Wanphen Sripirom has struggled for years to scrape a living as a subsistence farmer in Phichit Province, north of Bangkok. Chickens have provided her with a lifeline that has been crucial for survival.
But last week Wanphen had to face a heart-breaking prospect: the slaughter of her brood.
YUSHA
"They're going to be killed tonight," she said.
It was a bitter blow, although the farmer is not alone in the privations she faces. Thousands of others across Asia have already had their livelihoods devastated because their poultry has become infected by H5N1, the bird flu virus.
Tens of thousands of ducks and chickens have been infected and tens of millions have been culled this year in a bid to stop the disease spreading. Economists believe this price tag for China alone has been ?31 billion (US$60.2 billion). The figure for the whole of Southeast Asia is double that.
Health officials are unrepentant, however, for they are desperate to stop the disease spreading -- not just to other poultry but to humans. The farms of Southeast Asia, where humans and animals live beside each other in tiny yards and huts, have become a vast reservoir for the H5N1 virus, and that chills not just local officials but the world's health authorities.
The planet, they believe, is poised on the brink of a new flu pandemic whose source will be the infected farm birds of Thailand, Vietnam and China.
Already 44 confirmed human cases of H5N1 infection have been documented in Thailand and Vietnam (the only countries to report human cases). Of these, 32 have died, a fatality rate of 73 percent. No wonder the World Health Organization (WHO) and other international medical groups have become fixated about Southeast Asian agriculture.
"No man is an island," said John Oxford, professor of virology at Queen Mary Westfield School of Medicine, Lon-don. "It doesn't matter where it starts -- it will be on our doorstep within 12 hours."
"You can't argue that it isn't our problem," he said.
The struggle for survival of Wanphen Sripirom, and the thousands of other Southeast Asian subsistence farmers, is a matter of direct consequence for us all, in other words.
"I noticed the symptoms of the virus in one of my birds one morning and by nightfall 50 had died," Wanphen said. "The following day another 30 died, and then another 30 the following day.
"Their bodies began shaking; it was as if they were suffocating and thick saliva starting coming out of their mouths. We tried to give the hens herbs to make them better, but it made no difference," she said.
`The faces then went dark green and black, and then they died," she said.
Wanphen and her husband, Ban Noensai, were relatively lucky, however. They are still alive. The case of Pranee Thong-chan, in the north province of Kamphaengphet, presents a far more worrying example for health authorities.
Pranee had no contact with poultry but had spent several days looking after her dying daughter Sakuntala. The 11-year-old had become ill after playing with infected hens. Doctors believe she was a bird flu victim, although Sakuntala was cremated before final tests could be carried out.
Then Pranee became ill and was taken to hospital, where she died several days later. Post-mortem tests showed she carried the H5N1 virus. Given Pranee's history and given the facts of her daughter's death, doctors conclude she was one of the first recorded victims of the human-to-human transmission of the H5N1 virus.
The prospect of this being repeated in other cases terrifies doctors, although local officials are still desperately trying to calm the situation.
"From all the evidence that we have learnt, human-to-human transmission is very difficult," affirmed Dr Supanit Chunsuttiwat, who works for Thailand's Department of Disease Control.
WHO officials are not convinced, however. WHO's western Pacific direc-tor, Shigeru Omi, warned regional health ministers this month that there are genuine concerns that the virus could mutate into a form that could spread easily between humans and thus lead to a global pandemic.
"We are talking at least 7 million [deaths], but maybe more -- 10 million, 20 million and the worst case 100 million," he said.
And Shigeru was backed by Henk Bekedam, the Beijing WHO representative.
"This is a very real threat," he said.
A bird flu pandemic could erupt next year or the following one or the one after that, say doctors. No one can be sure when. But what is certain is that a world outbreak is inevitable, given that the region has become such a vast reservoir for H5N1.
Not surprisingly, officials are now desperate to control and ultimately eradicate the virus, although conditions in the region are so chaotic such prospects look slim.
Consider the example of China. It has reported far fewer cases of avian flu than have been highlighted by other countries in Southeast Asia. However, it is impossible to be sure about the extent of cases there because 80 percent of the nation's chickens and ducks are reared in small, remote and poorly regulated farms.
