Re: Egypt fears of bird flu mutation
AnneZ (post #1) said:
Tuesday, 13 March 2007, 08:20 GMT
Egypt fears of bird flu mutation
By Jenny Cuffe
BBC File On 4
Scientists in Egypt are examining the possibility that the deadly H5N1 Avian flu virus could be changing into a deadlier strain....
http://news.bbc.co.uk/2/hi/programmes/file_on_4/6441899.stm
Full transcript of the show:
BRITISH BROADCASTING CORPORATION RADIO 4
TRANSCRIPT OF ?FILE ON 4?- ?BIRD FLU?
CURRENT AFFAIRS GROUP
TRANSMISSION: Tuesday 13th March 2007 2000 - 2040
REPEAT: Sunday 18th March 2007 1700 - 1740
REPORTER: Jenny Cuffe
PRODUCER: Liz Carney
EDITOR: David Ross
PROGRAMME NUMBER: 06VQ3637LHO
THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY.
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HAY: We have received viruses from these other laboratories. They have been isolated and grown in cell culture so that we can identify any changes which are relevant to the virus.
CUFFE: Here in a laboratory on the edge of London, scientists have an urgent task in hand - to protect the world against the next bird flu pandemic.
HAY: The poultry viruses, in particular with regard to those which are causing human infections ? the H5N1 viruses ? these are very nasty viruses and very dangerous viruses, both for humans as well as for birds, and have to be handled under very strict containment conditions.
CUFFE: Under the microscope there are viruses from Egypt which give particular cause for concern - they show signs of mutation to a more virulent strain. Egypt is considered a high risk area for Avian flu, with 24 cases in the last year and 13 deaths. So what steps is it taking to stop the spread of the disease, and is the world doing enough to prepare for a future pandemic?
NABARRO: It?s the world as a whole that needs to get ready for pandemic, because it?s the world as a whole that will be threatened by pandemic, and the threat is potentially quite extraordinary. Millions, perhaps multimillions of deaths, great dislocation to our economic and social systems, and the prospect for suffering on a scale that we?ve actually not seen in recent history.
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ACTUALITY IN CAIRO STREET
CUFFE: 96% percent of Egyptians live in a narrow strip of land along the River Nile. Here in Cairo, they?re packed closely together in chaotic streets, where pedestrians, bicycles and donkey carts weave among the traffic, and historic buildings are dwarfed by brick apartment blocks that look as if they?ve been thrown together overnight. The Nile is a migratory route for birds and a wild teal is thought to have introduced avian flu to Egypt just over a year ago. This is a gateway between Asia and Africa, so the spread of disease here sets off alarm bells in the international community.
ALI: Egypt, if you look at it from Alexandria, appears as one continuous village, it?s six kilometres wide and you go 1,650 kilometres long.
CUFFE: Talib Ali is head of the UN?s Food and Agriculture Organisation for the central Mediterranean. With outbreaks of avian flu in poultry in 25 out of 27 provinces, he believes the disease will be difficult to contain ? particularly given the country?s reliance on poultry as a source of food.
ALI: Historically Egyptians like to have a live chicken killed at a market in front of them. Do you know why? Before they imported a lot of poultry and the poultry was rotten. People, they think, imported chicken or frozen chickens rotten. So their dietary habit is different, they have to change that as well. This will take a long time, it?s not where they are in a week, take a long time.
ACTUALITY IN STREET
CUFFE: You only have to walk down a street like this one to realise just how closely the Egyptians live with their poultry. There?s a woman selling bread at a stall with a chicken at her feet, and two women peeling vegetables, and again a couple of chickens in a cage beside them. And just over here, on this municipal rubbish dump, there?s a small group of ducks scavenging.
The hot spots for bird flu are mainly in the countryside and we?re now travelling south of Cairo to Fayoum, an area renowned for its poultry ? particularly the duck that?s a national speciality.
