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Avian influenza: Labor's five point regional plan to combat avian influenza.



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AVIAN INFLUNEZA

Labor’s Five Point Regional Plan to Combat Avian Influenza

Kevin Rudd MP

Shadow Minister for Foreign Affairs, Trade and International Security

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Index

Page

1. Background

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2. What is Avian Influenza

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2.1 The Virus 4

2.2 Impact on Humans

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3. Possibility of a Global Pandemic

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4 Foreign Policy, Trade and National Security Implications

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4.1 Regional and International Vaccine Availability 5

4.2 Possible Closure of Borders to People Movement 9

4.3 Implications for the Australian Economy 10

4.4 Implications for the Australian Diaspora 10

4.5 Regional Political Stability

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5 Possible Regional Responses - Conceptualising the Challenge

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5.1 Animal Health/Farming Practices 11

5.2 Surveillance and Early Detection 12

5.3 Vaccination 12

5.4 Research on the Virus 12

5.5 Public Health Preparedness 13

5.6 International, Regional and National Coordination Mechanisms 13

5.7 Public Information Strategy

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6 What are Regional Countries doing?

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6.1 Thailand 14

6.2 Vietnam 14

6.3 Cambodia/Laos PDR 14

6.4 Indonesia 14

6.5 China

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7 What is the International Community doing?

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7.1 WHO 15

7.2 FAO/OIE 17

7.3 ASEAN

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8 What are other Donors doing?

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8.1 United States 18

8.2 United Kingdom

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9 What is the Australian Government doing?

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9.1 AID Program 21

9.2 Animal Health/Farming Practices 23

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9.3 Surveillance and Early Detection 23

9.4 Vaccination 24

9.5 Scientific Research on the Virus 24

9.6 Public Health Preparedness

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10 Labor’s Policy to date

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11 Labor’s Five Point Regional Plan to Combat Avian Influenza

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11.1 Regional Ministerial Forum on Avian Influenza 27

11.2 Establishment of Community Level Surveillance Networks 27

11.3 Diagnostics Assistance: Expanded Role for CSIRO 28

11.4 Regional Compensation Fund 28

11.5 Agreements with Host Countries for Australians Abroad

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12 Cost

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Although at the time of publication, Labor made all reasonable efforts to verify the information cited in this document, given the resource constraints facing the Opposition, Labor is unable to provide an absolute guarantee that it is free from errors, inaccuracies or omissions. Labor expressly disclaims liability for any errors, inaccuracies or omissions or any actions taken in reliance thereon.

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Background

Since March 2005 Labor has been calling on Foreign Minister Downer to develop a comprehensive regional strategy to deal with the emerging threat of Avian Influenza. This was outlined in a speech in Parliament by the Shadow Foreign Minister on 8 March.

Prior to that, the Foreign Minister made a number of complacent remarks about the likelihood of Avian Influenza’s impact on Australia and the limits on what Australia would do on a regional basis to assist neighbouring countries in dealing with the threat within their own borders.

Partly as a result of Opposition pressure, but also as a result of increasing awareness within the Australian community of the potential impact of the AI threat within the region on Australia’s own national interests, the Foreign Minister in recent months has begun to correct his position - announcing further modest increases in Australia’s overseas aid allocations to combating internationally communicable diseases (including AI); as well as announcing on 28 August (in response to Labor’s call) that the Government would seek to have AI placed on the agenda of this year’s APEC and East Asian Summits.

The question arises as to what additional regional policy measures may be necessary now to reduce the AI threat to Australia’s national interests as well as what additional measures may be necessary to assist regional countries in their own right (and in the pursuit of their own national interests) to deal with the AI threat given current local resource constraints.

A global Avian Influenza pandemic would have significant foreign policy, trade policy and national security implications for Australia. This information submission addresses some of those implications.

This submission does not canvass Australia’s domestic preparedness as Julia Gillard will be bringing forward a submission on this.

Furthermore, this submission will be the first of a number of reports to Shadow Cabinet and caucus as more information on the Avian Influenza threat emerges and regional policy responses are required.

2. What is Avian Influenza?

2.1 The Virus

Avian influenza viruses are infectious diseases circulating among birds worldwide which are caused by various strains of the type A influenza virus, one of the three types of ‘flu’ virus, A, B and C.

Type A viruses occur in a variety of animals. As wild birds (particularly waterfowl) are the main host for all sub-types of A viruses, they are believed to be the source of type A flu viruses in all other animals.

Usually, the wild birds that are host to the virus do not get sick, but they can spread influenza to other birds. Infection with certain avian influenza A viruses (for example, some H5 and H7 strains) can cause widespread disease and death among some species of domesticated birds.

