Slow testing could undermine our bird flu response – the time for serious preparedness is now
The number of cow herds across the US testing positive for avian flu influenza (H5N1) continues to rise. The virus, which has been detected on every continent (including in penguins in Antarctica) continues to circulate in wild birds and has been detected in more than 50 mammal species. Cows are just the latest in a long line of animal infections, which has cost hundreds of millions of dollars.
In Vietnam, a 21-year old man died in March from the virus. In Texas, a dairy worker contracted a mild case of the disease. And just this week a child travelling from India was diagnosed with H5N1 in Australia.
Spillover to humans has so far just led to isolated cases and human-to-human transmission has not been seen, yet. Of the 874 human recorded cases of H5N1 reported in 23 countries since 2004, 458 people have died – a case fatality ratio of more than 50 per cent. This does not mean if the avian virus started spreading human-to-human that a large-scale pandemic would follow this same pattern, but it does reflect that the time for serious preparedness is clearly now.
The first thing to get right is surveillance and testing. FIND, the organisation I chair, is working with partners like the World Health Organization (WHO), CEPI and the 100 Days Mission to make sure that countries have access to quality diagnostic tests, treatments and vaccines.
Although animals are being tested, there are surprising limitations to how easily and how frequently this is being carried out. In the US, avian flu has been detected in so many cattle it is likely that the disease has been circulating undetected for months. In the UK, despite the situation across the Atlantic, the ministry in charge of the environment, food and rural affairs has said that it does not consider cattle to be at risk.
Ultimately the more testing, the more we understand how quickly the virus is moving and mutating. Furthermore, it’s obviously critical that if an outbreak is detected, tests are available everywhere so that those showing symptoms or coming into close contact with the sick can be tested and isolated. In the early days of a disease outbreak, this is the most effective way of breaking the chains of transmission and keeping epidemics from turning into pandemics.
Just because we have gone through the Covid-19 pandemic recently, does not mean that an outbreak of avian flu would follow the same track. The coronavirus hit hardest at people who were older or had underlying conditions like diabetes and heart disease. An H5N1 outbreak could have a very different trajectory, given its mutation across species and the nature of flu viruses
Testing appropriately and making sure there are multiple types of effective tests which work in different resource settings, along with and a diversity of manufacturers to supply tests, is really important in the preparation and response to any outbreak.
Strong surveillance – particularly of those groups who are likely to come into contact with the virus, like farm workers, or those living closely with animals – and accurate testing capabilities, are critical to establishing the genetic sequence of the virus, which is fundamental to the development of other counter measures, including treatments and vaccines. The faster we detect outbreaks of H5N1 or any other pathogen with pandemic potential, the better chance they can be tackled before they go transnational.
Earlier this year, FIND, in partnership with the 100 Days Mission, found that of WHO’s list of pathogens of pandemic potential approved tests, treatments and vaccines are limited for all but Covid-19 and Ebola Zaire. This is frankly illogical and poses a significant risk to our collective health security. We shouldn’t be waiting for outbreaks to happen to ramp up investment in countermeasures.
These gaps in the world’s blueprint for pandemic preparedness and response are the exact topics in discussion by Government leaders as they negotiate a pandemic accord in Geneva. With limited time left to finalise an international instrument before the end of May deadline, it will be a failure to future generations if leaders can’t prevent a repeat of the inequity that undermined the Covid-19 response and according to the UN led to more than 14.9 million excess deaths in 2021. A study in Nature noted that more than a million people died unnecessarily because of a failure to share vaccines.
Having accurate and accessible diagnostic testing and surveillance is the first step to an effective response that could stop an outbreak spreading. The animal kingdom has already been decimated but are we listening?
Dr Ayoade Alakija is board chair of FIND
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