ACTUALITY IN FAYOUM
CUFFE: We?ve just gone through the entrance into the oasis of Al Fayoum. There?s a concrete archway across the road and a police checkpoint. There?s also a vet posted there. Last night a man was stopped at the checkpoint and he was found to be carrying 700 live chickens. It?s against the law to transport chickens from one governorate to the other ? that?s one province to the other ? so he was arrested by the police and all the chickens were killed.
Fayoum authorities are on high alert because there?ve been two deaths here in the space of a month. 37 year old Nadia Hafez was the thirteenth Egyptian to die from the highly pathogenic virus. She lived here in the village of Minya Al Heit, in a small square surrounded by narrow alleys. Like her husband, Khalif, she was a teacher.
KHALIF ALI MOHAMMED (VIA INTERPRETER): We just thought it was a common flu and it was her being exhausted or something. It took like a more serious form but we did not have any doubts that this could be something else.
CUFFE: When did you realise how very serious it was?
KHALIF ALI MOHAMMED (VIA INTERPRETER): It was just two days before she passed away.
CUFFE: And how many children do you have?
KHALIF ALI MOHAMMED (VIA INTERPRETER): Six kids.
CUFFE: So how are they doing now without their mother?
KHALIF ALI MOHAMMED (VIA INTERPRETER): The kids did not know until very recently. We have hidden the fact that she died for several days. Unless we ourselves were able to grasp and understand what happened, and then we talked to them all together, they just hugged each other and start praying and crying. But they are learning to accept it, they are back to their schools now and life goes on.
CUFFE: What contact had your wife had with birds? Where do you think she got this from?
KHALIF ALI MOHAMMED (VIA INTERPRETER): Just like any other housewife. She was a teacher and she had a job, but at the end of the day she had chicken at houses and she took care of them. Yes she did, she did have contact with birds.
CUFFE: As soon as doctors confirmed that it was a case of bird flu, Dr Nasr Al-Sayyid from the Health Ministry in Cairo took a team of scientists to Fayoum to gather evidence.
AL- SAYYID: I visited her home, I met her daughters. She was breeding the chicken on the third floor. It was an apartment, but it?s an empty apartment, and they are living on the first floor. The poultry was there, they have chicken, she had goose, she has ducks, she have pigeons. Three weeks before she had the symptoms, the chickens start to die one after the other. She didn?t suspect avian flu, she was believing another disease. Once she had a fever and severe fever and chest pain. She went to the doctor and she said, ?I have diarrhoea, I have fever,? she didn?t mention that she had dead poultry. On the second day she went to the hospital and say, ?I have fever.? They ask her did she have dead poultry. She said, ?Yes, but three weeks ago.? It was confirmed and she was referred to the chest hospital in Cairo.
CUFFE: It?s the women in Egypt who keep the poultry. In a tradition dating back to the days of the Pharaohs, they feed turkeys and ducks by chewing corn and blowing it into their open beaks. Dr Suhir Hallaj, country director of the World Health Organisation, says that with this kind of intimate contact it?s no wonder people are catching bird flu.
HALLAJ: Most of the cases in Egypt and most of those who died are females and most of them are those who have back yard husbandry of poultry and chicken. Most of them practiced slaughtering infected chicken, defeathering infected chicken, so they were exposed to a very high dose of the virus. Our main problem in Egypt, and I think in most of the South East Asia, is in the back yard chicken raising. In these back yards you will see that people are living with chicken, they are not raised in a special place, protected, away from them ? no, they are living with them, the children are playing with the chicken, the chicken are in the bedroom, the chicken are anywhere, and you will see the excrements of these chicken everywhere, and they contain a large amount if they are infected, these will contain large amount of the virus. And then a dust in the air and this dust will contain millions of droplets containing the virus. So you will be inhaling all the time the virus if the chickens are infected. There are five, almost five and more million people, families raising poultry in their houses.
CUFFE: The first line of defence in the fight against pandemic is to cull all the birds in a two kilometre radius of infection. Last month, after Nadia Hafez died, her uncle, Abu al-Fadl, says a team of men in protective clothing arrived in her village ? and now there isn?t a feathered creature in sight.
