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Avian Influenza Daily Digest
October 22, 2008 14:00 GMT
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Article Summaries ...
Regional Reporting and Surveillance
Bulgaria: AI Control Measures Ordered
10/22/08 ARGUS--A national source reports that the Governor of Sliven has ordered the implementation of control measures against the possible spread of avian influenza (AI) in the country in response to recent AI cases in Germany. Municipal epizootic commissions in...
Regional Reporting and Surveillance
Science and Technology
Serologic and virologic surveillance of avian influenza in Nigeria, 2006-7
10/2008 Eurosurveillance--[link to full text pdf]--Introduction: Since January 2006, H5N1 avian influenza has affected Nigeria?s poultry population causing enormous loss of resources. The current circulating virus is a potential candidate for pandemic influenza which may severely affect the human and animal population worldwide especially in the resource-poor countries. In this study, we report on our field and laboratory surveillance efforts in Nigeria. A total of 1,821 tissue samples, 8,638 tracheal swabs, 7,976 cloacal swabs and 7,328 avian sera were analysed over a period of two years, with 312 positive results. Limited human serosurveillance involving 320 individuals was also carried out but yielded no positive result. We recovered 299 isolates of highly pathogenic avian influenza virus H5N1 mainly from the diagnostic samples of poultry kept in backyard, small scale and free range farms. This finding emphasised the role played by these farming systems in the dissemination of avian influenza in Nigeria and highlights the need for a continued surveillance in humans since human-animal interaction is a key feature in Africa. Furthermore, there is a need for the strengthening of border controls. Since October 2007, there has been no reported and confirmed outbreak of avian influenza in Nigeria.
AI Research
Co-circulation of two sublineages of HPAI H5N1 virus in the Kingdom of Saudi Arabia with unique molecular signatures suggesting separate introductions into the commercial poultry and falconry sectors
10/22/08 Journal of General Virology--[link to full text pdf]--Abstract: Since early 2007, the Kingdom of Saudi Arabia (KSA) has experienced several highly pathogenic avian influenza (HPAI) H5N1 outbreaks in the falconry and poultry sectors. The public health threat associated with peculiar husbandry systems, requiring close contact between humans and birds of prey, highlights the need of an improved understanding of the epidemiology and of the viral characteristics of H5N1 viruses circulating in the region. Here we report molecular and phylogenetic analyses of H5N1 viruses isolated in the KSA in 2007 in distinct compartments of avian husbandry. From the results of our investigation it appears that two separate introductions into the different sectors occurred. The identification of specific amino acid mutations, which are described as genetic signatures of human influenza A viruses or known to confer resistance to antiviral drugs, raises concerns for the possible human health implications of the KSA H5N1 viruses.
AI Research
An avian live attenuated master backbone for potential use in epidemic and pandemic influenza vaccines
10/20/08 Journal of General Virology--[link to full text pdf]--Abstract: The unprecedented emergence in Asia of multiple avian influenza virus (AIV) subtypes with a broad host range poses a major challenge in the design of vaccination strategies that are both effective and available in a timely manner. The present study focused on the protective effects of a genetically modified AIV as a source for the preparation of vaccines for epidemic and pandemic influenza. It has previously been demonstrated that a live attenuated AIV based on the internal backbone of influenza A/Guinea fowl/Hong Kong/WF10/99 (H9N2), called WF10att, is effective at protecting poultry species against low- and high-pathogenicity influenza strains. More importantly, this live attenuated virus provided effective protection when administered in ovo. In order to characterize the WF10att backbone further for use in epidemic and pandemic influenza vaccines, this study evaluated its protective effects in mice. Intranasal inoculation of modified attenuated viruses in mice provided adequate protective immunity against homologous lethal challenges with both the wild-type influenza A/WSN/33 (H1N1) and A/Vietnam/1203/04 (H5N1) viruses. Adequate heterotypic immunity was also observed in mice vaccinated with modified attenuated viruses carrying H7N2 surface proteins. The results presented in this report suggest that the internal genes of a genetically modified AIV confer similar protection in a mouse model and thus could be used as a master donor strain for the generation of live attenuated vaccines for epidemic and pandemic influenza.
