IFPRI Forum

June 2006

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FORUM: Who has been most affected by highly pathogenic avian influenza (HPAI) thus far, and why?

David Nabarro: Since 2003 the highly pathogenic avian influenza virus H5N1 has infected 227 people and has killed 129, mostly children and young adults. Direct contact with infected birds was the main reason for deaths among humans. Vietnam and Cambodia have the highest number of human cases.

Since the first avian influenza outbreaks in 2003 in Southeast Asia, the virus has spread to more than 50 countries in the Middle East, Western Asia, Eastern Europe, the Indian subcontinent, and Sub-Saharan Africa. Many of these countries are poultry-consuming and poultry-importing countries. Migratory birds have often transported the virus over thousands of kilometers, and at the same time the movement of poultry, poultry products, and people has significantly contributed to virus spread.

The ongoing avian influenza crisis has caused billions of dollars of losses-more than 200 million birds have been culled or have died from the disease. Human health concerns in many of the major consuming countries have led to lower poultry prices and market volatility. The Food and Agriculture Organization of the United Nations (FAO) predicts a reduction in global poultry production by 1 percent to 81 million tonnes in 2006. Per capita consumption in developed countries is estimated to decline by 3 percent in 2006, mainly in Europe. Asian poultry production is estimated to fall by 1 percent.

The spread of AI in Africa will likely reduce poultry production by nearly 5 percent. An estimated 5 percent decline in consumption per person has potential implications for livelihoods and food security in a region where poultry contributes nearly 30 percent to total meat availabilities, FAO has said. Consumers suffer when chicken meat and eggs are unavailable and the prices of alternative proteins are increasing.

FORUM: What would be the socioeconomic and nutritional impact on people at risk (the poor, people with HIV, and women) if HPAI is not controlled?

David Nabarro: Around 80 million people in Africa and 280 million people in Asia live in food-insecure households that keep poultry. Backyard poultry production across most countries in Africa and Asia contributes to poor people's access to food. Poultry production is used as an investment, as savings, as a source of income, for barter, and for social exchange. Especially in poor households, the contribution of poultry and eggs to better nutrition should not be underestimated. A widespread outbreak might reduce the ability of people to buy food.

In countries with large, dense poultry and human populations, the direct losses to poultry caused by the H5N1 virus are considerable. In Thailand and Vietnam, the outbreaks in 2003-04 were very extensive, with losses of between 15 and 20 percent of all poultry stock.

In Africa and Asia, more than 70 percent of backyard poultry is owned by women. The money they earn from selling birds and eggs is an important additional source of income and often used for child nutrition and the care of household members. It can be safely said that loss of birds from rural communities over a large area and over several weeks or months weakens the economic position of the rural poor, particularly women. On the other hand, selective hunger as a result of H5N1 outbreaks is possible given that AI outbreaks contribute to poverty among peoples whose livelihoods depend on poultry.

FORUM: What are the most effective control strategies? Can optimal short-term and long-term strategies be identified for controlling HPAI spread, depending on the specific vector or anthropogenic process responsible for the spread?

David Nabarro: The control and containment or final eradication of the H5N1 virus is a complicated task and requires a combination of measures. There is no quick-fix solution that is applicable to all countries. Control interventions must be chosen and adapted according to the economic conditions and the disease status of each country or region. The overall goal is to detect the virus as early as possible and preferably eradicate it in order to limit infections in humans and reduce economic losses.

The main internationally agreed-upon H5N1 containment measures are disease surveillance in order to quickly detect and report outbreaks; upgrading of biosecurity in poultry farms; control of movement of birds and products in outbreak areas; temporary market closures and border controls; culling of infected poultry; and vaccination, communication, and education.

Early detection of sick animals and a rapid response are key for a successful control campaign. This requires a well-informed general public and efficient veterinary and human health services, which are seldom all in place in developing countries.

It is important to offer incentives to farmers so that they report suspected cases immediately. Farmers should also be compensated for poultry losses. Far too often virus outbreaks in animals remain unreported because farmers fear economic losses if they report infections in their flocks. Instead they prefer selling diseased chickens on local markets, which often contributes to the spread of the disease.

Designing an effective compensation program appropriate for each country is important. Financial support has to be sufficient to ensure cooperation of particularly poor farmers, but it should not distort market prices and should not be overly generous so that farmers have no incentive to control the disease. Compensation schemes require well-functioning financial bodies; funds should reach farmers directly on a fair and equitable basis. Compensation schemes should follow the principles of transparency and good governance. In general we need to keep in mind that H5N1 containment measures will impose additional costs on poultry production.

