Is bird flu dead and gone?

WEEKENDER | Tue, 08/31/2010 12:38 PM |

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Bird flu is no longer a hot topic in the media. But that does not mean it has flown away.
By Arie Rukmantara

“Bird flu? What bird flu? That was last year, right?”

So spoke my rental car driver, commenting on the purpose of my June visit to Riau’s capital, Pekanbaru.

He did not know that a four-year-old girl had died of the deadly disease a few weeks before my arrival. One of the managing editors of the Riau Post, the province’s leading newspaper, was not aware of the child’s death either.

“I’m almost sure the latest bird flu fatality in Riau was in 2009,” the editor told me.

Risk communication expert Peter Sandman once said that the level of media attention equals the level of public attention. The fewer reports the media publishes on bird flu, the less people notice that it is still around.

In the public mind, bird flu has died down. Nobody pays attention to the once-global threat anymore – not even those who were in charge of controlling it during its outbreak from 2005 to 2009, when Indonesia was ground zero for avian influenza.

When the central government decided to dissolve the national committee on avian influenza control and pandemic preparedness (Komnas FBPI) last year, people assumed the war against H5N1 was over.
And when both the international community and the country’s leaders claim that Indonesia has done well in controlling bird flu, Indonesians have even more reason to dismiss the worry from their minds.

Reality bites. The virulent bug is still around, searching for more hosts and breeding places to multiply, looking for ways to spread more rapidly, infect humans more easily and kill them more quickly – to accomplish the virus’ most outstanding achievement: high morbidity and high mortality.

The death of the Riau toddler serves as a warning for us to remain vigilant.

Yes, it is just one death. But it always starts with one. One is not unimportant, especially this particular one, because so much is still unexplained.

“The risk factor has yet to be found,” says Askardiya R. Patrianov, the head of Riau’s Livestock and Animal Health Office.

“We can’t explain how the girl contracted bird flu,” says Ernawati Balia, head of Communicable Disease Control at the province’s health office.

Local media reported that no poultry living around the girl’s family home tested positive for H5N1. Her family did not keep poultry.

The official reports of both the health and the animal health offices say vets checked everything that could serve as the virus’ host, from chicken droppings to soil, but found nothing related to virus exposure.

“We have to carry out a scientific study to discover the cause,” says Patrianov.

Askardiya believes that studies by animal health experts, virologists or microbiologists will determine the risk factors.

Was it the air she breathed, the water she drank or the environment she lived in? Could the virus have been transmitted via a medium other than poultry? Is it the same virus strain or has it evolved or, to use the experts’ term, “mutated”?

“Those are some of the key questions to be answered,” he adds.

Solving the mystery would perhaps remind people that bird flu is still around.

The H1N1 pandemic – or swine flu, as it is popularly called – killed more than 18,000 people around the world, including many Indonesians, before it was declared over by the World Health Organization in August.

The consequences of the loss of government and public attention to H1N5 could severely affect health, the economy and politics. The less people trust those who are supposed to protect them, the more afraid they will be. And if they don’t trust the government, they won’t follow future government instructions, warns the World Health Organization’s manual on Outbreak Communications.

In this respect, many contend the Riau administration and the central government have failed. The mother of the victim expressed her disappointment with the health system. She even rejects the claim that her daughter had bird flu, because the little girl had never come into direct contact with poultry.

“Joyce never had any contact with birds; she rarely even played outside the house,” the bereaved mother, Emmawati, told the media, a few days after she buried her child.

She claimed that the doctor who treated her child was incompetent.

The peculiarities of human memory

For historians, Indonesia’s amnesia surrounding bird flu comes as no surprise. Very few Indonesians, including the country’s policymakers, ever mention the devastating influenza pandemic of 1918.

It has been deemed the greatest influenza pandemic ever in the history of the human race. The global epidemic killed some 50 million people worldwide, more casualties than during World War I.

Many senior health experts and government officials would be shocked to hear University of Indonesia historians’ finding that the 1918 pandemic might have claimed around 1.5 million lives in the archipelago.

After one year of searching and studying Dutch archives dating back to the 17th century, seven historians from the University of Indonesia’s Department of History published their findings in a free e-book titled Yang Terlupakan: Pandemi Influenza 1918 di Hindia Belanda (The Forgotten: The 1918 Influenza Pandemic in the Dutch East Indies).

“Our findings show that we too suffered the impact of the global influenza pandemic,” says the team’s lead researcher, Prijanto Wibowo.

“But 90 years ago, transportation and people’s migration were not as they are today,” he adds, warning that a future pandemic could be even more devastating.

Prijanto warns that ignoring bird flu will lower people’s awareness, which can contribute to triggering another pandemic: “By forgetting [bird flu], people may forget how to protect themselves.”

Avian influenza is a deadly yet preventable disease. Simple practices, such as routine hand washing, cooking poultry products thoroughly, burning and burying dead or sick fowl, as well as seeking medical attention at the onset of flu-like symptoms, could save lives.

But the challenge has become greater. The fact that very few people are concerned about the Riau toddler’s death shows that, serious though it is, bird flu is no longer a hot topic of discussion.

Several pandemic historians have analyzed the reasons for this phenomenon. US medical historian Alfred W. Crosby claims the incredible impact of the 1918 influenza pandemic failed to scar the people of the United States – and the world – because it was undermined by the headline-grabbing news from World War I.

Once again, political and economic news has shifted the attention of both the public and senior government officials away from the deadly microorganism.

Another reason that Crosby offers is that the pandemic did not take the life of any prominent figures back in 1918, a theory that rings true.

German economist and sociologist Max Weber was perhaps the only leading world figure to fall victim to the pandemic. He died in 1920 after catching what was then known as “Spanish Flu”.
Crosby calls such historical amnesia “peculiarities of human memory”.

Another pandemic history writer, John Farndon, supports Crosby’s argument by quoting philosopher Albert Camus: “A dead man has no substance unless one has seen him dead; a hundred million corpses broadcast through history are no more than a puff of smoke in the imagination.”

Gina Kolata, also a writer on pandemics, has said the fast-pace of medical science helped accelerate our collective memory about the 1918 influenza pandemic. Each new invention in the medical world tends to give people a sense of complacency that health threats such as flu pandemics are no longer a concern.

The introduction and promotion of seasonal flu vaccines in Indonesia has assuaged people’s anxiety over viral pandemics. But these vaccines are earmarked for seasonal influenza caused by low pathogenic virus strains, not the deadly H5N1 or the highly infectious H1N1.

The good news is that our brain works like a data bank: there are never too many things to remember. It can store up to 30 billion bits of information per second. It can save all the lessons learned from the terrible days of the past in facing bird flu. And we would be wise to keep the memory alive and ensure we are not complacent about the existing bird flu threat. It is important to remember that history repeats itself. If we do forget, the consequences could be dire.


Arie Rukmantara is a freelance environmental health writer and a public historian.