Vaccines
Pandemic Preparedness
Group urges next administration to reform public health
10/21/08 CIDRAP--Drawing on the expertise of more than 150 health experts, Trust for America's Health (TFAH), a nonprofit health advocacy group in Washington, DC, today released a report designed to help the next president and Congress reform the public health system to improve the nation's health and emergency preparedness.
Pandemic Preparedness
World Bank says flu pandemic could cost $3 trillion
10/17/08 CIDRAP--An internal report prepared by the World Bank estimates that a severe influenza pandemic could kill 71 million people and cause a recession costing more than $3 trillion
Pandemic Preparedness
Report from Lloyd's Financial: Pandemic/Potential insurance impacts
10/2008 Lloyd's Financial--[link to full text pdf]--Consideration of the impact the next pandemic could have on the insurance industry....
Pandemic Preparedness
Studies Of How SARS And Bird Flu Evade Antiviral Responses Funded By NIAID
10/22/08 MediLexicon News--The National Institute of Allergy and Infectious Diseases (NAID), one of the National Institutes of Health, has awarded a contract to the University of Washington (UW) to use systems biology approaches to comprehensively analyze and model the virus-host interactions and cellular response networks that are induced or altered during the course of acute respiratory virus infection.
Pandemic Preparedness
Web Monitoring may Slow Pandemics
10/22/08 Newswire--When the next pandemic strikes, technology may be key to lessening its impact. New research shows a real-time, Internet-based disease reporting system has sharpened detection of tuberculosis and bird flu in China.
Pandemic Preparedness
Bird flu pushed back, pandemic threat remains: UN
10/21/08 Reuters--International efforts have pushed back the spread of bird flu this year, but the risk of a global influenza pandemic killing millions is as great as ever, the United Nations and World Bank reported on Tuesday.
Pandemic Preparedness
The International Response to Highly Pathogenic Avian Influenza: Science, Policy and Politics
October 2008 STEPS--Introduction: On June 11th 2008 another outbreak of highly pathogenic avian influenza (H5N1) was reported in Hong Kong ? the site of the first reported human deaths from this virus in 1997. Media reports portrayed the possibility of a major catastrophe. Anxious citizens stopped eating chicken. With China hosting the Olympics in a matter of weeks, concerns were raised in the highest circles about the consequences of an outbreak ? for world profile and for business. Politicians wanted firm action.
Pandemic Preparedness
Full Text of Articles follow ...
Pandemic Preparedness
Group urges next administration to reform public health
10/21/08 CIDRAP--Drawing on the expertise of more than 150 health experts, Trust for America's Health (TFAH), a nonprofit health advocacy group in Washington, DC, today released a report designed to help the next president and Congress reform the public health system to improve the nation's health and emergency preparedness.
At a press conference today, Jeff Levi, PhD, executive director of TFAH, told reporters that the country is losing ground on battling preventable diseases such as diabetes and obesity and could stall in its efforts to prepare for a pandemic or other public health emergency. "We believe Americans deserve better, and these problems place us at a competitive disadvantage," he said in introducing the 119-page report.
Levi said both of the major presidential candidates are concerned about the nation's public health problems and have said new solutions are needed, as described in recent articles in the New England Journal of Medicine (NEJM).
Levi said the report, "Blueprint for a Healthier America: Modernizing the Federal Public Health System to Focus on Prevention and Preparedness," contains recommendations that came from a yearlong consensus-building effort among the 150 experts. The report also includes a number of public opinion surveys on Americans' perceptions of natural disaster and disease threats.
Alan Quinlan, president of Greenberg Quinlan Rosner Research, said at the press conference that opinion polling on behalf of TFAH suggests that 51% of Americans think the country is somewhat prepared for a major disaster such as a hurricane, but not as well as it should be. "In the back of their minds they're hoping that the government is ready. It's a soft confidence in government that we are prepared," he said.
