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REGIONAL FOCUS
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One Flu Over The Cuckoo's Nest
Asia And The Avian Flu Crisis.
By Lekshmi Santhosh |
An eight-year-old Vietnamese girl with pigtails happily pranced around her family farm. Her little bare feet sank into the moist earth as she playfully chased the chickens her father had worked so hard to raise. On 13 January, she was admitted to the local hospital, suffering from high fever, rapid pulse, severe muscular pains, and labored breathing. A week later, neither fowl nor friend was alive. Both had been silenced by Asia's most recent epidemic - avian flu.
Less than a year after the devastating attack of SARS (Severe Acute Respiratory Syndrome) on Asia, yet another virulent disease has taken root there, affecting both poultry and people. Avian influenza, commonly known as bird flu or avian flu, has flared up in ten Asian countries: mainland China, Japan, South Korea, Taiwan, Thailand, Vietnam, Indonesia, Cambodia, Laos, and Pakistan. According to the WHO (World Health Organization), there have been thirty-three human cases, with twenty-two fatalities. All of the fatal cases were reported in Thailand and Vietnam, the hotbeds of the disease. The WHO, however, only reports laboratory-confirmed cases; many other cases in tiny hamlets may have gone unreported, with merely rumors circulating to tell the tragic tale.
H5N1 is the mysterious strain that is associated with this year's avian flu outbreak. Until 1997, scientists believed that bird-to-human transmission was implausible, if not downright impossible - the Hong Kong avian flu outbreak of that year proved them wrong. Human contact with live chickens seems to be the preferred mode of transmission, either by breathing in fecal dust or by prolonged physical contact. Peter Cordingley, spokesman for the World Health Organization regional office in Manila, told the AFP news agency that the mortality rate for avian flu is higher than that of SARS, a 33% risk of fatality compared with a 9.6% risk, respectively. With twenty-two human deaths and over one million chicken deaths, the situation is growing to epidemic proportions. More alarmingly, scientists and officials fear that the versatility of this insidious virus will eventually allow human-to-human transmission of the disease. Since the virus has already mutated to jump across the species barrier from birds to humans, it is possible that the virus could swap genetic material (RNA) with an existing human influenza virus. According to Dr. Shigeru Omi, WHO regional director for the Western Pacific, a potent and lethal new virus strain could emerge, transmittable among humans.
As the WHO struggles to develop a vaccine to combat this deadly disease, the virus is constantly mutating, evading current treatments and developing a hardy resistance. The BBC World Service believes that bird flu could pose a greater threat than SARS if human-to-human transmission emerges. Since flu can be passed through the air, the infection would spread extremely rapidly. One would think that Asia's experience with the recent SARS crisis would have equipped the effected countries with the tools necessary to fight another public health catastrophe. Unfortunately, this has not been the case, and the mistakes of SARS are being repeated, if not magnified, everywhere from Thailand to Vietnam to China.
In context of the avian flu alone, the deception of Thai government officials may have contributed to the seven human deaths claimed by avian flu in this country. In January, while chickens were dropping dead and mysterious hospitalizations started to occur, President Thaksin Shinawatra declared that Thailand was safe from the bird flu which threatened the rest of Asia. To prove his point, he appeared on national television, cheerfully savoring spicy chicken dishes (although the virus is not passed on through meat - one cannot be infected by eating cooked chicken). As the accusations of a cover-up grew louder, the government denial grew stronger. The deputy Agriculture Minister, Newin Chidchob, told BBC reporters that "irresponsible media and some groups of people are trying to spread this rumor; there is no bird flu here." After weeks of lobbying by farmers and consumer groups, the government finally conceded that bird cholera was the problem, but not bird flu.
Politicians denied obvious claims and also tried to silence their critics. Senator Malinee Sukavejworakit, a doctor, refused to believe the government assurances that bird cholera was the problem and did some investigating on her own. After conducting some tests with the Public Health Department, she discovered that bird flu was indeed the problem. When she brought this to the attention of the authorities, instead of listening to her, they dismissed her claims and ridiculed her. Minister Chidchob accused her of being "irresponsible to the motherland" and jeopardizing the Thai economy, according to TIME Magazine reports. Even the President of the country condemned her efforts, and in a McCarthyan ploy, accused her and other whistle-blowers of being unpatriotic.
Finally, on 23 January, after much of the damage had already been done, Thai officials admitted that five human cases had tested positive for avian flu, and that more than 6 million chickens had been recalled. Thai officials also anonymously admitted that they were aware of the problem but consciously covered it up and attributed the chicken deaths to cholera.
In nearby Vietnam, similar deception was brewing. Fifteen of the human deaths attributable to avian flu occurred in Vietnam, and more than one million birds died from the virus; eight hundred thousand more were slaughtered as a precaution. Despite the astounding statistics, the Ministry of Agriculture and Rural Development issued a report on 7 January assuring the public that avian flu was not a health risk to humans. At that very same time, twelve patients had been hospitalized with the virus.
According to local farmers, the first mass chicken deaths started happening in July, a full six months before the official government acceptance of the disease. Officials from the government health departments later on admitted to having known about the disease, but did not act because of "political and economic reasons." Apparently the country's preparation for the Twenty Second Southeast Asian Games had taken precedence over human lives and safety in the eyes of the government.
Last year's SARS cover-up should have taught China a lesson in how not to respond to a public health crisis, but unfortunately this was not the case. According to TIME Magazine, last March, Chinese officials asked the WHO for antibodies to test for avian flu, indicating that they may have been aware of the impending crisis. However, the officials obstinately maintained that avian flu had not struck their country. In Shanghai, officials dismissed allegations that a local child had been afflicted with the disease, calling the reports mere rumors.
Local journalists tried hard to investigate the situation and learn the truth, but their attempts were thwarted by police. The Shanghai Publicity Bureau informed journalists that their stories regarding the avian flu outbreak had to be submitted directly to the bureau for censoring. As soon as this announcement was made, the roads to the bureau were blocked by police to prevent journalists from even trying to enter.
Finally, on January 27th, four days after Thailand's disclosure of a cover-up, the Chinese authorities officially admitted that avian flu had penetrated their country - and their country's veil of secrecy.
The major lesson learned from SARS was that in order to effectively combat a public health crisis, the government has to be frank and clear. The government must issue regular reports to the public and take action immediately by quarantining the infection, issuing guidelines and alerts for public awareness, and preventing the spread of the disease from one country to another. Denial, secrecy, government "filibusters" and false reassurances are not the answers. Sadly, the lessons of SARS have not been learned, as demonstrated by these Asian countries' responses to avian flu. Future generations of policy makers and public health officials should look at the dual crises of SARS and avian flu and learn how to nip pandemics in the bud - by action instead of acting.
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