The threat of an avian influenza (bird flu) pandemic


Current Issues

The threat of an avian influenza (bird flu) pandemic: key issues and resources

E-Brief: Online Only issued 7 November 2005; updated 24 November 2005

Angela Pratt, Analysis and Policy
Social Policy Section

What is Avian Influenza and why should we be worried about it?(1)

Many influenza experts agree that an influenza pandemic is inevitable and possibly imminent .(2) Some experts predict that the chance of a world-wide pandemic of avian influenza in the human population occurring in the next 12 months is around 10 per cent.(3) In the face of increasing public concern about the prospects of a pandemic, Health Minister Tony Abbott has cautioned that while a severe pandemic is a distinct possibility , it is by no means a certainty or even a probability .(4)

Avian influenza is an infectious disease of birds caused by particular strains of the influenza virus. The disease occurs worldwide, and is most commonly found in migratory water birds. Water birds are generally resistant to infection caused by avian influenza, but the virus can cause severe disease when it spreads to poultry and other birds. In rare cases, avian influenza can infect humans.

There are 15 different types of avian influenza virus. The types that cause the most deaths are known as highly pathogenic avian influenza (HPAI). There is currently an outbreak of an HPAI strain called H5N1 in birds in several countries in Asia and parts of Europe. The first cases of humans being infected by H5N1 were detected in Hong Kong in 1997. Eighteen people were affected, six of whom died. In that instance the virus did not spread from person to person. There have since been more outbreaks of human infection, including one in Vietnam in 2004, and others in Thailand and Indonesia more recently. To date, there have been no confirmed cases of human-to-human transmission into the general community, although there have been family clusters of avian influenza in Vietnam, Thailand and Indonesia. These cases have involved very close contact with an infected person and, as the family members were all exposed to the same potential animal and environmental sources of infection as well as to each other, it is impossible to know whether transmission was human-to-human.

The major cause for concern arising from the current outbreak of H5N1 is that the more the infection spreads in birds, the greater the opportunity for infection in humans. Not only has H5N1 shown a capacity to be deadly once it infects humans (to date about half of all confirmed human cases of H5N1 have resulted in death), but if an HPAI virus such as H5N1 infects humans who also have human influenza, it could mutate into a new sub-type of influenza virus which could be transmitted easily from person to person.(5) This could mark the start of an influenza pandemic.

An influenza pandemic would likely lead to high rates of morbidity (sickness) and mortality (death). The Senior United Nations System Coordinator for Avian and Human Influenza, David Nabarro, has said that, depending on a range of factors including the location of an outbreak, and the speed and quality of a response, the death toll from a human pandemic of avian influenza could be anything from 5 to 150 million . According to the Australian Management Plan for Pandemic Influenza (discussed below), it is estimated that an avian flu pandemic could lead to at least 2.6 million people seeking medical attention, 58 000 people being hospitalised and between 13 000 and 44 000 deaths.(6)

E-brief outline

This E-Brief provides links to information and key resources on avian influenza and the potential for an avian influenza pandemic, including:

The E-Brief will be updated regularly.

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General information: avian influenza

The following websites provide general information on avian influenza and the risk of an influenza pandemic:

Maps

The following sources provide maps showing locations of avian influenza outbreaks:

  • the European Commission and the WHO websites contain maps showing outbreaks of H5N1 in animals and humans in Asia since December 2003 (updated regularly)
  • the UN Food and Agriculture Organisation (FAO) website contains maps showing outbreaks of H5N1 around the world (updated regularly)
  • the BBC website contains an interactive map of cumulative human cases, outbreaks in birds, and bird migration routes (updated regularly).

Timelines

The WHO website contains a timeline of the emergence of H5N1. Nature magazine s website contains a more general timeline of influenza pandemics, starting with the first recorded influenza pandemic in recent history in 1890.

How many people have been infected so far?

The WHO s Regional Office for the Western Pacific has compiled a series of graphs of human cases of avian influenza: including by onset date and country, by age group and country, by outcome and date of symptoms onset, and by outcome and age group.

The website of the Centre for Infectious Disease Research and Policy at the University of Minnesota contains a table showing all laboratory-confirmed human cases of H5N1 avian influenza since December 2003 (updated regularly).

