Are we ready for bird flu?
Government has crafted an elaborate strategy to deal with avian influenza or bird flu, but it remains to be seen if it will have ironclad political will and pockets deep enough to push this master plan beyond the realm of its imposing protocols, training manuals, and PowerPoint presentations into actually saving Filipinos from a menacing global pandemic.
The Philippines remains free of the newest flu outbreak despite our proximity to Asian countries where the disease has killed millions of birds and dozens of people since December last year. Experts fret, however, that the virus--a subtype called influenza A/H5N1--is likely to spread out quickly to more countries soon enough and, worse, mutate into a more lethal strain resembling the one that snuffed out an estimated 20 to 40 million human lives in 1918.
Bird flu is a contagious disease afflicting birds, certain subtypes of which can cause illness or even death to humans. It is transmitted to humans through inhalation of or contamination with infected feces of sick chicken, causing fever, body weakness or muscle pain, cough, sore throat, sore eyes, and difficulty in breathing.
While the latest outbreak has spread in over a dozen countries in Asia and Europe and killed at least 44 people thus far, most of them in Vietnam, there is no case yet of a person infected by another person. But scientists and health experts fear the current virus will likely mutate into a new strain capable of easily transmitting the flu from fowl to humans and then from person to person, inducing a pandemic.
Anti-bird flu czar
A National Avian Influenza Task Force (NAITF) led by the Department of Agriculture (DA) has been formed to craft, and whip up multisectoral backing behind, an Avian Influenza Protection Program (AIPP) meant to ready Filipinos for the worst-case scenario of the virus becoming far deadlier and highly contagious among humans.
Malacanang is all pumped about the NAITF and AIPP because these allow its spinmeisters to picture the President as a proactive, forward-looking chief executive confronting public health crises like SARS.
Executive Secretary Eduardo Ermita has said that the President named agriculture secretary Domingo Panganiban as "anti-bird flu czar" in-charge of the AIPP so the task force can mount a campaign similar to the one that the Department of Health (DOH) had led in the successful fight against SARS.
AIPP includes stringent protocols on biosecurity measures in farms, close surveillance of ports, and sanctuaries of migratory birds, quarantine and area zoning procedures in infected sites, and "stamping out" or culling of all fowl in to-be affected areas--undoubtedly a sweeping array of procedures requiring tough government decisions and, as noted by the World Bank and World Health Organization (WHO), immense and urgent funding.
Here comes a sticky point in the anti-bird flu campaign, as an NAITF source concedes, in view of the Arroyo administration's failure to give to the AIPP the same level of financial support it did to the anti-SARS drive and its penchant for political accommodations and trade-offs. "The protocols are clear; the question is: will the national government implement them?" the source stressed.
While the Arroyo administration had pumped a hefty PhP1 billion into the war on SARS, it has poured into the anti-bird flu campaign only PhP112 million in fund contributions from the Philippine Charity Sweepstakes Office (PCSO). Additional allotments can be drawn from the PCSO if and when needed, he said.
Fund Squeeze
Panganiban told the Business Mirror that PhP60 million of the PCSO money went to the DOH, PhP40 million to the Bureau of Animal Industry (BAI), PhP7 million to the Philippine Information Agency (PIA), and PhP5 million to the Philippine Navy for their task force-related operations. The DA has also set aside PhP20 million of its own funds for the start-up operations of the NAITF, he said.
Dismissing allegations of a money squeeze, Panganiban said funding for the AIPP cannot be compared to that of the SARS program because the latter involved outright human-to-human transmission of the virus, whereas bird flu is in an early stage yet that "could still be licked provided adequate preventive and eradication measures are taken by both government and the private sector."
In a subsequent press briefing, Panganiban bared plans to ask the Congress for a supplemental outlay of PhP2.5 billion, specifically for bird-flu purposes, on top of the DA's PhP17 billion allocation under the proposed General Appropriations Act (GAA) of 2006. A supplemental budget is needed, he said, because the DA's 2006 GAA budget plan does not have any provision for bird-flu protection.
