Obtaining the Facts: Can media portrayal influence programmatic success?

Over the last 5 months, the media has portrayed Indonesia’s resistance to provide WHO with physical samples of the H5N1 virus as an insubordination in the fight avian influenza. I believe several well sited news articles have inaccurately portrayed the situation. Here are some facts journalists are omitting from their articles:

1. The Indonesian government stopped providing physical HPAI samples to WHO upon learning WHO was handing the samples over to CSL, a firm using the samples for vaccine development.
2. WHO did not request permission from the Indonesian government to hand samples over to CSL. In addition, WHO did not notify the Indonesian government of this exchange.
3. The Indonesian government did temporarily stop sending physical avian influenza samples to WHO.
4. The Indonesian government did not stop collecting HPAI materials. In fact, the Indonesian government continued sending viral genomic sequence data to Geneva (the location of WHO headquarters).
5. The government of Indonesia did make a deal with Baxter International because Baxter agreed to produce and deliver any vaccine it developed using Indonesian samples to the country under the terms provided by the government of Indonesia.

While I choose to ride the fence on this issue, I think it is important to know all the facts. Knowing the facts allows people to gain insight into motivational agendas.

How is this relevant to CARE’s work?
I draw attention to this situation because the manner in which the media presents information regarding the progression and management of the avian influenza situation may ultimately influence the success of programmatic response and control efforts. I also believe the media may influence the relationships CARE has with local governments. Do you agree?

Bird flu making a comeback in Vietnam

In the month of May, Vietnam witnessed the most dramatic spike in H5N1 outbreaks since the virus started reappearing in that country late last year. The H5N1 virus has been detected in 12 localities, including 2 more outbreaks confirmed today. These events prompted the Minister of Health to warn, "The risk of the epidemic's further development and spreading on a large scale is very high."

In response to these outbreaks, which have occurred primarily in waterfowl, the minister is calling for the vaccination of "100 percent of ducks" in Vietnam. From 2005 until now, Vietnam had successfully kept bird flu at bay through an aggressive campaign of mass vaccination and poultry trade restrictions.

More than 50,000 birds throughout Vietnam died from avian influenza infection or culling in this month alone.

Read more here: Vietnam issues warning over bird flu spread

World Health Assembly Emphasizes the Need for AI Preparedness

The World Health Assembly concluded last week with a resolution to prepare for a pandemic influenza. More than 2,400 people from WHO's 193 Member States, NGOs and other organizations attended the week-long assembly in Geneva. During the assembly, Member States jointly acknowledged the need for improving pandemic influenza preparedness. Collaborative initiatives to increase the production of vaccines and provide equitable access to them were identified as opportunities to enhance international preparedness. More specifically, the resolution delegated the task of sharing influenza viruses to the WHO Influenza Collaborating Centre Network and its H5 reference labs.

In her closing remarks, Director-General Margaret Chan underscored the importance of this decision by declaring that her "responsibilities in implementing the IHR depend on this sharing."

http://www.who.int/mediacentre/news/releases/2007/wha02/en/index.html

Avian Influenza Making a Comeback in Vietnam

In less than one month, H5N1 outbreaks in poultry have hit 10 provinces in Vietnam. The latest outbreak occurred in Bac Ninh province, 30 km northeast of the Vietnamese capital, Hanoi. It was first reported on May 25, and lab tests confirmed the presence of H5N1 three days later. All 950 of the birds on the affected farm were immediately culled.

International health officials have praised Vietnam's efforts in successfully preventing the spread of highly pathogenic avian influenza over the last year and half. However, last month's spike in H5N1 poultry outbreaks along with the country's first human case in 17 months last week indicate that avian influenza is making a resurgence in the southeast Asian country.

Read more here: http://www.bruneitimes.com.bn/details.php?shape_ID=31579

Using antibodies from H5N1 survivors may be our best hope

From the Independent:

"Scientists say they may have found a way of combating the deadly H5N1 strain of bird flu that has claimed dozens of lives around the world. The partly UK-funded research successfully used antibodies from survivors of the virus to stop the full-blown disease from developing in mice."

"[T]he scientists, based in Vietnam, Switzerland and the US, are optimistic that antibodies from Vietnamese survivors could be used in the fight against infection. The researchers found the antibodies provided significant immunity to mice that were subsequently infected with the Vietnam strain of H5N1."