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Australian preparations for a flu pandemic

In June 2005 the Federal Government released the Australian Management Plan for Pandemic Influenza, which provides information on national plans in place for an Australian response to an influenza pandemic should an outbreak occur. The Plan includes:

The Management Plan is currently being revised, with a view to finalising the next version of the Plan by the end of 2005.

A key component of Australia s preparation for a possible pandemic outbreak is the stockpiling of essential medicines, including anti-viral drugs. The use of anti-viral drugs (and vaccines) in a pandemic response are discussed further below under Treatment and Prevention .

The Department of Health and Ageing s website also includes information for medical practitioners and health care workers on preparing for an influenza pandemic.

The Department of Agriculture, Fisheries and Forestry website also includes information on Australia s preparations for responding to an outbreak of avian influenza in the animal population, including AUSVETPLAN the Australian Veterinary Emergency Plan.

The Australian Quarantine and Inspection Service (AQIS) has an Avian influenza plan and is already implementing border protection measures including screening all flights, passengers and baggage from high-risk countries.

A national exercise to test the preparedness of Australia s health and emergency response systems for an outbreak of avian influenza, Exercise Eleusis, will be held on 29 November 1 December 2005.

Recent statements by the Health Minister and the Chief Medical Officer

The following links are to major statements made recently by the Health Minister, Tony Abbott, and the Chief Medical Officer, Professor John Horvarth on avian influenza:

For more statements by Mr Abbott and Professor Horvarth see the Department of Health and Ageing s website.

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The international response

The WHO continually monitors infectious diseases around the world, including the evolving avian influenza situation. For example, the WHO s Global Influenza Programme closely monitors influenza developments all over the world.

In 2000 the WHO established the Global Outbreak Alert and Response Network a collaboration of institutions and networks who pool human and technical resources for the rapid identification, confirmation and response to outbreaks of international importance . The Network provides an operational framework to link this expertise and skill to keep the international community constantly alert to the threat of outbreaks and ready to respond . The WHO, through the Network, would play a major role in coordinating the international response in the event of an outbreak of pandemic influenza.

There have been a series of major international meetings on avian influenza recently:

  • on 25 October 2005 an international meeting of health ministers was held in Ottawa, Canada, to discusses global influenza pandemic preparedness. The key principles and recommendations agreed to at the meeting are included in the official communiqu . The meeting was attended by the Health Minister Tony Abbott, who gave a country report on Australia s preparedness
  • on 31 October 1 November 2005 a high level meeting of principal pandemic/disaster management coordinators from the 21 Asia-Pacific Economic Cooperation (APEC) countries was held in Brisbane. The meeting was aimed at identifying ways APEC countries might further cooperate in responding to a pandemic outbreak. (No communiqu was made available from this meeting)
  • on 7 9 November 2005 a meeting entitled The H5N1 Agenda: Towards a global strategy will be held at WHO headquarters in Geneva. The meeting will aim to put together a comprehensive assessment of the global challenge presented by the threat of avian influenza, and identify the next steps in controlling current avian influenza outbreaks in animals and preparing for a human influenza pandemic. (Communiqu to be added as soon as it is available.)

Australian assistance to the Asia-Pacific region

The issue of avian influenza was also discussed at the Pacific Nations Forum held in Papua New Guinea in October 2005. Prime Minister John Howard announced at the Forum that Australia would contribute $8 million to strengthen regional and national capacity to respond effectively to avian influenza and other infectious diseases.

In September 2005 the Federal Government announced an avian influenza assistance package for Indonesia, including the provision of 50 000 courses of Tamiflu to help combat the recent outbreak of avian influenza in Indonesia.

In June 2005 the government announced a $6 million package of measures to help combat avian influenza in South-East Asia, focusing in particular on assisting Indonesia, Vietnam, and China with influenza surveillance, emergency preparedness and response capabilities.

