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Agriculture ministers of the region met in Guatemala on Oct. 28 to plan strategies to deal with an eventual outbreak of avian flu. The disease is not present in Central America at this time, at least not in its most virulent form, the H5N1 strain. Agreeing that no single country can prevent an outbreak, ministers from Belize, Costa Rica, the Dominican Republic, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, and Panama worked toward an integrated plan.

The ministers also sought to keep the public from panicking in light of the potential for havoc the disease represents. "We want to call on the public for calm; no country in the area has avian flu. We have quarantine [facilities] at all our borders and airports," said Alvaro Aguilar, Guatemala's agriculture minister.

Having spread now from Asia to Eastern Europe and beyond, the disease produced by H5N1 easily qualifies as a pandemic. It has evolved by mutation the capability to jump from birds to humans, and, when it does, it kills 50% of the people it infects.

The ministers want money. Costa Rica wants money to hire specialists and improve controls. El Salvador's minister wants money to vaccinate birds. "In El Salvador we vaccinate 56 million birds annually and that costs us US$5 million. Now we are budgeting US$60,000 more to enforce inspection in ports, airports, and migratory bird habitats," said Minister Mario Salaverria. He said the possibility that avian flu will be brought to the region by some passing bird is remote, "but we can't ignore it."

Central America has also suspended imports of poultry products from infected areas, and the ministers are projecting a sense of confidence based on prior experience with other diseases. "We have had foot-and-mouth disease [in cattle] in Latin America for some 50 years, and our region has remained free of the disease, thanks to the controls we have," said Costa Rica's Agriculture Minister Rodolfo Coto.

In addition to restricting imports from affected areas, Costa Rica has stepped up scrutiny of importers who lack up-to-date import permits and reinforced its quarantine posts, where birds and poultry products are subjected to rigorous inspections and laboratory testing. On the borders, vehicles transporting poultry are disinfected.

Director of animal health for the Costa Rican Ministry of Agriculture and Cattle Alexis Sandi said, "For several years Costa Rica has been prepared to avoid the effects of avian flu. We have taken all possible biosecurity measures to prevent its entry." And if the disease does come, he added, "our professional teams are ready to attend immediately to any outbreak."

Sandi, like the ministers at the meeting in Guatemala, took care to reassure the public that at present there is no avian flu in the country and said that "investigation, training, and prevention gives us that assurance, and we can affirm that in Costa Rica consumption and handling of poultry products does not represent any risk to human health."

In El Salvador, Oscar Gutierrez, executive director of the Organismo Internacional Regional de Sanidad Agropecuaria (OIRSA), called for doubling border controls. "The border authorities must be alert for any movement of birds and animals that does not seem to pose a risk, like circuses, which bring birds for their presentations."

Gutierrez said he wants quarantine facilities and diagnostic capability on the borders. He said there is a bird-flu strain in the region, but it is much less dangerous than the H5N1. "We believe that in the American area there is a totally different strain, but that eventually it, too, could undergo a mutation," said Gutierrez. "The governments are alert to this situation through epidemiological vigilance and will be able to detect any outbreak."

Gutierrez was referring to a strain that has been making its way north from Colombia, and his words, like those of the others, were meant to reassure the populace.

Amid the protestations of preparedness and calm assurances, Salvadoran officials have said that, in addition to the meeting of agricultural ministers in Guatemala, the avian-flu threat would be taken up at a Nov. 11 international meeting on HIV/AIDS, and a separate commission for pandemic preparedness would be formed with representation from regional Ministries of Agriculture, Governance, and Defense, the Comision Ejecutiva Portuaria Autonoma (CEPA), the Asociacion Nacional de la Empresa Privada (ANEP), and others.

With all the inspection activities at the borders and the vaccination of domestic fowl, it is still the case that birds fly. The Salvadoran Ministry of Environment says 97 species of migratory birds regularly visit El Salvador, 11 kinds of ducks alone.

The pig factor

And there are pigs. Much of the prevention activity is aimed at controlling H5N1, as well as the less aggressive H5, H6, H7, and H9, that would save the aviculture industry, but the real threat is to human life. Epidemiologist Jorge Panameno said that the pig is the agent that can combine pathogens that would infect humans in a way that people could then pass the disease among themselves. "The pig is able to get human and avian flu," he said. "Both viruses can combine within the pig and it can transmit the disease to people who work with pigs on farms, through respiration or secretions." Panameno said he believes it will be the pig, if not in the Americas then in Asia, that will provide the means for the deadly virus to mutate to a form transmissible between humans.

Once that happens, whether by pig or other vector, the region's problem becomes as much economic as epidemiological. In the US, President George W. Bush outlined a plan to deal with such an epidemic in the world's most powerful country, and, even there, estimates are that the costs would be enormous, the logistics daunting. Bush estimated that as many as 1.9 million people in the US would die, that 40% of school-age children would be infected, and that health costs would amount to US$181 billion, not counting disruption to the economy.

Can't look to the US

Bush outlined a US$7.1 billion plan to prepare for an H5N1 pandemic. The plan included ginning up a vaccine industry that could immunize the entire population at a cost of billions but that would take years to implement and US$2.8 billion to initiate. In the meantime, he called for stockpiling scarce anti-flu drugs and available vaccines, and he wants ill-prepared states, some of which are already struggling with deficient budgets, to bear a major portion of the costs.

Bush wants to spend US$1.2 billion on stockpiles just to protect 20 million health workers and other first responders against H5N1 and another billion on the drugs Tamiflu and Relenza to treat about 44 million people. US$251 million would be spent on early warning systems to spot flu strains before they reach the US and US$100 billion for state preparation for delivery of stockpiled medications to populations. US$56 million would be spent on testing wild and domesticated birds.

Bush also wants the Congress to enact legislation protecting drug and vaccine makers from liability if their untested and experimental products kill or injure patients. Buried deep in the plan is a contingency by which troops could be used to keep citizens exposed or infected from leaving blighted areas.

Just one day after Bush's announcement, his plan was being bashed from all sides as being inadequate, too expensive, too risky, etc. If the degree of mobilization of resources necessary to deal with an outbreak of deadly flu is difficult for even the US to muster, then Central America has little chance of duplicating the effort or benefiting from it. [Sources: The Calgary Herald (Canada), 09/04/05; The Edmonton Journal (Canada), 09/06/05; Diario de Hoy (El Salvador), 10/19/05, 10/20/05; Notimex, 10/25/05; BBC News, 10/28/05; Associated Press, 10/29/05; The Washington Post, 11/02/05]
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Publication:NotiCen: Central American & Caribbean Affairs
Date:Nov 3, 2005

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