AL-FADL (VIA INTERPRETER): Within a day or two they came and took all the birds from all the surrounding areas, all the houses, took them to kill them, of course, and they have purified the area with some disinfectant, some chlorine, things like this. People just panicked when she died and they start getting rid of the birds and giving them away voluntarily.
CUFFE: Were the neighbours angry that their birds were being taken?
AL-FADL (VIA INTERPRETER): Actually they were very supportive. They were grieving for her and they were very supportive of the family and they did not make us feel guilty in any way that this is our mistake. They knew that this is for the benefit of all of us, not just because of us.
CUFFE: Will you have birds again?
AL-FADL (VIA INTERPRETER): No, I am scared to death for my children and myself. We only live one time and I will not be the reason that one of my children or my wife die. Unless there is an announcement that it?s okay to raise birds, I will never do that again.
CUFFE: But there are many people who are fiercely opposed to a cull. Veterinary teams go prepared for hostility - knowing that they?re destroying people?s livelihoods and an essential source of food. The chief executive of Fayoum Health District, Hussain Abu Talib, says because of this resistance, it?s almost impossible to be sure you?ve removed the source of infection.
TALIB: We take a big police brigade to protect us. Last week we had a very big campaign, but what happens is they take the birds away, they hide it, and then after spending three hours over there, only twenty birds, twenty chickens, because they?d escaped their birds. Although they have a lady that died of flu, despite all this, they refuse to kill their birds.
CUFFE: How many do you think were there that you couldn?t find?
TALIB: At this spot I would say no less than twenty thousand, so so.
CUFFE: But how could they be hiding thousands of birds from you?
TALIB: Well it is a big city, houses are very close to each other, so they give it either a boy or a girl or they hand it to each other and they are sympathetic with each other. Everyone is with them, when they hear the horn of the police they start hiding the birds.
CUFFE: The fear of losing their livelihoods makes people reluctant to report signs of disease. This year there have been 110 outbreaks in back yards, but only half of those were reported ? the rest were discovered during spot checks by veterinary teams who believe the real number may be much higher. They suggest another reason could be ignorance.
ACTUALITY OF GOVERNMENT ADVERT
CUFFE: In recent weeks, the Government has been blitzing the media with public health messages. In this one, which goes out on national television just before the afternoon soap opera, a housewife is showing us how she washes her hands with soap and water after contact with her birds. Dr Suhir Hallaj of the WHO says this is the kind of message that should have been delivered a lot earlier.
HALLAJ: Our communication strategy was not enough. Our talk in the media about avian flu was not enough. We were in the middle of something either to sacrifice the industry completely, because everybody was afraid that we might produce a panic if we talked too much, and people might restrain from dealing with chicken, eating chicken, and then there?s a big industry in Egypt and a lot of families survive on that industry, and we need the poultry in reality. Because once avian flu entered Egypt, immediately the price of the red meat and fish increased. So we lost the cheap protein and the already expensive one increased its prices. So I think in the Government they were thinking about the two issues, but still my personal opinion that we should have had more talk in the media about avian flu and at least direct the people what to do.
CUFFE: There are two kinds of poultry keeper in Egypt ? those who have birds in the back yard to supplement their income and provide food for the table and commercial poultry farmers who form an important part of the country?s economy. So far, most of the Government?s efforts have been concentrated on the commercial sector. The Health Minister, Hatem El-Gabaly, is chair of the Supreme Committee on avian flu, which represents ministries and agencies dealing with agriculture as well as health.
Is it a problem for you as a Government to balance the needs of the poultry industry, which is extremely important to the economy, and the need to raise public awareness?
EL-GABALY: I think this is absolutely true, especially this year. We are not using very aggressive techniques, as we did last year, because we have to balance between saving the poultry industry and at the same time protecting people from the danger of the disease. But still our top priority remains human safety before bird safety.
CUFFE: Do you think that you were fast enough to raise public awareness, because it?s been suggested to us by the WHO that perhaps there was a bit of a lag between the development of the disease and people really being told what was happening?
