PanAfrica: Africa Action Statement on Avian Influenza and Africa - Looking Ahead to the Annual G8 Meeting
The subject of infectious disease, prominent on the agenda of next month's Group of 8 wealthy nations (G8) meetings in St. Petersburg, Russia, cannot be addressed without special attention to Africa. In this continent where HIV/AIDS has already taken millions of lives, the same social and economic conditions that underpin that pandemic threaten to spread another: avian influenza.
Africa Action urges the international community to comprehensively address the threat of avian flu and the particular challenges facing public health systems in Africa and other developing regions. As they confront a possible future avian flu pandemic, the U.S. and other G8 countries must recognize the common vulnerability of all humanity and must help to prevent, monitor, and control outbreaks in developing countries. The leaders of the G8 must make new commitments to develop health care systems in Africa and to support African efforts to respond to deadly public health crises, from the current HIV/AIDS pandemic to the emerging challenge of the avian flu. A failure to mount a serious response towards such international health threats will have serious global consequences in the future.
The Origins of Avian Flu
Avian flu surged to the forefront of the mainstream media in 2003, when outbreaks of the potent H5N1 strain began to have destructive effects on poultry in Southeast Asia. In late 2003, bird-to-human transmissions of avian flu highlighted the increasing danger posed by the disease. As of June 20, 2006, over 200 confirmed human cases of avian flu H5N1 had been reported to the World Health Organization (WHO). Of these cases, found in Asia, Europe, and Africa, more than half have been fatal, demonstrating avian flu's high mortality in humans. Recent evidence from Indonesia shows that, in at least one instance, the rapidly evolving virus has developed the capacity to pass from human to human. Many researchers express grave concerns that, if this ability becomes stronger and more consistent, the world will face a major pandemic.
Africa faces particular vulnerabilities, which make the continent more susceptible and less capable to respond to a major avian flu outbreak. These weaknesses include inadequate and overburdened health care systems and economic under-development. In many areas of Africa, where frequent contact between humans and birds is common, families often own and rely heavily on small backyard poultry flocks. Furthermore, the migratory patterns of wild birds moving southward from Europe, as well as growing levels of international travel, carry the added danger of introducing and spreading the virus. These factors create ideal conditions for the silent and extensive spread of the virus. Africa also has a limited capacity to mount a comprehensive response in the case of an avian flu pandemic, due to the scarcity of vaccines and other treatment options.
The HIV/AIDS pandemic in Africa has been fueled by many of these same social and economic factors. HIV/AIDS has further weakened health care networks, drained resources from governments, and sapped the productivity of populations. The ability of African governments to respond has been worn thin, and it is unclear how robustly the continent could react to another significant health threat. Medical facilities experiencing shortages in trained medical workers, space and medical resources - familiar obstacles in the fight against HIV/AIDS - would quickly become overwhelmed by an avian flu pandemic. In addition, HIV-positive individuals with already compromised immune systems would be acutely susceptible to avian flu with its high mortality rate.
Health officials admit that it is hard to gauge the current extent of avian flu outbreaks in African countries. Many places lack the resources needed to consistently monitor the disease in birds. Poor communication between government officials, poultry farms, and the general population complicate efforts to spread information about prevention and surveillance tactics.
To date in Africa, avian flu outbreaks have emerged in domestic birds in Nigeria, Egypt, Niger, Cameroon, Burkina Faso, Sudan, and the Ivory Coast. The WHO has confirmed fifteen human cases of the avian flu H5N1 in Djibouti and Egypt, six of which were fatal.
The effects of inadequate access to education, economic resources, and health care have caused the devastating HIV/AIDS pandemic to overrun the African continent. These same inequities may now allow the avian flu virus, a potentially much faster killer, to spread unchecked through the continent and beyond its boundaries.
The Possible Impact of the Avian Flu
The last major global flu pandemic occurred in 1918. Conservative official estimates stated the death toll in that pandemic at 40 to 50 million, however it may have been as high as 100 million people globally.
The world remains unprepared for a major human pandemic of avian flu. The international community has already devoted insufficient attention and resources to containing outbreaks in Africa and Asia. By the time the virus begins to affect the U.S. and other G8 nations, the scale of the crisis will have swollen beyond the capacity of the international community to respond.
The WHO has issued an advisory for countries to begin stockpiling vaccines and antiviral drugs. But African and other developing countries do not have such a capacity, and even industrialized nations are likely to face shortages. The victims of a pandemic will be mainly those without access to treatment.
The 2004 outbreak of the relatively less dangerous H5N2 avian flu strain that infected South African ostriches strongly illustrates the potential negative economic impact of a flu pandemic in Africa, even if confined to poultry. This outbreak led to the deaths of more than 26,000 birds through culling. Reports suggest that the culling alone resulted in an estimated $100 million setback to farmers and a loss of 4,000 jobs. Additional losses incurred by the suspension of poultry exports further demonstrate the significant financial consequences of even a relatively limited avian flu outbreak.
Representatives of the health ministries of the G8 nations met on April 28, 2006 and issued a statement outlining their priorities concerning the prevention and control of infectious diseases. This statement acknowledged the imperative of advancing the health of populations in order to meet the Millennium Development Goals, and, importantly, the need for internationally coordinated efforts to counter major health threats. These priorities are likely to figure prominently on the G8 meeting agenda in July.
The G8 nations must commit to a comprehensive and globally integrated response to public health threats, and to investing in drastic improvements in global health systems. The U.S. must recognize the moral and practical necessity in dedicating the required funding, resources, and expertise to address Africa's public health challenges. Additionally, the U.S. must increase its support for programs seeking to promote a comprehensive response to health crises and to strengthen health systems in developing countries, such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
Recognizing the obstacles Africa faces in confronting the avian flu, in 2005 the WHO advised that certain precautions be taken. It stated that various health service sectors should seek to build stronger connections with each other, and that this coordinating effort should be supported by national governments. The WHO further recommended that countries improve their capacity to detect and respond to emerging cases of avian flu, and that this information be rapidly and widely communicated.
However, these important national efforts must be supported by the G8 on an international level, and new funding must be committed to this endeavor. In January 2006, a gathering of nations and organizations committed to spend $1.9 billion on avian flu measures. However, a recent World Bank report shows that only $286 million has actually been delivered so far. The U.S. was specifically implicated in the report for providing only $71 million of its previously pledged $334 million for avian flu efforts.
The G8 must take seriously the global threat posed by infectious disease, and must comprehend their own obligations in this regard. For it is clear that, aside from the very real considerations concerning a possible outbreak of the avian flu, the pandemic predictions made by world health officials have revealed a much broader reality. No longer can the U.S. and other G8 nations pretend to ignore the vulnerabilities in African health systems and the health crises faced in Africa in favor of strictly national concerns. As the spread of HIV/AIDS has shown, the boundaries of national and global health concerns no longer exist.
Africa Action emphasizes that the international community cannot afford to disregard the lessons learned from HIV/AIDS or the ongoing devastation wrought by this current pandemic, even as it seeks to avoid a possible avian flu catastrophe. The G8 meetings in July provide the opportunity for economically powerful nations to show responsible global leadership in the face of urgent public health threats, and they must seize this opportunity or pay a high price in the future.