FORUM: What type of institutional mechanisms can be used to involve smallholders and the poor in effectively implementing HPAI control strategies?

David Nabarro: The ingredients for success are strong political will and leadership that make H5N1 control campaigns a national priority, involve all sectors of society, mobilize financial resources, build capacity, promote best practices in poultry production, and operate with transparency.

Experience shows that HPAI control campaigns are very difficult to implement in countries with a decentralized government structure, including decentralized decisionmaking and decentralized funding sources. There should be a balance between centralized control and local involvement. It is essential to ensure that control measures are appropriate to vulnerable people as well as to commercial players.

At the local level, the involvement of community animal health workers (such as in emergency reporting and vaccination) and the involvement of civil society (in local control committees, reporting, and vaccination campaigns) are crucial. The strengthening of veterinary systems in poor countries is essential, but it will not happen overnight. Therefore the private sector, nongovernmental organizations, and volunteers could assist in virus search campaigns and could support veterinarians in containment interventions. We need a strong movement in rural areas that would make virus search a top priority.

FORUM: What lessons have been learned from the Southeast Asian experience with HPAI? How can this experience help to inform decisions in other affected and as yet unaffected regions of the world?

David Nabarro: Good surveillance and quick reporting have been the basis for successful H5N1 control campaigns in Southeast Asia. Thailand, for example, has involved thousands of volunteers who have "x-rayed" villages in search of potential virus spots. Early reporting is critical to reduce the spread of the disease and the overall costs of avian influenza. Early reporting, however, is of very little use if the veterinary system cannot rapidly react to investigate and, if necessary, contain an outbreak. Massive investments will be needed in developing-country veterinary services to ensure early diagnosis.

Since September 2005, Vietnam has conducted three rounds of vaccination for smallholder and village poultry, and the number of outbreaks and culled chicken decreased significantly. Vaccination campaigns, however, are very sophisticated interventions that must strictly follow international guidelines, standards, and quality requirements. In the context of Africa, for example, with millions of backyard poultry dispersed over vast rural areas, mass vaccination campaigns will be difficult to implement.

Good public awareness campaigns through a variety of media have helped people in Southeast Asia to learn about the H5N1 virus, to protect themselves and their poultry, and to take informed decisions. Many of the human H5N1 cases could have been avoided if people knew how to protect themselves against the virus.

FORUM: In your view, what type of information do decisionmakers need to effectively implement HPAI control strategies that do not disproportionately harm the poor?

David Nabarro: Decisionmakers need information about the structure of the poultry sector, trade flows through different types of market chains, the importance of poultry and other livestock to incomes and diets, the capacity of animal health systems at the ground level to carry out rapid response, and communication and information gaps.

Decisionmakers need to remember that while outbreaks have direct consequences, decisions made at various stages in a control program also affect livelihoods and food security. In almost all cases, a control process that minimizes the killing of birds will be preferable. It's a tricky task to balance the need to wipe out disease against the need to secure livelihoods-countries should include these kinds of calculations in their forward planning.

FORUM: The United Nations has been involved in a global effort to stop the spread of avian influenza, but what is it doing to address the impact of the disease on poor consumers and producers in developing countries who have already been affected by it?

David Nabarro: Since the first H5N1 outbreaks in 2003 UN agencies have been supporting countries in their battle against the virus. The UN advises governments in designing their avian influenza control strategies, provides technical assistance to upgrade animal and human health infrastructure, trains veterinarians and human health workers, conducts surveillance on human cases, monitors virus development, builds capacity to cope with a pandemic, and coordinates global scientific research and development. Communication campaigns are particularly targeting communities in rural areas to inform them about risky behaviors and how they can protect themselves against the virus.

With the spread of the virus outside Asia, particularly to Africa, the role of UN agencies in supporting poor countries has significantly increased and more countries are relying on UN agencies in building their defense line against the virus. I hope donor countries will increase their support to UN agencies so they can continue their important assistance to affected countries and countries at risk.

In the long term, UN agencies will help countries review the effectiveness of their avian influenza strategies, including their compensation plans; review the impact of their strategies on people's livelihoods; assess the need for rehabilitation of the poultry production sectors; and review possible social and environmental impacts. Balancing disease control measures and human safety against livelihoods will be a major challenge of the future.