Experts Fear Burma Is Ill-Equipped to Handle Bird Flu
Sunday, January 15, 2006
RANGOON, Burma -- When the chickens began dying in Mon state last year, residents feared that East Asia's lethal bird flu epidemic had finally crossed to Burma.
The provinces over the Thai border had already been hit hard by the disease and now hundreds of Burmese chickens were suddenly perishing without explanation. A local veterinary official initially blamed some of the deaths on sunstroke.
Alerted to the outbreak by reports on a Norway-based radio station run by Burmese exiles, the United Nations contacted Tang Zhengping of the Food and Agriculture Organization -- the chief U.N. agriculture official in Rangoon -- who in turn called the government's top animal health expert to inquire, according to U.N. and Burmese sources. The government official responded that he didn't know anything about it.
Burmese officials repeated as recently as last month that they have no confirmed cases of bird flu in either humans or poultry. A cluster of suspected human cases two months ago was reportedly caused by a less lethal strain of influenza, while several instances of mass bird deaths have been attributed by officials to ailments other than avian flu.
But the Burmese government said in a regional report last year that the country "is a frontier line between the affected and non-affected countries," adding that "the resources needed to launch a response are not adequate."
Global health experts outside Burma have been anxious to learn more about the situation on the inside, repeatedly questioning whether the military government is being candid when it claims the country remains free of the lethal virus.
The disease has already devastated poultry flocks across East Asia, including in China and Thailand, both of which border Burma, and has now appeared in Turkey. It has also infected at least 162 people, killing at least 80. International health officials have cautioned that the virus could spark a global pandemic if it develops into a form more easily passed from one person to another.
Burma's handling of the Mon state outbreak last year has reinforced concerns about whether its secretive, cash-strapped government could head off a bird flu outbreak, which international health experts warn might then spread quickly west to India and other South Asian countries that have so far been spared the epidemic.
In response to the telephone call from Tang, the FAO official, veterinary officials at the country's Livestock and Fisheries Ministry investigated the outbreak in Mon state. They reported back that it was caused by Newcastle disease, a widespread poultry ailment of little threat to humans.
But in an interview, a senior Burmese official admitted last month that he did not have complete confidence in these findings. He said it had taken so long for central authorities to learn about the outbreak that the samples were no longer fresh.
"In some situations, the communication is not so good in our country, so reports and information from the village level cannot reach the central government in time," said the official, who spoke on condition of anonymity.
Though the government had reassured international health experts that the poultry deaths were not due to bird flu, the official added that Burmese livestock experts had never tested the chickens for this virus. Animal health workers had run out of bird flu test kits while surveying live poultry markets, he explained.
Burmese and international health experts said the country's health and veterinary services are starved for money, and have difficulty dealing with the disease. While foreign health experts and diplomats in Rangoon widely praise the professionalism of Burma's health and livestock officials, these observers questioned the willingness of authorities to disclose outbreaks.
They said Burmese culture coupled with years of rule by the military discourages the reporting of bad news, including natural disasters and disease. The government, for instance, had long denied the severity of an AIDS outbreak until the prime minister finally called attention to it in late 2001, by which time it had already become one of the worst in Asia. Officials also minimize the threat of cholera, though foreign medical experts and local press reports mention continuing outbreaks.
"You'd have to assume there's been a big question mark about their data," said a foreign health expert, who spoke on condition of anonymity for fear of government reprisal. "They may not know if they have bird flu. If they did know, the question is how quickly anyone else would know."
A paper prepared in November by the Livestock and Fisheries Ministry acknowledged that Burma's location is "strategic," along the routes of East Asian migratory fowl. Several types of wild birds, including a species of geese that has already suffered casualties from the virus, fly from China, Mongolia and the Siberian region of Russia through Burma's east coast and on to South Asia. A second flyway runs from China, another country with human cases of bird flu, through a vast nature reserve in northern Burma before continuing to Thailand.
In areas where migratory birds congregate, Burmese officials have warned farmers to take precautions to protect poultry against infection. So far, Burmese officials and other wildlife experts have said there is no sign of abnormal disease among migratory birds.
Posing a second threat is trade and traffic across Burma's borders, especially from Thailand. Since bird flu erupted in Southeast Asia in 2003, most of the Thai provinces bordering Burma have recorded diseased poultry, and one of Thailand's most recent human cases also came from a border province.
Burmese livestock officials said they had stepped up monitoring of markets and farms in border towns, enlisting police in the effort. "Now there's a possibility that some outbreaks at the village level could involve avian influenza," said a Burmese agriculture official. "It's possible we would not know."
In the last year, there have been several suspicious poultry die-offs. One this summer was so widespread among free-ranging chickens that it squeezed the supply of meat in the markets, forcing prices up, according to a local press report. Government officials have attributed poultry deaths to either Newcastle disease or avian pox.
Burmese health officials became worried two months ago when they learned that about 15 people in eastern Shan state had come down with a serious influenza-like illness, said Soe Lwin Nyein, a senior government epidemiologist. Of the 15, three children died.
But health officials sent nine samples to a laboratory in Bangkok associated with the World Health Organization, which determined that four of the cases were ordinary human influenza while the others tested negative for flu altogether, Soe Lwin Nyein said.
U.N. officials welcomed the Burmese government response and are now urging reluctant livestock officials to likewise send virus samples from poultry to a foreign laboratory for testing. Given Burma's lack of openness, this would enhance international confidence, said a U.N. official, adding that the stakes of remaining secretive are tremendous.
"If they have an outbreak, I think it will spread very fast," he said.