Last week, Egyptian officials reported to the World Health Organization that a 6-year-old girl was successfully treated for avian influenza, which she is suspected to have contracted as a result of exposure to diseased poultry. A week earlier Cambodian officials confirmed that a 4-year-old girl from a farming village in that country died of avian influenza after being exposed to an infected chicken. According to World Health Organization statistics, these girls are the 563rd and 564th humans to be infected with bird flu, and the Cambodian girl was the 330th to die of it.
Most remarkable about these cases are just how unremarkable it has become to learn that bird flu has jumped the species barrier. When it first became apparent that avian influenza took a human life in Hong Kong in 1997, it was big news. The Centers for Disease Control and Prevention mobilized experts to conduct an on-site investigation. WHO officials went into crisis mode. And newspapers around the world reported on the events.
Since then, bird flu has become endemic among poultry in many countries, including China, Indonesia, Egypt and Vietnam, and it has killed nearly 60 percent of the humans it has infected. Nonetheless, the reports during the past two weeks of two recent infections and another death raised little concern except among public health officials.
The fact that bird flu in developing nations receives little public attention reveals that the world has become complacent about this threat. Not that we have been sitting idle. Countries have pledged more than $4 billion to combating bird flu since 2005, and developing nations have improved both their surveillance of animal health and the biosecurity of at least large-scale, industrial poultry production.
But the global commitment to preventing human infections with novel bird flu appears broken. With the exception of 2009 during the H1N1 scare, countries’ annual financial pledges to combat bird flu have dropped each year. In 2006, 35 countries donated nearly $2 billion to the cause. In comparison, the U.N. and World Bank report that only two countries pledged a total of $100 million in 2010.
Even more telling is how the focus of international giving has shifted from prevention to response strategies. Between 2005 and mid-2008, pledged funds were split almost equally between programs aimed at preventing bird flu infections and those that developed human pandemic response plans. Starting in 2008, however, commitments to response programs have more than doubled while pledges to prevention strategies have been cut in half.
The world’s diminished commitment to prevent human infections is also evident on the ground in nations where bird flu is endemic. Annual reports from the U.N. and World Bank reveal almost no progress in changing the practices of small-scale and backyard poultry farmers that raise the risk of transmitting bird flu to humans.
This is a critical problem. These farmers have unintentionally created bird flu breeding grounds because they raise their chickens and ducks in small, open-air spaces where the flocks mix with each other, with swine, and with migrating wild birds. In this environment, dangerous mutations occur rapidly as a virus moves among species and adapts. Moreover, backyard farmers raise poultry and swine in their residential spaces, giving ample opportunity for bird flu to infect farmers and their families.
Wet markets are also a problem. Small-scale farmers sell live poultry in roadside markets, slaughtering and selling chickens and ducks by hand with just a douse of water to cleanse each bird. Without any real effort to disinfect birds or the slaughtering site, flu moves easily from bird to bird and from bird to human.
Because this danger persists, the world cannot afford to be complacent about prevention. Each infection is a warning that the species barrier will not prevent human infections. Likewise, the H1N1 pandemic was a stark reminder that an animal-based flu can be transmissible among people, spreading rapidly around the globe and infecting wealthy and developing nations alike.
On the theory that an ounce of prevention is worth a pound of cure, all nations must recommit to the strategies that will prevent infections in the first place. At the very least, we must invest just as heavily in prevention strategies as we do in response planning.
Since 1997, the world has dodged an avian influenza pandemic at least 564 times. At what point will our luck run out?
Robert Gatter is co-director of the Center for Health Law Studies and professor of law at Saint Louis University.
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