One ‘flu’ over the chicken's nest

Unnikrishnan PV, ActionAid International

Putting the needs of poor people at the centre of the world’s response to bird flu is crucial in defeating the epidemic.

Though few humans have been infected so far, the World Health Organisation has projected that between 2 and 7.4 million people could die from a mild pandemic of avian flu. Experts warn that except for the ability to spread efficiently and in a sustainable way between humans, the H5N1 virus has already met all the prerequisites to start a pandemic.
It is nearly impossible to stop a pandemic once it starts. Precautionary planning is vital. But it must be done in a way that protects people’s wellbeing. That requires looking at the social and economic implications of the virus, particularly for poor people and poor communities in the developing world.
Measures to control the infection must be located in the context of the other multiple hazards that poor communities face. Preparations to respond to the epidemic by placing countries on a "war footing" can, for the poor, be as disastrous as the flu itself.
Chickens are one of the main sources of food and income for millions of poor people in developing countries. With images of mass slaughter of chickens – 300,000 have just been despatched in India’s Maharashtra state alone – panic is spreading in poor communities. To avoid rumour and anxiety, health authorities need to provide simple, useful and practical information.
The poor must also be compensated economically for the loss of poultry. Since this will be expensive, the generosity of the international community must supplement the efforts of national governments.
Governments must guarantee that people will not be displaced and evacuated without their consent, in the name of bird flu preparation. During the SARS scare, human rights groups complained that attempts were made to "clean up" slums in the name of hygiene promotion.
Poor people are already suffering disproportionately from the consequences of avian flu. If the virus begins to spread from human to human, the poor will suffer overwhelmingly.
Public health systems are the first line of defence in any epidemic. However, in many developing countries these have been paralysed by budget cuts and the privatisation of health care dictated by policies imposed by major aid donors working to a conservative agenda.
At an international level too, current trade rules are actively conspiring against the needs of poor countries to protect their citizens. Tamiflu is currently the only available medicine, but because of the patent regime imposed by the World Trade Organisation it is expensive and beyond the reach of the poor.
Developing countries should be allowed to take radical steps to protect their citizens and ensure that public health is placed before the profit interests of pharmaceutical companies. Health activists associated with the pressure group Health Action International (Asia-Pacific) have called for the temporary cancellation of Tamiflu patent rights, to ensure its availability and accessibility.
It is too early to predict which countries are going to be badly hit. We do not even know whether H5N1 bird flu will hybridise with the human influenza virus and begin to spread from person to person. But if an epidemic develops, many factors will hamper humanitarian intervention.
The flow of relief goods into affected areas can be disrupted due to border closures, quarantines and poor transportation systems. The powers of security forces – police and military – which are likely to take over running essential services will also need to be carefully monitored.
What we already know from experience of mass casualties in natural disasters is that they leave a long trail of mortality and unending suffering amongst poor people. Ensuring their safety, survival and recovery is crucial. How bird flu is handled in poor communities may affect the outcome for the whole world.

Unnikrishnan PV, ActionAid International