The World is Watching
The World is Watching
Helen Branswell in STAT interviews Maria Van Kerkhove of WHO regarding the U.S. H5 situation
Maria Van Kerkhove, the World Health Organization’s acting director of epidemic and pandemic preparedness and prevention, was interviewed by Helen Branswell and posted in STAT this morning. Once again, this article may be behind a paywall for those who repeatedly access STAT, but in my opinion, the information is well worth the minimal cost for access:
On H5N1 bird flu, the U.S. can and should do more, a top WHO official says (statnews.com)
Helen has a long and distinguished career as an influenza and emerging pandemic disease reporter and subject matter expert. Her range of contacts are impressive, and her question are always insightful.
I want to post segments of Maria’s responses to share current world concerns regarding our disjointed and incomplete response, especially on the animal side of this outbreak. While the segments I’ve extracted for your review are important, the article contains much more context and information, including discussions on the California situation which are worth reading in full.
In discussing the Missouri human case(s) Maria stated the following:
I’m not alarmed in the sense where I think something is happening, where we’re now seeing efficient human-to-human transmission. But what I need to see happening — speaking as the person leading the work at WHO on epidemic and pandemic prevention and preparedness, leading on the global influenza program — is more efforts by the animal sector to really understand what’s happening in animals.
I think the cross-sectoral collaboration that’s happening in the U.S. is challenging on many different fronts. But this is the One Health approach right in front of us. And if there are not investigations that take place when you have a detected case in humans — back tracing, forward tracing, looking at animal exposures, going to the ministry of agriculture or the USDA, looking at wildlife, looking at poultry, looking at dairy cattle, looking at swine — then we don’t have a complete picture. That’s what concerns me, not having that complete picture.
…What is more concerning to me at the moment is the ability for sectors to work closely with each other.
Helen asked Maria about the fact that Missouri hasn’t reported any positive dairy herds. What does that mean?
What I would like to see across the globe, including in the United States, is the results of negative tests. We only get positives. Knowing who’s testing and what’s negative is just as important as the positives right now.
(Helen) If you’re not doing any testing, then you don’t even have negative results.
Well, if you’re not doing testing, then you don’t know.
We’re piecing together clues from bits and pieces of information, and I think there’s much more that can be done to fill in those holes. The question is, why is it not being done? And how can we support it being done?
I understand resources are not infinite. But if we really want to get to the bottom of what’s happening — especially for this case, detected without any animal exposure — I think it’s important to follow up.
The really important question for me is not only knowing how this individual was infected, or the extent of infection around this individual, but are there any changes in the virus? Are we seeing something different?
I don’t believe that fundamentally something has changed in terms of the virus, in terms of its transmissibility. But my ability to say that is dependent upon what I know and dependent upon [the information that] is in the pipeline. So I would like there to be more in the pipeline in terms of those clues to help us disentangle this.
If we don’t address the incentives and disincentives for dealing with the drivers of spillovers, which include politics, which include financial incentives, which include trade, which include food security, then I think we’re going to continue to struggle to deal with these types of zoonotic viruses.
Perhaps Dr. Van Kerkhove’s final comments were the most troubling to me:
I think the surprise for me is a highly capable country that has incredible scientists across multiple sectors, what they are trying to do to tackle this. Because the world is watching. And they know that they can do more. …
I’m questioning what it is that is prohibiting animal and human health sectors globally to work more cohesively together.
I think more can be done.
There is nothing sought here that we don’t already know needs to be done; we simply need to execute. Here are some initial ideas:
Release virus, funding and assays to our research community - expedited review process for proposals
Immediately catch up all GISAID sequence posting
Bulk tank tests surrounding all positive herds
30-day post outbreak herd serology studies, including non-lactating animals in a least a portion of affected herds
Bulk tank testing in states with human cases linked to dairy virus (Missouri)
Increased funding for wildlife trapping and testing
Companion animal influenza screening pilot program
The dairy industry and animal health regulatory community has rapidly burned up its good will and social credibility on the H5 issue. It’s a shame, because dairy products are top quality and essential for adequate nutrition, and U.S. farmers are highly respected. The USDA and the agricultural research community have been bulwarks in the fight against national and world hunger. Let’s not burn up all the good will over “slow walking” in response to a known potential zoonotic risk. The H5 threat to domestic livestock is serious, but not as dire as the alarmists make the risk out to be, and solutions are not unobtainable. Whatever the challenges, the industry must join the engagement to survive and prosper. The world is watching!
John