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A big thank-you to the Geneva Meeting

The Meeting on Avian Influenza and Human Pandemic Influenza which was held in Geneva from 7-9 November 2005 was extremely useful on several counts. More than 600 participants from a hundred different countries took part in working out consensus conclusions, which will allow a better coordination of the worldwide management of the crisis started since the new H5N1 'Asia strain' appeared in South East Asia at the end of 2003.

For the first time, four world organisations (WHO, FAO, OIE and the World Bank) agreed to co-organise a meeting of this kind, bringing together the medical and veterinary professions and the international financial community, the meeting being hosted and perfectly organised by the WHO.

The Meeting in Geneva brought together government Delegations comprising doctors, veterinarians and diplomats, representatives of many Regional Organisations including the European Commission and the African Union, and, in addition to the World Bank, the major regional development banks (African, Asian and American Development Banks).

The OIE's first message, and one that our colleagues and partners at the FAO have always wholeheartedly shared, was as follows: the probability of a human pandemic occurring is directly correlated to the quantity of virus type H5 (and even H7) circulating in the world's farmed bird population, wild birds being more resistant to the infection.
The greater the number of farmed birds contaminated by this type of virus, the greater the quantity of virus circulating worldwide and the higher the probability of a human pandemic occurring as a result of virus mutation or reassortment. If on the other hand the number of birds infected by the H5 or H7 avian influenza virus subtypes were to remain at the same level as before the present crisis originating in Asia, the probability of an imminent pandemic would be lower, though it must be said that no scientist on earth has ever been able calculate this probability. Control of the virus in animals worldwide must therefore be one of the priorities in allocating national and global resources. This message was very clearly taken into account.

The second message, also well received by the Meeting, was that the viruses present in birds and potentially capable of evolving into viruses capable of human-to-human transmission by mutation or reassortment are currently circulating (or will circulate) above all in developing countries with neither the appropriate organisational structure nor the resources to set up prevention and control systems for farmed birds.

Developed countries and some transition countries have succeeded in controlling the virus as soon as it occurs in their livestock: Japan , Korea , Malaysia , Kazakhstan , Romania and Turkey , Croatia have so far succeeded in combating the first incursions of the Asian strain on their territory. Yet it must be said that, should the need arise, at least a hundred countries around the world still lack the appropriate veterinary legislation and administrative and financial structures to deal with an infection of this kind without international scientific, technical and financial support. In Vietnam , for example, the virus has broken through all the first lines of d efe nce since the beginning of 2004 and despite the slaughter of tens of millions of birds is now present in virtually all of the country. Several hundred million birds in Vietnam will have to be vaccinated to try to stem this disaster, and external aid will be absolutely essential if this is to be achieved within an acceptable period.
Fortunately, the majority of developing countries are not yet directly affected by the present strain, but the Meeting most opportunely acknowledged that the prevention and control of avian influenza and other emerging diseases of animal origin should be designated an International Public Good. Indeed, failure by a single country could place the entire world in danger, especially in a context of increasing globalisation in the movement of commodities, animals and people. As a result, there is also a globalisation of pathogens. By conquering new territories they encounter previously impossible opportunities for genetic mixing, carrying with it the possibility of their becoming increasingly dangerous for animals and for mankind.

The Meeting therefore emphasised the importance of these new sanitary issues and the urgent need to give unreserved support both to the developing countries currently infected and those that are at risk of becoming infected in the near future, such as those on the African continent, to help them be ready to prevent and control the disease.

However, the Meeting also took into account the third and last priority message on which I and my team laid particular emphasis: the emergency programmes will only be 'a flash in the pan' if we do not learn from the lessons of this crisis and set up sustainable veterinary prevention and control mechanisms throughout the world on behalf of poor countries and in the interests of the international community at large.

We know that 75% of emerging diseases in humans are of animal origin and that 80% of pathogens that could potentially be used for bioterrorism are also derived from animals. We can therefore be certain that from now on crises will repeatedly occur in our globalised world if we do not help the countries included in the emergency aid package evaluated in Geneva to equip themselves with Veterinary Services that comply with the minimum quality standards democratically adopted by all 167 Member Countries of the OIE. These standards deal with good governance and the adoption of the most effective veterinary sanitary policies, optimal legislation and administrative organisation, the role of producers in disease management, transparency, independence, the necessary scientific and technical competencies and the level of human and financial resources needed to implement the appropriate policies.

Good governance is based on a strong Veterinary Service capable of ensuring that the legislation is strictly applied. This will mean abandoning the components of the structural adjustment policies imposed on certain developing countries, which in some cases have reduced the public Veterinary Services to the bare bones and rendered them ineffective.

These standards also enable a country that complies with them to effectively apply two principles that are crucial for preventing and controlling animal diseases: early detection of a emerging or re-emerging disease as soon as it appears—for each minute counts if one is to stop a pathogen spreading—and a rapid response to the incursion by the emergency slaughter of infected or in-contact animals (while applying the OIE standards adopted to prevent unnecessary suffering for animals that have to be slaughtered).

It is both a duty and in their own interests for rich countries to help poor countries set up or re-establish sustainable veterinary systems, based on an effective administration supported by a dense and highly motivated network of private rural veterinarians and by livestock farmers who are well-trained and organised in the sanitary field.

The global cost of such a programme is far lower, for example, than the very high cost of stockpiling antiviral drugs currently being undertaken by the rich countries to prepare for a possible pandemic. Such a pandemic would now undoubtedly have been a much less likely occurrence had these same countries helped the poor countries of Asia at the start of the crisis in 2003, as we and the FAO suggested at the time but to no avail.

The Meeting also raised the thorny issue of communication about sanitary risks. How can we justify the fact that global communication, which for the past two years has been almost entirely concerned with the fear of a pandemic, has completely lost sight of the distress of hundreds of thousands of families in Asia suddenly deprived of their only means of support? How can we avoid the massive fall in the consumption of chicken (up to 50% recently in Italy ), which will lead to the loss of thousands of jobs even before the European Union has suffered a single case?

This subject could not be dealt with in depth in Geneva . It would merit a new international conference of its own to deal with our methods of communication in times of crisis, regardless of whether the issue is influenza or other emerging or re emerging diseases.

Let us not forget that the WHO defines human health as not merely the absence of disease or infirmity but a state of complete physical, mental and social well-being. Thousands of farmers, firms and employees in the poultry industry all over the world are going to disappear pointlessly. Who is going to compensate them for their distress? How long before we can say "never again"?

Bernard Vallat

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