The spreading bird-flu menace reaches Europe

Oct 20th 2005
From The Economist Global Agenda

European countries are taking emergency measures to contain the spread of a deadly strain of bird flu—which has already led to the deaths of millions of birds and over 60 people in Asia—after its arrival in Russia, Romania, Turkey and possibly Greece. The disease is a serious threat to the world’s sizeable poultry industry but its spread round the globe also increases the chances of it mutating into a form that causes a human pandemic

THE deadly H5N1 strain of bird flu, which has already led to the deaths of millions of fowl and more than 60 people in Asia since an outbreak began in South Korea in 2003, seems to be spreading around the world, with outbreaks confirmed in Russia, Romania and Turkey in recent days, plus possible cases in Greece. China and Vietnam also announced fresh outbreaks in poultry, while Thailand said the disease had killed a 48-year-old man. He is thought to have eaten infected chicken meat. Migratory birds, on their seasonal flights across the continents and oceans, seem the most likely explanation for its increasingly global spread.

This week, as the disease threatened to sweep across the European Union, its ministers held urgent meetings to discuss how to tackle an epidemic that could devastate the poultry industry or, worse, if the virus changes to become more easily communicable among people, set off a human influenza pandemic that threatens the lives of millions. Germany and Austria have ordered that all poultry be kept indoors to halt the disease's spread. Britain announced plans to produce vaccines for its entire 60m population in the event of a human pandemic.

In America, the Bush administration, following criticism of its response to Hurricane Katrina, is straining to demonstrate it is alert to the risks the disease poses. It is expected shortly to publish a long-delayed emergency plan for dealing with a bird-flu outbreak. Canada will host a summit of health ministers and officials later this month, to discuss international co-ordination of efforts to curb the disease’s spread.

Given the size of the poultry business worldwide, a pandemic among birds would be bad enough news. But it could be worse still: the more widespread the occurrence of the disease in birds, the more likely it is that the virus will either mutate into a form easily transmissible between people, or “recombine” (swap genes) with an existing strain of human influenza, resulting in a human pandemic.

Such a deadly transformation is much more likely to happen in poorer countries, since their health systems and surveillance are so much weaker, and since a greater proportion of their human population lives in close proximity to poultry and other livestock. On Thursday October 20th, Indonesia's health minister, Siti Fadillah Supari, expressed concern over clusters of possible bird flu within human families that had been detected in the country in recent days. She said such clusters, if confirmed, could mean that the virus's transformation into a form more threatening to humans may now have happened.

Scientists believe that H5N1 is a very good candidate for becoming a human pandemic strain. It mutates rapidly and has a propensity to acquire genes from viruses infecting other animal species. It has already shown itself capable of causing severe illness or death in people, though so far all or most human victims are believed to have caught the illness from birds rather than from other people.

Besides helping poorer countries to improve their disease surveillance, public-health officials are suggesting setting up funds to compensate these countries' farmers when they have to cull poultry. In cases where such countries cannot contemplate the destruction of such an important food source, an alternative to culling might be to vaccinate flocks in affected areas—in which case, richer countries could help out by supplying vaccines.

Drastic consequences

Human flu pandemics are expected three to four times every century, though it is still hard to predict when or where the next one will begin. The worst in living memory, in 1918, killed perhaps 50m people worldwide. Though there are no signs yet of such a grave risk to human life, the European Commission is urging the 25 EU member countries to stock up on anti-viral drugs and the World Health Organisation is urging all countries to produce contingency plans.
On Tuesday, Roche, a Swiss drugs firm, said it would consider granting other firms licences to produce its anti-viral treatment, Tamiflu—which is believed to offer some relief for people who contract bird flu—to ensure that supplies were sufficient.

Even if an outbreak of a new human flu strain were quickly contained, it could still have drastic economic consequences. The outbreak of severe acute respiratory syndrome, or SARS, in Asia in 2003 only infected around 8,000 people and killed about a tenth of these. According to the most pessimistic estimates, it caused almost $60 billion of lost output, with tourism-related businesses being especially hard hit.

A large-scale outbreak of human flu would put health services under enormous strain. To slow its spread, such measures as the closure of schools and the prohibition of large social gatherings might need to be contemplated. However, since people with the flu virus can be highly infectious despite showing no symptoms, it would be almost impossible to create an effective quarantine regime.

In the short term, anti-viral drugs will need to be stockpiled in those countries that can afford them, and decisions will need to be taken about who (eg, health-care workers) should have priority in receiving them. A vaccine against any new strain of human flu might take many months to develop. On Monday, Thomas Lonngren, the head of the European Medicines Agency, said such a human vaccine might not be ready before next year’s winter flu season.

In the longer term, maybe five to ten years, research into new treatment options, diagnostics and epidemiology could transform the situation: it is not unthinkable that an all-purpose “magic bullet” flu vaccine might be created, which prevents all strains, old and new. Until then, all countries need to prepare for the worst.

Copyright © 2005 The Economist Newspaper and The Economist Group. All rights reserved.