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Priority Setting for Pandemic Influenza: An Analysis of National Preparedness Plans

  • Lori Uscher-Pines mail,

    To whom correspondence should be addressed. E-mail: luscher@jhsph.edu

    X
  • Saad B Omer,
  • Daniel J Barnett,
  • Thomas A Burke,
  • Ran D Balicer
  • Published: October 17, 2006
  • DOI: 10.1371/journal.pmed.0030436

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H5N1 in Pakistan

Posted by plosmedicine on 31 Mar 2009 at 00:24 GMT

Author: Alefiyah Rajabali
Position: No occupation was given
Institution: Aga Khan University
E-mail: syed.ali@aku.edu
Additional Authors: Mohammad A. Rai, Syed H. Ali
Submitted Date: April 05, 2008
Published Date: April 8, 2008
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Following a brief hiatus, avian flu has made a comeback in Pakistan. For the third of three consecutive years, the cycle repeats itself - infected birds are culled, the economy faces huge losses, and the government scrabbles to reinforce infection control measures.

In February 2006, Pakistan reported its first case of the deadly H5N1 strain. Now in 2008, with yet another resurgence of the disease thousands of birds are being culled, and still counting. Adding to the gravity of situation, in December 2007, Pakistan’s first two cases of human infection with H5N1 surfaced, an unprecedented development thus far [1].

Uscher-Pines, et al.,[2] talk about the preparedness plans that various countries put together, responding to WHO guidelines. Uscher-Pines, et al. do not mention Pakistan, which was among the countries that developed their own National Preparedness Plan for prevention and control of Avian and Pandemic influenza, which gained World Bank approval in August 2007 [3]. The plan, costing US$5.511 million, aimed to target four areas of infection control: preparedness and response, laboratory strengthening, capacity building, and communications [4]. It appears that the Pakistani government has been earnest in trying to put together a system that could safeguard against another outbreak. Recurrence of the outbreak this year, however, indicates leaks in the preparedness plan that the Pakistani nation initially hoped to be foolproof.

Pakistan's susceptibility to the Bird Flu cases can be traced back to the high-risk farming methods that essentially come part-of-the-package with poor socio-economic background and low literacy level of the poultry farmers in developing countries. Basic protective measures, such as compartmentalization of flock, disinfection of clothes and equipment, proper control of human trafficking, and regular vaccinations are not a practice in Pakistani poultry farms. A well-structured system that can hold the farmers’ accountable for their animal rearing practices is sorely lacking. With an estimated 250,000 farms in the country [5], there is an urgent need to regulate poultry production. Compulsory registration of the farms will enable monitoring and enforcement of the stringent bio-security measures. For the backyard producers, this will include requirements to fence and house all poultry enabling confined poultry production, with no more ranging, herded flocks [6].

Wet markets or live poultry markets dotted across the country’s urban and rural landscape, provide the public with an opportunity to gain easy access to meat, their popularity based on the consumer satisfaction that the meat is fresh. However, the unsanitary conditions and overcrowding that accompany the wet market serve as a fertile breeding ground for infection. As a measure for controlling outbreaks of viral infection, we have previously emphasized centralized housing and slaughtering of animals in the country [7]. Hong Kong has successfully addressed this problem with upgraded infrastructure, better biosecurity, and licensed traders, centralized slaughter houses and a larger number of supermarkets in the city [7]; measures that the Pakistan government needs to adopt.

The spread of the disease stems from poor animal rearing practices, yet little has been done to increase awareness amongst the farmers about surveillance and disease prevention and control techniques. Although training and orientation workshops are reportedly being carried out [6], one can only speculate as to the number of farmers, particularly those in remote, rural locations who are privy to this information.

Policies for preventing an Avian Flu outbreak, among other potential epidemics [7, 8], have been long time coming in Pakistan. A realistic timeline for the implementation of proposed strategies needs to be allocated for the prevention of Bird Flu. As the virus once again starts to spread across Asia, we live on borrowed time.

References:

1. WHO bird flu experts to investigate if Pakistan outbreak was spread through human contact. http://www.hpj.com/archiv... January 2008.

2. Uscher-Pines L, Omer SB, Barnett DJ, Burke TA, Balicer RD. Priority setting for pandemic influenza: an analysis of national preparedness plans. PLoS Med. 2006;3(10):e436.

3. Avian influenza surveillance: govt-WB negotiate $500m aid. http://www.dawn.com/2007/... June 9, 2007, Dawn. (accessed, February, 2008)

4. Avian influenza situation in Pakistan and preparedness efforts for its prevention and control, Ministry of Health. http://www.unescap.org/ic... /2007/em-avian-influenza/Avian-Influenza-Pakistan.pdf Islamabad, Pakistan.

5. Alam. M. Bio-security measures a must to control bird flu http://www.dawn. com/2008/02/06/local4.htm February 6,2008,Dawn.

6. Anni McLeod, Nancy Morgan, Adam Prakash, Jan Hinrichs. Economic and Social impacts of avian influenza. http://www.fao.org/ag/aga... subjects/en/health/diseases-cards/CD/documents/Economic-and-social-impacts-of-avian-influenza-Geneva.pdf

7. Rai M. A., H. J. Warraich, M. R. Khanani, A. Hayat, Crimean Congo Hemorrhagic Fever in Pakistan. J. Med. Virol. (accepted)

8. Rai MA, Khan MN, Khanani R, Ali SH, Pakistan India Open Borders … to HIV? AIDS. 2006 Feb 28;20(4):634-5.

No competing interests declared.