Bill McInturff, partner and cofounder of Public Opinion Strategies, which also conducted polling for the TFAH report, told reporters that Americans are anxious to hear about solutions to public health problems. "The normal partisan breaks get clearly fuzzy," he said. However, public health concerns will battle for attention and funding, especially given the difficult economic environment. "The issues will have to fight for their piece of the pie," he said.
A $20 billion funding gap
Levi emphasized that the TFAH "blueprint" proposes a public health and preparedness strategy that doesn't depend solely on the federal government but envisions critical roles for state and local governments. He said some of the key themes of the blueprint are holding funding recipients accountable for progress and results and making prevention a cornerstone of the nation's health, not just an afterthought.
In the report, TFAH projects a $20 billion annual shortfall in funding for critical public health problems. Establishing a stable funding stream though various options outlined in the report would require increases of $12 billion at the federal level and $8 billion at state and local levels.
One option could include a "wellness trust"?an independent entity that would fund public health activities and infrastructure improvements with the support of public health agencies and private insurers. TFAH also suggests creating a matching requirement for state and local recipients of new public health funding and private-public partnerships at the state and local levels.
The report recommends that the next president appoint a Department of Health and Human Services (HHS) secretary who has a strong understanding of public health, name a public health task force within 90 days of taking office to help set short- and long-term national health goals and make policy recommendations, and issue an executive order that makes improving the nation's health a priority.
Pandemic and emergency preparedness
The report urges the next administration to ensure that emergency preparedness is part of the health reform debate. Levi told reporters that strengthening surge capacity is "the single biggest and hardest issue for health preparedness."
To make best use of federal resources, TFAH recommends that the next administration designate a single official at HHS to oversee all emergency preparedness activities and ensure coordination across other federal agencies that have a role in preparedness.
Among several specific suggestions for influenza pandemic preparedness, TFAH recommends developing a "Pandemic Vaccine Research and Development Master Plan," setting more ambitious goals for producing a pandemic vaccine, streamlining the licensing process for flu vaccines, implementing a nationwide system to track the use, safety, and efficacy of vaccines, and increasing the federal stockpile of antiviral drugs to enable it to treat 25% of the population.
Food safety considerations
Many of TFAH's recommendations for improving the nation's food safety system were detailed in a report that the group released in April. In that report, TFAH highlighted several problems with the nation's current food safety system, including an underfunded Food and Drug Administration (FDA), outdated laws, and safety responsibilities that are spread among 15 different federal agencies.
TFAH has recommended that federal officials create a single food safety agency to improve oversight and the efficiency of tasks such surveillance and foodborne illness outbreak response.
A public opinion poll included in the new report found that 78% of Americans believe that a major foodborne disease outbreak will occur again in the next 5 to 10 years, that 65% believe protecting the nation's food supply should be a primary government responsibility, and that 88% are concerned about the safety of imported food products.
AI Research
Serologic and virologic surveillance of avian influenza in Nigeria, 2006-7
10/2008 Eurosurveillance--[link to full text pdf]--Introduction: Since January 2006, H5N1 avian influenza has affected Nigeria?s poultry population causing enormous loss of resources. The current circulating virus is a potential candidate for pandemic influenza which may severely affect the human and animal population worldwide especially in the resource-poor countries. In this study, we report on our field and laboratory surveillance efforts in Nigeria. A total of 1,821 tissue samples, 8,638 tracheal swabs, 7,976 cloacal swabs and 7,328 avian sera were analysed over a period of two years, with 312 positive results. Limited human serosurveillance involving 320 individuals was also carried out but yielded no positive result. We recovered 299 isolates of highly pathogenic avian influenza virus H5N1 mainly from the diagnostic samples of poultry kept in backyard, small scale and free range farms. This finding emphasised the role played by these farming systems in the dissemination of avian influenza in Nigeria and highlights the need for a continued surveillance in humans since human-animal interaction is a key feature in Africa. Furthermore, there is a need for the strengthening of border controls. Since October 2007, there has been no reported and confirmed outbreak of avian influenza in Nigeria.
