Bird Flu: Annan pleads for urgent Aid to Poor Countries, especially in Africa by UN News / New York Times 4:01pm 30th Mar, 2006   March 29, 2006 (UN News)    Deeply concerned by the rapid spread of bird flu, United Nations Secretary-General Kofi Annan today made an impassioned plea for greater funding beyond the $1.9 billion already pledged to help poor countries, above all in Africa, to fight a disease that in a worst case scenario could mutate into a deadly human pandemic.    Since the International Pledging Conference on Avian and Human Influenza in Beijing in January, "vast and urgent needs have emerged which makes it yet more imperative to convert the pledges into cash quickly," Mr. Annan said in a statement.    "Bearing in mind the growing challenges faced by poor countries in all regions, donors will have to be prepared to mobilize additional resources for urgent as well as long-term needs. And we must work together to create flexible mechanisms that bring funds and expertise more rapidly to where they are needed, particularly for culling and compensation," he added.    Mr. Annan noted that with the rapid spread of the H5N1 virus from Asia into Europe, the Middle East and Africa, both the disease, and the measures needed to control it, will increase the vulnerability of millions of families, most of them in poor countries.    "We know that H5N1 avian influenza can be controlled if outbreaks are identified quickly, infected animals are culled, and movement and marketing of poultry are stopped in outbreak areas," he said.    "But such measures can succeed only if communities and animal health authorities work together, if we keep the public informed about risks and the means to reduce them, if we monitor progress carefully, and if we provide swift and adequate financial compensation for culled birds," he added of the need to encourage poor farmers and families to report the disease and take the necessary steps.    Stressing how absolutely dependent some nations are on outside assistance to do their part and protect their people, he said that nowhere was this clearer that in Africa, from where he has just returned after a two-week mission.    "As I learned at first hand, there is an immediate and desperate need for expertise, funds, transport and equipment. With H5N1 cases now confirmed in four African countries, that need grows more pressing every day," he declared. "Avian influenza threatens the entire world. It knows no borders. It is our collective responsibility to ensure that all countries - rich and poor - are protected and prepared. The United Nations family will do all it can to help ensure that this happens."    Since December 2003 the H5N1 virus is known to have infected 186 people, of whom 105 have died. According to the UN World Health Organization (WHO), it remains an animal pandemic that very rarely infects humans, and there is no sign that it is changing in order to spread more easily from animal to human or from human to human.    But the great concern is that the virus could mutate into a type that spreads easily from person to person. The so-called Spanish flu pandemic that broke out in 1918 is estimated to have killed from 20 million to 40 million people worldwide by the time it had run its course two years later.    March 28, 2006    The response to bird flu: Too much or not enough, by Donald McNeil. (New York Times)    Dr. David Nabarro, chief avian flu coordinator for the United Nations, has become gun-shy about making predictions - in particular, about if and when the H5N1 virus, now devastating bird populations around the world, will do the same to humans.    But Nabarro describes himself as "quite scared," especially since the disease has broken out of Eastern Asia and reached birds in Africa, Europe and India much faster than he expected it to.    "That rampant, explosive spread," he said, "and the dramatic way it''s killing poultry so rapidly suggests that we''ve got a very beastly virus in our midst."    Nabarro, the former chief of crisis response for the World Health Organization, admits that he has been accused before of being an alarmist.    On his first day in his current job, he was quoted as saying that the avian flu could kill 150 million people.    In December 2004, when he was in charge of the health organization''s response to the Indian Ocean tsunami, he warned that if help did not arrive quickly, cholera and malaria could kill twice as many people as the waves had just swept away.    In Darfur the same year, he said that 10,000 people a month were dying in refugee camps because the Sudanese government was rebuffing aid.    Earlier in 2004, he warned that Israeli roadblocks were endangering Palestinians who needed drugs for diabetes and high blood pressure.    Asked to reflect on those warnings, he answers: About Darfur, he was dead right; on the Palestinians, he was also right, but massive infusions of aid kept death rates down; and on the tsunami, he said, he made his dire forecast when only 40,000 people were believed dead, and the world''s abundant generosity paid for the clean water and mosquito control that prevented the worst from coming true.    On avian flu, he notes, he predicted a range of 5 million to 150 million deaths - the same range the World Bank was using - but headline writers quoted only the higher figure. And how many does Nabarro now say could die? "I don''t know," he said. "Nobody knows."    