Certain NAITF and DA sources griped, though, that the fund releases for the AIPP have come in "trickles." Said one of them: "Sufficient funds should be made available to the task force now, not when we are already in a crisis situation."
For one, the issue of compensating owners of chicken which have to be killed within a three-kilometer radius of an infected site, as provided for under the AIPP, will naturally be critical to the private sector's support for this drastic measure.
Indemnification package
Panganiban gave assurance that the government will come up with an indemnification package if and when necessary, although industry sources doubt if the government can raise enough money--and quickly--for this component once H5N1 outbreaks start hitting poultry centers where the number of chicken to be slaughtered can go up as high as four million heads for every three-kilometer radius.
"Of course this is one cause of worry for us, because we might end up absorbing the losses all by ourselves" said one source at the Philippine Association of Broiler Integrators (PABI). The source said they have tested the feasibility of this proposed indemnification program by plotting a three-kilometer radius in the poultry center of Minalin, Pampanga to see how much money would be involved were the task force to decide on compensating affected growers.
This Minalin site alone will require PhP320 million in compensation money at an average of PhP80 per head, said the source, because they have counted four million chicken within that three-kilometer radius.
More worrisome for the NAITF, said other sources at the task force, is when game-fowl farms fall within such a three-kilometer radius given that top-grade fighting cocks cost as high as PhP20,000 to PhP30,000 apiece. What more, they said, it remains doubtful if the government will have the resolve to kill these prized birds if they belong to cockfighting aficionados WHO happen to be diehard pro-Arroyo congressmen, governors, or other elective officials.
In fact, the task force is bracing for possible stiff resistance from certain poultry raisers and powerful politicians whose animals are on the death list. At a recent AIPP workshop at the Bureau of Soils, NAITF cocoordinator Ruben Pascual told participants from member-agencies the task force is working out with law enforcers, via the National Disaster Coordinating Council (NDCC), a set of protocols to help secure and back up the quick response teams to be assigned the thankless job of slaughtering animals in case of local outbreaks.
Tamiflu shortage
The AIPP protocols likewise provide for the medical treatment of would-be human victims, but the single biggest problem facing the task force is that (oseltamivir) Tamiflu, an antiflu medicine produced by Roche and proven effective against the H5N1 virus, is practically nowhere in the shelves of local drugstores and is in short supply abroad amid the ever swelling demand. And even if it becomes available soon, its prohibitive cost of about PhP1,700 per 10 capsules will make it beyond the reach of ordinary Filipinos.
"At a time when Filipino consumers are desperately trying to make ends meet or put decent food on their table, where will they get the money to pay for the expensive antiflu medicine?" said Sen. Manuel Roxas II in earlier pushing the government to pursue the compulsory licensing of Tamiflu as a "calibrated preemptive response" or CPR to a possible pandemic.
Compulsory licensing will enable local pharmaceutical companies to manufacture soon enough adequate stocks of a cheaper, generic version of Tamiflu, said the senator WHO used to be trade and industry secretary. Roxas is now chairman of the Senate committee on trade and commerce, which has began looking into the compulsory licensing of Tamiflu and other drugs even before the expiration of their patents.
Dr. Luningning Villa, program manager of the DOH for emerging infectious diseases, told a recent AIPP workshop the supply of Tamiflu is no longer an issue because the DOH has already ordered 110,000 capsules of this drug from Roche. These are due for delivery by Roche to Manila over the next few weeks, she said, and are enough to meet the needs of people in areas to be hit by the initial wave of poultry outbreaks.
On top of this purchase, Villa said that the WHO is also committed to send a portion of its Tamiflu stocks to the Philippines in case of an outbreak. The DOH is also working with pharmaceutical companies on the domestic production of a generic version, she said.
Economic meltdown
Health and financial experts are bracing for an economic meltdown in the event of a possible pandemic, and want
governments to put up their own war chests to beat the virus before it becomes a global pandemic that could jab the global economy to a tailspin.