AI Research
Co-circulation of two sublineages of HPAI H5N1 virus in the Kingdom of Saudi Arabia with unique molecular signatures suggesting separate introductions into the commercial poultry and falconry sectors
10/22/08 Journal of General Virology--[link to full text pdf]--Abstract: Since early 2007, the Kingdom of Saudi Arabia (KSA) has experienced several highly pathogenic avian influenza (HPAI) H5N1 outbreaks in the falconry and poultry sectors. The public health threat associated with peculiar husbandry systems, requiring close contact between humans and birds of prey, highlights the need of an improved understanding of the epidemiology and of the viral characteristics of H5N1 viruses circulating in the region. Here we report molecular and phylogenetic analyses of H5N1 viruses isolated in the KSA in 2007 in distinct compartments of avian husbandry. From the results of our investigation it appears that two separate introductions into the different sectors occurred. The identification of specific amino acid mutations, which are described as genetic signatures of human influenza A viruses or known to confer resistance to antiviral drugs, raises concerns for the possible human health implications of the KSA H5N1 viruses.
Vaccines
An avian live attenuated master backbone for potential use in epidemic and pandemic influenza vaccines
10/20/08 Journal of General Virology--[link to full text pdf]--Abstract: The unprecedented emergence in Asia of multiple avian influenza virus (AIV) subtypes with a broad host range poses a major challenge in the design of vaccination strategies that are both effective and available in a timely manner. The present study focused on the protective effects of a genetically modified AIV as a source for the preparation of vaccines for epidemic and pandemic influenza. It has previously been demonstrated that a live attenuated AIV based on the internal backbone of influenza A/Guinea fowl/Hong Kong/WF10/99 (H9N2), called WF10att, is effective at protecting poultry species against low- and high-pathogenicity influenza strains. More importantly, this live attenuated virus provided effective protection when administered in ovo. In order to characterize the WF10att backbone further for use in epidemic and pandemic influenza vaccines, this study evaluated its protective effects in mice. Intranasal inoculation of modified attenuated viruses in mice provided adequate protective immunity against homologous lethal challenges with both the wild-type influenza A/WSN/33 (H1N1) and A/Vietnam/1203/04 (H5N1) viruses. Adequate heterotypic immunity was also observed in mice vaccinated with modified attenuated viruses carrying H7N2 surface proteins. The results presented in this report suggest that the internal genes of a genetically modified AIV confer similar protection in a mouse model and thus could be used as a master donor strain for the generation of live attenuated vaccines for epidemic and pandemic influenza.
Pandemic Preparedness
World Bank says flu pandemic could cost $3 trillion
10/17/08 CIDRAP--An internal report prepared by the World Bank estimates that a severe influenza pandemic could kill 71 million people and cause a recession costing more than $3 trillion, Bloomberg News reported today.
The report says that in a severe pandemic, sagging tourism, transportation, retail sales, and productivity, coupled with worker absenteeism, could reduce global gross domestic product (GDP) by 4.8%, according to Bloomberg.
The new report increases the economic impact estimates made by the World Bank in June 2006. At that time the bank estimated GDP would drop by 3.1%, or about $2 trillion, according to Bloomberg. The story did not explain why the estimates have changed.
Bank officials estimate that a "mild" pandemic, similar to the Hong Kong flu of 1968-69, could kill 1.4 million people and reduce global GDP by 0.7% in the first year, Bloomberg reported.
The projection for a "moderate" pandemic like that of the Asian flu in 1957-58 is that it could cause 14.2 million deaths and reduce global economic activity by 2%, the story said.
The bank report also notes that some experts have estimated a death toll ranging from 180 million to 250 million in a severe pandemic.
World Bank predicts that changes in individual behavior, such as avoiding air travel, restaurants, and mass transportation, could account for 60% of the costs during a pandemic, the story said.
