For most people in Africa avian flu in humans is still at the arm’s-length, mildly curious stage. Non-one knows anyone who has it, so there can’t be too much to worry about.
Even warnings by United Nations health officials that the bird flu virus could mutate at any time and as a human to human virus would be likely to kill from 5 to 150 million people, is causing more than mild concern. Vaccine supplies are likely to be inadequate even if an effective vaccine could be produced quickly enough for a rapidly mutating strain of avian influenza.
Such numbers are so mind-numbing that they don’t mean much to ordinary citizens and no-one actually counts themselves amongst them. It’s just a newspaper story and something that’s happening in countries with strange-sounding names with un-African looking people living there. It’s really their problem.
Yet it’s a lot more of a problem for Africa than most Africans realise, and it’s as well that the more aware are taking the perilous phenomenon seriously. It’s going to be governments’ job soon to make everyone aware of the real and present danger that avian flu poses to each and every one of the 800 million people living on the continent. The 13 million or so living with AIDS or TB are particularly at risk.
According to animal health experts in Africa and in other parts of the world, the outbreak could strike Africa with “devastating effect”.
“Africa is not like Europe or Asia, we have a different situation here which means the problems in dealing with bird flu will be different and specific to Africa,” says Robert Hepworth, a United Nations official heading up the Convention on Migratory Species.
Controlling an outbreak in such regions as East Africa is likely to be difficult as poultry farming is often on a small scale and free range.
Few in Kenya’s rural areas know what bird flu is and what it could mean.
“Wild birds from the lake come here all the time and mix with our chickens and ducks,” says Ester Nyamwange, a resident of Nyavasha, some 160 kilometres from Nairobi. “I’ve heard of bird flu but I don’t know what it means and if our chickens die, we will just bury them because no one has told us what to do.”
Says Philip Nyaga, professor of virology at the University of Nairobi: “Public awareness is essential in preparing Africa should this bird flu virus reach us. If people know about the virus and the symptoms, they can respond appropriately and not misdiagnose treatment.”
Sudan and Uganda were amongst Africa’s first countries to start preventative measures. They closed their borders to all imports of fowl, and while that will go some way in containing the threat by imported domestic birds, the real danger could be winging its way along traditional migratory sky trails – wild birds fleeing winter in the northern hemisphere are making for Africa, particularly the Great Lakes of east and central Africa.
“The virus is probably already in wild ducks on the lakes and rivers, but for the moment it is not in domestic poultry,” a Nairobi conference was told by Bernard Vallat, secretary-general of the World Organisation of Animal Health (WOAH), an inter-governmental veterinary network. “I hope it will not be transferred to domestic poultry, but I think it is very important for us to be ready for that.”
The lakes of Rift Valley are a staging post for millions of migrating birds every year as they head farther south. Others will settle around the lakes in the first quarter of the year.
Muchane Muchai, head of National Museum of Kenya, reports that “the researchers will continue to watch the birds within migratory routes until March to see whether they have the virus.” In a response that seems inadequate for meeting what some organisations are describing as a “looming catastrophe” African animal health scientists have mustered a vanguard to formulate ways of countering the threat, and agriculture ministers met in Geneva, Switzerland, last month to hone up on the disease and its effects and how to prepare for it. In Nairobi, Kenya, veterinary experts and international donors got together to discuss how to prevent the disease from taking hold. Some countries have banned poultry from affected nations.
If the way Africa is reacting seems knee-jerk, it’s not that the rest of the world is performing much better.
According to the World Health Organisation (WHO), the world is ill-prepared to defend itself during a pandemic despite an advance warning that has lasted almost two years. As long ago as early 2003 WHO urged all countries to develop preparedness plans, but only around 40 have done so. WHO further urged countries with adequate resources to stockpile antiviral drugs nationally for use at the start of a pandemic.
Around 30 of the world’s wealthier countries are purchasing large quantities of these drugs. There’s only one manufacturer and it has no capacity to fill these orders immediately. Africa and other under-developed regions could well be left in the cold.
“On present trends, most developing countries will have no access to vaccines and antiviral drugs throughout the duration of a pandemic,” says WHO.
Modibo Traore, director of the African Union’s Inter-African Bureau for
Animal Resources, based in Nairobi, is one of the scientists coordinating the continent’s response. He believes Africa can learn from the Asian experience.
“Because there has not been an outbreak, we feel the best approach is to increase vigilance and then to identify any cases should they occur and deal with them immediately by destroying infected birds,” he said.