Addressing a November 9 international conference in Geneva, WHO Director General Lee Jong-wook said, "The world recognizes that this is a major public health challenge and is ready to focus its resources to reduce the risk of a human pandemic. We have plans on paper and we must now test them. Once a pandemic virus appears, it will be too late."
The World Bank estimated that an initial US$1 billion should be raised now for this global battle, but the actual cash requirements would swell astronomically once outbreaks strike more countries and lead to human-to-human transmissions. It further predicted that a yearlong pandemic outbreak could cost the world's economy US$800 billion in financial losses.
"The minute there are more regions or countries with animal outbreaks or human-to-human transmission, the funding needs will increase hugely," warned James Adams, World Bank vice president for operations and head of its Avian Flu Task Force.
The WHO sees the need for "urgent funding" over the next six months for "surveillance, control and preparedness work," to fight the disease in animals and quash any threat of a human pandemic akin to the H1N1 strain or "Spanish" flu of 1918.
In its web site, the WHO said the US$1 billion funding estimate of the World Bank "does not include financing for human or animal vaccine development, for antiviral medicines, or for compensating farmers for loss of income due to animals that have been culled."
"Time is of the essence," Dr. Margaret Chan, representative of the WHO director general for pandemic influenza, said. "We must act now if we are to have the maximum possible opportunity to contain an epidemic. It is vital to limit the risk of human exposure to the H5N1 virus and the consequent risk of an emergence of a new pandemic virus."
Local losses
The World Bank projection of an US$800-billion economic loss once a feared pandemic lingers for a year across the globe does not seem unlikely, considering that the SARS outbreak in East Asia during the first semester of 2003 reportedly forced its gross domestic product (GDP) to fall by two percent.
During the same conference in Geneva, World Bank lead economist Milan Brahmbhatt was reported as blaming "panic and disruption" for such losses. Most of the losses, he said, were caused by people WHO avoided traveling or stayed home and refused to work, shop or eat out.
A similar two-percent drop in global GDP would mean an US$800-billion loss over the course of a year, Brahmbhatt was reported as saying.
Even if a pandemic does occur, an outbreak of the H5N1 disease in Philippine poultry farms will severely hurt our economy.
Project Blue figures show that the poultry industry contributed PhP116 billion or almost a fifth of the total revenues of the agriculture sector in 2004. Three-fourths (74 percent) came from the sale of chicken meat; 19 percent from chicken eggs; four percent from ducks; and three percent from duck eggs. (Game fowl accounted for PhP40 billion.)
While the potential losses have not been quantified in money terms, Project Blue proponents predicted a "massive" number of mortalities due to the disease itself or the required culling of animals to control the spread, a drastic drop in consumption of chicken meat and eggs arising from consumer panic, and the loss of a budding export market.
Moreover, this scenario would jack up prices of pork, fish and other food items, and also weaken the market for corn producers and other suppliers of raw materials dependent on the industry, Project Blue said in a PowerPoint presentation.
Project Blue
Months after the virus spread anew in 2003, President Arroyo issued Executive Order No. 280 defining the powers and responsibilities of government agencies in response to avian influenza and named the health secretary as overall crisis manager and the agriculture secretary as comanager. Joint Administrative Order No. 001 was eventually issued establishing the NAITF to implement the AIPP.
Aside from the DOH and DA, eight more departments plus the Armed Forces of the Philippines and the Philippine National Police were enlisted by the President behind an anti-bird flu campaign meant primarily to regulate the entry or surveillance of people from infected countries, restrict the entry of infected poultry products, and regulate the movement of birds and other animals infected or suspected as potential virus carriers.
In keeping with its work, the task force launched Project Blue to serve as the policy communications and training component of the AIPP. The Department of Environment and Natural Resources (DENR) set up meanwhile a Task Force Wild Bird (TFWB) to watch closely the 55 wetland areas frequented by migratory birds. Headed by DENR undersecretary Armando de Castro, the TFWB aims to stop humans and local fowl from foraying into the wading areas of some100, 000 migratory birds expected to flock to the Philippines this cold season.
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