In regard to economic impact, "People's efforts to avoid infection are five times more important than mortality and more than twice as important as illness," Bloomberg quotes the report as saying. In the worst case, the authors estimate that air travel, tourism, restaurant business, and use of mass transit could drop 20% for the first year.
The World Bank's estimate of a 4.8% drop in GDP in a severe pandemic is slightly lower than some other estimates of the hit on the global and US economies. For example, researchers at Australian National University predicted that an "ultra" pandemic would slash global GDP by 5.5%.
In 2007, the health advocacy group Trust for America's Health estimated that US economic activity would shrink 5.5% in a 1918-like pandemic. And in 2005 the Congressional Budget Office projected that a pandemic would cut the US GDP by 5%.
The Bloomberg story, citing a United Nations official, also said world leaders will be asked to contribute about $500 million for avian flu control and pandemic preparedness when they meet Oct 24 to 26 in Egypt for the Sixth International Ministerial Conference on Avian and Pandemic Influenza.
In other developments, the British insurance market Lloyd's released a report on the possible effects of a pandemic on the insurance industry. The report says a pandemic on the scale of 1918's could reduce economic activity by anywhere from 1% to 10%.
"Economic impacts are likely to occur and a pandemic as severe as 1918 may lead to a global recession with reductions of between 1% and 10% of GDP," it states. "These may impact the general business environment."
The Lloyd's report also cautions against assuming that the 1918 pandemic necessarily represents the "worst case" event.
"1918 may not be a worst case," the report says. "It is certainly true that the 1918 event was extreme relative to other pandemics in history. However many published 'worst case' scenarios take 1918 as a base. There is a danger that we over optimise to this one scenario. There are other forms of pandemic than influenza, some have higher case mortality. Pandemic preparedness should consider a range of scenarios to ensure plans are appropriately flexible."
Pandemic Preparedness
Report from Lloyd's Financial: Pandemic/Potential insurance impacts
10/2008 Lloyd's Financial--[link to full text pdf]--Consideration of the impact the next pandemic could have on the insurance industry.
Pandemic Preparedness
Studies Of How SARS And Bird Flu Evade Antiviral Responses Funded By NIAID
10/22/08 MediLexicon News--The National Institute of Allergy and Infectious Diseases (NAID), one of the National Institutes of Health, has awarded a contract to the University of Washington (UW) to use systems biology approaches to comprehensively analyze and model the virus-host interactions and cellular response networks that are induced or altered during the course of acute respiratory virus infection.
This new research program will be led by Dr. Michael Katze, UW professor of microbiology and associate director of the Washington National Primate Research Center. Katze will head a multidisciplinary team of researchers from the UW, University of Wisconsin-Madison, University of North Carolina, Oregon Health & Science University, and Pacific Northwest National Laboratory in Richland, Wash.
The team will receive about $17 million over five years for the development of computational models of the host response to H5N1 avian influenza virus ("bird flu") and severe acute respiratory syndrome (SARS) associated coronavirus, two highly pathogenic respiratory viruses that represent significant threats to human health and the global economy. These models will be premised on the acquisition of large datasets through high-throughput genomic, proteomic, and metabolomic technologies, using samples from a variety of biological model systems.
The goal is to generate predictive models that can be experimentally validated in an in vivo setting and which will reveal whether influenza and SARS viruses use common strategies to regulate cellular signaling circuitry and evade antiviral defenses. In addition, these large datasets, as well as the modeled interpretations, will be made freely available to the research community via the Internet, thus providing powerful resources for other scientists exploring viral diseases.
Systems biology provides global views, or models, of the vast numbers of molecular components and interactions that make up complex functions inside living things. The UW research program is unusual in that, in addition to the traditional simple cell culture models, it will also use mouse and nonhuman primate infection models. These animal models will allow researchers to study disease-relevant complexities, Such information is likely to help translate findings into new clinical initiatives, including new targets for therapeutic intervention. Understanding the initial, innate, antiviral response also has potential in developing alternative vaccine strategies, where such early signals are exploited to induce more robust adaptive immune outcomes.
