On Front Lines Of Asian Battle Against Bird Flu

By Alan Sipress
Washington Post Foreign Service
Sunday, May 22, 2005

HANOI -- Behind high gray double doors, Professor Nguyen Thu Van, a simply dressed woman with black hair held back by a barrette, has been laboring tirelessly with her team of researchers in a race to avert a pandemic.

Her white-coated co-workers scurried about one recent day in their small, second-floor laboratory in an elegant French colonial building in the Vietnamese capital. Engaged in a drive to perfect a human vaccine against avian influenza, Van, 50, has produced an experimental version and conducted successful tests on monkeys. She and her researchers have volunteered to be the first subjects in human trials, which she hopes will begin this summer despite warnings from the World Health Organization.

Van is at the forefront of a campaign in Southeast Asia to halt the progress of bird flu. International health specialists say they fear the virus could undergo genetic changes suddenly and become the most deadly disease to strike humanity in modern times. Almost 200 million chickens, ducks and other birds throughout Southeast Asia have died from the virus or been slaughtered to contain it in the last two years.

So far, bird flu has killed 53 people, mostly as a result of close contact with infected poultry. But international health experts say they suspect the virus has also begun to spread among humans.

With bird flu endemic among birds in the Asian countryside, the disease could pose a threat to humans for years. And in an age of global travel, health experts predict that an easily transmitted human strain could move beyond Asia in a matter of weeks and infect tens of millions of people worldwide.

When bird flu began spreading in Southeast Asia, governments in the region initially denied its presence. But a Thai doctor, Prasert Thongcharoen, sounded the alarm, issuing blunt declarations that forced Thailand to acknowledge early last year that the disease was decimating bird populations and beginning to infect people.

In Indonesia, the government has campaigned to vaccinate poultry across the vast archipelago, but tens of thousands of doses sit unused in government refrigerators while farmers leave their birds unprotected. A veterinarian named Suparno patrols the country's most populous island in an ambitious endeavor to prevent the virus from spreading.

Van's eyes gleamed with enthusiasm as she predicted that Vietnam could become the first country to develop a human vaccine against the lethal H5N1 strain of bird flu endemic among poultry in Southeast Asia. But WHO officials charge that Van's team has flouted international guidelines, saying that material used to develop the vaccine is potentially contaminated and that the planned human tests involve imprudent shortcuts.

"We cannot wait," Van responded.

A Warning in Thailand

Prasert, 71, one of his country's most eminent virologists, literally wrote the book on influenza in Thailand, published seven years ago.

He was a physician fresh out of school when the 1957 Asian influenza pandemic swept through Thailand, flooding his hospital with patients. Later, when an outbreak of Hong Kong flu reached Bangkok in 1968, Prasert was already emerging as a leading researcher.

In the fall of 2003, he learned that tens of thousands of chickens had begun dying in Thailand, he said during an interview in his research office in Bangkok. The government was insisting that the birds had contracted fowl cholera, a common affliction. As the world's fourth-largest poultry exporter, Thailand would suffer an economic blow if other countries learned its flocks were infected with bird flu.

Prasert decided to obtain more information. He visited a Bangkok market, where farmers confided they believed it was something worse.

"They said it wasn't like fowl cholera," Prasert recounted. "If they have chickens that are sick with that, they give them tetracycline and they get better. But these chickens, by the next morning, they're all dead."

Prasert's suspicions mounted in early December when friends who usually bring him six or a dozen eggs when they visit their farm east of Bangkok came back empty-handed. "They told me the farm is usually full of chickens," he recalled, "but the chickens all died."

In mid-December, researchers privately showed Prasert results of tests done on chickens revealing that they had influenza. Prasert warned officials that urgent action was needed.

"I told them it is a public health concern and I would not close my mouth. I will talk even louder," Prasert said.

Senior ministers continued to deny the presence of bird flu throughout much of January 2004, according to Thai and international officials.

But in the first week of January, a 6-year-old boy from a province west of the capital developed a high fever, followed a week later by symptoms of severe pneumonia. The boy was admitted to Prasert's hospital, and tests on Jan. 22 came back positive for bird flu. He died three days later.

Prasert told the Health Ministry that it was too late for a coverup, he recounted with an ironic smile and narrowed eyes. The strain had reached humans.

On Jan. 23, the health and agriculture ministers announced that bird flu had arrived in Thailand.

Late Response in Indonesia

Suparno, the Indonesian government veterinarian, crouched in the cramped backyard of a farmhouse in a Central Java village, clad in a tan uniform. He slowly drew the bird flu vaccine from a plastic container into a syringe. Then his fellow animal health officers brought five black hens, one by one, from a barn. Suparno inoculated each one.

