accounting for one percent of the gross domestic product, according to the department of livestock development.

Burmese migrants working in the poultry sector are among the nearly two million registered and unregistered migrant workers from Burma, Laos and Cambodia who work in Thailand. They labour in the food processing industry, in the agriculture, garments and construction sectors and are also employed as domestic workers.

Set against this lapse, however, is Thailand’s impressive record in containing the spread of the deadly virus through a range of public and private-sector initiatives. Consequently, the country has not recorded human cases over the past two years. Between January 2004 and August 2006 there were 25 reported human cases of AI, resulting in 17 deaths.

An army of village health volunteers – now running into 800,000 people – has been a key factor in the country’s containment drive.

‘’We have established a rapid disease reporting system using health volunteers and the 1,030-strong surveillance and rapid response teams,’’ says Darika Kingnate, deputy director of the emerging infectious disease control department at the public health ministry.

Such efforts are being praised by the U.N. arm created in response to the poultry virus that is threatening to become a pandemic, by acquiring the capability of being passed among humans, which could result in the deaths of millions of people across the globe.

‘’Thailand is the only country in the Asia-Pacific region that has preventive activity in all its 76 provinces,’’ says Koji Nabe, avian and human influenza regional officer of the United Nations Systems Influenza Coordinator.

‘’Actions have to take place at local levels. We cannot expect help from outside if a pandemic happens,’’ he adds. ‘’Individuals should know how to take care of themselves.’’

Thailand’s regional neighbour Vietnam has also benefited from a network of community groups to deal with the spread of the H5N1 virus, largely spread by ducks, in the Mekong Delta. Vietnam, which has recorded 52 human fatalities of 108 confirmed cases, had to deal with 34 reports of AI in poultry last year.

‘’We succeeded in eliminating the spread of avian influenza through awareness campaigns involving farmers in the Delta who are largely poor,’’ Hanh Tran Thi, head of research at the Can Tho Medical College, told IPS. ‘’We used the Self-control Groups in each village in the Delta to get this message out.’’

The ILO’s drive to target poultry workers in the region comes at a time when countries from China to India are grappling with more reported cases of bird flu. The worst affected country in the region is Indonesia, which accounts for 113 fatalities of the 247 people who have died from AI since the beginning of 2004.

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By Marwaan Macan-Markar
BANGKOK, Dec 20 2008 (IPS)

New cases of avian influenza across Asia in recent weeks confirm warnings that the deadly virus still lurks in the region and raise questions of gaps in efforts to contain it in affected communities.

For now, the only comfort is the speed at which the cases are being reported for local authorities to respond, say experts. Tightening of the information flow from farms and chicken coops to veterinary officials was part of the programme implemented in the region since there was a major outbreak of bird flu in the winter of 2003.

Hong Kong is grappling with an outbreak of the H5N1 virus that struck chickens last week. The infected poultry, kept in a farm equipped with modern biosecurity measures, resulted in the culling of close to 80,000 chickens in nearby farms and even at a large market known for its wholesale trade of the birds.

Chinese authorities also confirmed this week that the virus has been reported in the eastern province of Jiangsu, resulting in the culling of over 350,000 chickens. In addition, local authorities have increased vaccinating poultry in local farms, state media reports.

Cambodia has turned its attention to infected chickens and ducks in an area south of Phnom Penh, the capital. Authorities have ordered poultry to be slaughtered in the infected smallholder farms, in addition to imposing a 30-day ban on the selling and transport of poultry to the Kandal province.

Cambodian authorities confirmed that a 19-year-old man from Kandal has tested positive for the deadly H5N1 strain of the virus, the local media reported. He is the first person reported to have contracted the virus and the eighth Cambodian diagnosed with avian influenza since it struck one of South-east Asia’s poorest countries.

Last week, authorities in India’s West Bengal state announced the sealing of large sections of its border with Bangladesh after tests confirmed a new outbreak in Malda district, through which ducks and chickens are regularly smuggled in.

Outbreaks were reported, last month, from two other Indian states that shares borders with Bangladesh – Assam and Meghalaya.

