RAISING THE ALERT LEVEL OF BIRD FLU PANDEMIC

WHO should consider raising the bird flu pandemic alert going by recent US actions and Indonesia’s cluster cases? The world may be much closer to a bird flu pandemic than when the first human case of H5N1 infection was diagnosed in late 2003. This could well be what the World Health Organization’s (WHO) recent flurry of activity to clarify its pandemic alert system may have implied. That clarification came after questions arose as to why even a large cluster of human cases in Indonesia seemed to not have nudged the pandemic alert level up a notch.
Most of Indonesia’s reported human cases have come from the Jakarta area or nearby locations In West Java, until its largest cluster to date which involved eight members of a family in North Sumatra. Of these, seven have died. This arguably called for the alert level to be increased to Phase 4. But the WHO did not do so. Instead, it set up a dedicated website about Indonesia’s bird flu situation.
Now consider two recent decisions made by the United States. On March 25, the US decided to use a strain of the virus isolated in Sumatra to make its new pandemic Vaccine. Then, it decided to send a supply of Tamiflu to Asia to prepare for an H5N1 outbreak.
Taken together, these actions suggest some urgency on the part of experts in the know. After all, the US has less of Tamiflu in stock-piles than most industrialized countries, so its deployment in Asia suggests that the situation here could be worse than is let on. Last week, the US Health and Human Services Secretary Mike Leavitt even said that while he refused to specify the amount or the location, he want to make clear that they are beginning to deploy it”.
Reading between the lines, the WHO’S recent attempt to “clarify” its pandemic alert
system suggests that H5N1 spread from human to human has already become more efficient. This is no scare-mongering either. Some folks who survived the Yogyakarta quake on May 27 are taking shelter in chicken sheds where they could be exposed to infected poultry. After all, in 2004, H5N1 was isolated from poultry in Yogyakarta. Meanwhile, in the rest of Indonesia, the virus is now spreading from the thousands of backyard farms found in both urban and rural areas, including Jakarta, where free-range chickens are to be found in many of its neighborhoods.
WHO epidemiologist Steven Biorge told reporters in Jakarta last week: “There is a pandemic in birds.” It is already entrenched in the environment in Indonesia, he added, which is why low-risk groups — not poultry workers — including children and students, are making up to 50 per cent of the cases. He also noted that there was a practice that promoted the bug’s spread — trade in chicken droppings as fertilizer. It is big business in Indonesia but one that helps move the bug across the far-flung archipelago. And that is talking only about the risk of spread from poultry to humans. Reading between the lines, the WHO’S recent attempt to “clarify” its pandemic alert system suggests that H5N1 spread from human to human has already become more efficient.

For in the Sumatra cluster, spread from person to person to person, a three-person chain had been observed for the first time. Despite acknowledging so, however, the WHO has thought best not to raise the alert level, even though, by its own recent explanation, this would be necessary when “small cluster(s)” of human cases appeared.
Since June 3, a family in Pamulang, West Java, with five members who have already fallen ill looks set to become Indonesia’s second-largest cluster to date. Perhaps it is already time to raise the alert level.
The implications for neighboring countries, Singapore included, are enormous if we are that much nearer to a pandemic.
Public health education campaigns may have to be stepped up, businesses might have to start dry runs of their contingency plans sooner rather than later, checks at border entry points might have to be tightened, and so on. While GlaxoSmithKline broke ground for a huge vaccine manufacturing facility in Singapore this week, it will be ready only in 2010. We can only pray that it will come online in time to help us combat a pandemic.