Indonesia Prepares To Treat Up To 1 Million If Bird Flu Breakout

by Marwaan Macan-Markaar

(IPS) BANGKOK -- As Indonesia grapples with new deaths from bird flu, public health officials in the region are racing against time to try to prevent a pandemic.

The fate of millions of lives in Asia hangs on the speed with which a patient infected with a human-to-human transmission of a mutated strain of bird flu is diagnosed, and the speed with which the prevention measures are implemented.

"We will only have a 21-day golden period to stop the virus spreading and becoming a pandemic," says Dr. Kumnuan Ungchusak, director of epidemiology at Thailand's department of disease control and a key player in plans being mapped out to stall the virus ravaging Southeast Asia. "A longer delay, even a month, can be very fatal."

The new urgency follows the deaths announced on Sept. 21 of two young girls, admitted in Jakarta hospitals, after they developed symptoms indicating bird flu. Five others are currently under treatment for suspected bird flu in Indonesia.

On Wednesday, Indonesia's health minister, Siti Fadilah Supari, told reporters in Jakarta that she considered the outbreak the possible start of an epidemic on the archipelago and that "most definitely there will be others as long as we are not able to identify positively the sources."

The government will follow two broad paths to try to head off a pandemic if the virus mutates, she said. The first is geared toward the immediate family of the patient diagnosed with the potentially lethal virus. Each family member who came into contact with the patient will be given a dose of Tamiflu within two days of the patient showing symptoms of the disease.

The regime of Tamiflu, the only known drug capable of stopping the spread of a mutated form of the H5N1 avian flu virus, will continue for a 10-day period, Kumnuan said.

More challenging, though, is to provide medication for the second part of this pre-emptive initiative. "It would require giving (medicine to) around 10,000 people, 100,000 people or even 1 million who live within the area where this human-to-human form of the virus has been diagnosed," says the Thai epidemiologist.

It is this phase -- a novel way to destroy a possible pandemic at its roots -- that has the 21-day window. "This is a very challenging concept, very new, and necessary if we have to save lives," adds Kumnuan. "Cooperation at every level and speed will matter the most."

According to public health officials, Southeast Asia needs to stockpile antiviral drugs to treat at least 3 million people if the deadly H5N1 virus mutates to one that could explode into a pandemic.

But meeting this demand is already proving to be a problem because of limited drug stocks for the developing world. The World Health Organization (WHO) is due to receive 1 million doses of Tamiflu from the Swiss pharma giant Roche by the end of this year and another 2 million doses by mid-2006.

The WHO has said a bird-flu pandemic could result in 2 million to 7 million deaths around the world.

The region has had 63 fatalities from the H5N1 strain of the bird-flu virus since January last year: 43 in Vietnam, 12 in Thailand and four each in Cambodia and Indonesia.

These deaths account for more than half of the estimated 119 people who have been infected with the H5N1 strain of bird flu after having come into contact with infected poultry.

"Asia is still the weakest link in pandemic preparedness when compared with what is under way in Europe," says Peter Cordingley, spokesman for the WHO's Western Pacific regional office (WPRO) in Manila.

Earlier in the week, the head of WPRO said at a news conference that there were still many gaps in the health surveillance systems, which are pivotal in detecting a new virus and mounting a response within a limited span of time.

"At the national level we need to improve further the capacity for surveillance and virological investigation. In addition, we need greater cooperation in sharing specimen samples," the director, Dr. Shigeru Omi, said in New Caledonia, an island in the South Pacific.

"Vietnam is on par with Thailand in health surveillance, but poorer countries like Cambodia and Laos don't have the capacity due to the lack of resources," Cordingley told IPS. "This is also too big for the WHO and FAO (Food and Agriculture Organization) to handle. We need a lot of international help."

The rising concern about a pandemic comes in the wake of revelations by researchers at the Rome-based Instituto Superiore di Santi that people can be infected with strains of low-pathogenic avian influenza. Hitherto, medical researchers have maintained that humans were only susceptible to the high-pathogenic strain of H5N1 influenza.

Since the winter of 2003, when the current strain of bird-flu began spreading through Asia, more than 100 million birds have died from the disease or been culled to prevent its spread. Russia recently became the 11th country to be struck by this spreading virus.

Humans lack a natural response to fight the H5N1 strain of the virus.

Health authorities fear a scenario like the 1918-1919 global influenza pandemic, which killed an estimated 50 million people when a flu strain jumped from birds to humans.

WHO's Omi fears it is only a matter of time before disaster strikes, since the current bird flu virus is "resilient, unpredictable, unstable and extremely versatile."