EL-GABALY: It?s not a lag. You might call it avian flu fatigue, you know, you keep repeating, repeating the whole thing and people, you know, at the end of the day are fed up, they don?t want to act. Until mortality starts to appear again, then they take it seriously again. But I think many other countries have gone through that phase of being very active and then, after things cooling down a little bit, and then once the activity of the disease shows up again, then they start really worrying about what?s going on. But we are going to maintain our policy, whether we have cases or we don?t have cases, and that?s 100% to protect us from any pandemic.
CUFFE: But some of the Government?s efforts to protect people have been less than successful. Last year it offered compensation to commercial poultry farmers, who?d seen a collapse in exports to Gulf states and Africa. But the scheme seriously backfired. Hussein Abu Talib, head of Fayoum?s health authority, thinks it may even have helped spread the virus.
TALIB: We tried one thing, is when I take the bird from you, I will give money instead of it, so this would encourage people to give the birds, but what they did is, they gave the died bird to each other so that they will take the compensation.
CUFFE: Right, so they passed around dead birds?
TALIB: Yes, yes. And then how much money do you have really to compensate for these thousands of birds you have to slaughter?
CUFFE: Health Minister, Hatem el-Gabaly, puts his hands up, admitting it was a costly mistake.
EL-GABALY: I don?t think compensation in Egypt was a successful thing. Last year we spent about $20 million for compensation, but the outcome was not very productive. People misused it, brought sick chicken from one area and put it in another farm so that they can be compensated and so we stopped this. However, one must emphasise that as regards the farms, which account for about 85% to 90% of the production of birds here, the matter is under proper control. However, for us as a country, it is very important to eradicate the disease.
ACTUALITY IN VEHICLE
CUFFE: We?ve just turned off the desert highway between Cairo and Alexandria on our way to one of Egypt?s largest commercial poultry farms ? the equivalent of Bernard Matthews? turkey business.
ACTUALITY IN CAR WASH
CUFFE: We?re now at our third car wash since leaving the main road ? bio-security is clearly taken very seriously. Ahead is a modern warehouse set in a newly planted grove of olive trees.
ACTUALITY OF CLANKING GATE
CUFFE: The managing director of this business is Mohamed El-Shafei, who?s also vice chairman of the Egyptian Poultry Producers? Association.
EL-SHAFEI: The capacity of this hatchery is approximately fifteen million hatching eggs per year, yeah.
CUFFE: Are you satisfied with the measures that the Government has taken to control the disease?
EL-SHAFEI: Maybe [laughs], maybe. Until now it is okay, but we are looking for a lot of actions in the near future. I think the Government, it is a must to say we will compensate the people in the back yard area, number one. The commercial, production of the commercial sector don?t need any compensation from the Government, yeah? We have a lot of money, we have a lot of hygiene where we can vaccinate all our birds, we have professional people, they know what can they do. We need only the Government to prevent the virus in the back yard and we can help them.
CUFFE: Mr El-Shafei is proud of the fact that there?s been no disease in his farms. Since the arrival in Egypt of bird flu, the industry has adopted a policy of mass vaccination.
ACTUALITY ON FARM
CUFFE: We?ve got white gowns and plastic hats and overshoes and a mask as well. So where are we going now?
EL-SHAFEI: This is our hatchery, biggest hatchery that we have. Our production today is 65,000 day old chicks, and we vaccinate all the birds before sending to our customers. It was H5N1 vaccine, sometimes it was H5N2, yeah.
CUFFE: But is this vaccination complete protection?
EL-SHAFEI: Over 90% protection for the birds.
CUFFE: So there are hundreds of crates here full of chicks that have already been vaccinated. Now the Egyptian Government plans to follow industry?s example. Under pressure from the international community, it?s decided to offer free vaccination for domestic poultry, starting with a pilot scheme in three provinces. It says it will need $450 million for the scheme - and hopes donors will come forward.
