Interview with WHO experts Hassan al-Bushra and John Jabbour

Human cases of bird flu have now been detected in three Middle Eastern countries: Iraq, Egypt and Jordan, with fatalities in the first two. While infected poultry has been found in Lebanon, Kuwait, Israel and Gaza. Mass culling has accompanied the detection of the virus in poultry, along with recommendations from health bodies to prevent a new influenza virus from mutating from its current form into one which could spread from human-to-human. Major losses have been reported by those selling poultry with demands on governments to offer adequate compensation. In an interview with IRIN, the World Health Organization’s (WHO) regional adviser for communicable diseases surveillance Dr Hassan al-Bushra and senior epidemiologist and international health regulations officer Dr John Jabbour warn of the risks involved and urge all involved parties to work hard to allay the dangers of an outbreak. QUESTION: How serious is the threat of avian influenza in the Middle East? ANSWER: Hassan Al-Bushra [HAB]. The threat is indeed very serious, and it is a global threat. While avian influenza virus H5N1 is essentially an animal disease, it is the potential of a future pandemic stemming from this virus that we are most concerned about, and most intent on trying to prevent. If people continue to be in contact with [avian flu] and infected by avian flu, at some stage the virus either will mutate into a new form that spreads from human to human, or a new influenza virus will be created through the combination in humans of the bird flu virus with an existing influenza virus. The results of either eventuality would be disastrous. We predict that an influenza pandemic outbreak, which could cross the world in about three months, could end up killing hundreds of thousands of people. Thus the importance of containing bird flu relates more to preventing the future outbreak of a new influenza pandemic, rather than to H5N1 itself. Q: What steps are being taken to prevent a human-to-human outbreak? A: [HAB] We have been working hard in collaboration with the governments of the region, and urging civil cooperation, to prevent a further spread of bird flu. By containing bird flu, we are by default minimising the risks of a new influenza pandemic. Bearing in mind the seriousness of the threat, we have been encouraging mass culling of poultry, sanitation, awareness campaigns and general improvements in hygiene practices, while devising tight plans and seeing their implementation through. Q: Human cases of bird flu have been detected in Egypt, Iraq and Jordan so far. Could governments have done more to prevent the spread of bird flu to humans? A: [HAB] Notice that it has been over two years since we started to work in collaboration with governments to fight a bird flu outbreak. In all countries, there has been close cooperation between various government agencies. Here in Egypt, the health, agriculture, information and environment ministries have been involved, along with the military. There have been steps taken across the board, both to devise appropriate measures and to implement them. The governments have been doing well in implementing our recommendations. Q: In light of government awareness campaigns, is the public sufficiently informed on the virus in the Middle East region? A: [HAB] Awareness campaigns, which involve television spots, brochures, posters and radio campaigns, were ready long before the virus was detected in poultry in Egypt, or elsewhere in the Middle East. Here in Egypt, the campaigns were launched within hours of the first detection of the virus in poultry. However, there has also been much misinformation owing to conflicts of interests. For instance, the poultry industry, which has suffered badly from the emergence of the virus and consequent mass culling, has sought to misrepresent the dangers by claiming the virus cannot infect humans. On the other hand, many people do not trust their governments, and [some members of the public] are spreading misinformation. A: John Jabbour [JJ]. While the media has done very well on the whole with providing the public with information on the disease, some outlets have also used this crisis as an opportunity to attack governments. This is a health crisis, and should be handled responsibly as such by governments, civil groups and individuals alike. Q: What new recommendations has the WHO made to governments in this region to prevent a further spread? A: [HAB] We are urging the continued implementation of all appropriate recommendations. While there was a momentary decrease in the frequency of awareness campaigns prior to the first detection in humans in Egypt, perhaps in a government bid to calm the population, we all soon realised that there was no room for such laxities, however relative. A: [JJ] We are also encouraging the development of non-pharmaceutical interventions, which include better hygiene and sanitation practices. As far as potentially infected areas, they must be cordoned off and people should stay away, however low they deem the risk to be. Q: To what extent is Tamiflu effective in combating the virus? Would a vaccine against a potential influenza virus be effective? A: [HAB]: Even now, we remain unsure about Tamiflu’s real effectiveness. As for a vaccine, work cannot start on it until the emergence of a new virus, and we predict it would take six to nine months to develop it. For the moment, we cannot by any means count on a potential vaccine to prevent the spread of a contagious influenza virus, whose various precedents in the past 90 years have been highly pathogenic. However, it is crucial that countries in the Middle East invest and start developing their own research and technical facilities, where they can produce their own drugs when the time comes rather than wait to import expensive medicines from abroad at the risk of their populations. Q: What are your recommendations to the general public in the Middle East region? A: [HAB] Listen to your governments and implement the recommendations. A health crisis such as this is no time for mistrust.