“In Asia also this is the approach proposed. Some countries did not quite follow it, and so they found themselves moving on to vaccination, a very lengthy process. And it is expensive.”
This means extending and improving Africa’s surveillance network – already in place and effective for rinderpest, a fatal cattle virus – include avian influenza. It also means investing in diagnostic laboratories and mounting a public awareness campaign so that small-scale traders such as Ngugi notify veterinarians when they spot sick birds.
Kenya bird experts, along with US and Egyptian scientists, have already begun the process of testing migratory birds in the Rift Valley region of Kenya for H5N1 on Friday.
Traore concedes it is a huge task, particularly in countries such as Somalia, Congo and southern Sudan, where years of civil war have destroyed health and veterinary services.
“It’s in the developed world’s interests to help Africa defend itself against avian influenza,” maintains WOAH’s Vallat of the World Organisation of Animal Health. “If we do it now, we can spend about $50mn,” he says. “If we don’t do that, the economic consequences will be far more than $50mn.”
The world of commerce is already beginning to feel the effects of the bird flu scare. And this is not necessarily as a result of a pandemic, a scenario that might never happen, says the BBC’s Jorn Madslien, “but rather because business is a confidence game that relies entirely on the emotional responses of investors and consumers”.
Hardest hit by an epidemic – imagined or real – will be the multi-billion dollar global poultry industry: the egg producers and broiler breeders, and those who take poultry to market, either a few at a time in poorer countries to the developed world’s super-producers that deliver millions daily to food manufacturers, supermarkets and restaurants.
Experts believe rural communities around the lakes of the Rift Valley region in east Africa, which rely heavily on poultry farming to survive, could be hardest hit.
“Losing poultry would have a devastating effect on livelihoods in the area,” says Lea Borkenhagen, sustainable-living development manager for the charity Oxfam.
“For the moment,” reports Madslien, “this sector’s most immediate concern is that talk of a possible pandemic will spook consumers.”
Unlike other food-related scares, such as mad cow and foot and mouth, the bird flu contagion “is not a food safety issue,” insists Britain’s National Farmers’ Union president, Tim Bennett, who is concerned that consumers are not getting a clear message that poultry is safe to eat.
In Europe, especially, early signs of a bird flu impact on companies are already appearing. Two months ago, when the British Veterinary Association said it was inevitable that wild birds would eventually carry bird flu to Britain, there was a “blip in sales” of poultry, Bennett observes. In the UK chicken pies and ready meals have already been marked up on supermarket shelves because the “uncertainties over avian flu has had the tendency to push up the price of chicken we buy in the UK”, according to Jez Maiden, finance director of Britain’s giant Northern Foods manufacturing company.
Concerns are also rising that Europe’s rural economy could be hit beyond any suffering endured by the poultry sector.Tourism agents and operators in Europe and Asia are especially nervy about the effect the outbreak could have on the industry; Europeans especially recall the devastating downturn in visitors, occasioned by the foot and mouth outbreak in 2001, when tourists grew wary about visiting rural areas or even entire countries where the virus has been detected.
For East Africa, Kenya in particular, the possible epidemic is worrying. Its lucrative tourism industry is recovering from a terrorist attack two years ago and well on the way to regaining its prime position as the country’s biggest foreign currency earner.
According to the World Health Organisation the widespread persistence of H5N1 in poultry populations poses two main risks for human health.
“The first is the risk of direct infection when the virus passes from poultry to humans, resulting in very severe disease,” it reports. “Of the few avian influenza viruses that have crossed the species barrier to infect humans, H5N1 has caused the largest number of cases of severe disease and death in humans. Unlike normal seasonal influenza, where infection causes only mild respiratory symptoms in most people, the disease caused by H5N1 follows an unusually aggressive clinical course, with rapid deterioration and high fatality. Primary viral pneumonia and multi-organ failure are common. In the present outbreak, more than half of those infected with the virus have died. Most cases have occurred in previously healthy children and young adults.”
A second risk is of even greater concern, says WHO. The virus – if given enough opportunities – will change into a form that is highly infectious for humans and spreads easily from person to person. Such a change could mark the start of a global outbreak.
The organisation says the most important signals that a pandemic is about to start will be evident when clusters of patients with clinical symptoms of influenza, closely related in time and place, are detected. This will suggests that human-to-human transmission is taking place. Studies of viruses, conducted by specialised WHO reference laboratories, can corroborate field investigations by spotting genetic and other changes in the virus indicative of an improved ability to infect humans. This is why WHO repeatedly asks affected countries to share viruses with the international research community.
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