"This program is distinctive in its comparison of different respiratory viruses and the incorporation of animal models," said Katze. "There are few antiviral drugs available and none that work against diverse types of viruses. It would be extremely beneficial to have information that could lead to the rational design of a drug that could be used against a range of different viruses."
Pandemic Preparedness
Web Monitoring may Slow Pandemics
10/22/08 Newswire--When the next pandemic strikes, technology may be key to lessening its impact. New research shows a real-time, Internet-based disease reporting system has sharpened detection of tuberculosis and bird flu in China.
After looking at strategies undertaken in China to bring infections diseases under control, researchers found a real-time monitoring system implemented during the SARS epidemic increased the efficiency of disease reporting. The system has both reduced underreporting of infectious diseases and provided more details about disease outbreaks than were available through the country?s traditional surveillance system.
A new approach that included the new internet-based reporting system increased detection of tuberculosis in China by 80 percent between 2000 and 2005, surpassing the country?s goal that was set by the World Health Organization. A new program aimed specifically at bringing tuberculosis under control included immediate, Internet-based reporting of tuberculosis cases to the local Centre for Disease Control and Prevention and active follow-up on those cases.
The new reporting system also identified 21 cases of bird flu in humans out of 236 cases of unidentified pneumonia between 2005 and 2006.
Authors write the surveillance system may serve as a good model for disease monitoring in developing countries.
SOURCE: Lancet, 2008
Regional Reporting and Surveillance
Bulgaria: AI Control Measures Ordered
10/22/08 ARGUS--A national source reports that the Governor of Sliven has ordered the implementation of control measures against the possible spread of avian influenza (AI) in the country in response to recent AI cases in Germany. Municipal epizootic commissions in the country have been ordered to convene until 23 October in order to decide upon specific measures as needed. The Director of the Regional Veterinary Service is to arrange for the delivery of disinfection equipment and materials to Sliven, and the Director of the Regional Directorate for Forests has been ordered to increase wild bird surveillance efforts for the detection of sick or dead birds. Virological investigations, bird health monitoring, and inspections at private and [public] facilities with birds in urban areas will be carried out as well. Lastly, traffic and police authorities have been tasked with strengthening controls on the transportation of live poultry and to report all violations. Live poultry trade in "unregulated" areas has been banned.
Article URL(s)
http://dariknews.bg/view_article.php?article_id=297343
Conferences and Training
Egypt to host international bird flu conference
10/21/08 Ria Novosti--Egypt is to host an international conference on the bird flu virus in the Red Sea resort of Sharm el Sheikh on October 25, the country's health minister said on Tuesday.
The two-day conference, which will gather 500 participants from 116 countries, including 50 health and agriculture ministers, is being co-organized by the European Union as part of global efforts to combat the disease.
"The conference in Sharm el Sheikh will provide the opportunity to talk about what Africa needs in financial terms to continue the fight against bird flu, as well as the early diagnosis and prevention of the virus," Hatem El-Gabali said.
Bird flu first appeared in Egypt in 2006. Since then, 50 people have been infected, with 22 fatalities. The country is the worst-hit outside Asia by avian flu.
Previous conferences on avian flu were held in Washington, Beijing, Vienna, Bamako and New Delhi.
According to the World Health Organization, avian influenza has so far killed 245 people out of a total 387 confirmed cases worldwide. Although there have been no incidences of human to human infection, experts fear that it may mutate into a form that could easily be transmitted from person to person, causing a global pandemic.
Pandemic Preparedness
Bird flu pushed back, pandemic threat remains: UN
10/21/08 Reuters--International efforts have pushed back the spread of bird flu this year, but the risk of a global influenza pandemic killing millions is as great as ever, the United Nations and World Bank reported on Tuesday.
Most countries now have plans to combat a pandemic, but many of the plans are defective, said the report, issued ahead of a bird flu conference due to be attended by ministers from some 60 countries in Sharm el-Sheikh, Egypt, from October 24-26.
The report, fourth in a series since a bird flu scare swept the globe three years ago, followed a new World Bank estimate that a severe flu pandemic could cost $3 trillion and result in a drop of nearly 5 percent in world gross domestic product.