Low pathogenic forms of avian influenza viruses are responsible for most avian influenza outbreaks in poultry. Such outbreaks usually result in either no illness or mild illness (e.g. chickens producing fewer or no eggs), or low levels of mortality.

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But when highly pathogenic avian influenza viruses cause outbreaks, between 90% and 100% of poultry can die from infection. In early 2004, a strain of Highly Pathogenic Avian Influenza (HPAI) known as ‘H5N1’ swept across much of Asia leading to culling of 120 million birds.

Influenza A viruses, normally seen in one species, sometimes can cross over and cause illness in another species, for example avian flu has been found in pigs.

2.2 Impact on Humans

The first documented infection of humans with an avian influenza virus occurred in Hong Kong in 1997, when the H5N1 strain caused severe respiratory disease in 18 humans, of whom 6 died. The infection of humans coincided with an epidemic of highly pathogenic avian influenza, caused by the same strain, in Hong Kong’s poultry population.

Extensive investigation of the Hong Kong outbreak determined that close contact with live, infected poultry was the source of human infection. Studies at the genetic level further determined that the virus had jumped directly from birds to humans.

Rapid destruction - within three days - of Hong Kong’s entire poultry population, estimated at around 1.5 million birds, reduced opportunities for further direct transmission to humans. Most influenza experts agree that the prompt culling of Hong Kong’s entire poultry population in 1997 probably averted a

pandemic.

The most recent outbreak of AI began in January 2004. The total number of confirmed human cases of Avian Influenza is 112, and of these, 57 cases have been fatal. A geographic breakdown of the fatalities is: Vietnam - 40, Thailand - 12, Cambodia - 4 and most recently Indonesia - 3.

AI has been found in birds and even pigs in China, North Korea, Russia and Kazakhstan but to date there have been no reports of human cases in those countries.

While there are indications that Avian Flu could be passed between humans, it is yet to be proven conclusively. According to the epidemiologists, there is reason to believe it is possible - and even probable.

3. Possibility of a Global Pandemic

An influenza pandemic occurs when a new strain of influenza virus emerges, spreading around the globe and infecting many people at once. An influenza virus capable of causing a pandemic is one that people have no natural immunity to, can easily spread from person to person, and is capable of causing severe disease in humans.

Influenza pandemics are associated with high morbidity, excess mortality, and social and economic disruption. There have been three such pandemics in the twentieth century: in 1918, 1957, and 1968.

The Spanish Flu killed between 40 to 50 million people worldwide. More US citizens died from Spanish Flu than died in combat in the entire twentieth century. And even in the days before international commercial air travel, as many as 11,500 died in Australia.

The key question is what is the probability of H5N1 developing into a pandemic. On this, there have been a number of alarming projections from a range of international and national public health authorities. What follows is a representative sample.

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3.1 Aileen Plant, Professor of International Health at the Australian Biosecurity Co-operative Research Centre at Curtin University:

"In our worst-case scenario we'd look at really up to 25 per cent of the population being infected,"

"I think some time within the next couple of years we will see a pandemic of flu”.

(16 March 2005, ABC)

3.2 Dr Michael T. Osterholm, PhD, MPH, Director of the University of Minnesota Center for Infectious Disease Research and Policy (CIDRAP):

“there are disquieting signs that the H5N1 virus circulating in Asian poultry flocks could do as much damage to humanity as the "Spanish flu" virus of 1918”

(The New Yorker, 28 February 2005)

3.3 Robert Webster, Chair in Virology at St Jude Children’s Research Hospital, Memphis:

“this is the worst flu virus I have ever seen or worked with or read about ……We have to prepare as if we are going to war - and the public needs to understand that clearly. This virus is playing its role as a natural bioterrorist. The politicians are going to say Chicken Little is at it again. And, if I’m wrong, then thank God. But if it does happen, and I fully expect that it will, there will be no place for any of us to hide. Not in the United States or in Europe or in a bunker somewhere. The virus is a very promiscuous and efficient killer. That much we have known since 1997.”

(The New Yorker, 28 February 2005)

3.4 Dr Julie Gerberding, Head of the US Center for Disease Control and Prevention:

“This is a very ominous situation for the globe……… We are seeing a highly pathogenic strain of influenza virus emerge to an extraordinary proportion………. The reason this is so ominous is because of the evolution of flu. You may see the emergence of a new strain to which the human population has no immunity.”

"I think we can all recognize a similar pattern probably occurred prior to 1918."

(22 February 2005, Address to American Association for the Advancement of Science)

3.5 Tommy Thompson, former US Secretary of the Department of Health and Human Services:

"This is a really huge bomb out there that could adversely impact on the health care of the world."

