Contents
|
 |
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.
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).
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:
- Tony Abbott, Bracing
for the worst—Country report for Pandemic Flu Conference, Ottawa,
25 October 2005
- Professor Horvarth, Bird
Flu Update, Media release, 22 September 2005
- Tony Abbott, ‘The
odds shorten on Australia facing a deadly test of its national psyche’,
Sydney Morning Herald, 16 September 2005
- Tony Abbott, Preparing
for an Influenza Pandemic—the Plan, Media release, 6 June 2005
- Tony Abbott, Australia’s
preparedness for an Influenza Pandemic at the Communicable Diseases
Conference, Sydney, 2 May 2005.
For more statements by Mr Abbott and Professor Horvarth see the Department
of Health and Ageing’s website.
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
communiqué. 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 communiqué 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. (Communiqué
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.
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-Barré 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.
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:
- Max Walsh, ‘Cold
Comfort’, Bulletin with Newsweek, 6 September 2005
- Matt Wade, ‘Economy
at risk of meltdown if killer flu strikes’, The Sydney Morning
Herald, 25 October 2005
- Health Minister Tony Abbott has said that in the event of a pandemic,
international travel would likely cease ‘for a significant period of
time’ (see Tony Abbott on ‘Meet
the Press’, Channel Ten, 30 October 2005), and
- ‘World
bank warns of huge cost of flu pandemic’, ABC News Online,
7 November 2005.
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.
Endnotes
- Sources for background information: World
Health Organization (WHO) website; Department
of Health and Ageing website.
- WHO
website.
- Alan Hampson, cited in Steve Dow, ‘Count
your chickens’, Sydney Morning Herald, 6 October 2005, p.
4.
- Tony Abbott, Minister for Health and Ageing, ‘Doorstop
Interview at the Sydney International Airport regarding Flu Pandemic’,
27 October 2005.
- Centre
for Infectious Disease Research and Policy, University of Minnesota.
- Australian
Management Plan for Pandemic Influenza, p. 27.
- 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.
- 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.
- 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.
- Abbott, Bracing
for the worst, op. cit.
- 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.
|
|
