[afro-nets] Avian Flu

[Claudio Schuftan <claudio@hcmc.netnam.vn>]

Avian Flu
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One 'flu' over the chicken's nest...
Putting the needs of poor people at the centre of the world's
response to bird flu is crucial in defeating the epidemic.

by Unnikrishnan PV, ActionAid International

Though few humans have been infected so far, the World Health
Organisation has projected that between 2 and 7.4 million people
could die from a mild pandemic of avian flu. Experts warn that
except for the ability to spread efficiently and in a sustain-
able way between humans, the H5N1 virus has already met all the
prerequisites to start a pandemic.

It is nearly impossible to stop a pandemic once it starts. Pre-
cautionary planning is vital. But it must be done in a way that
protects people's wellbeing. That requires looking at the social
and economic implications of the virus, particularly for poor
people and poor communities in the developing world.

Measures to control the infection must be located in the context
of the other multiple hazards that poor communities face. Prepa-
rations to respond to the epidemic by placing countries on a
"war footing" can, for the poor, be as disastrous as the flu it-
self.

Chickens are one of the main sources of food and income for mil-
lions of poor people in developing countries. With images of
mass slaughter of chickens - 300,000 have just been despatched
in India's Maharashtra state alone - panic is spreading in poor
communities. To avoid rumour and anxiety, health authorities
need to provide simple, useful and practical information.

The poor must also be compensated economically for the loss of
poultry. Since this will be expensive, the generosity of the in-
ternational community must supplement the efforts of national
governments.

Governments must guarantee that people will not be displaced and
evacuated without their consent, in the name of bird flu prepa-
ration. During the SARS scare, human rights groups complained
that attempts were made to "clean up" slums in the name of hy-
giene promotion.

Poor people are already suffering disproportionately from the
consequences of avian flu. If the virus begins to spread from
human to human, the poor will suffer overwhelmingly.

Public health systems are the first line of defence in any epi-
demic. However, in many developing countries these have been
paralysed by budget cuts and the privatisation of health care
dictated by policies imposed by major aid donors working to a
conservative agenda.

At an international level too, current trade rules are actively
conspiring against the needs of poor countries to protect their
citizens. Tamiflu is currently the only available medicine, but
because of the patent regime imposed by the World Trade Organi-
sation it is expensive and beyond the reach of the poor.

Developing countries should be allowed to take radical steps to
protect their citizens and ensure that public health is placed
before the profit interests of pharmaceutical companies. Health
activists associated with the pressure group Health Action In-
ternational (Asia-Pacific) have called for the temporary cancel-
lation of Tamiflu patent rights, to ensure its availability and
accessibility.

It is too early to predict which countries are going to be badly
hit. We do not even know whether H5N1 bird flu will hybridise
with the human influenza virus and begin to spread from person
to person. But if an epidemic develops, many factors will hamper
humanitarian intervention.

The flow of relief goods into affected areas can be disrupted
due to border closures, quarantines and poor transportation sys-
tems. The powers of security forces - police and military -
which are likely to take over running essential services will
also need to be carefully monitored.

What we already know from experience of mass casualties in natu-
ral disasters is that they leave a long trail of mortality and
unending suffering amongst poor people. Ensuring their safety,
survival and recovery is crucial. How bird flu is handled in
poor communities may affect the outcome for the whole world.

Dr. Unnikrishnan works on health and humanitarian issues. He is
Emergencies and Conflicts Advisor, International Emergencies
Team, ActionAid International (AAI). AAI works in over 45 coun-
tries including 6 already affected by bird flu. He is currently
in Geneva, attending a UN- InterAgency meeting on Avian and Hu-
man Influenza Virus.