This is an interesting and encouraging development. I've read from previous studies of the 1918 pandemic response that using antibodies from those that caught the flu and survived was one of the only treatment strategies that seemed to work...

http://news.independent.co.uk/sci_tech/article2591500.ece

Also, more info at CNN: http://www.cnn.com/2007/HEALTH/conditions/05/28/bird.flu.ap/index.html

Human case in Vietnam: First in 17 months

Vietnam has seen its first human case of H5N1 infection since late 2005. On May 24, lab results confirmed the presence of the highly pathogenic influenza strain in a 30 year old man who had first fallen ill two weeks prior. The patient is from the northern province of Vinh Phuc, and news reports say that his bird flu symptoms appeared after slaughtering chickens. This is Vietnam's 94th human case of avian flu since 2003.

The infection of this man with the deadly H5N1 virus follows a resurgence of outbreaks among Vietnamese poultry since December 2006. Just last weekend, 2,000 ducks died and 6,000 more were culled throughout the country. Five provinces have witnessed outbreaks this month, although it is interesting to note that the recent human case of bird flu did not come from any of those provinces.

You can read more here:
Vietnam confirms human bird flu infection
H5N1 hits birds in Vietnam, Ghana, Pakistan

A Busy Week For Avian Influenza

There have been a flurry of bird flu reports!

In Central Java, a five year old girl has succumbed to the bird flu, bringing Indonesia's death toll to 77. In Vietnam, the WHO is investigating a possible human case of the bird flu. If this is avian influenza, it will be the first case since 2005. Pakistan has also experienced bird flu outbreaks in three poultry farms outside of Islamabad.

So are bird flu outbreaks cyclical or endemic? What's the difference?

http://www.radioaustralia.net.au/news/stories/s1931441.htm

H5N1 in Ghana probably came from Africa, not Asia

OIE released an analysis of the strain of H5N1 that caused the Ghana outbreak, which they say probably came from another West african country rather than a new introduction of a the virus from Asia.

"The analysis of the H5N1 avian influenza strain isolated from the outbreak occurring in Ghana clearly indicates that it is closely related to other isolates from Sub-Saharan African countries like Ivory Coast , Sudan, Burkina Faso and Nigeria and that it is less similar to the Asian strains currently isolated. "

http://www.oie.int/eng/press/en_070518.htm

Oh, We Got Trouble. Right Here in China.

A new avian influenza outbreak has hit China in Shijiping, Hunan Province. Luckily, there were no reports of any human infection, but over 11,000 bird died from the virus. 53,000 more were culled. Health authorities say the outbreak has been contained.



http://news.bbc.co.uk/2/hi/asia-pacific/6672661.stm

AED's avian influenza educational story book for children and schools

The Academy for Educational Development has produced this great story book to raise avian influenza awareness among children in Africa. Zandi’s song focuses upon the importance of girls’ education and the school environment as a resource to be tapped for effective delivery of avian flu information. At the same time, the story draws attention to the empowered women within the community who support each other to educate to educate the wider members of their village. It neatly stresses the importance of understanding the different networks and motivation behind each individual’s action to reduce the risk of avian flu, be that a matter of livelihoods or impressing the village leader!

Please click on the link for a copy of Zandi’s Song, the teacher’s training guide, poster and fact sheet:http://avianflu.aed.org/zandi.htm

For copies in French and Portuguese:http://avianflu.aed.org/zandi_foreignlanguage.htm

AED are happy for this to be used in country office projects and will send copies on request. To obtain or use multiple copies please see Education Material Distribution Agreement: http://avianflu.aed.org/dsp_materialsregistration.cfm

Thanks to Silvio Waisbord and Antonia Wolff at AED for their time and help.

AED Avian and Pandemic Influenza Resource Link: http://avianflu.aed.org/index.htm

WHO pledges fair access to avian influenza vaccines and warns those withholding samples

"World Health Organisation (WHO) chief Margaret Chan pledged on Wednesday to ensure that poorer nations get access to vaccines against the deadly H5N1 bird flu virus at an affordable price

..."If you do not share the virus with us, I want to be absolutely honest with you, I will fail you," Chan told a technical briefing of country representatives ... "I will fail you because you are tying my hands, you are muffling my ears, you are blinding my eyes.""

