HEADS OR TAILS?
"To say that the virus will cause no deaths or millions of deaths is like tossing a coin."
By
Didier Lauras N. Jayaram
Agence
France-Presse
HANOI
Millions of deaths from bird flu have been predicted and hundreds of millions of dollars have been demanded to fight it, but experts admit they have no real idea of the potential impact of the disease.
"We are in a scenario of probability. Any forecast can only be hypothetical," said epidemiologist Christophe Paquet of France's National Institute of Sanitary Prevention at a joint meeting of the Food and Agriculture Organization (FAO) and the World Organization for Anima Health (OIE) held February 23 to 25 in Ho Chi Minh City.
The three-day conference on bird flu, attended by delegations from more than 20 countries and organizations, including major donors and agencies of the United Nations, heard dire new warnings of a looming pandemic.
Bird flu has been discovered in eight countries since late 2003-Viet Nam, Cambodia, Thailand, China, Indonesia, Japan, Laos, and South Korea. Last year the WHO had already said bird flu could kill millions of people.
But so far only 46 deaths have been officially reported since late 2003-34 in Viet Nam and 12 in Thailand. In comparison, tuberculosis kills 150,000 people every year in China alone.
"To say that the virus will cause no deaths or millions of deaths is like tossing a coin," Paquet said. "Nobody knows which of the two would come true. But the price of getting it wrong is not the same in the two hypotheses."
But he said dire warnings were not out of place. "The WHO has done its job for a year in sounding the alarm. It's not at all a case of delirium," he said.
Juan Lubroth, a FAO senior official, suggested that the threat had been overplayed. He said there was no doubt countries had to be well prepared to battle the disease, but "I do not think that we are sitting on a pandemic."
"I think that we have lived with influenza viruses all along and we don't really have an ability to predict the next pandemic," he noted. "What is highly pathogenic avian influenza in chickens may not necessarily be highly pathogenic in humans."
Samuel Jutzi, FAO director of animal production and health, said the UN body "was in unison with the WHO when they stress the urgency of the situation."
But he said the focus should be on fighting the virus in poultry, not on the potential threat to humans. "The longer the virus circulates in poultry, the higher the exposure is to humans," he said.
The FAO, WHO, and OIE have said that US$100 million was needed to fight the H5N1 virus, while hundreds of millions of dollars more would be needed to restock poultry farms after millions of infected birds have been killed across the region to stop the disease.
However they are finding it difficult to "sell" the plan to donors, whose response so far has fallen below targeted amounts.
"To mobilize media attention on the tsunami is possible," said FAO animal-health director Joseph Domenech, referring to the huge sums pledged in the wake of the giant waves that ravaged coastlines around the Indian Ocean in December. "But to mobilize long-term assistance over animal health is more difficult," he said.
The FAO representative in Viet Nam Anton Rychener had other calculations in mind. "By the time the sun sets [on the three-day conference], the rich countries will have spent US$3 billion to subsidize their farmers," he said, referring to subsidies that amount to US$1 billion per day. Asked how much he was hoping for, he said, "One percent of that is US$30 million."
And despite what some called the "alarmist" message of the Ho Chi Minh City meeting, "Many donor countries say they didn't get a sense of real emergency," Rychener said.
Still unraveling
Experts also agreed that bird flu still holds many mysteries that need to be unraveled before the deadly virus can be brought under control.
"There are more questions than when we started the conference," said Patrick Deboyser, a health and food-safety specialist with the European Union delegation based in Thailand. "There is still little knowledge about how the virus moves from animal to human and human to human," he added.
Deboyser said that among the questions raised during the conference concerned the risk to poultry famers. "Why some are infected and others are not infected?" he asked. "Why are there not more human cases as so many people have been in contact with diseased birds?" he said.
FAO epidemiologist Juan Lubroth said the conference had also raised important issues about the origin of the virus, and the origin of the latest epidemics in Asia.
"Production systems and marketing of poultry and poultry products are, from my perspective, more responsible for the widespread epidemic," he said, stressing that resources needed to be made available to the veterinary and animal-health authorities "to really put a lid on this problem."
Real risk
At the start of the conference, experts warned that the deadly bird-flu virus will take years to eradicate.
"We at WHO believe that the world is now in the gravest possible danger of a pandemic," warned Dr. Shigeru Omi, WHO director for Western Pacific. "The health impact in terms of death and sickness will be enormous and certainly much greater that SARS," he said.
