Wednesday, Nov. 2, at 1 p.m. ET

Avian Flu: U.S. Prepares for Possible Pandemic

Dr. Yanzhong Huang
Director of the Center for Global Health Studies at Seton Hall University's Whitehead School of Diplomacy and International Relations
Wednesday, November 2, 2005; 1:00 PM

Dr. Yanzhong Huang, director of the Center for Global Health Studies at Seton Hall University's Whitehead School of Diplomacy and International Relations, was online Wednesday, Nov. 2, at 1 p.m. ET to discuss the avian flu and preparations in the U.S. for a possible pandemic.

The transcript follows.


New York, N.Y.: The U.S. plan presented yesterday puts an emphasis on the creation of vaccine and drug stockpiles. However, stockpiles alone aren't enough without the capacity to make use of them. Do you think there should be more emphasis on building communities and hospitals capacities to develop a rapid reaction plan?

Dr. Yanzhong Huang: I agree there should be more emphasis on local health system capacity building. The President's plan did mention the need to have adequate medical personnel and supplies of equipment in responding to a pandemic, but he did not talk about how to engage effectively communities or the civil society in the event of an outbreak. Also, even though he discussed the need to coordinate response at the federal level with response at the state and local levels, he failed to lay out a plan addressing the chain of command issue -- lack of clear chain of command and communication indeed accounted for the failure in New Orleans.


Detroit, Mich.: Dr. Huang, I understand that the avian flu can travel from animal to person and from person to person. I am, however, confused as to how it travels from animal to person. Does the person have to consume the animal in order to get influenza or do they just have to be in contact with the animal? Thank you so much for your time.

Dr. Yanzhong Huang: According to WHO, direct contact with infected poultry, or surfaces and objects contaminated by their feces, is presently considered the main route of human infection. To date, most human cases have occurred in rural or periurban areas where human beings live in close proximity to poultry flocks. As infected birds shed large quantities of virus in their feces, opportunities for exposure to infected droppings or to environments contaminated by the virus are abundant under such conditions. Moreover, because many households in Asia depend on poultry for income and food, many families sell or slaughter and consume birds when signs of illness appear in a flock, and this practice has proved difficult to change. Exposure is considered most likely during slaughter, defeathering, butchering, and preparation of poultry for cooking. There is no evidence that properly cooked poultry or eggs can be a source of infection. In affected area, though, it is advisable not to use dead and sick chicken or other poultry for preparing food for humans and/or animals. Even healthy-looking poultry of any kind from a bird-flu affected area should not be used for food.


Maryland : How much can the U.S. affect the policies of other countries regarding containment of the avian flu?

Dr. Yanzhong Huang: As the world's only superpower, the United States can play a very important role in building a global bioshield against pandemic flu. It could share with capacity-deficient countries information, experiences and lessons in the development of surveillance systems while helping them drawing up preparedness plans. It could provide the needed training, diagnostic reagents, and facilities for rapid case detection, laboratory confirmation, and reporting. What's more, it could use its influences to engage political leaders in capacity-deficient countries so that strong political commitment is achieved toward the prevention and control of bird flu. With strong political commitment at the national and subnational levels, effective public awareness campaigns can be launched to educate people about the risks of the disease and government measures, which are essential for timely disease identification and reporting in these countries.


New York, N.Y.: Is avian flu really a threat to world health? We have a handful of cases worldwide. Meanwhile AIDS ravages Africa and no one cares. It seems more a story that Republicans pull out of their hat when they need something in the news to distract from scandal. Should we be concerned? If so, what damage do you expect will be done to the human population worldwide?

