The Ban Yanyao farmers meeting under the shade of a jumpa tree to protect themselves from the tropical midday sun form an unlikely vanguard of a task force to stop a bird-flu pandemic claiming tens of millions of lives around the world.
Few have more than a basic education, none have travelled far outside their province of Suphanburi, 136km north of Bangkok, and none know much about the world outside Thailand.
But they do have an intimate knowledge of the people and animals in their village.
”We’d know within a day if someone caught a cold, let alone came down with something like bird flu,” said Prasert Somprasong.
This information, plus the training given to 750 000 similar volunteers across Thailand, is likely to make the difference to whether a pandemic is contained, experts say.
”The world has to get ready for a pandemic because the behaviour of the virus can’t be predicted and the movement of birds can’t be controlled,” said Carolyn Benigno, the head of Asia surveillance operations for the United Nations Food and Agriculture Organisation (FAO). ”The first step in that process is to have a proper surveillance system.”
The H5N1 strain of bird flu has killed 62 people in south-east Asia since emerging in Vietnam in December 2003, and resulted in the deaths of 140-million birds. It recently appeared suddenly in Russia and Kazakhstan, a westward jump of hundreds of miles from the nearest outbreak in western China.
The European Union is now assessing its readiness to handle infections. The Netherlands has already ordered all free-range birds to be moved inside.
William Aldis, the head of the World Health Organisation in south-east Asia, says although he does not want to be accused of scaremongering, he believes it is likely to be only a matter of time before the world faces a huge bird-flu outbreak.
”The biological and epidemiological evidence strongly supports the probability that an avian-derived virus will cause a global pandemic,” he said. ”But whether that will happen from H5N1 or in the next few years no one knows.”
The main elements of successful containment are thorough surveillance leading to rapid reporting, speedy and accurate diagnosis, swift distribution of treatment to contain the flu’s spread, and a stockpile of at least three million courses of the main anti-viral drug, oseltamivir.
This would be followed by the production of a human vaccine as quickly as possible, something that cannot be done in advance since the precise nature of the pandemic-causing virus would not be known until it emerges. This is likely to take up to six months.
Aldis says any country could do well to study Thailand’s plans. Besides retraining the network of health and livestock volunteers, the government has increased the number of diagnostic labs from one to 13 and started stockpiling oseltamivir.
”In our planning we expect the volunteers to report any outbreak within a day or two and that we [in central government] would be informed within one to two days of that,” said Supamit Shunsuttiwaat, an expert in disease control at the ministry of public health. ”The idea is, it will take about 24 hours to confirm it’s an H5N1 infection; we would investigate for one to two days, and then take appropriate action.”
In Thailand’s latest outbreak of animal bird flu, in Yanyao, it was just more than a week from when the first birds started dying to the government’s rapid-response team descending on the village.
The biggest weakness in the Thai plan is the lack of a drug stockpile. Dr Supamit estimates Thailand will have about 70 000 courses of Tamiflu, the oseltamivir brand made by Roche, by the end of the year and will steadily increase from there. Last week, Roche agreed to build up a reserve of three million courses of the drug for use by the World Health Organisation. The stockpile is expected to be ready by the middle of next year.
There is consensus that any pandemic is most likely to start in south-east Asia, since bird flu is endemic in Thailand, Cambodia, Indonesia and Vietnam. It is in the latter three countries, which are less prepared, that the problems really lie.
In Indonesia, the response after the latest human outbreak in July, in which three people died, shows there is not even the full political will to tackle the problem, according to Dr Soedarmono of the Indonesian agriculture ministry’s animal health directorate.
”We wanted to do more in-depth research, but the local authorities blocked us because they said the local community was too nervous and might panic,” Dr Soedarmono said.
This outbreak in Indonesia is particularly worrying because it occurred in an urban area: the town of Tangerang, 19,2km west of the capital, Jakarta, where there are no fowl. The nearest infected animals, ducks and pigs were 24km away, but their owners had not fallen ill.
”None of us have any idea how they got infected,” said Sunaryo, the head of the neighbourhood where the victims lived. ”There are no chickens here and no one else fell ill. It remains a mystery.”
Aldis says these three deaths, the first in such circumstances, ”turned on its head everything that has been considered the norm as regards a likely outbreak”.
”Up till now the assumption has been that [any pandemic] is going to happen in an isolated rural population,” he said. ”If it happens in an urban centre, we’re dead meat. There’s not much we can do.”
Wantanee Kalpravidh, the head of the FAO’s south-east Asia surveillance mission, said: ”If you ask us when we will have a complete picture of the disease … Well, let me say we’re always on the move with bird flu.”
As far as eradicating it is concerned, Kalpravidh says: ”In the global strategy, we’re working on 10 years.”
Experts say although the West should not neglect its defences, it should focus on helping south-east Asia to prepare.
”The smaller area a pandemic can be contained in the better,” said a Thai microbiologist, Praset Auewarakul.
”A very possible scenario is that it will be slowed but not contained in south-east Asia. But by the time the virus gets to Western countries, it could well become resistant to Tamiflu.”
The FAO’s Dr Benigno agrees.
”We would rather the resources be spent over at the likely source than kept back for national defences,” she said.
Supamit estimates Thailand has spent about £100-million on containing bird flu and preparing for a pandemic. At a summit this year, the UN received pledges of about half that for the whole world.
Hundreds of millions of pounds are therefore still needed. In a study on strategies to contain a pandemic published last month, Neil Ferguson, of Imperial College London, wrote: ”A feasible strategy for containment of the next pandemic offers global benefits in potentially preventing millions of deaths.
”It is therefore in the interest of all countries to contribute to ensuring the resources, infrastructure and collaborative relationships are in place within the region currently most likely to be the source of a new pandemic.”
Aldis says: ”If it doesn’t happen, then hopefully the measures we’re putting in place will mean we’re better prepared for the next disease when it comes along.” — Guardian Unlimited Â