Although no recent outbreaks have been reported from Bangladesh, that impoverished country was the victim of a major epidemic in 2007 when millions of birds were culled.

‘’Our analysis shows that this season is when we will get cases of avian influenza,’’ says Subash Morzaria, regional manger of the Bangkok-based emergency centre for trans-boundary animal diseases at the Food and Agriculture Organisation (FAO). ‘’Countries have to be prepared for bird flu outbreaks during the winter season.’’

The latest outbreaks follow a pattern that began in 2003 are still linked to causes that were singled out five years ago. ‘’The main reasons are still because of poor bio-security and the movement of birds due to trade,’’ Morzaria told IPS. ‘’Bio-security is still not adequate in some communities despite the high awareness for its need.’’

Such measures seek to keep poultry in a confined environment to limit contact with wild birds. Bigger farms have implemented bio-security measures on an industrial scale, where workers have to be sprayed with disinfectant and must also shower, shampoo and wear protective clothing before going into the long, low-rise sheds covered with black fabric where the poultry are raised.

Yet even such controlled environments failed to prevent the recent outbreaks in Hong Kong. It has also raised concerns about the vaccines being used to inoculate poultry from the H5N1 virus.

‘’The vaccine failure is something that they are investigating in Hong Kong,’’ says FAO’s Morzaria. ‘’Vaccines are a very important control option if delivered properly and at the right time.’’

The U.N. food agency sees better success in its awareness campaigns aimed at getting rural and urban communities to raise the alarm and secure prompt responses when there is an outbreak. ‘’We are getting more reports than before, and they are reporting it fairly early,’’ says Morzaria. ‘’The training at grassroots levels has contributed to this change.’’

The success of the international efforts to contain avian influenza is reflected in the number of countries that have managed to eliminate it, stated a global study released in October. ‘’The success of the control efforts (has been) reflected in the fact that 50 of the 63 countries affected by the virus have managed to eliminate it.’’

That is an improvement from December 2005, when an assessment was made at a major international meeting held in Beijing, added the global study, published by the World Bank, the FAO and the World Health Organisation (WHO), among other agencies. ‘’It was recognised that the world was unprepared for the rapid spread of the virus.’’

‘’H5N1 has already cost over 20 billion US dollars in economic losses,’’ the study revealed of the virus that began in China in the winter of 2003 and spread across South-east Asia and thereafter to Europe and Africa.

According to the WHO, 247 people have died from this strain of the virus out of 391 people infected since 2003. Indonesia tops the list of fatalities, with 113 deaths out of 139 confirmed cases, followed by Vietnam, with 52 deaths out of 106 confirmed cases.

Public health and animal health experts have been monitoring the virus to study signs of mutation, given concerns that if H5N1 acquires the capability to be passed between humans, it could result in a global pandemic, killing close to 180 million, according to some estimates.

Such projections are based on the 1918 Spanish Flu, which claimed 50 million human lives after a bird flu strain crossed over into the human population.

Indonesia’s lead has become central in the global efforts. Jakarta announced this week that intensive measures to curb the H5N1 virus between 2009 and 2011 will lay the foundation for the set goal of eradicating the virus by 2014.

‘’If all goes well, the nation will be free of the highly pathogenic bird flu virus by 2014,’’ Tjeppy D. Soedjana, a ranking official at Indonesia’s agriculture ministry, was quoted as having told the ‘Jakarta Post’ newspaper.

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By IPS Correspondents
WASHINGTON, Oct 17 2008 (IPS)

A severe outbreak of flu could kill tens of millions of people and spur a “major global recession”, the World Bank is warning world leaders preoccupied with financial, food, and fuel crises.

The bank has drawn up a worst-case scenario in which a flu pandemic could kill as many as 71 million people, cost some three trillion dollars, and cut global gross domestic product (GDP) by “almost 5 percent, constituting a major global recession.”

Some experts have said the death toll could exceed 180 million people.

The threat of a pandemic stems from the H5N1 bird flu virus, which surfaced in 2003, is entrenched in parts of Asia and Africa, and has killed hundreds of people while causing billions of dollars in losses. This is nothing compared to the massive outbreak among humans that would follow the emergence of a new strain of influenza to which almost no one would have natural immunity, experts say.