"Good reporting is crucial to deal with this problem," Bekedam said. "But what are the incentives to report? Nil. If farmers tell officials, they risk losing their stocks. And if local officials tell the central government, they face trade bans."
In addition, poorly planned vaccination programs for poultry are making matters worse. Many farmers are buying black-market vaccines that have not been developed for H5N1.
These products keep the birds alive, even if they have the virus, which raises the risks of contagion when they are sold or transported. Farmers have also been sold fake vaccines that served only to make them falsely complacent about the poultry's safety.
The risks of the disease spreading to humans is also compounded by the poor living conditions in much of rural China, where average incomes are less than a quarter of those in the cities, and health insurance is almost non-existent.
Migratory birds also pose the problem of carrying the virus around the region, as do fighting cocks, a huge pastime in Thailand.
"People will go to great lengths to smuggle birds through cordons to get them to a fight," said Priecha Asawa-metha, head of the Phichit provincial livestock office. "It is very difficult to stop."
Containment is clearly going to be extraordinarily difficult, if not impos-sible. So if the disease cannot be managed at source, the world must find ways to deal with an outbreak once it has begun to spread. Anti-viral drugs and vaccines offer the best hopes.
In the former case, one of the most successful anti-flu agents is Tamiflu, also known as oseltamivir. It is manufactured by Roche. It can alleviate victims' symptoms and prevent them from passing the virus to others.
Unfortunately, Roche's factory in Basel has had to double in size this year, and will double again next year simply in an attempt to keep up with demand.
Nevertheless, a serious shortage seem inevitable.
Another treatment, Relenza, which is made by GlaxoSmithKline, is also available but this is difficult to administer.
And despite the grim warning signs from Southeast Asia, it is clear that many countries have not yet stockpiled anti-viral drugs.
The UK, for example, has been in negotiations with Roche for months. Even if Britain buy enough doses only to cover between 10 to 20 percent of its population, that bill will still come to millions of pounds. Yet no virus has actually emerged.
Vaccines, by contrast, will take time to develop. The problem is that, until the strain of H5N1 virus appears in this country, no one can create a vaccine against it, although scientists say that those that provide protection against existing strains could provide partial protection against the new one.
Britain also has a strong network of public health groups and is well placed to implement the plans that it is currently working on for dealing with the emergence of a flu pandemic.
By contrast, the US looks ill-prepared and has bought antivirals to treat only 1 million of its 300 million citizens.
"We're all holding our breath," said Julie Gerberding, head of the Centers for Disease Control and Prevention.
Australia and the Netherlands have stockpiles that meet the demands of around one- third of their populations.
Given the death rates that the WHO is predicting, some of these preparations may seem poor. Oxford counsels caution, however. It is not time for hysteria yet.
"There has never been better monitoring than there is at present. For the first time in history we will watch the emergence of a human virus, step by step, and we now have this window of opportunity to meet that challenge," he said.
Canada, which took such a battering, both economically and morale-wise over the recent SARS epidemic, provides a good example.
It has learnt a great deal over the last year and has produced a pandemic plan. This is a prudent course of action, given that it has a large immigrant population from Southeast Asia and is therefore badly exposed to the threat that bird flu poses.
Among the measures it plans to carry out is the publication of guides for helping people react should an outbreak occur. Measures include ensuring good hand-washing to prevent the spread of germs.
If people fall ill, they should not go to work. If they fall into one of the high-risk categories -- the elderly, the asthmatic, the immuno-suppressed -- they should seek medical attention.
The point is that you cannot totally rely on drugs or the promise of a vaccine to lessen the risk, said Dr Theresa Tam, of the Immunization and Respiratory Infections Division at the Public Health Agency of Canada. Behavior has an enormous effect on the direction of an epidemic. As to identifying who should be the first to get anti-viral treatments, the Canadians have asked a group of ethicists to help them draw up the plans.
As Tam said: "We involved them, because these are not decisions that are purely scientific."
On the other hand, the world has only limited time before that great flu epidemic erupts.
As every scientist, epidemiologist and doctor has said over the past few days, it is not a matter of if H5N1 erupts upon the world; it is simply a matter of when. We have time, but not a great deal, and should make the very most of it while we can. Politicians therefore need to pursue their plans with urgency, as Oxford warned.
"This is the time to act. It's like an insurance policy; you don't wait until you've been burgled before you buy proper cover for your contents," he said.
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