3.1.  Avian influenza is a disease of birds, not people. Many strains of the influenza virus are found in wild bird populations, particularly waterfowl, and present no significant risk to human health. Occasionally a particularly virulent strain, such as H5N1, will emerge, and become endemic in domestic as well as wild birds, with serious economic consequences, but without any necessary impact on human health.

3.2.  At present H5N1 remains primarily a disease of birds, which only rarely infects people. While there have been over a hundred cases of human infection in south east Asia, those concerned have almost without exception worked closely with infected birds. Cases in other animals (such as the tigers in a zoo near Bangkok which died after eating the carcases of infected birds) have also been traced back to avian sources. While these cases are in themselves a matter of serious concern, there is no current indication that the virus is capable of sustained transmission other than within bird populations.

3.3.  As a disease of birds, the economic consequences of H5N1 have already been serious—the United Nations Food and Agriculture Organization (FAO) estimates the cost to south east Asian economies at $10 billion, though Dr Slingenbergh of the FAO conceded that this was a "back of the envelope calculation". However, such costs would be dwarfed by those of a human pandemic, which, as we have already noted, the World Bank puts speculatively at $800 billion. (Q 16)

3.4.  Thus, as Dr Fresco, also of the FAO, said, "to control the animal side is absolutely key … the real work has to be done in the backyards in Indonesia, in the waterways of the Mekong Valley". Preventing a pandemic from happening must be the top priority, though "prevention" in this context cannot be absolute. But even if it is only possible to reduce the frequency of influenza pandemics through effective control of avian viruses, this will bring huge human and economic benefits. (Q 303)

3.5.  Despite the spread of H5N1 via wild birds into Europe, the size of the domestic bird populations in south east Asia (China contains, according to Dr Slingenbergh, 700 million domestic ducks, some 70 percent of the world's total population), and the patterns of agriculture (in particular the close proximity between birds, other domestic animals, and human populations), mean that the likeliest source of the next influenza pandemic remains south east Asia. Efforts to prevent a pandemic must therefore be focused in that region. (Q 26)

3.6.  The keys to preventing a pandemic are well known. They have been demonstrated both in Hong Kong in 1997, where H5N1 was effectively eradicated, and to a lesser extent in Thailand since 2003, where incidence of H5N1 in domestic poultry has been much reduced. They are:

• Effective surveillance of bird populations, and good bio-security, including measures to separate wild and domestic birds;
• Rapid culling of infected flocks;
• Targeted vaccination of flocks to disrupt transmission cycles.

3.7.  However, the practical barriers to such action remain formidable, particularly in Vietnam, Indonesia and China. They include: poor veterinary infrastructure; the lack of a co-ordinated and efficient system of information exchange; traditional patterns of agriculture, including the huge "backyard" poultry population; and the lack of compensation arrangements for farmers, creating an incentive to send sick birds to market rather than reporting them. Dr Slingenbergh, who outlined these barriers, also noted that the FAO had only $25-30 million of funding in hand, as against some $160 million required in order to deal effectively with current problems. (QQ 24-26)

3.8.  Dr David Nabarro, the United Nations (UN) Senior System Co-ordinator for Avian and Human Influenza summarised the position as follows: "It is absolutely vital to … deal with the avian flu outbreak at source and we are not winning this battle in several of the severely affected countries. The only organisation we have globally which has the potential penetration to do this is the Food and Agricultural Organization of the UN. They are under-funded." (Q 304)

3.9.  This message has not been wholly lost on the international community. Dr Nabarro highlighted the offer of the Dutch government to supply not just cash, but personnel. In November the World Bank announced the establishment of a $500 million fund to support regional development, including the strengthening of medical and veterinary systems, and support for vaccine and culling programs.[9] At the same time the Bank announced that it was discussing with the European Commission and UN agencies the establishment of a multi-donor trust fund to support longer-term investments.

3.10.  The Department of Health has actively supported the WHO in improving surveillance in south east Asia, and the United Kingdom hosts one of four WHO Collaborating Centres for Influenza at the National Institute for Medical Research (NIMR). The Department's memorandum further notes that a senior British epidemiologist is seconded to the European Centre for Disease Control, assisting the WHO's influenza work, while the Health Protection Agency (HPA) provides further support.

