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Vigilance for further disease outbreak

Updated On: Jun 08, 2007

Once again, East Asiais in the spotlight for disease outbreaks and, this time, it is a recurrence of diseases that have broken out in various spots in the region.

In Malaysia, the highly pathogenic H5N1 avian flu strain has been detected in a village in Sg Buloh, the first resurfacing after the outbreak in March 2006. Agricultural and Agro-based Industries Ministry secretary-general Datuk Dr Zulkifli Idris assured the public that his department is on “red alert” and all his officers “have been directed to monitor birds in their areas”.

Malaysia went into mobilization mode as an estimated 2,000 birds and eggs, including chicken and ducks, were scheduled to be culled in the operation. According to Dr Zulkifli, "this is an isolated case and there is no worry at present. We will attempt to clear the affected areas of any sick bird within 36 hours".  Ever on the alert for infectious diseases, Singapore immediately suspended the import of chickens and eggs from Selangor in fear of a second outbreak. To prevent any political economic and social fallouts, however, Singapore is not stopping importation from Johor, Malacca, Negri Sembilan and Perak which are still officially disease-free. Malaysia supplies 3.6 million poultry and 83.7 million eggs per month to Singapore.

Southeast Asia with its limited resources and capacity is unable to handle the constant surfacing of outbreaks in the region. Thus, they must rely on international efforts to combat communicable diseases. Such efforts are given a boost by the recent gathering of health stakeholders and practitioners to ask the World Health Organisation (WHO) to set up a global stockpile of vaccines for the virulent H5N1 bird flu strain and other influenza viruses that can reap havoc on the world health system.

Such global efforts are not without problems and one of the main obstacles is who should benefit and how vaccine stockpiles should be use. One example is the complaint highlighted by Indonesia of the developed world’s pharmaceutical companies developing vaccines that poverty-stricken region like most parts of Southeast Asiacould not afford. Indonesia retaliated in December 2006 by stopping to send H5N1 samples to the WHO, with the reason that such samples were used for profit-making by the developed world.

Such moves may end up putting the whole world at risk because without the latest sample, scientists are unable to track the mutation as well as adaptation of the viruses to their environment, especially inIndonesia which now holds the ominous records of the country with the highest death rate from the virus. In addition, bird flu strains from Indonesia have spread to North-east AsiaCentral AsiaRussia,Europe and Africa, putting the world at risk. Recurrent H5N1 bird flu strains may keep popping up unless there is a concerted effort to stamp it out.

China reported its 25th human case of bird flu in May 2007, an ominous sign that regional proliferation is activating again. Unlike Indonesia, however, the difference is that China has the capabilities and technologies to produce its own vaccines for infected birds and humans.

China’s indigenous capability in developing and manufacturing vaccines is demonstrated in the recent outbreak of “blue-ear disease” which has affected 45 000 pigs, including killing 18 000 of them. In crisis mode, the Chinese government through the Ministry of Agriculture immediately ordered its specialized industries catering to animal medicine to manufacture more vaccines to contain the virus. All recovery work, research and implementation procedures were done within and by China.

Without developing its own capabilities like ChinaIndonesia’s move is highly controversial as its accusations of the advanced countries benefiting from virus sample cannot overrule the fact that research capabilities for vaccine production are mainly located in nine industrialised countries: AustraliaCanadaFranceGermanyItalyJapanHollandBritainand the United States. Its neighbour Singapore is only an aspirant that is currently developing its own capabilities. Would Indonesia prefer to share samples with fellow ASEAN labs as opposed to developed world labs? This question is still out in the open.

Moreover, time is running out for Indonesia as, under the most optimistic scenarios, maximum world capacity for pandemic flu vaccine production by 2009 would be around 2.34 billion doses. Given a world population of 6.7 billion by then, there would be a shortage of more than four billion doses. The most affected countries, like Indonesia, would face greater risks than others. Indonesia’s fellow ASEAN neighbours, already experiencing their own bouts of infection, would also be hit. Thailand has already reported 25 human bird flu cases, including 17 fatalities.

Already, there is evidence that Indonesia’s situation is heading for the worse as the virus has mutated to optimize transmission to humans. The head of Indonesia's national committee for bird flu control, Bayu Krisnamurthi at a press conference marking the second anniversary of the appearance of bird flu in humans in Indonesia, stated that Indonesiahad recorded 99 human infections, 79 of them fatal. 'We found a new indication that the bird flu virus is transmitted easily (to humans) now. Previously a high intensity (of contact) with the virus was needed to enable contamination of the victims,' he said.

Vaccine is only one of the many issues in which Indonesia needs international help. Education, public awareness programs and training are also important. Poultry and humans continue to live in close proximity in this archipelago (31 out of 33 provinces affected), increasing risks of infection. Unlike ChinaIndonesia’s decentralized political system makes it harder to implement these programs or the vaccine shots. In the Chinese case, in dealing with the blue ear disease, China’s centralized command was able to quickly order local vet stations to implement vaccination and disease control measures. Other speedy measures include the ban on sale and transport of sick pigs. The highest authority in the land, Prime Minister Wen Jiabao, was activated to personally institute measures to ensure pork supplies would not go into shortage. "We have noticed the recent rise in pork prices and the government is going all out to ensure the supply of pork and keep it affordable," Wen said in late May 2007.  (7 June 2007)

Sources:

COPING WITH PANDEMICS Injecting new urgency into bird flu fight (Straits Times, 7 June 2007)

Bird flu detected, culling begins (Star, 6 June 2007)

Humans could face greater bird flu risk, Indonesiawarns (Straits Times, 6 June 2007)

S'pore suspends poultry, egg imports from Selangor (Straits Times, 6 June 2007)

Bird flu reappears in Malaysia(Channelnewsasia, 6 June 2007)

AVA suspends poultry and egg imports from Selangor (Channelnewsasia, 6 June 2007)

Chinaurges vaccination against disease that has killed 18,000 pigs (Channelnewsasia, 5 June 2007)