But it?s one thing vaccinating crate-loads of chicks in a large warehouse, quite another attempting to do the same here in a place like Fayoum, where the birds are running around people?s houses and back yards. Since last May, the local veterinary service has been making a brave attempt to vaccinate all sixteen and a half million poultry in commercial farms, and twelve million in backyards. They?ve already vaccinated seven million birds ? leaving another twenty-one million to go ? among them those belonging to Soad Ismael and her sister Amal.
Did anybody come and vaccinate your chickens or invite you to come and have them vaccinated?
ISMAEL (VIA INTERPRETER): As long as the birds are not dying or there is any detection, usually do not go to have vaccines.
CUFFE: Why not?
ISMAEL (VIA INTERPRETER): Obviously the free vaccination plan is not implemented in this neighbourhood yet. Nobody has offered to vaccinate it for free and we cannot afford it. If it was for free we will do.
CUFFE: Fayoum?s chief veterinary officer, Mustapha Awis, admits it?s proving more difficult and time-consuming than he thought.
AWIS (VIA INTERPRETER): He said one of the major burdens of dealing with poultry in the domestic sector is that 20% to 25% of this poultry are either consumed or sold on a weekly basis, sometimes on a monthly basis, but most times on a weekly basis, so the houses, they get new poultry and this new poultry needs to be vaccinated, and if they do not report the cases we have to have to visit again the same houses, the same streets, which means that sometimes as soon as we get out of one street, the very next day they have new poultry. This is a burden and this is a real challenge for us.
CUFFE: It?s not just Egypt that?s struggling to find the best way to tackle the threat of a pandemic. In Europe there?s an argument between countries like the Netherlands, which have gone for mass vaccination, and those like Britain, which resist the idea. Within the UN, that argument?s writ large. It has twelve different agencies with funds for tackling avian flu and two external partners. As co-ordinator, David Nabarro?s job is to try and ensure they all work around agreed objectives.
NABARRO: Should you or should you not introduce vaccination for poultry against the avian influenza virus? On the one hand this seems to be, at least from Vietnamese experience, a good way of reducing the amount of virus the birds excrete when they are sick. On the other hand, if you introduce a vaccination programme, it?s a very expensive and time-consuming activity. In practice in Egypt it has been possible to start a vaccination programme. It?s going to be expensive to maintain. I?ve been to other countries where avian influenza is endemic amongst poultry and there is still quite a lot of dissent as to whether or not vaccination should be introduced. Some of the parts of the UN who are fundamentally concerned with human health risk are taking a strong line on trying to find ways to restrict contact between people and birds in back yards, whereas other agencies that are more concerned on the animal side and also particularly worried about the impact of controlling back yard poultry on human livelihoods are saying, ?Hang on a bit, this could have poverty implications.? My job is to try to make sure that we find a common line and we do it as quickly as possible.
CUFFE: Although you can vaccinate birds, as yet there?s no effective vaccine to protect people. Doctors rely on anti-virals, like Tamiflu, to treat the symptoms. But recent cases in Egypt show worrying signs that the H5N1 virus may be developing a moderate resistance to Tamiflu. Dr Suhir Hallaj of the WHO in Egypt, says patients like Nadia Hafez have suffered multi-organ failure as well as respiratory disease.
HALLAJ: In all the six cases which died lately in Egypt, in five of them we have seen this multi-organ failure. We cannot say whether this is due to a delay in coming to the hospital and accordingly the anti-viral we have against the disease might not work if it is given after the 48 hours of appearance of symptoms, or it is to a more virulent virus. But most probably it is a more virulent virus, because clinically we have seen a new picture, we have seen a multi-organ affection, a multi-organ failure, it is not only the respiratory tract.
CUFFE: So the nature of the symptoms has changed?
HALLAJ: Yes, to some extent the severity and the nature, of course there is a respiratory affection and there is a pneumonia, the viral pneumonia, but in addition to that we have seen renal failure, we have seen bone marrow suppression and we
HALLAJ: have seen liver failure. But still we haven?t seen such a clinical picture in the early cases, although they were late in coming to the hospital too.
CUFFE: So that makes you worry that the virus may be changing and becoming more aggressive?