3.11.  Nevertheless, we are concerned at the apparent lack of co-ordination of United Kingdom efforts in south east Asia. It does not, for instance, appear that the Department of Health provides direct support for the FAO or the World Organization for Animal Health (OIE). As for other departments, the Government's memorandum states that Department for International Development (DfID)—

"has encouraged UN agencies to use existing resources to focus on avian flu as a potential precursor for a flu pandemic. It is also urging relevant UN agencies to work with affected countries to develop affordable plans for tackling avian flu and improving wider pandemic preparedness." (p. 83)

3.12.  It was clear from our discussion with Dr Slingenbergh that the FAO is fully aware of the need to focus on avian influenza, and that the agency is held back from effective action primarily by a shortfall in funding. Encouragement and urging from DfID will do nothing to remedy the situation. On the other hand, the memorandum goes on to note that Defra has "provided technical supplies and expertise" to FAO as well as to individual countries.

3.13.  The lack of co-ordination is further shown by the fact that the HPA, while internationally it works closely with other agencies and Departments (notably DfID and Defra), has to finance international work out of its "business as usual" budget for health protection. It cannot, for instance, draw on DfID funding for long-term projects in south east Asia, though the Minister told us in a letter that DfID might consider funding the HPA through the WHO or other multilateral organisations. We are concerned that this fragmentation of international efforts along departmental lines risks undermining the United Kingdom's contribution in south east Asia. (p. 103)

3.14.  In the longer term it will be essential to gain a better understanding of transmission dynamics—the processes whereby avian viruses infect mammals or humans, and the mutations within the virus that make human-to-human transmission possible. The current spread of H5N1 offers an exceptional opportunity to conduct detailed serological surveys and analysis, which will inform future responses to the threat of pandemics.

3.15.  It looks at present as if this opportunity is being missed. Dr Klaus Stohr, of the WHO, described surveillance of the virus in animals as "sub-optimal"; there had for instance been "no large-scale serological investigation" to ascertain whether the virus was circulating in pigs, generally regarded as the likeliest "mixing vessels" for recombination of avian and human influenza viruses. In some countries human cases had been reported "before there was knowledge of the presence of the disease in animals". (Q 202)

3.16.  Even where data are available they are not necessarily shared among agencies or researchers: Dr Slingenbergh noted not only that the Center for Disease Control in Atlanta held details of virus samples which "they are very often not prepared to share with the international scientific community", but that the WHO influenza network itself was not "communicating fully" with the OIE and FAO networks. One of Dr Nabarro's key roles, as Senior UN System Co-ordinator for Avian and Human Influenza, is to bring UN agencies and other bodies together, providing a "maypole" around which they can "dance and be more effective". (QQ 13, 301)

Conclusions

3.17.  The first line of defence against a potential human influenza pandemic is effective surveillance and control of avian influenza, in particular in south east Asia. We are encouraged that there seems to be a growing consensus on this point, and in particular that the World Bank has committed $500 million to supporting the work of UN agencies and regional programs.

3.18.  Nevertheless the FAO, which is uniquely well placed to tackle avian influenza at source, remains under-funded. We recommend therefore that the Government review its support, financial and institutional, for the FAO; we further urge the Government, in partnership with the European Commission and other European Union countries, to respond positively to the World Bank's establishment of a multi-donor trust fund to support investment in the region.

3.19.  The Government should also make every effort to ensure that the efforts of United Kingdom departments and agencies in both animal and human health are fully co-ordinated. We therefore recommend that the Government review the current rules governing funding of HPA activities overseas.

3.20.  We welcome the appointment of Dr David Nabarro as UN Senior System Co-ordinator for Avian and Human Influenza. The performance of UN agencies, and the co-ordination between different agencies, has not always been optimal. We look to Dr Nabarro to ensure that the UN is well placed to co-ordinate international efforts to prevent the current epidemic of avian influenza turning into a full human pandemic.