Dr. Yanzhong Huang: While much remains to be understood about the molecular basis of influenza pathogenesis, host immune response, immune protection, immune enhancement, virulence, and transmissibility, pandemic influenza poses one of the most significant global health challenges to the humankind. On December 2004, WHO conceded that 2 million to over 50 million people could die in the event of a pandemic flu. The present situation appears to resemble that leading to the 1918 pandemic which cost 50 million lives worldwide. According to WHO, similarities between the H5N1 and 1918 viruses have been suggested in the gradual adaptation of an avian to a human-like virus, the severity of disease, its concentration in young and healthy people, and the occurrence of primary viral pneumonia in addition to secondary bacterial pneumonia. Some scientists pointed out that given today s world population, a 1918-like virus could kill at least 72 million. In addition to human suffering, the pandemic can rapidly take on significant political, economic, and social dimensions. Already, recent avian influenza outbreaks have devastated many local economies in Southeast Asia. I agree that emphasizing the threat of pandemic flu now would divert much needed resources and attention from the campaign against an existing pandemic: HIV/AIDS. Yet if we don't act now and allow avian flu to spread to Africa (which has a large HIV/AIDS population unable to mount an effective immune response against H5N1), the consequence would be disastrous.


Newark, N.J.: Are the policies recently announced by the Bush administration appropriate for the current situation?

Dr. Yanzhong Huang: I think the President's speech demonstrated strong political commitment to influenza preparation and response in the United States. Some policy measures, such as utilizing new technologies in vaccine development and providing liability protection for the vaccine makers, are essential for strengthening our surge capacity in preparing for the next disease outbreak. The plan was stronger than its August draft form. It would be greater if he could also lay out some concrete measures of helping countries that are most vulnerable to disease outbreaks (e.g., Southeast Asia, Africa) beefing up their system capacities in fending off a disease outbreak or, if that has failed, mitigating the consequences of the attack. This is important because in an era of globalization and economic interdependence, helping "them" is also helping "us."


Chesapeake Beach, Md.: Is there some particular reason to believe that an easily transmitted strain will emerge at this time, or is this another instance of the Gambler's Falacy? (that it hasn't happened in a long time, so we're "due" for another outbreak)

Dr. Yanzhong Huang: You are right, we do face tremendous uncertainty over the risk posed by avian influenza to human health. This uncertainty has placed policy-makers in a dilemma: how can governments justify committing already scarce public health funds to an unpredictable but potentially catastrophic event? An examination of the timeline of human influenza over the past 100 years, however, suggests a disproportionate increase in the number of reports of novel subtypes in humans and in the number of animal and bird species involved. In addition, the interval years between outbreaks are increasingly reduced, from 39 years (1918-1957) to 6 (1997-2003). Most infectious disease experts agree that the world now stands on the verge of an influenza pandemic. According to WHO, all prerequisites for the start of a pandemic were met save one: efficient human-to-human transmission.


Maplewood, N.J.: What is the difference between pandemic and epidemic?

Dr. Yanzhong Huang: An epidemic such as SARS occurs when an infectious disease spreads beyond a local population, lasts longer, and reaches people in a wider geographic area. A pandemic occurs when an epidemic spreads around the world (e.g., HIV/AIDS and Spanish flu).


Johnstown, Pa.: It seems that the United States and other major countries have the infrastructure and economy to minimize the the danger of the bird flu. But at the same time, it seems that the majority of countries would not be able to successfully fight the bird flu. Are there plans in the United States or the WHO to prevent a tragic loss of life in these other nations? Or will it be an every-nation-for-itself scenario where the underdeveloped countries are left to fend for themselves?

Dr. Yanzhong Huang: Thank you for the question. Yes, while it is true that some countries do not have the needed the system capacities in fending off a major disease outbreak, the international community, including WHO and the United States do have some plans to prevent the loss of life in these nations. President Bush in September announced a new International Partnership on Avian and Pandemic Influenza, which is a global network of surveillance and preparedness to help rapidly detect and respond to any outbreaks. According to him, 88 countries have joined the effort. The President in his speech yesterday also mentioned that he had requested $251 million from Congress to help the foreign partners train medical personnel, draw up preparedness plans, and expand their surveillance and testing capacities. In addition, WHO has published its recommended strategic actions for those countries that lack the requisite epidemiological and lab capacity for responding to any emerging disease. The strategic actions focus on strengthening the early warning system. To that end WHO will provide the needed training, diagnostic reagents, and mobile high containment labs for rapid case detection, laboratory confirmation, and reporting.


