Effect Measure

The debate about how much wild migratory birds contribute to the spread of highly pathogenic influenza/A H5N1 goes on. According to a sensible Commentary in Nature (Dec. 6) it needn’t. We should have taken steps some time ago to answer an answerable question. But we didn’t and still haven’t initiated those steps:

Two years ago, some believed that H5N1 viruses were poised to spread around the globe on the wings of migrating wild birds. A massive effort was mounted to track their movement but, as of September 2007, very few positive birds have been found in tests of over 300,000 healthy wild birds from more than 40 countries1. Several hundred infected birds (almost all of them dead) were found in endemic and outlying areas, but dead birds do not tell us about the birds that don’t get sick when infected — those that could spread H5N1 over longer distances. (Walter Boyce, Nature 450, 791-792 [6 December 2007] | doi:10.1038/450791a)

Boyce is director of the Wildlife Health Center and co-director of the NIH Center for Rapid Influenza Surveillance and Research at the University of California in Davis. He suggests three steps to exit from the revolving door of endless debate about whether it is wild birds or illicit movement of poultry that is spreading H5N1:

  • Share and swap viral isolates.

    You may have heard this one before. It is amazing how often it has to be said. We have just been through turmoil and handwringing over Indonesia’s refusal to provide their viral isolates over concerns about “intellectual property” and affordability. Boyce reminds us that this kind of bad behavior is widespread. Italian scientist Ilaria Capua sounded the same call a year and a half ago and we have discussed it here countless times. As far as I know, CDC has yet to release thousands of human isolates of influenza (not H5N1) and major flu researchers are also guilty:

    Despite calls for a more open approach by researchers such as Ilaria Capua at the National Reference Laboratory for Avian Influenza and Newcastle Disease in Padova, Italy, there are still substantial obstacles to the rapid sharing of data and samples, whether they are from wild birds or poultry. Regulatory problems hinder shipping of these samples between countries — it can take weeks to months to arrange for the proper import/export permits, and some countries do not allow any samples to be analysed outside their borders. It is also difficult to balance rapid public release of data with appropriate protection of intellectual-property rights.

    [snip]

    Although these and other approaches and policies are important, it is ultimately up to the researchers on the front lines to ensure that data and samples make it into the pipeline as quickly as possible. Because isolating viruses is such hard work and because the resulting samples can yield a wealth of information and publications over time, there may be a tendency to view viruses in the freezer as money in the bank — a rich resource to be guarded and tapped later. This approach does not enhance pandemic preparedness, and future publications won’t seem so important in the middle of a roaring pandemic. We simply must do a better job, and making data release within 45 days a community standard would be a step in the right direction.

    Note Boyce’s comment about balancing “rapid public release of data with appropriate protection of intellectual-property rights.” This is not just a problem with Indonesia. In fact it is a problem that major scientists and big drug companies created and the Indonesian episode is the monster coming back to bite us.

    I am particularly dismayed with my scientific colleagues. They are acting selfishly. I have cut them a good deal of slack because I understand the pressures of today’s academic life. But this isn’t an ordinary situation. If they want to act like ordinary academics, they should move to a different scientific field of study. They get the benefit of high profile publication because of their reputations and urgent interest in their subject areas. Time to give something back by acting in a less self-centered way. These are very decent people acting in a bad way.

  • Start systematic surveillance of wild birds in endemic areas.

    As Boyce points out, the bulk of the effort at systematic surveillance has been in the non-endemic areas of North America and Europe. We have found that wild, healthy bird infection with H5N1, if it exists in these areas (and no examples have been found in North America) it is very rare.

    It is clear that wild aquatic birds are a natural reservoir of influenza viruses, although it is possible that H5N1 persists in a wild-bird species we wouldn’t normally suspect. But we don’t know whether H5N1 viruses are endemic in wild-bird populations or if infections in wild birds represent spillover from poultry. And although movement of infected poultry plays a pivotal part in spreading H5N1 to new areas, we continue to debate, year after year, the risk to poultry posed by migrating wild birds.

    To move beyond debate and come up with definitive answers, we must investigate H5N1 in the areas where virus transmission actually takes place.

    [snip]

    It is live birds, not dead birds, that shed the virus and pose a threat. Because our surveillance efforts have struggled to find infected live birds in non-endemic regions, it is essential that we shift sufficient resources and efforts to evaluate H5N1 transmission in wild birds in known endemic areas such as southeastern Asia, China, Indonesia and Africa.

    We have called for this here, too. But it hasn’t happened.

  • Really do influenza surveillance on wild birds

    In a way the most disconcerting part of Boyce’s Commentary was this one. Influenza is a disease of birds. A small proportion of the subtypes routinely infect humans and other animals, too. A persistent threat is that a human virulent subtype to which we have no previous experience will emerge from the bird population in a form that is easily transmissible between people and we’re off to the races (and we won’t be standing in the Winner’s Circle, either). So far all or most of the attention has been focussed on H5N1 as playing this role and there are excellent reasons for this. But it’s certainly not the only plausible candidate. Yet we learn from Boyce’s piece that our systematic surveillance has acted as if it is, and worse, destroyed the isolates that revealed many other possibilities:

    The global human population is immunologically naive to at least 12 viral subtypes in addition to H5, and we don’t know which virus will cause the next pandemic, or the one after that. Besides H5, today’s ‘short list’ should include H2, H6, H7 and H9. We must look beyond H5N1 and conduct surveillance that captures the full list of viral genetic diversity — and feed those data into the development of effective pandemic vaccines.

