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Avian Flu in Asia

An Agriculture Ministry worker sprays disinfectant at cages at a bird farm in Jakarta, Indonesia, Monday, Sept. 26, 2005. (quiplash/flickr)

An Agriculture Ministry worker sprays disinfectant at cages at a bird farm in Jakarta, Indonesia, Monday, Sept. 26, 2005. (quiplash/flickr)

Richard Holbrooke: Before Elisabeth comes up here, I should add two things. I mentioned the Asia Society earlier. For those of you that are not members, there should be a membership form somewhere on your chair or outside, and I hope you will consider joining. We are open to everybody. It is not expensive to join. If you want to give us more money, we will accept it. And we would love to see you on all the issues, not just health. But I welcome you all here, and I will ask Elisabeth to come up and start the discussion.

Elisabeth Rosenthal: Will all the panelists come up, and we will do this all together. I want to thank Ambassador Holbrooke and former commissioner Deboino for making this possible and the Asia Society. It is a topic that is near and dear to my heart. I was on vacation in 1997 in Hong Kong when the first bird flu outbreak occurred there. I was suddenly pulled away from my mother and told to go to chicken markets and watch a million chickens being killed. So I feel like I was there at the start and have been there ever since. Let me first introduce our panel, and we are really lucky to have all the different perspectives represented here. In the end, Dr. David Nabarro, who is the UN System Coordinator for Avian and Human Influenza who really represents the kind of global health perspective on this. It is his job to convince the world that this is a problem and to keep it in perspective. There is next to him, Donald Ainslie, who is a principle at Deloitte & Touche, who specializes in security issues, and he kind of represents the other end of the spectrum: what individual companies do to prepare for a pandemic whether Avian Influenza or otherwise. His company is fairly unusual and has done a lot of thinking and consulting on this issue. Finally, Andrew Erickson, from the Naval War College, who represents the intergovernmental perspective on Avian Influenza and what it means as an issue of international politics and global security. Is that fair enough? I have to say, I feel privileged to be the moderator here and to be a journalist because in this position I get to ask questions about what is a very very difficult issue without having to come up with answers. I would not want to have to find the answer to this one. Because I think it is very difficult to know what to do for pandemic preparedness, how to handle it, how to strike the right balance between alarmism and rational planning, how to get people energized, and how to prepare. I guess we all share questions. My first question and kind of basic question: How can you prepare for something like this? What do we mean by preparedness? What are our goals? I am king of the guinea pig in this situation. I was in Hong Kong in 1997. I lived in Beijing during the whole SARS epidemic. More recently, I covered Avian Influenza. I was in Turkey, and was there for the first outbreak. I guess I am going to be kind of provocative on this and tell you a couple of brief anecdotes to show how difficult I think this is and why we really need to think in advance and be very realistic. The first thing I want to remember is going to Turkey last January to do a story on a family of four children who were the first human victims of Avian Influenza out of South East Asia. I went to the village, and it was a snowy day, and it was a holiday in Turkey. We spun off the road before we got to the village and got rescued by these four men from another village who brought us into the village. We said, 'Have you had any issues with Avian Influenza here?' They said, 'not really, but all the birds in this village died last month.' This is a rural Kurdish village, and we said, 'Well, what did you do?' He said, 'We ate them.' This is a big village with tens of thousands of birds. I said, 'Have you hear of Avian Influenza?' They said, 'Sure, we have heard of Avian Influenza, but this is dinner.' Avian Influenza to us is a theoretical problem, and dinner is a real problem. That was first issue: How do you deal with that kind of preparedness? How do you prepare for that? The second issue was that this was an unreported epidemic. How do you get people in that setting to report? Second part of the story is coming back to my base, which was in Paris as the time. I came down with a really nasty viral infection. Now I had been in the home of this family with the four kids who had died. It had been disinfected, and I was thinking, how should Avian Influenza guidelines apply to me? Here I am: I have a runny nose, a cough, a little bit of a fever. Should I go into quarantine? And my reaction, 'it actually started—I think—before I went to his house.' Anyway, I want to get back and see my kids. I don't think this is bird flu. But you have to realize that I am one traveler. I have a medical background. I can maybe make a more rational choice, but people don't make rational choices. So how do you prepare for that? The last thing that I wanted to say, we talk about preparing companies and government. Living in China during the SARS outbreak, schools were closed down. Business was closed down. We talk as a solution. Most companies when you say 'what are you going to do about bird flu?' they say 'telecommuting.' Then I think, would that have worked with SARS in Beijing. People did that to some extent; you want to telecommute, that is fine, but your kid's school is closed down. So your kids are at home. The supermarkets tend not to be getting that much in goods. I was lucky; I had a car. I could drive around to find what I needed, but a lot of people couldn't. Every step of the way was difficult. They said wear a mask if you are in public. Do you think you could find a mask to bye in Beijing? No. That was not there. So basically, in a very short time, even though some companies had done what they thought of as a little planning, most of the ex-pats got on planes and left, leaving most companies severely understaffed. So again, how do we prepare for that? So let's start. Why don't we start with each of the panelists saying a little bit about their particular take on this subject. I guess Dr. Nabarro, the obvious question. How do you get people to be conscious of this and worry about it without being alarmed? How do you get them to take it seriously without thinking you are saying 'the sky is falling, the sky is falling' because the sky may not fall anytime soon.

David Nabbaro: Well thank you, and first of all, I would just like to say how pleased I am to be here and to be working with this group on such an important issue. You have all come, so you are all—at some level at least—aware that pandemics are a reality of modern life. You are also I suspect aware that without preparing as Elisabeth said, all sorts of problem arise. Heads of States of most of the world's countries have committed themselves to acting to both try to prevent the next pandemic and also to respond to it. It is not difficult at the moment to engage them in this issue because they are aware of the catastrophic economic and social and governance consequences that could come as a result. They just need to look at SARS: less than a thousand people died in what is generally thought to be a public health success. But the economic cost was at least 50 billion dollars for the kind of reasons that Elisabeth has described. Further analysis of the economic and social costs of HIV and other pandemics, which are still with us obviously, show that unless we do anticipate well in advance what might happen we are not going to be able to limit the consequences, and there are a very clear set of techniques that can be used that I and my team at the United Nations are responsible for working with governments on. Whether or not people in the wider world are yet convinced is of course another matter, and what I am hoping is that instead of creating messages that cause real high level of fear and possible paralysis. Instead, what we are working towards—and I believe it is happening in this country—is an indication that government, private sector, and others are aware that there will be an influenza pandemic sooner or later and are taking preparatory action. Therefore, perhaps there is not a need for people to say this is something about which I need to be frightened because nobody else is taking it seriously. Instead hopefully they are saying this is something I need to be concerned but I am pleased to see that my government and institutions like the Red Cross are taking it seriously and therefore, I don't need to panic about it.

Elisabeth Rosenthal: I think maybe we will just go through the three panelists first and come back to each one.