There were 20 more chickens running around the farm, but they escaped the needle.

"Too hard to catch," Suparno explained before driving off.

But by leaving most of the flock unprotected, the exercise was pointless. The remaining chickens could catch avian flu, and sick birds, in turn, could infect even those that had been immunized. Vaccinated birds can still become carriers of the disease and transmit it to humans.

Several governments in Southeast Asia are considering following Indonesia's lead in making poultry vaccination central to efforts to contain bird flu.

But interviews with livestock officials and farmers in three districts of Central Java, the Indonesian province hardest hit by bird flu, suggest that the immunization campaign sputtered from the start and has now all but stalled.

Tri Satya Putri Naipospos, national director of animal health, said Indonesia turned to vaccination because it was too costly to carry out widespread culling of flocks as Vietnam and Thailand were doing. By the time Indonesian officials acknowledged the presence of the virus, it had already infected much of Java, Bali and the Sumatra islands.

"The announcement of the government came very late," Naipospos admitted. "Our laboratory people knew it already." She said senior Indonesian officials delayed acknowledging the disease after the outbreak in August 2003 because of intense pressure from the poultry industry, which was afraid it would hurt sales.

Central government officials said they distributed 150 million doses of free vaccine to inoculate poultry nationwide at small and mid-size farms and that 98 percent of those earmarked for Central Java had been used.

But local officials and farmers countered that immunization was spotty at best. "Maybe the farmers get the vaccine," said Widodo Sumantri, chief livestock officer in Karanganyar district. "The percentage of those who use it is small."

In the neighboring Sragen district, Sri Harjono, a farmer who runs a cooperative that has 23,000 broiler chickens, said he lost more than half of his flock after the initial bird flu outbreak in 2003. He restocked and began vaccinating in October, Harjono recalled, standing outside a cavernous coop on stilts fashioned from bamboo and screens.

But no longer. "It's too much hassle," he said, stroking a baby chick. "You have to go one by one. Can you imagine vaccinating 23,000 chickens over and over?"

Hope, Hazards in Vietnam

Educated partly in the Soviet Union, Van, the Hanoi scientist, later trained at the Centers for Disease Control in Atlanta, where she developed an interest in working on hepatitis. Her efforts to develop a hepatitis B vaccine in Vietnam helped her win appointment as general director of Vietnam's Vaccine and Biological Production Company No. 1.

As the number of human cases in Vietnam grew last year, a senior colleague suggested that Van try to reprise her success with hepatitis B by developing an avian influenza vaccine.

"It was difficult at the beginning because we did not have the experience," she said, but added that Vietnam could not afford to wait for vaccines being developed in the West, which she also feared would be exorbitantly expensive.

Vietnam publicly acknowledged the presence of the disease in January 2004, although Trinh Quan Huan, director general of preventive medicine, said the Health Ministry knew of it five months earlier. Hospitals in the Hanoi area had already admitted 13 children and an adult with symptoms associated with bird flu, according to WHO. Twelve people had died.

Vietnam's current strategy of poultry control measures has not tamed the outbreak. The government recently extended a ban on hatching ducks and other waterfowl, but enforcement has been erratic. The raising of all poultry in cities was recently prohibited. But in Ho Chi Minh City, where such a ban was already in effect last year, chickens are still a common sight in back lanes.

After a study last month discovered that more than 70 percent of ducks and geese sampled in the Mekong Delta tested positive for influenza, the government ordered the slaughter of 1.5 million waterfowl, according to state media. But experts with the U.N. Food and Agriculture Organization predicted that as long as farmers were offered only a fraction of the birds' value in compensation, they would refuse to cooperate.

Last year, Van's researchers developed the virus strain for the vaccine. The self-administered clinical tests are due to begin as early as August. If they are successful, Van says, she hopes Vietnam can produce about half a million doses by January.

WHO experts visited Hanoi earlier this year and warned that the material used to grow the virus strain in Van's laboratory was not approved by international health agencies. It could be contaminated and was grown in cancer cells, according to Michael L. Perdue, a WHO influenza expert. Perdue's team also told the Vietnamese that testing the vaccine on researchers rather than on true volunteers would be unethical.

Van's worry is that by the time the vaccine is ready, it will no longer be effective against an influenza virus that easily mutates. If the vaccine cannot be updated, she cautioned, Vietnam would be left vulnerable in the face of a mass killer.

"I'm confident it will work," she said, adding, "I'm 80 percent confident we will succeed."

Special correspondent Yayu Yuniar in Jakarta contributed to this report.

© 2005 The Washington Post Company