HALLAJ: Yes, yes, yes. I don?t have any evidence, but I think this virus is being studied more in depth before WHO reference laboratories.
ACTUALITY AT NATIONAL INSTITUTE OF MEDICAL RESEARCH
CUFFE: This is one of the four WHO collaborating centres ? the National Institute of Medical Research at Mill Hill. For the past fifty years, scientists here have been studying seasonal influenza, collecting viruses from eighty countries around the world. Now, with the arrival of the H5N1 virus, Dr Alan Hay and his team are at the forefront of a battle to protect the world against a pandemic. Now some of the virus samples that you?ve had have come from Egypt and there is concern there that there might be a resistance to anti-viral medication.
HAY: We?ve seen in one or two instances in the past, particularly in viruses in Vietnam, last year we received samples from some of the Egyptian cases, and again this year we have received some samples from the unfortunate individuals who contracted it more recently, and we will collaborate with others to understand as much as we can about the changes that have occurred in these viruses. And we?re particularly interested in this change which reduces the susceptibility of that component to inhibition by the drug, to try to evaluate the significance of those mutations.
CUFFE: In layman?s terms, that?s its resistance to the drug that you?re talking about?
HAY: Yes, but this is not necessarily true total resistance. This is just a reduction, potentially a reduction in the effectiveness of the drug. We don?t even know that that is true for this mutation, but it?s early days really. We don?t have a full understanding of the picture at the moment.
CUFFE: What would alarm Dr Hay and his team more than anything is any mutation that will enable the virus to be transmitted from person to person, spelling the start of the pandemic.
HAY: We want to know, is it the same as the viruses in poultry? Are all the genes derived from an avian virus or has something happened? Has it now got an odd human gene in it as well or a gene from other animals such as a pig, etc, which again might facilitate its establishment in the human population. So we need to be analysing in detail every human case that happens so that we can know whether the risk of a pandemic has actually increased.
CUFFE: Looking at the types of viruses that you?re getting from around the globe, is there one area which is most likely to lead to an eventual pandemic?
HAY: We?ve always seen that the epicentre of a pandemic is in South East Asia, but since the middle of 2005, the viruses moved westwards and northwards through Russia into Eastern Europe and down into Africa.
CUFFE: And how worrying is that? Because obviously these countries are not so well prepared.
HAY: This is very worrying, because again you?ve got conditions in African countries where you cannot control the infection in poultry as effectively as you can in some more commercially organised poultry production in developed countries, and that?s why the utmost vigilance is of prime importance.
CUFFE: There?s a real sense of urgency within the network of scientists and development agencies working on avian flu. Dr Michael Osterholm is director of the Center for Infectious Disease Research and Control at the University of Minnesota. He wants more help for developing countries and more leadership from world governments.
OSTERHOLM: This is as strategic as anything we have to think about today from a military standpoint.
CUFFE: How optimistic are you that we?ll rise to this challenge?
OSTERHOLM: I?m not optimistic at all right now, which is troubling. I think we?re moving into a period what I?ve labelled pandemic fatigue. What we do well is respond to the actual crisis, when it?s right here in front of our face, when it?s actually everywhere around us. But unfortunately with pandemic influenza, if we wait until then, it?ll be far too late. You can?t go back and recover that time, you can?t recover that effort, and so I don?t know what?s going to change that. A situation that?s pandemic fatigue, but it?s clearly one where it?s very evident it?s going to happen. No one in San Francisco, California, sits there and says, ?We haven?t had an earthquake in ten to twenty years so why should I worry about it?? If anything it?s quite the opposite, they anticipate another earthquake will happen and so the longer it is between the last one and the current time, the closer they?re getting to the next one. We almost need that same mentality to become prevalent among the pandemic preparedness world, and if that were the case they would know that the clock is ticking. Pandemic influenza is coming and we just don?t know what time it is relevant to its arrival.
