- The Washington Times - Thursday, November 17, 2005

I could be the carrier. Just as SARS was brought to Canada by unsuspecting airline passengers, I could carry the H5N1 virus. I just returned from Vietnam and Thailand, where avian flu is endemic in birds.

Fortunately, I am doing fine — and avian flu is still found mainly in birds. Almost all the 125 people who have caught the flu have had close contact with poultry. Unfortunately, when and if this virus becomes easily transmissible between persons, it will spread rapidly unless early outbreaks are contained. When most travel was by ship, flu pandemics reached all corners of the world in nine months. Today, avian flu could sweep the globe in weeks.

President Bush and Congress have recognized this grave threat. The Senate approved an amendment to the Labor, Health and Human Services Appropriations Bill for $8 billion to prepare for avian flu. Mr. Bush announced a pandemic flu strategy and requested $7.1 billion in emergency funding from Congress.

While these efforts are important, a vital aspect has received appallingly little attention: the need to attack avian flu at its source, in countries where a deadly strain is likeliest to emerge. Of the $7.1 billion the president has requested, only $251 million — some 31/2 percent — is dedicated to detecting and containing outbreaks abroad and an even smaller percentage is targeted for poor farmers, health staff and veterinary workers in places like Vietnam and China. Congress has proposed even less for work at the source.

This is shortsighted, if only in terms of self-interest. It is not too late to prevent avian flu from becoming a human pandemic. To do so, we must first slow the spread of avian flu in birds; second, prevent its spread from birds to humans; and, finally, detect human cases rapidly and contain early human-to-human outbreaks. In these areas, both Mr. Bush and Congress have come up short.

The first line of defense is in communities throughout Southeast Asia, where people and poultry live closely together — and the U.S. should do much more to shore up this frontline.

First, poor communities must be better equipped to address avian flu as both an animal- and human-health issue. In many countries, people are still unsure how avian flu spreads and how to prevent it. In a recent survey in Vietnam, CARE found 1 in 3 people believed there was nothing they could do to protect poultry from avian flu. Moreover, farmers were unlikely to report infected poultry, for fear of losing their entire flock. Many developing countries cannot afford to compensate farmers or offer them an alternative livelihood. This is a major obstacle to containing avian flu in poultry.

Organizations working at the community level are well-placed to help: not only can they promote changes in behavior to prevent the spread of avian flu, but they can also contribute to grass-roots surveillance to identify and respond to outbreaks rapidly. By funding programs that promote, for example, separation of species and safe handling of poultry, as well as fair compensation for culling, the U.S. could slow the spread of avian flu among birds and help prevent transmission to humans.

Second, developing countries most likely to see human-to-human outbreaks must have ready access to antiviral drugs and other containment measures. There is an urgent need to accelerate production of antiviral drugs like Tamiflu by facilitating manufacture of generic drugs in developing countries. Experts believe some 3 million courses would be needed to contain one localized outbreak. The World Health Organization (WHO) must have access to affordable antiviral drugs pre-positioned to reach affected areas within 48 hours of an outbreak. The U.S. strategy should focus both on stockpiling antiviral drugs at home and on helping build the WHO stockpile.

Finally, effective surveillance and containment depends on functioning health infrastructure and improved coordination between veterinary and human health sectors. In countries like Vietnam and Cambodia, health systems are weak and veterinary services languishing. The situation is worse in Africa. The U.S. should invest in rapidly enhancing the quality and reach of health infrastructure in countries likeliest to be hit by avian flu.

Mr. Bush’s pandemic flu strategy affirms that the most effective way to protect Americans is to contain an outbreak beyond our borders. Yet it promises precious little funding to support work with farmers and communities in Southeast Asia, where avian flu spreads among birds every day. There is almost no funding for Africa, which may be the next stop on the routes of migratory birds carrying the virus.

Expensive defenses are constructed at home, but the frontlines remain exposed. In Southeast Asia, flu spreads most rapidly in the rainy season — October to February. President Bush and Congress must act quickly.

Peter D. Bell is president and chief executive officer of CARE, an international humanitarian organization fighting poverty in the world’s poorest communities.

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