Subject: Re: Bird flu: it's Biden's fault!
latest The Lancet on avian flu

H5N1: international failures and uncomfortable truths
If you ask an infectious diseases specialist whether we
should start worrying about influenza A H5N1, they will
probably tell you that we should always be worrying
about it. An influenza pandemic has long topped the
list of global threats to health, and avian influenza
poses a particularly serious concern. H5N1 has infected
over 800 people since its identification in 1996, with a
mortality rate exceeding 50%. Since 2020, it has become
endemic in bird populations, triggering an unparalleled
animal pandemic, affecting at least 26 mammal species.
There is nothing new in influenza strains evolving, shifting
their epidemiological habits, and causing infections in
people, although human-to-human transmission of
H5N1 is rare. Nonetheless, although developments over
the past 3 months may or may not signal the start of a
global pandemic, they are at the very least a pressing and
unwelcome reminder of the caprices of zoonotic influenza
and our continued collective complacency about it.
An unprecedented outbreak of highly pathogenic
avian influenza A(H5N1), the first documented infection
in dairy cows, was reported on March 25, 2024 in Texas,
Kansas, and New Mexico, raising the potential of cow-to
human transmission. Three confirmed human cases in
the USA, all farm workers, have been reported so far, with
the third person presenting with respiratory symptoms.
Genetic analysis shows that the virus lacks changes that
would make it better adapted to transmit between
people and the risk to human health remains low, but
it did detect adaptation to mammalian hosts. Despite
calls for increased surveillance, the US response has been
slow, with many cases likely going undetected. There
has been resistance from the farming industry around
testing and prevention, driven by a lack of awareness
or understanding around changing practice and fear of
trade restrictions and product loss. The US Department
of Agriculture (USDA) and the US Centers for Disease
Control and Prevention are incentivising dairy producers
to supply personal protective equipment and offer
laundering services for employees, but the USDA has been
accused of being slow in sharing crucial virus sequence
data, complicating our understanding of the outbreak. In
Canada, early warning systems have been implemented
to screen for H5N1 in milk. The UK says it has intensified
its response to the US outbreak, but according to a report
last month, it is not yet testing cows for the virus.
www.thelancet.com Vol 403 June 8, 2024
Action to curb this outbreak is needed urgently,
including improving testing, surveillance, and reporting
of infected animals and food products; vaccinating
animal populations; transparent information sharing;
developing and stockpiling human vaccine; and
promoting protective measures among farm workers.
All countries should build capacities to test, detect, and
report infections, cases, and deaths above expected levels
and share this information. Countries in need of external
assistance to bolster their capacity should receive support.
The need for a robust and coordinated response
to highly pathogenic avian influenza A(H5N1), as
described in a Comment by Kojima and colleagues,
serves to highlight the scale of the failure of countries
to secure an international agreement on the pandemic
accord. The 77th World Health Assembly, which closed
on June 1, was meant to see a finalised draft of an
international instrument on pandemic prevention,
preparedness, and response. As The Lancet has noted,
negotiations have been mired in disagreement and draft
provisions have been unjust and inequitable (although
changes to the International Health Regulations have
been agreed). The process is not over yet—discussions
continue with the hope of securing an agreement by
May, 2025. Until then, the continued absence of a
meaningful and effective accord undermines the ability
to respond appropriately to international health threats,
such as H5N1. Despite COVID-19, most countries are not
prepared for a new pandemic.
Beyond the proximal drivers of outbreaks and potential
interventions though, there is a need to confront
an uncomfortable truth that the US H5N1 outbreak
once again raises. Spillover of zoonoses into human
populations stems ultimately from our ways of life and
how they shape the human–animal interface. Our diets,
our intensive farming practices, our livelihoods, our
behaviours, and our cultures. Our exploitation of the
natural world and our destruction of the environment.
These issues are tractable through interdisciplinary
education, intersectoral collaboration, adequate funding,
and integrated policies. The concept of One Health,
although often acknowledged, is rarely prioritised and
operationalised. The result is a missed opportunity to not
just respond to pandemic threats, but to prevent them
altogether.
n The Lancet