Bird flu scare boosts healthcare systems across the world

The WHO’s ability to tackle health threats has been bolstered by a focus on the bird flu threat. Emily Smith reports.

At least 201 people have been killed by a human variant of the H5N1 bird flu virus since 2003.

None of the deaths occurred in the EU. The areas affected - in Azerbaijan, Cambodia, China, Egypt, Indonesia, Iraq, Laos, Nigeria, Thailand, Turkey and Vietnam - were host to relatively poor households, limited medical facilities and basic poultry farming standards, all of which made it easier for the disease to reach fatal proportions.

The World Health Organization has spent the last four years working with representatives from its 53 member states to make sure the virus does not turn into a pandemic across rich and poor regions and countries alike.

In early 2005 it published a checklist for pandemic preparedness and a revised global pandemic preparedness plan. Since then, with help from organisations including the United Nations Children’s Fund (Unicef) and the European Centre for Disease Prevention and Control (ECDC), the WHO has hosted local and international meetings to prepare for an influenza pandemic, be it H5N1 or any other flu virus. Countries are encouraged to learn from each others’ success and mistakes. The number of WHO members with an influenza pandemic preparedness plan has risen from 18 in 2005, to 40 this month.

Glancing at the many causes of death in the world today, it might seem strange to focus so much attention on preparing for a hypothetical bird flu pandemic .

The WHO reports that upper respiratory infections, including influenza, account for just over 75,000 deaths every year. This is well below tuberculosis, responsible for 15.7 million annual deaths at the last count, or HIV, at 2.7m, or even malaria, at 1.3m. All three diseases have arguably reached pandemic proportions in the developing world, and certainly have the potential to develop into a global problem.

But Gudjón Magnússon, a director at the WHO health programmes division, says it is no mistake to concentrate efforts on influenza.

"The positive thing about all this work," he said, "is that much of it has raised our ability to handle health threats in general."

Many of the systems dreamt up under WHO avian influenza pandemic preparedness programmes could also work to counter any disease. "Sweden, to give just one example, has had to develop a military protection programme for the protection of hospitals," said Magnússon.

"This means that, in the event of a pandemic, hospitals would be surrounded by a military protection zone," he said, "preventing people from coming in or out unless they absolutely needed to."

"This sort of precaution was drawn up in case of a bird flu pandemic," he said, "but it would be equally relevant to handling any kind of contagious disease."

He said that international co-operation to develop pandemic preparedness plans had also led to huge benefits in poorer countries such as Armenia, which four years ago had no facilities for the diagnosis of bird flu. It now has four diagnostic centres. One was a gift from Austria, while the other three were bought with part of the $1.9 billion (€1.33bn) pledged by wealthy governments to fight bird flu, at an international conference in Beijing in 2005.

Modern life has made us all more vulnerable to health threats, according to Magnússon. "We travel more than before, making it easier for germs to spread," he said. "In addition, people like to visit the most exotic places, which are home to diseases they would never normally have encountered."

But he added that pandemic preparedness plans had also made people in the western world revisit "an area we had more or less forgotten to worry about: personal hygiene".

Children are not taught to wash their hands often enough, according to Magnússon, and worrying levels of hospital infections such as MRSA suggested that even wealthy countries were not applying proper hygiene standards in medical wards.

Outbreaks of tuberculosis in Europe and the US in the 1940s saw the end of public spittoons, he said, as people realised the danger of germs in public places.

Magnússon hoped that the bird-flu scare could serve as a similar wake-up call for cleanliness today.

The WHO’s ability to tackle health threats has been bolstered by a focus on the bird flu threat. Emily Smith reports.