On Front Lines Of Asian Battle Against Bird Flu

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On Front Lines Of Asian Battle Against Bird Flu

By Alan Sipress, Washington Post Foreign Service

Sun May 22, 1:00 AM ET

HANOI -- Behind high gray double doors, Professor Nguyen Thu Van, a

simply dressed woman with black hair held back by a barrette, has

been laboring tirelessly with her team of researchers in a race to

avert a pandemic.

Her white-coated co-workers scurried about one recent day in their

small, second-floor laboratory in an elegant French colonial building

in the Vietnamese capital. Engaged in a drive to perfect a human

vaccine against avian influenza, Van, 50, has produced an

experimental version and conducted successful tests on monkeys. She

and her researchers have volunteered to be the first subjects in

human trials, which she hopes will begin this summer despite warnings

from the World Health Organization.

Van is at the forefront of a campaign in Southeast Asia to halt the

progress of bird flu. International health specialists say they fear

the virus could undergo genetic changes suddenly and become the most

deadly disease to strike humanity in modern times. Almost 200 million

chickens, ducks and other birds throughout Southeast Asia have died

from the virus or been slaughtered to contain it in the last two

years.

So far, bird flu has killed 53 people, mostly as a result of close

contact with infected poultry. But international health experts say

they suspect the virus has also begun to spread among humans.

With bird flu endemic among birds in the Asian countryside, the

disease could pose a threat to humans for years. And in an age of

global travel, health experts predict that an easily transmitted

human strain could move beyond Asia in a matter of weeks and infect

tens of millions of people worldwide.

When bird flu began spreading in Southeast Asia, governments in the

region initially denied its presence. But a Thai doctor, Prasert

Thongcharoen, sounded the alarm, issuing blunt declarations that

forced Thailand to acknowledge early last year that the disease was

decimating bird populations and beginning to infect people.

In Indonesia, the government has campaigned to vaccinate poultry

across the vast archipelago, but tens of thousands of doses sit

unused in government refrigerators while farmers leave their birds

unprotected. A veterinarian named Suparno patrols the country's most

populous island in an ambitious endeavor to prevent the virus from

spreading.

Van's eyes gleamed with enthusiasm as she predicted that Vietnam

could become the first country to develop a human vaccine against the

lethal H5N1 strain of bird flu endemic among poultry in Southeast

Asia. But WHO officials charge that Van's team has flouted

international guidelines, saying that material used to develop the

vaccine is potentially contaminated and that the planned human tests

involve imprudent shortcuts.

" We cannot wait, " Van responded.

Prasert, 71, one of his country's most eminent virologists, literally

wrote the book on influenza in Thailand, published seven years ago.

He was a physician fresh out of school when the 1957 Asian influenza

pandemic swept through Thailand, flooding his hospital with patients.

Later, when an outbreak of Hong Kong flu reached Bangkok in 1968,

Prasert was already emerging as a leading researcher.

In the fall of 2003, he learned that tens of thousands of chickens

had begun dying in Thailand, he said during an interview in his

research office in Bangkok. The government was insisting that the

birds had contracted fowl cholera, a common affliction. As the

world's fourth-largest poultry exporter, Thailand would suffer an

economic blow if other countries learned its flocks were infected

with bird flu.

Prasert decided to obtain more information. He visited a Bangkok

market, where farmers confided they believed it was something worse.

" They said it wasn't like fowl cholera, " Prasert recounted. " If they

have chickens that are sick with that, they give them tetracycline

and they get better. But these chickens, by the next morning, they're

all dead. "

Prasert's suspicions mounted in early December when friends who

usually bring him six or a dozen eggs when they visit their farm east

of Bangkok came back empty-handed. " They told me the farm is usually

full of chickens, " he recalled, " but the chickens all died. "

In mid-December, researchers privately showed Prasert results of

tests done on chickens revealing that they had influenza. Prasert

warned officials that urgent action was needed.

" I told them it is a public health concern and I would not close my

mouth. I will talk even louder, " Prasert said.

Senior ministers continued to deny the presence of bird flu

throughout much of January 2004, according to Thai and international

officials.

But in the first week of January, a 6-year-old boy from a province

west of the capital developed a high fever, followed a week later by

symptoms of severe pneumonia. The boy was admitted to Prasert's

hospital, and tests on Jan. 22 came back positive for bird flu. He

died three days later.

Prasert told the Health Ministry that it was too late for a coverup,

he recounted with an ironic smile and narrowed eyes. The strain had

reached humans.

On Jan. 23, the health and agriculture ministers announced that bird

flu had arrived in Thailand.

Suparno, the Indonesian government veterinarian, crouched in the

cramped backyard of a farmhouse in a Central Java village, clad in a

tan uniform. He slowly drew the bird flu vaccine from a plastic

container into a syringe. Then his fellow animal health officers

brought five black hens, one by one, from a barn. Suparno inoculated

each one.

