Global plans to tackle any possible bird flu pandemic dominated an international ministerial conference in Sharm El-Sheikh, reports Reem Leila Delegates from 124 nations and 24 international organisations gathered in Egypt between 24 and 26 October for the sixth International Ministerial Conference on Avian and Pandemic Influenza. The conference, organised in collaboration with the Egyptian government, the International Partnership on Avian and Pandemic Influenza and the European Union (EU), with the support of the US government, the European Commission, the UN Food and Agriculture Organisation, the World Organisation for Animal Health (OIE), the World Health Organisation, World Bank (WB) and UNICEF, reviewed progress and mobilised resources for a long-term response to avian and pandemic influenza. The spread of the virus and the possibility of a human pandemic continue to pose serious dangers. "The threat is as great as it was five years ago -- when it first appeared in Asia in 2003 -- and the frequency of Highly Pathogenic Avian Influenza [HPAI] outbreaks around the world started to increase. The virus is not stagnant but is mutating, thus creating great fear to us from the appearance of a human-to-human strain," stated UN Assistant Secretary-General David Nabarro. According to the EU report, Egypt and Nigeria are the two countries most affected by avian influenza in Africa, and Egypt and Indonesia worst hit by the H5N1 strain. "The problem we have is mainly in the backyards of poor families in Indonesia and Egypt," said Bernard Vallat, director-general of the OIE. The virus has spread to 26 of Egypt's 29 governorates, with Sharqiya and Daqahliya being worst affected. Egypt's $2-3 billion poultry industry has been devastated. Vallat pointed out that farmers no longer treat the virus with the urgency they did when it first appeared. "Now there is fatigue, and the solution is to have new incentives for these people to cooperate with veterinary services in the field of disease policy implementation," he said. If indifference could be overcome, he predicted that the virus, which has killed 245 people in 15 countries and resulted in the culling of countless birds, could be contained within three years. On preparedness for a human influenza pandemic, Nabarro said that, "the situation is quite promising. But when it comes to countries being ready for a pandemic -- in particular ready for the social, economic and political implications of a pandemic -- more work really has to be done, not just by individual countries but by countries working together". Compensation for farmers affected by bird flu helps in the early detection of new outbreaks, said Nabarro, though he refrained from criticising countries such as Egypt that lack compensation programmes. "Compensation for the value of birds that are destroyed for the control of avian influenza is important if public cooperation is to occur," he argued. Egypt did pay compensation for birds culled in the first months after the avian influenza virus arrived in February 2006 but payments ended in May 2006. "Egypt wanted to provide compensation," said Minister of Agriculture and Land Reclamation Amin Abaza, "but this is a cost we cannot shoulder." Egypt, he continued, was relying on public information campaigns to combat the disease, alongside a large-scale vaccination programme. Sixty per cent of non-commercial poultry had been vaccinated so far at a cost of LE150 million. "Egypt's only alternative is free vaccinations and not compensation," Abaza added. The WB estimates that a global pandemic resulting from the mutation of bird flu to a strain capable of human-to-human transmission could cost $3 trillion and result in a five per cent drop in the world's gross domestic product. It has said that more than 70 million people could die worldwide in a severe outbreak. The US government used the conference to announce a $320 million funding package directed to global efforts to fight avian and pandemic influenza. This is on top of the $629 million the US has already pledged in battling the virus. "We all know the world will face another pandemic," Paula Dobriansky, US under-secretary of state for democracy and global affairs, told delegates. "Our continuing efforts to strengthen animal and human health infrastructure around the world to confront the avian flu threat have substantially enhanced global capacity -- not only to deal with pandemics but also with other emerging infectious diseases." John Groarke, deputy director to the US Agency for International Development (USAID), revealed that Egypt's share of the US grant will be around $23 million. He stressed that the financial crisis sweeping the world would not impact on US grants to developing countries to help fight the deadly virus. "It is a serious and threatening issue and the US cannot take the risk of not helping other countries," he said. In many countries pandemic contingency and preparedness plans have been devised. Yet coordination at country level has been found wanting; rivalries between professions and organisations persist; and funding and capacities for an effective and equitable global response to a pandemic remain weak. As Dennis Carroll, senior infectious diseases advisor and director of USAID Avian and Pandemic Influenza Preparedness and Response Unit, told the conference that H5N1 is a dynamic, evolving pathogen and the threat it poses rapidly changes. Genetic data on H5N1 has allowed scientists to track outbreaks outside the six endemic countries, Carroll said. "That data has shown us that outbreaks reported over the last couple of years in Israel, Jordan, West Bank/Gaza and Djibouti... the genetic evidence clearly indicates that the point of origin was in birds within Egypt." Although most countries have put in place plans to deal with a possible outbreak of avian flu, these plans have not been properly tested, according to the report by the UN System Influenza Coordinator (UNSIC) and the WB. Of the 148 countries that have developed a national plan at the top executive level of government, only 53 per cent have tested their plans in the past 12 months, and only 25 per cent have tested their plans at national and local level, the report said. "What we want to avoid is for countries to believe that just because they have written a plan, they are prepared. This is not true. Putting the plan [in place] is just the beginning of the job. You have to test your plan to make sure that your assumptions are right," Nabarro said. While international efforts have pushed back the spread of bird flu this year, the threat of a global influenza pandemic killing millions remains, cautioned international experts in advance of the convention held in Egypt. Ambassador John Lange, special representative on avian and pandemic influenza at the US Department of State, pointed out that the threat of bird flu virus is as serious as before, placing it within the larger context of global health issues competing for limited resources. Developing and least-developed countries require additional technical and financial support. According to Hatem El-Gabali, Egyptian minister of health and population, Egypt has adopted a low-cost plan compared to those implemented in other regions. "Egypt has allocated more than LE500 million to implement effective control measures to combat the deadly virus," he said. More efficient medical case management had, he argued, led to a decrease in fatality rates to 44 per cent with zero mortality among the 22 cases below the age of 10 years compared to 63 per cent internationally. Abdel-Rahman Shahin, official spokesman at the Ministry of Health and Population, announced that Egypt already has a set of protocols and plans to be implemented during a pandemic phase. "The plan covers supply management, infection control, quarantine measures, clinical management, death manipulation, hospital and primary health care management, communication and education, in addition to a strategy for ministries' intervention," Shahin explained. He added that the Egyptian Holding Company for Biological Products and Vaccines (VACSERA) is working towards manufacture poultry vaccine rather than importing it.
