Preparing for Pandemics of Infectious Diseases Like Bird Flu

Threats to human, national and international security as a result of biological warfare and pandemics are inadequately discussed in the popular media. Non-state actors are expected to use innovative methods to execute acts of terrorism. It is often contended that a terrorist organisation may well get the best results using conventional high explosives. This trend is clearly discernible in the methods used by terrorists worldwide. Manufacturing terror-grade dirty radiological or biological bombs that can be delivered effectively is far more difficult than using conventional explosives. Yet the security establishment cannot take the threat of use of bio weapons lightly. Used effectively, it has a very high probability of causing mass disruption if not destruction.

But as we debate and deploy the bulk of our resources on anthropogenic methods for acts of terror on human beings, some viruses as “gifts” of nature seem to be on mission to mutate and spread to humans. The bird or avian flu (H5N1) virus is one contemporary example. Unlike the nearly 40 to 50 million deaths recorded due to the Spanish flu of 1918-1920, this bird flu is forecast to cause nearly 150 to 200 million deaths if it mutates and gets transmitted from human to human. Mainstream international journals and magazines such as Foreign Affairs, Nature, National Geographic, Newsweek and India’s very own Economic and Political Weekly amongst others have featured articles on the subject as a call to action. That the threat is hyped and driven by business interests of the powerful pharmaceutical industry is yet another view put forth. We need to remember that with the onset of global warming, the home air conditioning industry is bound to make huge profits or for that matter with the rise of obesity in India the cash registers of neighbourhood health clubs are ringing. Our preparations to deal with this threat must not be bogged down by the debates mentioned above. While all viewpoints must be deliberated upon, it is vital for the national security establishment to be prepared now rather than wait for that disaster to strike and then adopt reactive measures.

In a recently conducted bilateral round table conference between the Institute for Defence Studies and Analyses (IDSA) and the National Chengchi University (NCCU), Taiwan, a session was devoted to the challenges of avian flu. Professor Peter W S Chang from Taiwan’s Department of Health gave a comprehensive presentation from Taipei’s perspective. Taiwan and India have so far been safe from bird flu. One reason for Taiwan avoiding a bird flu outbreak was that it was not on the migratory routes of birds. Its isolation as an island has proved to be a blessing in disguise. According to an Indian official present at the conference, India has escaped a bird flu outbreak so far due to the fact that no major poultry farms exist near the 112 water bodies that are frequented by migratory birds. Interestingly, besides vegetarianism, the Indian habit of frying and deep cooking of chicken meat is also regarded as a reason for the inability of the virus to spread from birds to humans. However, we cannot be assured of comprehensive security by just being vegetarians or relishing the popular cooked chicken dishes or keeping our fingers crossed. The world now is much more integrated and globalised. Recall how pathogens of cholera travelled from Bangladesh to Chile in the ballast of ships. Human to human strains can well move across borders and so can infected vectors of birds and animals.

Taiwan had experienced the severe acute respiratory syndrome (SARS) in 2003. This was the closest to the new scenario of bird flu. Taiwan then suffered 73 human deaths and a loss of one per cent of gross domestic product (GDP). If adequate precautions are not taken and bird flu strikes then Taipei expects 10,000 deaths and a much higher loss of GDP. Having undergone the experience, it is very clear about the manner in which to take proactive measures. The reasons for concerns are that the Spanish flu virus is genetically similar to the present H5N1 strain; birds to human transmissions exists, there is 50 per cent mortality in infected human cases; once the bird virus spreads to humans and acquires human genes it can easily transmit between humans and the bird flu can impact globally within three months.

While in India we do not want the public to panic by this scare, in Taiwan the health minister is like a TV performer educating the public via the media on a daily basis. Preparations include announcing Novel Influenza virus infection as a notifiable disease, formulation of a national preparedness plan for influenza pandemics and strategies and defences termed as “3 main strategies and 4 lines of defence plans”. The three main strategies comprise of infection prevention and control, Novel flu vaccines and antiviral drugs. Research and Development is in progress to manufacture a vaccine. Anti viral drugs like Tami flu is available for 0.7 per cent of the population in 2005 and this figure would increase to four per cent by 2006. The eventual goal is to stockpile drugs for 10 per cent of the population. In the four lines of defence plans, the strategy is to block the problem outside the country through international cooperation, quarantine of suspected persons on the border, strengthening health care system and health management in the community.

What lessons does this experience and practice of Taiwan for dealing with the bird flu have for India? India is a vast country with a population of over 1 billion in comparison to Taiwan’s 22.6 million. There are a number of uncertainties. The effect of Tami Flu is not proven. Vaccines are yet to be manufactured after due research and development. Even if a vaccine is researched for a particular type of strain of the virus, the time for manufacturing and administering vaccines may not be sufficient enough to counter the spread of disease. Another vulnerability is of the disease surveillance system. The private sector provides 75 per cent of curative care in India. The data from private health providers are not included in any disease surveillance. The existing system is passive or has the capacity to report an occurrence. Not all the people have access to government hospitals. Most private hospitals and clinics are not in the chain of reporting of such diseases. Poverty by itself precludes timely treatment for the poor. Economic reforms have made India a tourist destination for chronic diseases, but for infectious diseases and pandemics it is unlikely that the private sector would be able to deliver. Thus an effective passive reporting system in a revived public health care system may be the first step to cope with the threat. Simultaneously, a proactive Integrated Disease Surveillance Programme must be put in place. The National Disaster Management Authority may need to carry out a reappraisal of the looming threat of bird flu. Undoubtedly, security threats have become more complex. In this particular case the link cuts across the human, animal and wildlife divide. A high degree of coordination is expected amongst doctors, veterinarians, wild life experts, the pharmaceutical industry, animal farms, the poultry sector, and the government health service, etc. Much more simulation of disaster management scenarios needs to be done. At the same time mitigation measures must be sustained in coordination with the World Health Organisation. A precautionary principle is considered the best approach.