But he repeatedly said that he is more scared than he was when he took the job in September. In October, he predicted that the virus would reach Africa, where surveillance is so poor that deaths of chickens or humans could easily go undiagnosed for weeks. Last month, he was proved right.    The infection of millions more birds in many more countries "has led to an exponential increase of the load of virus in the world," he said. And influenza is a fast-mutating virus. Each infected bird and person is actually awash in minutely different strains, and it takes lengthy genetic testing to sequence each one - so if a pandemic strain were to appear, "it might be quite difficult for us to pick up that change when it happens."    To skeptics who doubt that the H5N1 strain will become a threat to humans because it has existed for 10 years without doing so, he counters that it had the same 10 years to move out of Southeast Asia, but it did not until last year, when it shot across half the globe.    The skepticism reminds him of his stint in East Africa in the 1980s. No one realized then how widespread the AIDS virus was, and it was unclear then whether it was transmitted by sex. Some experts argued that sex was such an inefficient method of disease transmission that it would never be much of a threat. It has now killed 20 million people and 40 million more are infected.    "We failed to give it the proper focus, right at the beginning," he said.    Like early AIDS, he said, avian flu has too many unanswered questions, like: Why did the disease, after years of smoldering in poultry, suddenly start hitchhiking in migratory birds? Why does the northern China strain - the one now spreading westward - cause so many false negatives in diagnostic tests? Why did so many people fall sick so quickly in Turkey?    "Bits of the puzzle are missing," he said. "In six months, will we be cursing ourselves for missing some key phenomena now?"    He said he fears that the virus will soon be endemic in birds everywhere, rendering containment fruitless and condemning the world to mounting a perpetual vigil for human outbreaks. Its movement into cats frightens him even more because humans routinely curl up with them.    Mutations making it less lethal to humans may, paradoxically, be bad news, he said. A disease that kills half of those it infects often burns out before it reaches new victims, while one that leaves 98 percent of its victims alive, as the 1918 flu did, rapidly reaches hundreds of millions because it has so many carriers.    As a public-health bureaucrat, the 56- year-old British doctor wants to come across as "honest, accurate, down-to- earth, someone who can translate complex facts in a way that makes emotional sense to those receiving them."    Still, there is something about his voice. Experience has made him wary of misquotation, so he chooses his words as carefully as a surgeon picks through his tray of instruments. But his enunciation is chilling - reminiscent of Basil Rathbone as Sherlock Holmes, describing with slow, awful precision how a body was mutilated.    Even his lighthearted similes come across that way. An Oxford graduate and son of a prominent doctor, he knows the value of a yard chicken because he has worked in Nepal, northern Iraq and East Africa fighting malaria and malnutrition.    Each bird that lays eggs until it ends up in the pot, he said, "is a short-term savings account with a high rate of growth and a yield that no bank can match."    Culling ruins Third World farmers the same way canceling Social Security would devastate the American working class. It forces the poor to hide their flocks and thus protect the virus.    Nabarro rejects the word "gloomy" as a description of his outlook, but if he were an oncologist, his patients would flee.    He works out of rented UN offices in the Chrysler Building in New York and spends much of his time traveling. But that will end abruptly if the disease starts spreading to humans. There will be, he predicted, a "period of wonderment," while the authorities figure out whether the first cases are real, then borders will close, airports will shut down and travelers everywhere will be stranded.    "Assuming I''m here, I''ll just camp down, probably in the Secretariat, and stay there for 6 to 10 weeks," he said referring to the UN headquarters.    That means he will not be with his wife and five children, who are in Switzerland, where he was posted with the health organization, or in college in England. He has not stockpiled Tamiflu, the antivirus drug, for them or for himself, he said, although he does carry a box of it to show at meetings. They, too, will have to hunker down where they are.    "But they know the job I''m doing," he said. "They see me as I''m plotting the virus on maps."    The one aspect of his job that makes him more optimistic is that the world is waking up to the threat of bird flu. In January, Nabarro went to a summit in Beijing hoping to raise $1.2 billion for the fight. He got $1.9 billion. Still, that is just a beginning, he said.    "We spend billions to protect ourselves from threats that may not exist, from missiles, bombs and human combatants," he said. "But pathogens from the animal kingdom are something against which we are appallingly badly protected, and our investment in pandemic insurance is minute."
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