For more see: http://www.alertnet.org/thenews/newsdesk/L16570561.htm

Online Avian Influenza Course

This is pretty cool! The Centers for Disease Control and Prevention (CDC) and the Council of State and Territorial Epidemiologists (CSTE) have created a three-day training course for responding to avian influenza.

Here's a link to the powerpoint presentations and materials: http://www.cste.org/Influenza/avian.asp

Training Objectives:

• identify potential for human health problems associated with cases of HPAI,
• minimize the risk of spread or further human infection if human infection or disease is identified,
• provide guidance to individuals who are involved in the response to an HPAI cases and other HPAI exposure settings,
• protect against the risk of infection and disease and minimize the risk of viral reassortment (i.e., mixing of genes from human and avian influenza viruses) should an outbreak of HPAI occur,
• provide guidance for multi-disciplinary rapid response teams to discuss, plan, and to facilitate discussion between all state and local avian influenza rapid response teams, and
• provide funding for state and local health agencies to conduct their own rapid response training session(s).

Poor Countries Demand their Fair Share of Pandemic Vaccines

Things are getting interesting at the WHO Assembly - 17 countries have put forth a resolution demanding more equity.

"There is an unfair mechanism in which avian flu virus samples are provided free by developing countries but drug companies patented this vaccine and are selling them at unaffordable cost for the developing countries," said Indonesian Health Minister Siti Fadillah Supari.

Details of the resolution...

"Three countries which have recorded human bird flu cases -- Indonesia, Laos and Iraq -- are among the 17 sponsors of the resolution which will be debated at the assembly which ends May 23.

The text calls for ensuring 'the transparent, fair and equitable sharing of benefits" arising from information and biological specimens provided by countries. Any vaccines, diagnostics, antiviral agents and other medical supplies arising from the use of the virus...must be made available at an affordable price and in a timely manner to developing countries, particularly to those under the most serious threat of, or already experiencing a pandemic,' it said.

There must be 'prior informed consent' of the country contributing the virus, thereby giving it a say on the publishing of any findings and in commercial use. "

Pregnant Woman dies of H5N1 in Indonesia

This is Indonesia's 76th human death.

It's reported that some of her poultry died and the family buried them. The remaining, living poultry they slaughtered and ate. This makes me think we need to refine our messages some. Often the message revolves around not eating dead or sick poultry, maybe we need to be more inclusive, using phrases like "Don't eat any dead or sick poultry or poultry that has mixed with a flock where there have been recent poultry deaths"

http://news.yahoo.com/s/afp/healthfluindonesia;_ylt=AmOu6sHfWVL8TFIH932wGeSTvyIi

Reprocessing, Reusing, and Reproducing Expired Tamiflu

The National Institute of Chemistry of Vietnam is conducting experiments to reproduce and reuse expired Tamiflu. This would help governments cut costs and reduce the environmental impact of expired medicine.

http://www.thanhniennews.com/healthy/?catid=8&newsid=28037

But are vaccines the way to go? Are global efforts against avian influenza focusing on the right thing (vaccines) or should we spend more resources in prevention? What should be the next step?

60th World Health Assembly puts avian influenza high on the agenda.

Indonesia’s recent withholding of virus samples has forced the issue of avian flu to be high on the agenda for the WHO’s ten day session (14^th – 23^rd May). Similarly, Taiwan’s request for UN membership has recently prompted many to comment upon the quandary of when political rifts impact negatively on matters of international health. Pro-Taiwan media highlights China’s block to Taiwan’s UN membership as responsible for preventing access to WHO medical supplies during a vial epidemic in 1998, and causing a delay in WHO’s response to a SARS outbreak in 2003.

For more on WHO & Indonesia: http://www.france24.com/france24Public/en/news/science/20070514-health-WHO-bird-flu-africa.html

For more on WHO & Taiwan: http://www.worldpress.org/Asia/2786.cfm

http://www.courant.com/news/opinion/editorials/hc-taiwan.artmay14,0,7336992.story?coll=hc-headlines-editorials

Seven new host species for H5N1 identified

"In a new study published online in the open-access journal PLoS Pathogens, Dr. Vincent J. Munster, of Erasmus Medical Center, Rotterdam, and colleagues identify new host species for avian influenza A virus (H5N1) and provide important information on the distinctions between the ecology and epidemiology of various global strains of the virus.