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Prevention and treatment

Anti-viral drugs

Currently, there are two anti-viral drugs which can be used as protection against disease caused by avian influenza (that is, as prophylactic, or preventative medicine), and in the treatment of symptoms of flu victims: these are oseltamivir (sold as Tamiflu), manufactured by Swiss pharmaceutical company Roche, and zanamivir (sold as Relenza), developed by Australian biotechnology company Biota and manufactured by Britain-based pharmaceutical company GlaxoSmithKline.

In Australia, Tamiflu and Relenza are available as prescription-only medicines. The recommended retail price for one ten-dose course of Tamiflu is $49.20. The recommended retailed price for one four-dose course of Relenza is $49.95.(8)

The National Medicines Stockpile

As part of its preparations for an avian influenza pandemic, in 2004 05 the Federal Government allocated $123.8 million to stockpiling anti-viral drugs for use in the event of a pandemic influenza outbreak. Australia s stockpile contains enough anti-viral doses for about 20 per cent of the population this is one of the biggest per capita stockpiles in the world.(9) According to Health Minister Tony Abbott, with current technology and manufacturing processes , obtaining enough anti-virals to protect the entire Australian population for six months (the anticipated time it would take to develop a vaccine see below) would be almost impossible at any price .

According to the Australian Management Plan for Pandemic Influenza, in the event of a pandemic outbreak, 10 per cent of the anti-viral stockpile will be earmarked for treatment of people with flu symptoms, and 90 per cent would be reserved for prophylaxis (preventative treatment). According to Health Minister Tony Abbott, the current supply of anti-viral drugs in Australia s National Medicines Stockpile would be sufficient to protect 1 million essential service workers for about six weeks. The Chief Medical Officer, in consultation with the Australian Health Disaster Management Policy Committee (AHDMPC), would advise government on when and to whom anti-virals should be released.(10)

Generic anti-virals?

There is currently a worldwide shortage of anti-viral drugs. Global supply of both Tamiflu and Relenza is controlled by the patent owners, Roche and GlaxoSmithKline, which limits overall manufacturing capacity and therefore overall supply.(11)

In October 2005, however, New Scientist magazine reported that the Indian company Cipla will begin making a generic version of Tamiflu, and that Roche, who had previously opposed any moves to manufacture generic Tamiflu, has decided that it would not oppose companies that want to strike a licensing deal .

There has recently been some debate in Australia about the manufacture of generic versions of anti-viral drugs. In an article published in the Medical Journal of Australia in October 2005, Australian National University academics Buddhima Lokuge, Peter Drahos and Warwick Neville urged the Australian Government to consider enacting compulsory licensing provisions to allow generic manufacturers to start producing anti-virals locally, or to import them from generic manufacturers overseas.

Vaccines

The most effective defence against influenza is vaccination. However, most experts agree that in the event of a pandemic of a new strain of highly pathogenic influenza, it would probably take scientists at least six months to develop and produce a vaccine.

The Federal Government has entered into contracts with the Australian company CSL Ltd and Sanofi Pasteur (which has a Sydney-based Australian operation) for vaccine supply in the event of a pandemic. In July, the government announced that it would provide CSL Ltd with $5 million to fast-track the development of a pandemic influenza vaccine in Australia.

Clinical trials of a bird flu vaccine being conducted by the Murdoch Children s Research Institute and the University of Melbourne (and sponsored by CSL Ltd) commenced in Melbourne and Adelaide in early October 2005.

Vaccination side-effects

Influenza vaccination does carry a small risk of side effects. For example, according to the Australian Immunisation Handbook, fever, malaise and myalgia occur commonly after vaccination. The Immunisation Handbook also notes that an association between an influenza vaccine used in the Northern hemisphere from 1992 94 and Guillain-Barr syndrome (GBS), a rare neurological condition, has been shown, with one to two cases of the syndrome occurring per million people vaccinated. However, according to the US Centers for Disease Control and Prevention, reports of GBS after the administration of flu vaccines are extremely rare. In most cases where GBS developed after an immunisation, proof that the vaccine caused GBS has not been established.

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Australian research on avian influenza

On 28 September 2005, the Federal Government announced that funding for research into pandemic influenza would be fast-tracked by the National Health and Medical Research Council (which oversees the administration of funding for health and medical research).

