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09-01-2007 - Avian Flu 2007: Virus Continues to Spread January 9, 2007— Avian flu may not be front-page news right now, but the disease is spreading and remains a threat to poultry and human health, say World Bank avian flu experts.

The virus has continued to spread since countries pledged some $1.9 billion last January to prevent and combat bird flu. Carried by wild birds and through poultry trade, it now has reached at least 55 nations around the world.

According to the Food and Agriculture Organization (FAO), over 220 million domestic birds—most owned by poor farmers in developing countries—have died or been “culled” (slaughtered) in efforts to contain the virus. Economic losses in the Southeast Asia poultry sector alone are estimated at around US$10 billion, and culling has cost the African poultry industry another $60 million.

The number of countries with human cases has risen from two in 2003 (China and Vietnam) to 10 in 2006, according to the World Health Organization (WHO). By the end of 2006, the total number of human avian flu cases stood at 261, and the number of deaths at 157.

Indonesia has become the most severely affected country, with 74 cases and 54 deaths. In 2006 alone human cases appeared in five additional countries: Azerbaijan, Djibouti, Egypt, Iraq and Turkey. The vast majority of cases to date were apparently caused by close contact with infected poultry

The number of human deaths is still very small compared with the millions who might die in an influenza pandemic, which experts say is long overdue. Medical researchers are closely monitoring human avian flu cases for the first sign the virus is becoming transmissible from human to human.

So far there is no evidence that is happening. But the virus’s emergence in Africa worries many.

“We continue to be very concerned about Africa,” says World Bank avian flu advisor John Underwood, formerly the Bank’s director of country services.

“The disease has become widespread in Nigeria, and there are several other countries where the threat is pretty big,” including Egypt, where 18 people contracted avian flu and 10 died from the virus in 2006.

According to Francois Le Gall, the World Bank's lead livestock specialist for Africa, socio-economic vulnerability, the impact of already existing diseases such as malaria, TB and HIV/AIDS, and poor capacity of veterinary services combine to make a complex situation in Africa.

“The experts are telling us that other diseases are going to emerge or re-emerge," he says. "Almost every year there is a new disease appearing, and 75 percent of these emerging or re-emerging diseases are coming from animals; 80 percent of those have the potential to be transmitted from animal to human. These could come together to create what the experts are calling 'the perfect microbial storm.'"

Many fear the virus will expand across the continent. Migrating birds help spread the virus, along with trade in products and animals. Experts see evidence bird flu is slowly becoming endemic in Africa, increasing the risk of the virus mutating into a type that can be transmitted from human to human.

“Once that happens, you have a completely different situation, and you cannot start preparing then, because that will be way too late,” says Ok Pannenborg, senior health advisor for the Bank’s Africa region.

“This is not going away,” adds Underwood.

“Even in countries where there have been huge efforts in control, there have been new outbreaks. So it’s not a threat we should start to ignore. It’s one we really do need to keep paying attention to.”

More Funds Pledged

A year ago, donors pledged US$1.9 billion to help countries put systems in place that would allow them to respond quickly if hit by the virus.

And donors meeting in Bamako, Mali, in December responded to a World Bank report that another US$1.2 to $1.5 billion would be needed in the next two to three years by pledging an additional $475 million in grants, bringing the total to nearly $2.4 billion.

The funding—consisting of about US$1 billion in World Bank, Asian Development Bank, and African Development Bank loans and concessional credits, and the rest bilateral aid, grants and trust fund money—pays for a broad range of activities to strengthen human and animal health services.

It also helps compensate poor farmers whose poultry have been slaughtered because of exposure to the virus.

“Lots of African people depend on poultry for their livelihood, or at least for a pretty large share of their protein consumption,” says Underwood. “And so the destruction of birds because of the disease has had a huge impact on a group of people who are already pretty vulnerable because of low incomes and low consumption level.”

Bank rural strategy advisor Christopher Delgado led a multi-agency study on compensating farmers for birds culled because of avian flu. The study responded to repeated requests from field officers for help implementing compensation.

“Compensation is fundamental to animal disease control everywhere, but especially in developing countries where you're reliant on the compliance of small farmers for success,” he says.

“The problem is that in developing countries a lot of livestock and a lot of poultry are kept on very small farms in very remote places. If these producers do not comply with orders to report outbreaks or cooperate in presenting animals for culling when requested, [countries] are not going to be successful at disease control. That's the basic issue,” Delgado says.

Delgado stresses the importance of having a plan before the onset of disease outbreaks to cull infected birds, set compensation rates that are high enough to provide real incentives, communicate the compensation plan, involve civil, veterinary and—where warranted and feasible—medical authorities in the culling operation, and disburse money promptly and fairly to affected farmers.

“That's really the important part of being prepared in advance,” he says.

Funds also pay for poultry vaccines, staff training, and equipment. A multidonor trust fund to which donors originally pledged $65 million has now grown to $75 million with support from nine donors, the largest being the European Commission. It pays for expenses not covered by other funding and is considered a “fund of last resort,” says David Potten, administrator of the Avian and Human Influenza Facility.

The Facility approved six grants totaling $28 million from the trust fund in December. Two grants pay for regional avian flu programs in the Middle East and the southern cone of Latin America to support collaboration between countries “because bird flu can very easily travel across borders,” says Potten.

“Birds migrate across borders, this is how bird flu spreads, and therefore collaboration between countries is very important.”

Another funding mechanism for the Africa region is the ALive platform,, a multi-institutional and interdisciplinary partnership. The World Bank, World Organization for Animal Health (OIE), the FAO, and the African Union created this coordinating mechanism for the fight against avian influenza, and the prevention of future emerging and re-emerging animal diseases. A recent ALive publication estimates that the financial needs for an integrated avian influenza prevention strategy focusing on communication and animal and human health would be around US$720 million over three years. The European Commission recently signed an agreement to provide US$10.5 million additional funding to the ALive Partnership.

What is the true threat to humans? Underwood acknowledges it's impossible to say.

“We do strongly suspect there will be another human pandemic at some point. They've occurred periodically throughout history and we need to be prepared for another one. Whether it comes from this particular virus or some other one, there still exists a threat to humans,” says Underwood.

He says avian flu funds will be well spent if they help prepare developing countries for emergencies and strengthen animal and human health systems “to help with all sorts of diseases.”

“One of the things we need to do is keep the attention on the fact that this is still a threat. Many more countries are affected by it than there were when this disease was very much publicized.”

Olga Jonas, the World Bank’s economic advisor on avian and pandemic influenza, adds that spending now on control is very worthwhile insurance, since the economic costs of a pandemic would be enormous—on the order of US$1.2 trillion to US$2 trillion, according to World Bank simulations of a severe case scenario.

Le Gall says that progress is being made now to tackle the current bird flu outbreak by strengthening veterinary and human health monitoring systems around the world. This, he noted, would temper the risk of an apocalyptic conflagration of diseases.

"All the measures we are using now are going to be useful to control all these emerging or re-emerging diseases—like veterinary services, public health services."

“We have no choice but to be prepared,” says Dr. Bernard Demure, director of the World Bank’s Health Services Department and member of the institution’s flu pandemic task force. “The real difficulty is we do not know what we would face.”

“The key issue is changing behavior,” he adds. “Beyond that, let us hope that the odds are on our side.”

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