A RIA Novosti interview with United Nations System Influenza Coordination (UNSIC) senior coordinator David Nabarro
Question: It's been almost five years since the first human victims of bird flu died. This is no longer a major news story, just additions to a 200-long list. Is it true to say the most severe danger relating to bird flu is forgetting about the threat altogether?
Answer: In public health we are often dealing with problems that have potentially serious consequences. And they are small news when we are actually responding to them but they become big news when they get out of control after we fail to do our job. I would like to see intense work by governments, by community organizations to deal with this issue. I would like to see it as number one. High media publicity for me is not so important.
What would not be helpful actually is to scare people into thinking massive pandemic starting any second now and have them in uncertainty on what they should be doing. So I'm not distressed about the reduced media coverage, I think we are reaching a more balanced media coverage by this time. What I'm very concerned about is to ensure there's still a sustained popular action and sustained governement action in the next few years to do with the issue. If governments stop thinking about it or if people stop thinking about it then we would have something to worry about.
Q: So this is not a situation where a pandemic could start any second?
A: In my job it is normal to behave as if a pandemic could start tomorrow, because this is my job, this is what I have to deal with 24 hours a day, seven days a week. But I wouldn't want you in your job spending a lot of time thinking a pandemic is about to start. I want you to get on with your life and rely on those who are responsible of dealing with this issue.
Q: What is the probability of a pandemic?
A: I wish I could. I'll tell you how I do it: if we look at history, we can be certain one day there would be another influenza pandemic. But we cannot say with any certainty at all when it would happen, where it would start, how severe it would be. So the only certainty we can share with each other is that it would happen one day.
Q: Just like an earthquake?
A: People in Indonesia are very used to the reality that disasters and catastrophes will happen, unfortunately, that they don't know when they will start and how severe they are going to be. People that I talked to in Indonesia understand this language that I am using. In other settings people are less comfortable with it and get nervous.
Q: In your opinion, what are the chances of developing a successful vaccine against a virus that does not yet exist?
A: In developing vaccines from evolving viruses the challenge is to find a part of the virus that would stay constant during the evolution. and have the vaccine against that common part of the virus. Then that vaccine would have the capacity to do with whatever pathogenic forms that might evolve. And this process of identifying the necessary genetic or cell material is being undertaken in many laboratories all over the world.
I can't say how likely it is that it would be successful - I have seen some vaccine research that has been amazingly successful, others like HIV vaccines turned out to be more difficult, so I can't give you the probability. But I would say that there is a scientific basis for finding a vaccine that would have a multiple coverage and personally I very much hope that that kind of research would prove to be successful.
Q: What are the news stories of human-to-human transmission in Indonesia really about?
A: When we talk about a human to human transmission of the influenza virus we are talking about sustained human to human transmission: I am giving the virus to you, you are passing the virus over to other people, and it acts like a chain reaction to end up with a wide spread disease. That is what understood as a human to human transmission, and what we see at the moment is called a sporadic human infection.
The distinction is terribly important. Sustained human to human transmission is bringing with it the threat of influenza pandemic that would change whole of our lives, it would have very major consequences. Sporadic human cases of H5N1 are very rare: we have only seen three hundred something reported in the last few years. They are very rare but they are important as they indicate to us that there is an underlying H5N1 infection in the poultry we have to worry about.
Q: What makes Indonesia so important?
A: There are more outbreaks of H5N1 infection in poultry and H5N1 infection in humans in Indonesia than anywhere else in the world, so to me Indonesia is extremely important.
Indonesia and Egypt are countries where H5N1 is entrenched in poultry population and for that reason these countries are trying very hard to control the virus and to restrict its circulation. And that is not easy to keep the virus under control when it is entrenched in poultry. Intense efforts for several years would be necessary to completely control it.
We have to remember that Indonesia is highly decentralized and that means that it is necessary for us to be encouraging authorities at the district level as well as regional governments to be taking this issue extremely seriously.
In countries with highly centralized administration it is relatively easy to issue instructions about the control of diseases in animals or in humans and then to get all levels of government to comply. With decentralized administration it is sometimes more difficult.
Q: How would you summarize the overall bird flu situation that you have been discussing in Indonesia?
A: I am very pleased that we have actually seen the situation to be relatively stable in the last years. That is not of course a success but it could have been much worse.
By RIA Novosti's Mikhail Tsyganov from Nusa-Dua (Bali, Indonesia)