CUFFE: In December, delegates from 72 donor countries met at Bamako in Mali to review global spending requirements with a focus on Africa. Egypt was reported to be $66 million short of its needs, giving it the second biggest funding gap after Tanzania. David Nabarro of the UN pressed the case for action, but admits he was disappointed with the outcome.
NABARRO: I have sympathy with the points made by the Government of Egypt. I have worked closely with Government ministers and, to some extent, also with the Prime Minister on the issue of trying to locate external assistance. Raising funds for this issue is an ongoing struggle. When we then went to Bamako, we said that generally the world will need between half a billion and a billion dollars a year in order to deal with the ongoing threat posed by avian influenza in poultry and also potential for a pandemic. Only $475 million were pledged and I was concerned that there still wasn?t really enough money for African countries. And so we will, during 2007, be making a stronger case still for substantial external funding and do a very careful analysis of the risks that will be faced by the world if we don?t manage to maintain funding and also political commitment on this issue at the level I?ve described, probably for the next five to ten years, because I?m afraid it?s not going to go away quickly.
ACTUALITY IN FAYOUM
CUFFE: The funding gap leaves Egyptian officials struggling to protect themselves and the world from a pandemic within an already over-stretched budget. At the headquarters of Fayoum?s health authority, Hussein Abu-Talib, is almost overwhelmed.
TALIB: You can?t imagine the load I have to look after. The primary care units, 160 units scattered in the governorate and at the same time I have to take care of the hospitals, supervise the doctors, take care of the equipment and medicine, make it available. And then came on top of that the flu. It constitutes now no less than 60% of our effort. Every night, we spend two or three hours every night with the Governor, seeing what number of patients have been referred to the fever hospital and the results of the analysis. We need manpower, we need volunteers, we need more vaccinations. It?s a big problem.
CUFFE: Is it big enough to keep you awake at night?
TALIB: Yes, everyone actually, everyone. We don?t sleep really, every day for the past two months. It exhausts, I?m telling you, no less than 60%-70% of our effort. And of course this is at the expense of the other responsibilities we have to do with the human health.
CUFFE: A report commissioned for the UN and published last month, criticises the Egyptian Government for lacking commitment and failing to develop a national strategy for pandemic. But Hatem el-Gabaly, head of the country?s avian flu task force, says Egypt can?t defeat the disease on its own. Now there was a report recently from the UN and this report raised concerns about the lack of a national strategy in Egypt and said that worry about whether Egypt would have a credible plan.
EL-GABALY: Egypt has a very clearly defined plan in managing avian flu, highly pathogenic avian flu among birds. As regards to pandemic, we have an overall global strategy, which we are converting now to an extremely detailed plan in the coming three or four months. However, implementing that plan, if God forbid something happens and the pandemic starts, it needs a lot of funding which we cannot afford alone. What I?m trying to do now is convince the international community that it?s much cheaper for them to fight the disease in Egypt than to fight it in their own land, and that they have to direct a great deal of their efforts and a great deal of their money from Asia to Africa. Africa is a much bigger problem. Egypt is the least of all problems in Africa, so I don?t think that the world is taking Africa seriously. Although Africa is the back yard of Europe and very close to the US and it?s not as far away as Asia is, so I would think that the whole global community should reconsider how they are going to direct their resources in this respect in the coming couple of years.
CUFFE: It?s now four years since the H5N1 virus started to spread, yet experts are still arguing about how best to prepare for a future pandemic and who should pay the bill. No one knows when the pandemic will occur or how bad it will be. But the UN?s David Nabarro says it will happen and we have to be ready.
NABARRO: It?s the world as a whole that needs to get ready for pandemic, because it?s the world as a whole that will be threatened by pandemic. And the threat is potentially quite extraordinary. Millions ? perhaps multimillions - of deaths, great dislocation to our economic and social systems and the prospect for suffering on a scale that we?ve actually not seen in recent history, built on by the interconnectedness of our current world. And so it really is important that we see pandemic preparedness as a global challenge and not as a local or regional challenge.
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http://news.bbc.co.uk/2/shared/bsp/hi/pdfs/13_3_07_fo4_flu.pdf