However, Omi acknowledged that the bird-flu virus had not yet "gained the potential for efficient human-to-human transmission." He also said it was difficult to predict when a human vaccine against the disease would be available.
Jutzi noted "an increasing risk of avian influenza spread that no poultry-keeping country can afford to ignore." "We must assume that avian influenza will persist for many years in some of the countries that had disease outbreaks in 2004-2005. It is in the interest of both developed and developing countries to invest in the control and containment of avian influenza," Jutzi told the conference.
OIE's Dr. Teruhide Fujita echoed the warning. "Immediate eradication of the disease in the region cannot be envisaged in the short term under the current situation," he said. Fujita noted that "ducks can act as reservoirs of infection with or without clinical signs and are capable of excreting large amounts of viruses into the environment."
Scientists fear a possible mutation of the virus that could unleash a global pandemic, and ways of permanently eradicating the virus topped the agenda.
Domenech said eradication of the virus in poultry "will come in many years." But, he added, "controlling can be done today. With more investment, it is possible to control the effect of the disease."
Up to US$18 million from multilateral donors has been spent on the crisis since late 2003, eight million of it in Viet Nam alone. No figure was available for bilateral aid.
While "there is a lot of focus put on human health," Domenech said, "we hope governments will put the focus on the source."
Scientists have long said further outbreaks of the disease are inevitable in the region as long as humans live cheek by jowl with livestock. Animal husbandry practices across the entire region need to be changed, they said.
NOW A LAW
World's first antismoking treaty took effect on February 27
GENEVA
The world's first tobacco-control treaty, the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), became binding international law on February 27.
The WHO hopes the first ever public-health treaty will stop the estimated five million annual deaths caused by smoking from doubling by 2020, once it is ratified by all the 168 countries that have signed up.
"I encourage all countries to become party to the treaty. This can result in millions of lives saved, and that is where the real success of this treaty resides," said Lee Jong-Wook, WHO director general. "Its entry into force is a demonstration of governments' commitment to reduce death and illness from tobacco use," he added.
The WHO regards tobacco as the only legal product that eventually kills half its regular users, fuelling the second leading cause of death in the world. This means that out of 1.3 billion smokers, 650 million will die early. It will prematurely end the lives of 10 million people a year by 2020 if current trends are not reversed.
Tobacco-related ill health is thought to sap US$200 billion from rich and poor countries. The cost of treating illness due to smoking is estimated to rise to US$6.5 billion in China alone.
"The devastation caused by the tobacco pandemic dwarfs SARS and the recent tsunami," said Dr. Shigeru Omi, WHO regional director for Western Pacific. "Every year, five million people die from tobacco-related diseases. In the Western Pacific Region alone, 3,000 people die each day from tobacco use. Now we have the global tools to fight a global problem. It's time for all countries to join the battle."
The FCTC was unanimously adopted by the 56th World Health Assembly in May 2003, following almost three years of negotiations. During the year that followed, while it was open for signature, 167 countries and the European Community signed, and 23 countries became contracting parties.
On November 30, 2004, the 40th country ratified the convention, triggering a 90-day countdown for its entry into force. As of February 23, 57 countries have ratified the convention, including 13 in the Western Pacific Region: Australia, Brunei Darussalam, Cook Islands, Fiji, Japan, the Marshall Islands, Mongolia, Nauru, New Zealand, Palau, Singapore, Solomon Islands and Viet Nam. Fiji was the first Western Pacific country to ratify it on October 3, 2003. The Philippines has yet to ratify the treaty.
The treaty advocates bans on advertising and sponsorship, as well as sale to minors. It restricts smoking in public places, requires larger health warnings on cigarette packs, and promotes taxation as a way to cut consumption and fight smuggling.
Vera Luiza da Costa e Silva, head of the WHO tobacco-free initiative, said the convention would "leave fewer loopholes for the tobacco industry, which currently finds ways to circumvent national laws." "The difference for global tobacco control is that countries party to the convention will be able to implement these measures, especially those with cross-border implications, in a coordinated and standardized way," she added.
The treaty is expected to have an impact on direct sponsorship for public and sports events.
Antitobacco campaigners urged the United States to ratify the treaty. "We are calling on our government to join with the global community in prioritizing people's lives over the profits of giant corporations," said Kathryn Mulvey, head of the US-based advocacy group Corporate Accountability International.