    We don’t have to look far. Depending on species, location and season, up to 25% of the wild birds sampled in the past two years were infected with non-H5N1 influenza viruses. The early detection efforts in North America and Europe may have failed to find H5N1, but they did an excellent job of sampling other influenza viruses. Unfortunately, too many of these viruses were discarded and their information lost forever once samples were classified as non-H5N1. This is not good enough. We must evaluate the pandemic potential of all the influenza subtypes detected during surveillance.

    I’m not sure I agree with Boyce’s judgment that “this isn’t good enough.” I would opt more for “This is monumentally stupid, short sighted and bordering on incompetence.”

None of this is 20-20 hindsight. Others have been saying these things for some time. Is no one listening?

Comments

  1. #1 Susan Och
    December 10, 2007

    “Wild Birds Did It!” has worked so well as an excuse for the poultry industry that I’m surprised there is any funding at all for this sort of research. Perhaps the focus on H5N1 reflects a search for excuses for past problems rather than an honest assessment of future risk.

  2. #2 herman
    December 10, 2007

    Lo Wing-lok, a specialist in infectious diseases in Hong Kong, said there were two possibilities in the case – that the father was infected through close contact with the son or that both had bought poultry from the same source. Lo said there had been 30 family clusters so far where the infection had been contracted due to a blood relationship.

    “The critical factor is whether these two men had been in close proximity for an extended period rather than the blood relationship, although blood relatives are more likely to be affected” Lo said.
    Please note one important fact. “There had been 30 family clusters so far where the infection had been contracted due to blood relationship.”
    Thirty family clusters indicate human to human contagion, period. If there really were 30 clusters, the world is in deep do do. And you can probably anticipate a pandemic soon, no matter what all the wise ass bird flu specialists say. Just use common sense, and forget the rest. So get ready, and expect 60% of those infected to die.
    And would you really have the guts to help those infected with such a dangerous diesease, knowing you might contact the it and die a horrible death. I honestly doubt it, no matter what people write on the internet. It is one thing to write bullshit about how brave you are, and it is another to actually expose yourself to a disease where you have a 60% chance of dying, if you contact it. Once you see just one patient bleeding from the mouth or turning black, you would probably run for cover in your house, and never again go outside until the pandemic wave had passed. Be honest, please.
    Do not worry about H1, H2, etc. for the moment. Do not worry about wild birds or chickens. Just keep your eye on the ball. Thirty human clusters of H5N1 is more than enough to worry about for now. All the birds in the world can go to hell, no matter what strain they have. But we are now talking about 30 clusters of human beings, with a disease with a 60% fatility rate. So how many humans in those cluster will die? This in itself is a tragedy.
    Goodbye world, hello eternity.
    Randy, where are you to help me? Revere is pissed off, since I Herman, alias Juan, keep getting in trouble. Be cool Randy, and say something important, to reduce the heat on me before I get blasted into eternity. I know you told me I am full of shit, but I still enjoy reading your posts.
    Please come to my assistance, superstar, you right wing fascist.

  3. #3 caia
    December 10, 2007

    Herman, do you have a link for those remarks by Lo?

    And while thirty is more family clusters than I’d have expected, I think we all know there are more than “a couple”… I read recently someone talking about clusters who left out Turkey entirely. It’s common practice to downplay and underestimate… let us not all panic when an expert forgoes the traditional charade.

    There is, as we have all learned in the past couple years, a big difference between a patient infecting a home caretaker, or families who all sleep in one room infecting each other, and efficient human-to-human transmission. If there weren’t, we would have already had a pandemic.

    That isn’t to say the clusters aren’t alarming, but we’ve been alarmed before. As long as we might have time, I think Revere is right that the more real information we have, the better.

  4. #4 caia
    December 10, 2007

    Never mind about the link, I found Lo’s comments.

  5. #5 revere
    December 10, 2007

    herman: As far as I know, this is the 32nd cluster. This has been reviewed many times, including here. See this paper.

    Randy is not going to protect you. You need to get yourself under control. This is a serious site and hysterical posts are unhelpful to everyone. Read your comment over and then tell me you think it is helpful and constructive. If you are frightened, go hide under the bed.

  6. #6 Patch
    December 11, 2007

    Thank you Revere! Please keep this a serious site.

