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Bird flu toll hard to predict

Claims that bird flu could kill up to 150 million people are being downplayed by the World Health Organization as "guesswork."

BY PJ HELLER | BALTIM0RE | October 1, 2005

"We keep encouraging countries to develop a plan because a pandemic is inevitable."

—Dick Thompson

Claims by a senior public health expert at the World Health Organization (WHO) that bird flu could kill up to 150 million people are being downplayed by the agency as "guesswork" and "scare-mongering."

David Nabarro, recently named by the United Nations to coordinate its response to avian influenza and a possible human influenza pandemic, told the BBC in an interview that anywhere from 5 million to 150 million people could die from bird flu.

A day later, a spokesman for WHO dismissed those figures, saying it was almost impossible to predict a death toll if the bird flu outbreak spread.

"There is obvious confusion, and I think that has to be straightened out," said Dick Thompson, a WHO spokesman on influenza of the vastly conflicting numbers. "I don't think you will hear Dr. Nabarro say the same sort of thing again."

WHO has issued guidelines estimating that between 2 million and 7.4 million people could die. Other experts have predicted anywhere between 2 million and 50 million deaths, with the actual number depending on whether the virus was able to change form which would allow it to be easily passed between humans.

"As people would have no natural immunity, a new influenza virus could cause widespread death, illness, social and economic disruption," WHO said.

While the numbers may be in dispute, what is clear is that a global response is taking shape, albeit slowly in some cases, to address a possible human influenza pandemic. WHO reported that only 40 countries have submitted plans for how they would deal with a pandemic.

In some areas of the world - particularly Asian countries where the H5N1 avian influenza virus has been reported and has left at least 60 people dead - reports indicate that efforts there have been even slower to address the problem.

However, agriculture ministers from the Association of South East Asian Nations recently announced support for a three-year program to fight the spread of the virus. They also pledged $2 million for funding and research.

The U.S. announced a new international partnership on avian and pandemic influenza at the World Summit in New York. Several countries are scheduled to meet in Washington next week on the issue and WHO has scheduled a meeting in November of all partners to coordinate funding needs.

"We keep encouraging countries to develop a plan because a pandemic is inevitable," Thompson said.

Nabarro's appointment as senior UN system coordinator for avian and human influenza and which will lead the UN effort was seen as an important step to speeding up worldwide response.

"The appointment is critical as the world is fast recognizing the risk of an imminent human influenza pandemic, and is taking steps to reduce the risk and to get prepared," WHO said in statement announcing his appointment.

Nabarro said he stood by the figures he presented, noting that he wanted the world to be prepared for a worst case scenario when the next flu pandemic occurs. He said efforts currently under way could determine whether the death toll is 5 million or 150 million people.

The last global pandemic was in 1968 when an estimated 4 million people died, Thompson said. He noted that such a pandemic occurs about every 40 years.

"There's going to be another influenza pandemic," agreed Dr. Jonathan Fox, president of the Royal College of General Practitioners in New Zealand. "History teaches us that. We don't know if the current bird flu is the start of that.

"We don't know when it will hit," he added. "It could happen soon or it might be years off."

The H5N1 strain of the bird flu became a worldwide concern when it surfaced in 1997 in Hong Kong, leaving six people dead. In 2003, it was reported in poultry across Asia and resulted in nearly 60 deaths in Cambodia, Vietnam, Thailand and Indonesia. The latest death believed linked to bird flu was last week, when a 27-year-old Indonesian woman died in a Jakarta hospital.

Officials say that humans catch the disease through close contact with live infected birds. The greatest concern is the possibility of H5N1 combining with human flu viruses, which would allow it to spread easily and rapidly worldwide.

The anti-viral drug Tamiflu could be effective in combating the virus, officials said, and its Swiss manufacturer, Roche, is making 3 million doses available to WHO. Millions of doses have also been ordered by governments worldwide, including some 14 million doses in Britain. New Zealand has allocated NZ$26 million to purchase 850,000 doses of the drug; individual demand in that country is so high that the manufacturer has said it cannot keep up with demand. The purchase requires a doctor's prescription.

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