An eight-year surveillance study, which included more than 36,000 wild migratory birds tested for low pathogenic avian influenza, details new data on host species, prevalence, and temporal and geographical variation of avian influenza in wild migratory birds in Europe. Seven previously unknown host species for H5N1 were identified, including four species of goose and the common gull, and dabbling ducks were found to harbor all but two known influenza virus subtypes."

Source: http://www.biologynews.net/archives/2007/05/12/new_host_species_for_avian_influenza_identified.html

Government of India announces negative avian influenza lab results for West Bengal & Kerala

For the press release see: http://pib.nic.in/release/release.asp?relid=27833

"Indonesia's Bird Flu Showdown."

Here's a link to a TIME article entitled, "Indonesia's Bird Flu Showdown."

http://www.time.com/time/health/article/0,8599,1619229,00.html

The article addresses Indonesia's reluctance to send their physical bird flu samples to the WHO for fear that the WHO will turn them over to pharmaceutical companies to create vaccines that developing nations, including Indonesia, will not be able to afford.

What is fair here?

On one hand, Indonesia has handed over the DNA codes of the samples, but there seems to be a perception that Indonesia is endangering the rest of the world by impeding the vaccine research and production. But are they really? Is it fair to make developing countries hand over, wait, and then pay for their panacea due to their lack of capacity or resources to do it themselves?

I'd love to hear from all of you.

Vietnamese officials guilty of embezzling 101 million dong (US$ 6300)

“Two former Vietnamese government officials were given three-year suspended jail terms after they were found guilty of embezzling state funds earmarked to fight bird flu”

These events highlight the need for programs to strengthen communication, accurate reporting, and accountability between all stakeholders. Please comment on how your programs have built accountability at the local, district, and national level.

For more see: http://hosted.ap.org/dynamic/stories/A/AS_GEN_VIETNAM_BIRD_FLU_CORRUPTION_ASOL-?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2007-05-08-23-46-43

Nigeria’s Health Minister announces plans for avian influenza research center.

Speaking at the first African International Symposium on Avian and Pandemic Influenza, Nigeria’s Health Minister announced plans for a center to contribute to global research on avian influenza. The center would build the strategic and technical capacity of Nigeria to support bird flu patients.

The Minister of State for Agriculture and Water Resources, Chief Bamidele Dada stated that 300,000 birds have been culled between January and April 2007, with a total of 1.3 million birds culled since the first outbreak of bird flu in Nigeria last year.

“The government has paid more than N163 million (approx US$1.3 million) to affected poultry farmers whose birds were culled, while an outstanding N281 million (approx. US$2.3 million) would soon be paid to more than 111 farmers in 13 states.”

For information on the International Symposium on Avian and Pandemic Influenza: http://www.icav-citav.ca/viral_global_threat/2007_nigeria/2007_meeting_nigeria.php

For more: http://allafrica.com/stories/200705080421.html

http://allafrica.com/stories/200705080098.html

India tests for suspected avian influenza outbreak as the virus spreads in Bangladesh

Samples have been sent to a laboratory in Bhopal to test for avian influenza in West Bengal’s Darjeeling district. On Tuesday officials announced the death of more than 3,000 birds in the regions remote Matigara village, twenty-five km from the border with Bangladesh. It is believed that Newcastle disease is responsible, but the government is taking no risks in light of the rapid spread of avian influenza in Bangladesh. The 2,200 km boarder between West Bengal and Bangladesh has been sealed to prevent illegal poultry smuggling.

In response to the further spread of avian influenza in Bangladesh, 25,000 more chickens and more than 200,000 eggs have been destroyed over the past four days as outbreaks spread to eight additional farms in the Dhaka and Magura district. Since the initial outbreak on March 22^nd, 2007, approximately 1.3 million eggs have been destroyed and “132,000 chickens have been culled in 52 farms in 10 districts." The government has committed to pay 70 taka (nearly US$1) for each culled bird.