The cigarette giant Philip Morris, which lobbied heavily against the convention, has since said it accepts some of its provisions, including health warnings and anticontraband measures, but is urging a more consistent approach to taxation.
"We encourage and support regulation which must provide a level playing field for all tobacco products," Hermann Waldemer, Philip Morris president for western Europe, said in a statement.
The group expected "further significant erosion of total cigarette consumption" in 2005, he added.
The body that will govern the FCTC, the Conference of the Parties (COP), will hold its first session in February 2006, a year from the date of entry into force. The COP is expected to determine further procedural and technical issues relating to its future development.
With a report from AFP
SHADOW EPIDEMIC
Growing drug resistance worries health experts
WASHINGTON
Health and medical experts from the World Health Organization (WHO) and the United States warn that the increasing ability of bacteria to resist antibiotics threatens the existing arsenal of drugs against dangerous infectious diseases.
The experts, WHO met for the Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington, DC last year, called for an urgent and coordinated worldwide response to the potential crisis.
"Drug resistance as first recognized in bacteria is now becoming apparent in the pathogens causing HIV/AIDS and malaria," said Stuart Levy, president of the Alliance for Prudent Use of Antibiotics.
"These findings are so compelling that we have prepared an early release calling for a redoubling of efforts to strengthen our national security against resistant infections," Levy said. "Without coordinated action, we risk facing a return to the time when infectious disease deaths were commonplace and life expectancy was short," he added.
Antibiotics developed in the 1940s revolutionized the battle against bacteria, but the ability of microorganisms to quickly mutate in order to survive poses a new challenge to the medical world, according to the preliminary conclusions of a report scheduled for release this year.
According to the report, titled Shadow Epidemic: The Growing Menace of Drug Resistance, the overuse of antibiotics in industrialized nations has caused the increased resistance to drugs among bacteria. There has been a sharp increase of infectious diseases among employees at hospitals in industrialized nations due to bacteria's resistance to drugs, according to the report.
"This is really a threat," said Thomas O'Brien, a WHO official. "We are not doing enough. ... There is a tendency of overlooking this problem."
The problem is compounded by the lack of understanding of the rise of infectious diseases in parts of the world, experts said.
"In addition to the ominous findings, there is a larger problem of a complete lack of knowledge in vast regions of the world about the emergence of dangerous infectious agents," Levy said. "Because microbes in one part of the world can easily spread to another there is a national security mandate to expand our global surveillance networks throughout the world."
The issue has some US members of Congress worried.
"Drug-resistant infections have the potential to overrun our most widely used antibiotics and pose a very serious threat to public health," Stephen Lynch, a Massachusetts Democrat and member of the House subcommittee on national security and emerging threats, said recently.
J. Santini, AFP
GREATER THREAT
Biological weapons now more dangerous than nuclear
LONDON
The threat from biological weapons has outstripped that of chemical and nuclear weapons because of advances in biotechnology, the respected British Medical Association (BMA) warned in a report published in October.
"What we are talking about here is the development of a technology that could clearly be misused by terrorists or deranged individuals," the author of the report, Prof. Malcolm Dando, said. "We have a much more difficult problem in controlling biological weapons (as opposed to nuclear) in the long term," said Dando, an arms-control expert for over 20 years.
In 1999, the BMA issued a report calling unsuccessfully for the 1975 UN convention on biological and chemical weapons to be strengthened.
The US government argued that imposing controls on biotechnology would interfere with benign research being carried out and consequently pulled out of international talks aimed at boosting the convention in 2001.
In its latest report, Weapons and Humanity II, the BMA warns that the window of opportunity to tackle the spread of biological weapons was shrinking fast. If unchecked, terrorists could target specific ethnic groups and spread devastating diseases such as deadly strains of flu, a synthetic version of the poliovirus or genetically engineered anthrax, it said.
"It's never been easier to develop biological weapons--all you have to do is look on the Internet," said Vivienne Nathanson, head of science and ethics at the BMA. "The situation today is arguably worse than it was when we published our last report five years ago. The very existence of international laws to protect us is being questioned, and the anthrax attacks in the US in 2001 caused widespread panic and fear."
Urging the international community to take up the issue, she said: "This report does not make comfortable reading, but it is essential governments take action on this issue now.
If we wait too long it will be virtually impossible to defend ourselves."
AFP
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