| The chief veterinary officer at the U.N. Food and Agriculture Organisation (FAO), Joseph Domenech told Reuters in an interview yesterday that avian flu should be seen as a "permanent" problem, but one that can be controlled with the right procedures. "The virus will be introduced into countries, it's a permanent risk."
There is a difference between long-term risk and permanent risk.
H5N1 has repeatedly shown its deadliness to humans. There are no signs that this deadliness is going to reverse any time soon. As long as it is present in significant amounts where people are in close contact with infected avian hosts, the risk to the world is great.
We are not talking about `only' another several hundred people dying in the next couple of years. The 1918 pandemic killed an estimated 50 - 100 million people (Updating the accounts: global mortality of the 1918-1920 "Spanish" influenza pandemic. Johnson NP, Mueller J. Bull Hist Med, 2002 76:105-15). Since then, the world population has increased by more than 3-fold. How much is the lives of 150 - 300 million people worth to Mr Domenech and his colleagues? Would it be too much to ask them to officially (even hypothetically) assume that we still have the eradication of this threat as a long-term goal?
Lest someone from the FAO or otherwise starts to suggest that we cannot use 1918 figures for comparison, I'd like to point out with all respect that, with the sole exception of the 1918 H1N1 virus, H5N1 is the only other influenza virus that we know of which has repeatedly jumped directly from avian to human hosts without reassortment. It would be irresponsible to compare this risk to any other virus such as those that caused the pandemics of 1957 or 68. To do so would be the equivalent of comparing a massive explosion in a conventional explosives depot to one in a nuclear power plant.
In addition, do we have scientific data supporting this idea of permanence, that we have run out of ways to eradicate this virus, that there are no potentially effective measures on the horizon, even if not currently well-developed? That we as a civilization are condemned to have this Damocles' sword over us for generations to come? If so, please feel free to enlighten me in my ignorance.
Does the FAO have so little faith in science, political will, and the huge amount of talent that are still untapped in the world in finding innovative solutions to this problem? Because, solutions do not happen accidentally, out of nowhere. They are the result of focus, commitment, initiative, co-operative thinking, sheer willpower, and, most importantly, leadership.
Let's take, for example, data from various scientists suggesting that domestic ducks are the reservoirs perpetuating this virus, and that these ducks are being moved over long distances as part of routine agricultural practice. Let's say, for argument's sakes, that given enough financial incentives farmers all around the world can be persuaded to stop rearing them except in bio-secure environments.
Let's say consumers around the world stop eating duck as a means of putting pressure on countries.
How much would it cost? How long would negotiations and political maneuvering take to achieve this goal? Again, how much would 150 - 300 million lives be worth, not counting the secondary and tertiary consequences of a 1918-like pandemic today?
Let's take the idea that vaccines targeting virulence antigens might affect the course of viral evolution. Granted there has not been enough research on this, but what if, in a few years time, we can create veterinary vaccines that target the HA antigen especially the characteristic cleavage site, might there be a chance that we could reverse the evolution of the virus back into the LP form? This is not as far-fetched as it sounds, but even if it is, isn't that a worthwhile goal to work for? But, vaccine research needs funding. Where is the money going to come from if eradication of H5N1 in its current HP form is no longer the goal?
You might say, well, we get rid of it from domestic ducks, it is still present in wild birds or whatever other hidden reservoir there might be. True, but we don't know that domestic duck isn't the essential and critical component to the evolution of this virus. And we won't know it unless and until we have taken actions commensurate with the goal of ultimate eradication.
If we accept HPAI H5N1 as a `permanent' problem now, we will have accepted defeat before we have tried everything possible in our arsenal. What does Mr Domenech suggest we tell parents of all those tens or hundreds of millions who will die in the next pandemic when they ask us why? That we tried our best...almost? That we really wanted to stop this from happening ...but not quite? That agricultural interests are worth more than their kids' lives? Or that we no longer cared if any of us have grandchildren, as long as we can continue to have our cosy jobs and stay on good terms with those who seek to influence us?
I also want to ask this question. As a UN agency, the FAO is mandated to work in the interests and according to the wishes of the 189 member countries. According to this document on the FAO website, referring to the Sep 2004 document `Recommendations on the Prevention, Control and Eradication of Highly Pathogenic Avian Influenza (HPAI) in Asia',
Both OIE and WHO are key partners of FAO in the effort to prevent further disease spread and to protect the human population. The combined efforts of these international organizations are aimed at the control and eradication of HPAI by decreasing and eventually eliminating the viral load in the environment, assuring the use of proper standards and procedures for diagnostic testing, application of high quality vaccine products, and protection against occupational hazards in the implementation of programs.
Furthermore, it also says "Recommendations of FAO/OIE/WHO conferences held in Bangkok and Rome, in February 2004 are still relevant and applicable."
I'd like to ask Mr Domenech to confirm whether his statements indicate a change in policy goal from the above document. If yes, whether the 189 member countries have been consulted, whether the proper statutory procedures have been followed, to arrive at this change. If they have taken a vote at some point, I want to know how my country, the UK, voted. I want to know how the US, China, Japan, the other EU member states voted. I want to know exactly what they voted on.
There may be some who are ready to accept defeat. I'm not, and, I suspect, neither are 99.9% of the world's parents, if they fully understood the implications of a pandemic caused by the H5N1 virus directly switching hosts to humans.
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UPDATE March 19
For the official policy position of FAO/OIE prior to now, download and read this document A Global Strategy for the Progressive Control of Highly Pathogenic Avian Influenza (HPAI)
3.1 Goal
The overall goal of the strategy is to progressively control and eradicate HPAI from the domestic poultry sector in Asia and Europe, and prevent further introduction of HPAI in non-infected countries....
4.2 Control and eradication is feasible - learning from the success stories
The tools, methodologies and approaches outlined above have been successfully used by many countries to control and eradicate HPAI infections in Europe (Italy and the Netherlands) and North America (Mexico, USA and Canada).
To date, HPAI H5N1 outbreaks have been stamped out in Hong Kong SAR, Japan, Republic of Korea, DPR Korea and Malaysia. Thailand, after 14 difficult months, has made tremendous progress in controlling the disease through enhanced surveillance, strict biosecurity measures and culling of infected poultry. The disease has now been almost eradicated in the commercial poultry sector (sectors 1, 2 and 3, see Table 3) and probably pushed back into village poultry and free-ranging domestic ducks in the Central Plain....
FWIW, I don't personally see eradication as likely any time soon. OTOH, organizations like the OIE and FAO live and die by formal procedures, so I'm curious as to whether changes are being made in a
way that is not immediately obvious to the public... Or it could be that reuters had been unclear in how they presented the story? |