Rockville, Md.: Dear Dr. Huang, have any particular preparations been made to vaccinate or protect the large populations here in the U.S. and elsewhere who are immunocompromised? The spread of HIV/AIDS has, I would suggest, created a population of highly-vulnerable people -- such a population did not exist in 1918. Thank you.

Dr. Yanzhong Huang: This is a very interesting question. We still do not know how H5N1 will behave in the body of a person living with HIV/AIDS. There are two scenarios here. In one scenario, the HIV positive individuals, because of the suppressed immune system, will be unable to mount a protective immune response against H5N1, and they will be easily infected and die in a very short period of time. In the other scenario, the HIV positive individuals would allow the avian flu virus to mutate or adapt to human beings. That could create new forms of the virus. The situation could be made worse by the debilitated health systems and lack of state capacities in some of the affected countries.


Schaumburg, Ill.: The President of the American Veterinary Medical Association attended President Bush's speech yesterday on the U.S. efforts towards combating a possible avian influenza pandemic. While we applaud the efforts being made by the government, we believe that the most effective preventative efforts are those endorsed by by the World Animal Health Organization, that focus on rapid response to outbreaks in animal populations. If animal outbreaks are controlled effectively, the AVMA believes that this will go a long way toward protecting human populations. To do this, the veterinarian infrastructure in those countries experiencing outbreaks must be enhanced. Do you agree?

Dr. Yanzhong Huang: There is no doubt that we should strengthen veterinarian infrastructures in affected countries. Yet given the interface between animal and human disease, fortifying the partnership and collaboration among multilateral organizations (e.g., FAO, WHO, and OIE) will also be important. These organizations could engage a number of common activities, including joint field investigations, epidemiological studies, acquiring and sharing of a full inventory of H5N1 virus strains from humans, poultry, wild birds, and other animals. Through the collaboration of these organizations, the international community could gain a better understanding of conditions that increase the risk of human infection and therefore favor emergence of a pandemic virus. Collaboration of research would also improve understanding of the links between animal disease, human behaviours, and the risk of acquiring H5N1 infection. Such information will be used as the basis for more precise and timely risk communication to farmers and their families on preventive measures.


New York, N.Y.: It seems that the drug "Tamiflu" is one of the key components of the prevention program. Is this drug really the most effective one out there....and does it make any difference that Donald Rumsfeld was the chairman of Gilead, who owns the patent on the drug. Isn't Relenza more effective?

Dr. Yanzhong Huang: Anti-viral drugs such as Tamiflu can reduce the severity and duration of illness caused by seasonal influenza. It may also reduce the likelihood of being struck by flu. Its effectiveness, however, should not be exaggerated. For cases of human influenza with H5N1, the drug may improve prospects of survival, but it should be administered within 48 hours after the onset of the symptoms. So timely diagnosis is the key.


Los Angeles, Calif.: Dr. Huang,

As far as population is concerned in the United States, where do you see the most vulnerability for the avian flu? Or are we all equally vulnerable? Thank you.

Dr. Yanzhong Huang: The vulnerability of population in the United States depends on a lot of factors, e.g., immune response, environment, vitality of the communities, and level of preparedness at the state level. We know that some states are better prepared than others. This can be an important factor accounting for the variation of the response and the outcomes in the event of a disease outbreak. For example, during the 1918 Spanish Flu, some localities (e.g., San Francisco) did better than others (e.g., Philadelphia). Again, a lot of factors are involved in this process.

It's almost 2 p.m.. I have to go. It's a great pleasure chatting with you all. The questions are interesting and stimulating. Thank you and good bye!


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