For more see: http://in.today.reuters.com/news/newsArticle.aspx?type=topNews&storyID=2007-05-08T144610Z_01_NOOTR_RTRJONC_0_India-297174-1.xml

http://www.alertnet.org/thenews/newsdesk/DHA219057.htm

Google “supermap” shows global spread of avian influenza

This map has been the talk of the bird flu town! Created by a team of biomedical experts from Ohio State University, University of Colorado, and the American Museum of Natural History, the Google Earth map incorporates “genetic, geographic and evolutionary information” to project an ‘evolutionary tree of the virus’s mutations” across both time and geography.

"We found the visualization of multiple layers of information very helpful in generating hypotheses we could test through statistical analysis of the mutation data we organized in the evolutionary tree….The findings helped us understand whether mutations that appear to be associated with certain hosts or geographic regions appeared by chance, or whether they were true adaptations of the virus as it spread." Daniel Janies, an assistant professor in the department of biomedical informatics at Ohio State University.

Please see this website for the clear instructions to view the Google Earth avian influenza map: http://declanbutler.info/blog/?p=58

(Note: Once you have downloaded Google Earth make sure you click on the hyperlinked sentence “new link for the time-enabled maps is this one” within the Decan Bulter’s website. This will automatically stream the avian flu time series within your opened Google Earth program).

For a short video introducing the supermap please see: http://researchnews.osu.edu/archive/flumap.mov
(Be warned, it can take a while to load!)

Source: http://researchnews.osu.edu/archive/flumap.htm

Indonesia: Avian flu death toll rises to 75

The Indonesian health ministry has announced the death of a 29 year old woman from the H5N1 virus. “The woman… who was from Pekanbaru in Riau province on Sumatra island, was hospitalised in Medan on May 1 after suffering from fever and respiratory problems and died two days later.” An investigation is being conducted into how the women contracted the virus as officials claim "there were no fowl in her neighbourhood in Pekanbaru.”

For more see: http://www.alertnet.org/thenews/newsdesk/SP233038.htm

Philippines implements precautionary ban on US poultry

The Philippines has announced a ban on poultry imports from West Virginia, after authorities confirmed an H5N2 outbreak in the US state.

For more see: http://www.allheadlinenews.com/articles/7007260717

Vietnam: Bird Flu Outbreak on Duck Farm

For more see: http://uk.reuters.com/article/healthNews/idUKHAN19629120070506

And: http://www.thanhniennews.com/healthy/?catid=8&newsid=27788

To wear or not to wear? This is the question for surgical masks.

Health authorities are divided on whether proper use of surgical masks could reduce transmission of a human-to-human outbreak of avian influenza.

I think its more important to ask questions about the feasibility of requiring people to wear masks. Would it be better to emphasize hand washing? Provide guidelines for home-based care for loved ones who contract the illness?

What do you think?

http://www.themoneytimes.com/articles/20070504/fighting_bird_flu_with_masks_still_a_question_mark-id-103444.html

Ghana stops poultry exports

"Ghana halted poultry exports and began farm-to-farm checks around the capital Accra on Thursday, a day after the West African country declared its first outbreak of the highly pathogenic H5N1 bird flu." ... For more: http://www.alertnet.org/thenews/newsdesk/L038610.htm

This recent outbreak will surely add to the livelihoods insecurity of many small scale poultry raisers who are left vulnerable to increasing cheap poultry imports.

"Ghana imported 26,000 tonnes of chicken in 2002, mostly from the European Union, where farmers receive generous subsidies. Two years later this figure had almost doubled, to about 40,000 tonnes. The annual import bill currently hovers around 30 million dollars.

In contrast, the domestic market -- which supplied 95 percent of Ghana's poultry requirements in 1992 -- only provided a dismal 11 percent by 2002. Unconfirmed estimates currently put the domestic poultry supply at single-digit figures."

For more: http://ipsnews.net/africa/nota.asp?idnews=32293

Ghana has first confirmed poultry case of H5N1

The infection was detected at farm 20km from Accra. 1,600 birds had already been culled as the lab in Egypt confirmed it was H5N1

http://africa.reuters.com/wire/news/usnL021930.html

http://www.iht.com/articles/ap/2007/05/02/africa/AF-GEN-Ghana-Bird-Flu.php