There are several highly regarded institutions conducting influenza research in Australia, including:

See the following articles discussing research into influenza currently being conducted in Australia:

Commentary

The threat posed to Australia by an outbreak of pandemic influenza and the adequacy of Australia s preparedness have been the subject of much public debate over recent months. The following is a brief selection of opinion pieces, articles and other commentary on some of the key issues.

The adequacy of Australia s preparedness for an influenza pandemic has been the subject of debate. For example:

  • in October 2005 the Australian Labor Party released a detailed critique of Australia s pandemic management plan (Julia Gillard, Shadow Minister for Health, Preparedness of the Australian Health Care System for an Avian Flu Pandemic: No room for complacency , September 2005)
  • flu experts such as researcher Professor Graeme Laver have also argued that Australia s plans for responding to a pandemic are flawed. Professor Laver argues, for instance, that the government should allow Tamiflu to be sold over the counter to make it more widely available to the general public (see, for instance, Avian flu: are we prepared? , Australian Science Magazine, vol. 26, no. 6, July 2005)
  • Professor Peter Curson, Director of Health Studies at Macquarie University, has argued that Australia needs to be better prepared for the public fear and panic that could occur in the event of a pandemic outbreak (Peter Curson, Pandemic threat demands the truth: there is something to be afraid of , Sydney Morning Herald, 20 September 2005), and
  • on the other hand, some commentators such as WHO flu researcher Ian Barr have argued that the threat of an avian flu pandemic in Australia has been greatly over-stated (see Lisa Macnamara, Bird flu risk here almost non-existent , The Australian, 22 October 2005).

As mentioned above under the prevention and treatment heading, there has been some discussion about the potential for manufacturing generic anti-viral drugs. See:

The likely economic fallout from a flu pandemic has also been the subject of some discussion. See:

Parliamentary Library publications

The Parliamentary Library has produced the following publications related to the threat of pandemic influenza:

In September 2005 the Parliamentary Library held a Vital Issues Seminar on the threat of a flu pandemic.

Keeping up to date: latest news and information

Several general news websites have pages dedicated to avian influenza. These include:

  • Australian websites such as ABC Online and news.com.au
  • UK websites including the BBC, which is also a good source for general information
  • NewsNow, which provides up to the minute information on the latest developments around the world, and
  • Reuters Alert Net provides frequent updates on bird flu developments around the world.

Medline Plus, an information service managed by the US National Library of Medicine and the National Institutes of Health, provides a website with the latest bird flu news, as well as links to information about the latest developments in research on avian influenza.

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Endnotes

  1. Sources for background information: World Health Organization (WHO) website; Department of Health and Ageing website.
  2. WHO website.
  3. Alan Hampson, cited in Steve Dow, Count your chickens , Sydney Morning Herald, 6 October 2005, p. 4.
  4. Tony Abbott, Minister for Health and Ageing, Doorstop Interview at the Sydney International Airport regarding Flu Pandemic , 27 October 2005.
  5. Centre for Infectious Disease Research and Policy, University of Minnesota.
  6. Australian Management Plan for Pandemic Influenza, p. 27.
  7. A Wiki is a form of collaborative web page that allows anyone to edit any page on the site . The open nature of Wikis means that the content of the webpage is not managed or monitored by any official organisation or institution, and thus some caution should be exercised in using the information in Wikis. However, in this instance the Flu Wiki is an extensive source of general information on avian influenza.
  8. The recommended retail price for non-PBS medicines includes the minimum private dispensing fee of $7.25 where appropriate. However, this fee maybe higher for more complex preparations so these prices may vary at the counter. Source: MIMS, eMIMs database, 1 August 2005 30 November 2005.
  9. B. Lokuge, P. Drahos and W. Neville, Pandemics, antiviral stockpiles and biosecurity in Australia: what about the generic option? , Medical Journal of Australia, 26 October 2005; Tony Abbott, Minister for Health and Ageing, Bracing for the worst Country report for Pandemic Flu Conference , Ottawa, 25 October 2005.
  10. Abbott, Bracing for the worst, op. cit.
  11. Lokuge et al, Pandemics, antiviral stockpiles and biosecurity in Australia , op. cit.

For copyright reasons some linked items are only available to members of Parliament.

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