Lack of Adequate Measures Taken to Address the Threat of Avian Flu: Solutions Available
Note from the Editor: Tom Frieden, former director of the US Centers for Disease Control and Prevention (CDC) from 2009 to 2017, is currently the president and CEO of Resolve to Save Lives and a senior fellow for global health at the Council on Foreign Relations.
We've witnessed the looming threat of H5N1 for over two decades. last summer, Finland successfully halted H5N1's spread from animals to humans, an event that has been overshadowed by other outbreaks. This story, along with several other unreported incidents, are outlined in our latest report titled Outbreaks That Never Occurred.
Finland excelled in three key areas:
Prompt action. Within a day of the initial cases being reported on a mink farm, Finland identified H5N1 in the infected animals, a strain already recognized to be circulating among Finnish birds. Both animal and human health officials collaborated promptly to investigate infections, even testing people potentially at risk on farms with contaminated animals.
In the US, H5N1 has been spreading since at least the end of last year. Even today, we are unaware of the full extent of spread among animals or humans due to inadequate testing and tracking. The ideal approach, the 7-1-7 plan for outbreak detection and response, should serve as our blueprint: 7 days to identify a suspected infectious disease outbreak, 1 day to notify public health authorities to commence an investigation, and 7 days to complete the initial response. This strategy is crucial for halting outbreaks before they escalate. Finland's response adhered to this plan, while the US took around 100 days to do so for H5N1. We need to enhance the relationship between human and animal health and boost animal public health measures.
Trust. Over time, Finnish farmers had built trust in the Finnish Food Authority due to successful programs and launched a surveillance program that enabled rapid reporting of unusual symptoms in their livestock. Farmers were compensated for the value of animals that needed to be culled to halt the disease spread, which increased trust between farmers and the government. This trust will undoubtedly help Finland with its next step: Vaccinating frontline workers against H5N1, making them the first country to do so.
Trust in the US government is low, particularly among rural Americans who are at the forefront of these outbreaks. In May, in an attempt to build trust with the farming community, the US Department of Agriculture introduced financial incentives for farms to help prevent the spread of H5N1 in dairy cattle, covering veterinary expenses for cattle testing positive for H5N1, compensating farms that supplied personal protective equipment to their workers, and paying farm workers to participate in USDA and CDC studies. Perhaps we need to do more to protect our agricultural sector.
Consensus among government agencies. Human health and agriculture officials in Finland worked harmoniously, facilitating a swift, effective response. Joint responses strengthened detection, collaborated with industry groups, and protected workers from infection. Finland swiftly amended legislation to grant its Food Authority the necessary authority to implement effective control measures.
In the US, government agencies have faced challenges due to varying priorities, legal authorities, agility, and politics. Coordination appears to be improving. Specific directives from the government should cater to the unique needs of each community, as national mandates are unlikely to be practical for our vast, diverse country.
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We have much to learn and no time to waste. First, states and national authorities must collaborate. This will necessitate multiple federal agencies – including CDC, USDA, APHIS – and their state counterparts to exchange information openly and immediately with one another and with the public. Second, Congress needs to provide resources to respond to the next pandemic and also for systems, workforce, and infrastructure so that we are prepared to stop new and unknown events before they escalate to epidemics. Third, it is crucial that we expeditiously establish ties with farm owners and workers by responding to their needs and addressing their questions and concerns.
If one country responds effectively to H5N1, that alone is not sufficient. Microbes recognise no borders. Every country – including the US – needs to mount a unified response. My organization's latest report highlights how countries with responsive health systems prevented outbreaks from becoming epidemics through early detection, careful planning, and swift action.
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The US needs to adhere to the 7-1-7 plan for outbreak detection and response, similar to Finland's approach, to identify and contain H5N1 outbreaks more quickly. This strategy could reduce the time it takes to take prompt action and halt outbreaks before they escalate.
Encouraging trust between farmers and the government, like Finland did, could help improve the response to H5N1 outbreaks in the US. Financial incentives for farms and addressing farmers' concerns could build trust and support for prevention measures.