There were 20 more chickens running around the farm, but they escaped

the needle.

" Too hard to catch, " Suparno explained before driving off.

But by leaving most of the flock unprotected, the exercise was

pointless. The remaining chickens could catch avian flu, and sick

birds, in turn, could infect even those that had been immunized.

Vaccinated birds can still become carriers of the disease and

transmit it to humans.

Several governments in Southeast Asia are considering following

Indonesia's lead in making poultry vaccination central to efforts to

contain bird flu.

But interviews with livestock officials and farmers in three

districts of Central Java, the Indonesian province hardest hit by

bird flu, suggest that the immunization campaign sputtered from the

start and has now all but stalled.

Tri Satya Putri Naipospos, national director of animal health, said

Indonesia turned to vaccination because it was too costly to carry

out widespread culling of flocks as Vietnam and Thailand were doing.

By the time Indonesian officials acknowledged the presence of the

virus, it had already infected much of Java, Bali and the Sumatra

islands.

" The announcement of the government came very late, " Naipospos

admitted. " Our laboratory people knew it already. " She said senior

Indonesian officials delayed acknowledging the disease after the

outbreak in August 2003 because of intense pressure from the poultry

industry, which was afraid it would hurt sales.

Central government officials said they distributed 150 million doses

of free vaccine to inoculate poultry nationwide at small and mid-size

farms and that 98 percent of those earmarked for Central Java had

been used.

But local officials and farmers countered that immunization was

spotty at best. " Maybe the farmers get the vaccine, " said Widodo

Sumantri, chief livestock officer in Karanganyar district. " The

percentage of those who use it is small. "

In the neighboring Sragen district, Sri Harjono, a farmer who runs a

cooperative that has 23,000 broiler chickens, said he lost more than

half of his flock after the initial bird flu outbreak in 2003. He

restocked and began vaccinating in October, Harjono recalled,

standing outside a cavernous coop on stilts fashioned from bamboo and

screens.

But no longer. " It's too much hassle, " he said, stroking a baby

chick. " You have to go one by one. Can you imagine vaccinating 23,000

chickens over and over? "

Educated partly in the Soviet Union, Van, the Hanoi scientist, later

trained at the Centers for Disease Control in Atlanta, where she

developed an interest in working on hepatitis. Her efforts to develop

a hepatitis B vaccine in Vietnam helped her win appointment as

general director of Vietnam's Vaccine and Biological Production

Company No. 1.

As the number of human cases in Vietnam grew last year, a senior

colleague suggested that Van try to reprise her success with

hepatitis B by developing an avian influenza vaccine.

" It was difficult at the beginning because we did not have the

experience, " she said, but added that Vietnam could not afford to

wait for vaccines being developed in the West, which she also feared

would be exorbitantly expensive.

Vietnam publicly acknowledged the presence of the disease in January

2004, although Trinh Quan Huan, director general of preventive

medicine, said the Health Ministry knew of it five months earlier.

Hospitals in the Hanoi area had already admitted 13 children and an

adult with symptoms associated with bird flu, according to WHO.

Twelve people had died.

Vietnam's current strategy of poultry control measures has not tamed

the outbreak. The government recently extended a ban on hatching

ducks and other waterfowl, but enforcement has been erratic. The

raising of all poultry in cities was recently prohibited. But in Ho

Chi Minh City, where such a ban was already in effect last year,

chickens are still a common sight in back lanes.

After a study last month discovered that more than 70 percent of

ducks and geese sampled in the Mekong Delta tested positive for

influenza, the government ordered the slaughter of 1.5 million

waterfowl, according to state media. But experts with the U.N.

Food and Agriculture Organization predicted that as long as farmers

were offered only a fraction of the birds' value in compensation,

they would refuse to cooperate.

Last year, Van's researchers developed the virus strain for the

vaccine. The self-administered clinical tests are due to begin as

early as August. If they are successful, Van says, she hopes Vietnam

can produce about half a million doses by January.

WHO experts visited Hanoi earlier this year and warned that the

material used to grow the virus strain in Van's laboratory was not

approved by international health agencies. It could be contaminated

and was grown in cancer cells, according to L. Perdue, a WHO

influenza expert. Perdue's team also told the Vietnamese that testing

the vaccine on researchers rather than on true volunteers would be

unethical.

Van's worry is that by the time the vaccine is ready, it will no

longer be effective against an influenza virus that easily mutates.

If the vaccine cannot be updated, she cautioned, Vietnam would be

left vulnerable in the face of a mass killer.

" I'm confident it will work, " she said, adding, " I'm 80 percent

confident we will succeed. "

Special correspondent Yayu Yuniar in Jakarta contributed to this

report.

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