Information service of the Pontifical Mission Societies since 1927
New York (Agenzia Fides) - A leading expert in tropical medicine who is observing the wave of avian flu in the world, Irish born Prof. Kevin M. Cahill, Health advisor in charge of anti-terrorism in New York City. Kevin M. Cahill, M.D. is University Professor and Director of The Institute of International Humanitarian Affairs at Fordham University, Director of the Tropical Disease Center at Lenox Hill Hospital, Clinical Professor of Tropical Medicine and Molecular Parasitology at New York University School of Medicine, Chief Medical Advisor for Counterterrorism, NYPD, Professor and Chairman of the Department of International Health at the Royal College of Surgeons in Ireland, Senior Consultant to the United Nations Health Service and President-General of the American-Irish Historical Society.
Here professor Cahill comments exclusively for Fides the question of a global epidemic of H5N1.
“Avian, or bird, flu has been recognised as a significant veterinary problem for more than a century. Migratory birds, especially ducks, are ideal reservoirs of infection since they develop few symptoms, while domestic fowl are very vulnerable, dying in large numbers when highly pathogenic strains of flu virus infect their flocks.
Avian flu is caused by a Type A viral organism. Scientific advances have allowed further specification; all serious outbreaks have been caused by H5 and H7 subtypes. It is furthermore known that these flu viruses have the capacity to mutate, changing their genetic structure and protein coverings to evade the normal host protection offered by antibodies elicited from previous exposures. Finally, transmission of bird flu to humans is well documented, and humans may then, in turn, infect other humans.
These basic facts must be understood in order to appreciate the current concern regarding a potential human avian flu pandemic. A global outbreak of human avian flu poses a fatal threat to millions of people around the world, and will be particularly dangerous for the vast majority living in countries where public health programs, medical facilities, trained personnel, vaccines and drugs are woefully inadequate.
A deadly H5N1 strain of avian flu was detected in birds and domestic fowl in Southeast Asia in 2003. This is the largest and most severe outbreak ever recorded with an estimated 150 million birds now either dead from the disease or destroyed in desperate efforts to control its spread. This particular strain of bird flu, moving with migratory bird patterns, has been identified in recent months in a broad geographic swath reaching from Asia to Russia, Turkey, Greece and many parts of China. The causative virus is a hardy organism passed in the saliva or feces of infected animals; the crowded poultry markets traditional in Southeast Asia offer a perfect breeding place for transmission. The economic consequences for the poultry industry are obviously severe. The focus, however, is appropriately on the costs of a human outbreak that would be almost catastrophic. To date there have been less than 100 human cases traced to the new H5N1 strain but more than half of those infected died.
In 1918 a bird flu mutated into a highly lethal human epidemic causing almost 50 million deaths within a year; more people died of that flu outbreak than were killed in both World Wars. The Economist newspaper has recently calculated that if one third of Americans were to fall ill in a new bird flu outbreak the health costs and lost earnings would exceed $200 billion. If a global epidemic - a pandemic - occurs then control measures would have to include mandatory quarantine measures that would utterly disrupt normal trade, travel, and tourism patterns with almost incalculable damage to the global economy and even political stability, especially in the fragile less developed nations of the world.
The threat posed by H5N1 to both veterinary and human health is, therefore, very real indeed. A threat, however, is not a certainly and both nature and man can influence the outcome, modifying a potential disaster. Some viruses weaken as they mutate and what is lethal to birds may, hopefully, prove less damaging to humans. But the world cannot simply hope and pray for that to save us.
There is an urgent need to strengthen control measures, carefully monitoring the spread of infected birds, vaccinating domestic fowl, promptly isolating and destroying known reservoirs, improving surveillance, developing innovative incentives to reimburse poor farmers for the loss of their flocks. Such methods, along with public education, can teach people to recognise H5N1 infection while it is still primarily an avian problem, and encourage local farmers to promptly report sick birds rather than hide them from authorities for fear of economic loss.
In facing a human pandemic there are both public health and individual clinical responses. Once again, education is a critical component in devising appropriate preparedness programs. Governments must invest in developing and stockpiling vaccines and anti viral medication for use in an emergency. They must improve international flu surveillance and understand that infectious diseases do not respect borders. Wealthy nations must learn that helping poor countries facing flu outbreaks is not some form of charity. Such cooperation might allow an outbreak to be contained as rapidly as possible at its source and thereby benefit all mankind regardless of race or religion, wealth or nationality.
There is simply no role for parochialism in facing a pandemic. Individuals who seek security in hoarding personal supplies of drugs should be aware that such self centred efforts are probably foolish at this time. There are very real problems that must be recognised; the vaccines and medicaments now being developed may not be suitable if viral mutation occurs or drug resistance emerges, both being probable if one is to depend on previous outbreaks.
Facing a pandemic requires knowledge, calm professionalism, and major investments in training and enhancing the entire infrastructures of public health. Panic and selfishness will serve no good purpose.
(KC) (13/2/2006 Agenzia Fides; Righe: 87; Parole:1121)
