The Avian Flu Challenge in Southeast Asia: the Potential of Public-Private Partnerships
The Wilson Center would like to express its appreciation to the GE Foundation for its support in making this program possible.
In the past few months, the H5N1 strain of avian flu has infected birds in 30 new countries, which is twice the number of countries previously infected since 2003. According to the World Health Organization, there are 192 total confirmed cases of H5N1, 109 of them fatal. Avian flu's global spread, coupled with its high human fatality rate, has catapulted the virus to the top of the public health agenda. As exemplified by many international health care programs, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, public-private partnerships have the potential to merge industry expertise, public interest and financing for the effective delivery of services, drugs and resources to the people and communities in need. Public-private partnerships are defined as a collaboration between a public entity, such as a local authority or central government, and private companies. Very often, civil society actors are also included.
By April 8th of this year, Tjandra Yoga Aditama stated, the Indonesian Ministry of Health had recorded 32 confirmed human avian flu cases and 24 deaths nationwide. The Ministry's avian flu strategy focuses on epidemic control and prevention of animal infection, as well as public information and transparency. Key aspects of its work include research and information dissemination, active surveillance and protection of high risk groups and patient management, which involves preparation of a wide range of referral hospitals. To combat human infection the Ministry of Health is increasing access to anti-viral drugs, safety equipment and insurance protection. According to Tjandra, the Ministry confronts several limitations, such as the lack of financial capacity; limited hospital supplies; insufficient stockpiles of the anti-viral drug, Tamiflu; weak surveillance at the district level; and a lack of strategy in dealing with the local media. He emphasized that pandemic preparedness in Indonesia requires the collaboration of the health and veterinary sectors, and must involve all levels of authority, mobilize available health services and secure the participation of external stakeholders.
David Reddy of Roche Pharmaceuticals confirmed the international concern that the demand for vaccines will far exceed the available supply in the event of a pandemic, due to currently inadequate manufacturing and delivery capacities. To address this challenge the World Heath Organization (WHO) advises countries to build their national stockpile of drugs in order to ensure sufficient supplies in the event of a human pandemic. Thus, Roche has delivered stockpiles of its signature anti-viral drug, Tamiflu, to the governments of 80 countries, including 28 in Africa and 14 in Asia. Governments are then responsible for Tamiflu storage and distribution, which is an "essential adjunct to vaccines in the effective management of an influenza pandemic." Other initiatives Roche has been actively taking to support global pandemic preparedness efforts include increasing Tamiflu manufacturing capacity since February 2004; reducing Tamiflu pricing to low and lower middle income countries; pledging 5.2 million Tamiflu courses to the WHO for exclusive use in developing countries; and ensuring that intellectual property rules do not create barriers to the accessibility of Tamiflu by granting sub-licenses for generic production to companies in India and China.
Tracy DuVernoy focused on agricultural practices in Southeast Asia that need to be considered in avian flu prevention and control efforts, clarifying that despite the media's focus on human infections, avian influenza is primarily a poultry disease. The Southeast Asian countries of Cambodia, Indonesia, Laos, Thailand and Vietnam are predominantly rural and agricultural, with a high poultry density ranging between 1.3 and 4.0 birds per human. In comparison to industrial and commercial poultry production systems in developed countries, poultry production in Southeast Asia is characterized by backyard farming. Mixed free-range birds in an environment that lacks bio-security poses high risks of bird-to-human infection, which DuVernoy argued is the key challenge in combating the spread of avian flu in Southeast Asia. Traditional trading practices also pose increased risk of contamination, as individuals move poultry between villages on wheelbarrow carts, trade birds in live markets and kill them without safety equipment such as gloves, face masks or in some cases, even shoes. Another critical challenge in the Southeast Asian context is the lack of economic compensation provided to smallholder poultry farmers to report sick birds to local authorities. The negative economic impact on these farmers, she stated, affects local food security, as poultry is a key protein source in local diets, farmer livelihoods and female empowerment, as women are the primary caretakers of backyard poultry. In addition, poor veterinary infrastructure, wildlife and poultry smuggling across porous borders and other indigenous poultry diseases all create additional dangers. To address these myriad challenges, she urges national governments to work closely with international organizations such as the Food and Agricultural Organization, the World Organization for Animal Health and the World Health Organization. In conclusion, DuVernoy emphasized that avian influenza control strategies must be country specific, as "one size does not fit all" and various tools need to employed to adapt to the particular local context.
Peter Gourlay introduced JHPIEGO as an international leader in Infection Prevention and Control (IPC) practices that protect both patients and healthcare workers from infection risks, while building the institutional capacity of national hospitals and health care centers. In order to implement IPC practices in developing countries, JHPIEGO pursues public-private partnerships, which "allow governments to receive the public health funding they lack with greater flexibility." To address avian flu in Indonesia, JHPIEGO has partnered with the U.S.-ASEAN Business Council, which has had an active role in bringing investment to and strengthening bilateral relations with Indonesia. The Council's motivation, Gourlay explained, is that if a pandemic outbreak were to occur, businesses region-wide would be profoundly affected. JHPIEGO has worked in Indonesia for almost 30 years, building its credibility through developing SARS-specific IPC practices, establishing a wide network of local partners, and securing the trust of local government and key stakeholders in its technical expertise. The JHPIEGO-U.S.-ASEAN Business Council partnership works alongside the Indonesian Ministry of Health in holding training programs to upgrade IPC skills specific to avian flu at 30 hospitals across Indonesia, while disseminating the partnership's manual, IP Guidelines for Health Facilities with Limited Resources, in Bahasa Indonesia. JHPIEGO fashions its programs in Indonesia to the requests of local authorities and links their efforts to the national avian flu prevention and control strategy.