  7. #7 AnnieRN
    December 12, 2007

    Regarding scientific arrogance and the profound need for viral sharing: The world has agreed to keep military hands off the entire continent of Antarctica, and Antarctica is not a “necessity” except to those who work there. If the world can agree on that, then it shouldn’t be that difficult for any scientist or any government official in any nation on earth to get viruses/DNA sequences out into the open, simply for the sake of the horrendous outcome for failing to do so. AnnieRN

  8. #8 Kathleen M
    December 12, 2007

    Annie RN: I think you’re being too naive about Antartica. see link
    http://www.thestar.com/News/Ideas/article/277390
    (snip) The 1959 Antarctic Treaty put a freeze on all seven previous claims, with the intention of preserving the continent as a demilitarized zone and a haven for scientific research. All mineral exploitation south of 60 degrees latitude is supposed to be barred until at least 2048.
    (snip) Britain is considering submitting data to the United Nations Commission on the Limits of the Continental Shelf (CLCS) that would give the U.K. exclusive economic rights to over a million square miles of seabed off the coast of its Antarctic territory. Australia has already put in their own claim to the seabed off their Antarctic territory, and there is little doubt the other five nations that claim a slice of the continent Norway, Argentina, Chile, France, and New Zealand will do so as well by a 2009 deadline.

    So if Antarctica is officially nobody’s territory,would these claims violate the 1959 Treaty? Technically no, says Triggs. The seven nations that claim territory in Antarctica did so before the 1959 treaty in Britain’s case, back in 1908 with the early explorers. So those claims are not in breach of Article 4 (2) of the Antarctic Treaty, which states that “no new claim, or enlargement of an existing claim to territorial sovereignty in Antarctica shall be asserted while the present treaty is in force.”

    “Continental shelf rights exist as a consequence of the original territorial claim. Delimitation is not therefore either a `new claim or an enlargement of an existing claim,’” she says.

    Dodds agrees that there is “nothing illegal” about seabed claims but says they violate the spirit of the 1959 Treaty, which was supposed to mark a milestone for international peace and cooperation.

  9. #9 M. Randolph Kruger
    December 12, 2007

    No Herman. Even when I go off on my sometimes slightly rightist rants I never run around on friend Revere’s blog under any name other than my own. I dont run a blogo-name for just that reason. I dont want anyone to ever think I was hiding behind one.

    Revere has to. He is a scientist, doctor, dad and grand daddy. My deeply right wing controlled Administration may not hold the Congress or the Supreme Court, but they do make the appointments along with the money grants going to them. Revere and I dont agree on much but he is a great american on the other side of the fence giving balance as one lefty against the Great Republican Conspiracy. And being in control they could hurt him or one of the other Reveres both politically and financially. I dont stand on many issues but fairness is one of them. It wouldnt be fair say for them to find out his name and then knock him out of something he is doing in his field just because he is a leftwinger. Nope, just aint right.

    OTOH, you apparently have been using multiple names and well, you got caught. I have to be honest with you herman it DOES take a lot to get Revere to “issue the warning”. In fact, I havent seen it done but once before. He closed down a thread about two years ago because people were getting threatening. Nowhere did he say he was going to pull the plug on someone in defiance of free speech, he just cut the thread because everyone was over the edge and machine gunning as we all went.

    Never have I seen him warn anyone about trolling. Maybe for being an asshole but not trolling. He wont shut you down for being an asshole, but yep for trolling he will and with my high approval and condolences.

    Revere is about serious science and it takes a lot to crawl into the shop everyday as it is and then, oh shit my left wing friend has time to provide us something that our own government just caught on to last year. Blogging on health and science issues. They did a study, made some notes and with DemfromCT and Revere’s help decided that it might work in a pandemic. NO SHIT? Duh. Unfortunately they gave the contract to Halliburton and Cheney will be the senior moderator in about 13 months, available for comment on January 20th, at 10:19 a.m..

    I am one of the few righties here and respect for laws and regulations is where I start and finish from, not in the interpretation of them. Follow the rules Herman. They are Reveres laws, you are in his home. Dont crap on the carpet unless you are Afghani. If you are then you have to wait for the floor of the hospital to clear, sorry.

  10. #10 anon
    December 12, 2007

    what does the sequencing cost ?
    isn’t it justified by the panflu thread ?
    can’t we fund it through WHO,FAO ?

    Capua,OFFLU,GISAID,niman, keep remarkably silent this year about
    withheld sequences.
    There were even some sequences from Indonesia and while everyone blames
    Indonesia, no one seems to bother that the Indo-2007 sequences are only
    in the secret WHO-database and not published at genbank.

    Often we have delays of 1 year or more – is this just only to increase
    the authors reputations ? Can’t they somehow be awarded for early
    publication so to make it more attractive ?
    We argue, that those billions spent on panflu are not enough.
    But to end this sequences-withholding for author’s reputation increase
    only costs some millions, I guess.

    Other flu-viruses are not only important because of pandemics other than H5N1,
    but also because of possible reassortments and to learn about flu-spread
    in general by migratory birds. This could also be useful for human
    seasonal flu which causes enough damage already to justify it.

  11. #11 paiwan
    December 13, 2007

    anon and Rando

    If B2H virus has been invovling with human health and poultry, then not only WHO,but also FAO has to be accountable in dealing with this matter. It seems that we rarely hear any treatments from FAO, is it weird?

    Herman
    I commented on your inputs one time valued as prophesy, so you owe me an explanation for trusting you, I will listen carefully,I promise.