Similar events have already unfolded: The Spanish Flu of 1918, which may have killed some 50 million people, is thought to have begun when another strain of bird flu crossed over into the human population.

“Because such a pandemic would spread very quickly, substantial efforts need to be put into place to develop effective strategies and contingency plans that could be enacted at short notice,” says the bank.

In June 2006, the agency anticipated costs of 3.1 percent of global GDP or about two trillion dollars. Its more calamitous assessment, completed in recent weeks, comes ahead of international talks to be held in Egypt next week.

Poorer nations face the greatest risk.

“Generally speaking, developing countries would be hardest hit, because higher population densities and poverty accentuate the economic impacts,” bank economists Andrew Burns, Dominique van der Mensbrugghe, and Hans Timmer write in the latest estimate.

In their current estimation, a “mild” pandemic, like the Hong Kong Flu of 1968, could kill some 1.4 million people and cut global GDP by 0.7 percent in the first year. A “moderate” pandemic, similar to the Asian Flu of 1957, could claim 14.2 million lives and cut global economic output by 2 percent in the first year. The “severe” worst case, in which 71 million or more could die, would slash global GDP by 4.8 percent.

Some of the loss would result from deaths and infections, which could affect 35 percent of the population and would prompt absences from work. However, says the bank, ”people’s efforts to avoid infection are five times more important than mortality and more than twice as important as illness.”

Most of the cost would arise because people would change their behaviour in hopes of avoiding infection, it says.

The bank assumes that fears of contracting disease in the close confines of an airplane would push down air travel by 20 percent during the first year of a severe pandemic, with similar declines in tourism, mass transport, and restaurants.

“The assumed 20 percent declines are well below the peak decline of 75 percent in air travel to Hong Kong during the SARS epidemic and an average decline of 50-60 percent during the four-month period the outbreak was active,” the report says.

Since it is virtually impossible to say when and to what extent a pandemic will sweep the globe, the bank cautions that its latest scenarios are “purely illustrative”.

“They provide a sense of the overall magnitude of potential costs. Actual costs, both in terms of human lives and economic losses, may be very different,” it says.

Participants in the Oct. 24-26 Sixth International Ministerial Conference on Avian and Pandemic Influenza will be confronted with the bank’s estimates and asked to commit some 500 million dollars, the annual amount the United Nations says is needed to fend off and prepare for a potentially ruinous outbreak.

International donors have pledged 2.7 billion dollars – and delivered 1.5 billion dollars – to buttress affected and at-risk countries’ own spending on the fight against bird flu in the five years since the highly pathogenic disease broke out in Southeast Asia and spread across Asia, Europe and Africa, according to a joint World Bank-U.N. report prepared for next week’s talks.

Vaccines have been developed, poultry has been slaughtered from Hong Kong to Britain, public awareness has been raised, and health personnel are being trained to distinguish bird flu among humans from other ailments with similar symptoms.

As a result, so far this year the world has seen “fewer outbreaks in poultry, fewer newly infected countries, fewer human cases, and fewer deaths compared to the same period in 2006 and 2007,” says the “Fourth Global Progress Report on Responses to Avian Influenza and Pandemic Readiness.”

More than 50 of the 61 countries that have suffered outbreaks of H5N1 have succeeded in eliminating the disease but “the virus remains entrenched in several countries and the threat of further outbreaks…in poultry (and sporadic cases in humans) persists,” the report says.

However, it warns: “Even with such efforts, an eventual human pandemic at some unknown point in the future is virtually inevitable.”

Since December 2007, according to the bank, new outbreaks have been confirmed in Bangladesh, Benin, China, Egypt, Germany, India, Indonesia, Iran, Israel, Myanmar (also known as Burma), Poland, Russia, Turkey, Ukraine, and Vietnam. The disease has affected chickens, turkeys, geese, and ducks.

Other animal viruses that have afflicted and killed humans include SARS, HIV, Ebola, and West Nile.

Seasonal flu epidemics result in 250,000-500,000 deaths a year, mostly among the elderly, according to the World Health Organisation.

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