Bulletin of the World Health Organization

Poor countries need help to fight bird flu

The Bulletin interview with Shigeru Omi.

Dr Shigeru Omi
Dr Shigeru Omi

Dr Shigeru Omi, 56, earned his MD in 1978 and a PhD in molecular biology in 1990 at Jichi Medical School in his native Japan. He started his career as a medical officer for the Tokyo Metropolitan Government and worked as a medical doctor to promote health on remote Japanese islands where resources were scarce. In 1989, he became Deputy Director of the Office of Medical Guidance and Inspection in Japan’s Ministry of Health and Welfare. In 1990, he joined WHO as medical officer and developed the Western Pacific Region’s strategy for polio eradication. After holding a number of senior posts in the Western Pacific Region, Dr Omi became Regional Director in 1999.

Nearly one-third of the world’s population or 1.6 billion people live in the 37 countries and areas of WHO’s Western Pacific Region, which stretches from China in the north to New Zealand in the south and French Polynesia in the east. The Western Pacific Region and WHO’s 11-country South-East Asia Region have been at the forefront of WHO’s efforts to stem the spread of avian influenza and to help countries prepare for an outbreak among humans. Among the first to warn the world about the possible dimensions of a flu pandemic was Dr Omi.

In this interview with the Bulletin, Dr Omi calls on donor countries and institutions to help raise US$ 260 million to support measures in developing countries in Asia — countries where the virus has already infected and killed humans — to prevent further spread of avian influenza. He also talks about other public health priorities in his Region.

Q: How likely is an avian influenza pandemic among humans? What is your assessment of the current situation?

A: We are very concerned by the current situation. The virus is already entrenched in this part of the world and has now moved westward through Mongolia and Kazakhstan into Russia and beyond. More human cases of avian influenza have been reported this year than last year. The H5N1 virus remains unstable and unpredictable. A case in point: a few months ago in Qinghai Province (China) many migratory birds died. Usually migratory birds are regarded as quite resilient to the H5N1 virus, so this was another indication that it remains very unstable and changeable. Another concern is that ducks and some other species of birds are serving as a silent reservoir. They are infected but they don’t show any symptoms and so they can pass the virus to other birds and to human beings. If you also take into account the historical perspective, looking at the history of the 20th century, every 30 or 40 years we have a human influenza

Q. Are countries in the Western Pacific Region doing enough to stop the spread of avian influenza among birds?

A: All the countries are doing their best under the circumstances. But the capacity for detecting and reporting cases among birds is very limited in those countries, particularly where there are no mechanisms for financial compensation for farmers to encourage such reporting. The majority of human cases occur in rural areas where reporting lines are not good. In general, the level of awareness is quite poor. Some rural people may have heard that the virus can pass from birds to humans, but their knowledge is still quite limited. All the Member States have to double and triple their efforts, but I don’t think they can solve all the issues alone. That’s why I believe that the international community, partner agencies and donor agencies need to help countries to cope with this daunting challenge.

Q: How is WHO helping these countries cope with that challenge?

A: We have established systems for reporting, surveillance and laboratory testing and we have approached major donor countries and agencies to help them meet the financial gap. We still need an additional US$ 160 million for the next couple of years.

Q: What kind of support are you seeking from the international community? For prevention of the spread of the disease or measures in the event of a pandemic?

A: We need both. On the one hand, we must do our best to avert this pandemic, but at the same time we have to prepare for the worst-case scenario by stockpiling antiviral drugs in strategic locations so that they will be immediately available if needed. Developing vaccines for the virus is not an easy task, and so far only developed countries are doing this. But in the long term, I think some of the developing countries in our Region are also interested in developing vaccines on their own. One of WHO’s aims is to help countries to become self sufficient.

Q: Why are humans becoming affected by diseases that spring from the animal world, such as SARS (Severe Acute Respiratory Syndrome) and avian influenza?

A: There are many factors. One is that for the last 20 years growing prosperity in Asia has increased the demand for animal meat, particularly chicken. To meet this demand, chicken farmers have increased production, but often in unhygienic conditions. That’s why it’s very important to restructure and improve farming practices, down the chain of production to how chickens are sold in the market. There are many things we can do: segregation between ducks and chickens, between poultry and humans. Markets can be cleaned regularly. Hong Kong is doing this kind of thing. To avoid the risk of transmission, when slaughtering chickens, we propose central slaughtering houses. These are measures countries can implement, but it’s not easy. That’s why the international community needs to help these countries.

Q: The measures you have outlined will not be cheap or easy to implement. How much will all this cost and where’s the money coming from?

A: It’s very difficult to estimate how much it will cost. The Food and Agriculture Organization of the UN (FAO) and the World Organisation for Animal Health (OIE) have asked [for funds] to the tune of US$ 100 million for their short-term needs. On the public health front, we have asked for US$ 160 million for the immediate couple of years, although as we go along we may need additional funds. US$ 260 million sounds like a very big figure, but it is worthwhile for the international community, because if we are faced with an influenza pandemic, economies will lose billions of dollars.

Q: Apart from avian influenza, what are your priorities?

A: First, to tackle emerging communicable diseases, including the growing problem of tuberculosis and HIV/AIDS. Secondly, to tackle noncommunicable diseases, such as diabetes, high blood pressure, cancer and mental health problems. And, thirdly, to address broader health systems issues, such as financing health services and the huge problem of the migration of health workers for economic reasons from countries that need them most.

Q: What other areas of work are important?

A: In this part of the world, we have reached a point in terms of life expectancy and GDP where we can discuss the quality of medical services. Medical services and science have been dictated by biomedical approaches, forgetting about the psychosocial approach. So in parallel to communicable and noncommunicable diseases, we are starting to focus on the improvement of patient safety and quality of medical services – not just taking into account biomedical factors, such as measuring blood pressure, but also psychosocial factors; in other words, taking a more holistic approach. We are working on publishing a book that indicates how psychosocial factors have an influence on the health outcome. Also for our regional committee meeting next year, we will present a policy framework that can be the basis for developing national policies.

Q: How successful have countries in your Region been in tobacco control?

A: New Zealand’s tobacco control programme provides a global model and China, the biggest country in the world, recently ratified the WHO Framework Convention on Tobacco Control, which will have a huge impact. Indeed, most Western Pacific states have already ratified [the treaty], and this is very important because the Region has an exceptionally high mortality rate, with more and more young women and others taking up smoking. The multi-billion dollar and multinational cigarette industry is relying on that [uptake]. They lost markets in the developed world and now they are eyeing this part of the world. So it’s not an easy battle.

“… it’s very important to restructure and improve farming practices, down the chain of production to how chickens are sold in the market. There are many things we can do ...”

“US$ 260 million sounds like a very big figure, but it is worthwhile for the international community, because if we are faced with an influenza pandemic, economies will loose billions of dollars.”