The highly pathogenic H5N1 bird flu virus is endemic in poultry in parts of Asia, but experts fear it will mutate into a form that is easily passed from human to human, sparking a pandemic similar to three others in the past century.
The U.N.-World Bank report said that in the first nine months of this year no countries were newly infected with highly pathogenic bird flu, compared with four in the first half of 2007. Just 20 countries had experienced outbreaks so far this year, compared with 25 last year.
Since late 2003 there have been 387 cases of humans catching the disease from birds, of whom 245 have died in Asia, Africa and Europe. But of these there have been only 36 human cases this year, of which 28 proved fatal.
"This particular virus, H5N1, is a much milder threat now than it was in September 2005," U.N. influenza coordinator David Nabarro told a news conference.
PANDEMIC THREAT UNCHANGED
But the report said H5N1 was still "actively circulating among poultry in a number of hotspots" and was entrenched in Indonesia and Egypt. It called for continued vigilance and investment worldwide to combat the disease, saying, "The threat of an influenza pandemic remains unchanged."
Nearly all the 148 countries that provided data for the report have contingency plans in place to deal with a pandemic, the authors said.
But many plans were "not legally or logistically feasible" and lessons from simulations had not been drawn on to revise plans, they said. Authorities in rich countries were better prepared than in poor countries, they added.
"We worry that many of those plans have still not been adequately tested to see whether or not they will be valid when the pandemic actually starts," Nabarro said.
"It's not enough just to have written a plan and have everybody signing off on it, you also have to check it, test it and make sure that it works."
Nabarro also said while the focus had been on H5N1, "any influenza virus could cause a pandemic and we just can't say for certain when the next pandemic will come."
The World Bank has estimated that more than 70 million people could die worldwide in a severe pandemic. According to a Stanford University Web site, some 20-40 million people died in the so-called Spanish Flu influenza pandemic in 1918-1919.
In its latest study, a September update of a report first published two years ago, the World Bank raised the cost of such a pandemic from $1.5-$2 trillion to more than $3 trillion and said world GDP could drop by 4.8 percent.
Pandemic Preparedness
The International Response to Highly Pathogenic Avian Influenza: Science, Policy and Politics
October 2008 STEPS--Introduction: On June 11th 2008 another outbreak of highly pathogenic avian influenza (H5N1) was reported in Hong Kong ? the site of the first reported human deaths from this virus in 1997. Media reports portrayed the possibility of a major catastrophe. Anxious citizens stopped eating chicken. With China hosting the Olympics in a matter of weeks, concerns were raised in the highest circles about the consequences of an outbreak ? for world profile and for business. Politicians wanted firm action. On June 20th, officials proposed a package of US$128 million to put the small-scale poultry sector and wet markets out of business. Traders have rejected the proposal, and many consumers argue that the alternative frozen supermarket chickens are not what they want. Others argue that attempts at regulating imports and banning wet markets are futile. Informal, unregulated trade abounds, and with South China being a known, if poorly reported, hot spot of avian influenza virus circulation, the chances of keeping Hong Kong free of the disease are very small indeed. Yet, sceptics argue that the proposed measures are more about political grandstanding and public relations than sensible, science-based control policies. They argue that the net consequences for farmers?, traders? and poorer consumers? livelihoods will be negative, with only the well-connected large suppliers and supermarkets benefiting. But, given the fears around viral mutation into a form capable of efficient human-to-human transmission, others conclude that precaution, even if drastic, is the most appropriate route1.
This example highlights the complex trade-offs involved in policy processes around avian influenza. These are intensely political, pitting different interests and groups of actors against each other. Public image, business interests and poor people?s livelihoods are all involved in a complex mix. And the science often is so uncertain that firm decisions based on exact predictions and precise measures are impossible. Judgements ? normally political judgements ? are made, and these are necessarily highly contextual. Media pressure, political effectiveness, implementation capacity and geopolitical positioning all come into the picture.