(The New Yorker, 28 February 2005)

3.6 Shigeru Omi, Regional Director for the Western Pacific Region of the WHO:

“I believe we are closer now to a pandemic than at any time in recent years. There are a number of reasons for this, but the three basic ones are as follows: First, the extent of the current outbreak in poultry is historically unprecedented in terms of its geographical spread and impact. So far, more than 120 million poultry have died or been destroyed. Despite the

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intensified efforts of affected countries, there are indications that the disease may remain entrenched in this part of the world. The second reason for concern is that history has taught us that influenza pandemics occur on a regular cycle, with one appearing every 20 to 30 years. On this basis, the next one is overdue.”

(26 November 2004)

3.7 Furthermore a joint statement on 6 July 2005 by the World Health Organisation/ Food and Agriculture Organization of the United Nations and the World Organisation for Animal Health stated:

“The unprecedented widespread outbreaks of avian influenza in many countries in Asia, and the demonstrated capacity of the avian influenza H5N1 strain to directly infect humans and cause death, have together significantly increased the risk of the emergence of a human influenza pandemic.”

“Without substantial national and international financial and technical support, avian influenza will continue to be a significant public health and animal production issue in many countries in Asia and the risk of a human influenza pandemic occurring will remain.”

4. Foreign Policy, Trade and National Security Implications

Biological Weapons expert Christian Enemark of the ANU’s Strategic and Defence Studies Centre said in January 2005:

“Against a disease based security threat that transcends political borders, international cooperation is vital. The SARS outbreak of 2003 showed that cooperative efforts can contain and defeat a common microbial enemy. Unfortunately some countries in Southeast Asia did not heed that lesson when bird flu emerged soon afterwards.”

“South East Asia deserves assistance and cooperation from countries outside the region, not least because they have an interest in preventing a regional phenomenon from becoming a global disaster.”

“The potential human damage from bird flu is of such magnitude that it transcends economic and health considerations. Rather, this disease deserves to be treated with the utmost seriousness as a threat to national and international security.”

4.1 Regional and International Vaccine Availability

Unless and until Avian influenza mutates to the point that you have airborne human-to-human transmission, it is impossible to definitively develop an effective vaccine. In other words, nothing can really be done on the vaccine front until an infectious pandemic emerges. Scientific advice suggests that researchers would then take at least 12 months to develop a vaccine and to test it and this would rely on the strain not mutating further as it spread around the world. Furthermore, once mutation occurs and an effective vaccine is developed, you then hit capacity constraints in terms of manufacture and distribution.

The World Health Organisation recently issued the following statement on what it describes as the “first steps” towards a human vaccine. This statement also highlights some of the production constraints which exist for the manufacture of influenza vaccines in general - that is for “seasonal” epidemics as opposed to the type of influenza pandemics to which AI could give rise. The statement also points to

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the impact which any switch to the manufacture of a pandemic vaccine would have on the continued capacity to produce vaccines for seasonal epidemics which predictability cause up to 500,000 deaths every year. The full WHO statement is reproduced below.

STATEMENT BY THE WORLD HEALTH ORGANISATION

H5N1 avian influenza - first steps towards development of a human vaccine

12 AUGUST 2005

On 6 August, government scientists at the US National Institute of Allergy and Infectious Diseases announced results from initial clinical trials of a vaccine being developed to protect humans against infection with H5N1 avian influenza. Preliminary data indicate that the experimental vaccine evoked an immune response in a small group of healthy adults.

Although more trials are needed, the new findings reconfirm the feasibility of developing an H5N1-specific vaccine.

H5N1 is presently considered the most likely virus to ignite the next pandemic. The increasing spread and evolution of H5N1 viruses in Asia have brought the world closer to another pandemic than at any time since 1968, when the last of the previous century’s three pandemics began.

Vaccines are the principal medical intervention for protecting individuals against pandemic influenza. If available rapidly and in sufficient quantities, they can reduce the morbidity and mortality that have traditionally made pandemics such socially disruptive as well as deadly events.

However, many problems need to be resolved before vaccines can assume such a role in mitigating the effects of the next pandemic. The most important need is to find vaccine formulations that make the best use of limited antigen supplies.

Antigen is the component of the vaccine that elicits an immune response. The US trial provides important insight into possible vaccine formulations. It used doses that are higher than the amount of virus antigen contained in influenza vaccines produced yearly for normal seasonal epidemics.

Strategies for stretching limited antigen supplies - by adding an adjuvant to the vaccine formulation or injecting the vaccine into the skin rather than into muscle - have been proposed. Adjuvants are chemicals that can be added to the vaccine formulation to boost the immune response, theoretically allowing the use of smaller doses of antigen to achieve an immune response. Such antigen-sparing strategies using adjuvants are currently being tested by several manufacturers, and preliminary results are expected within the next three months.

At present, 90% of production capacity for all influenza vaccines is concentrated in Europe and North America in countries that account for only 10% of the world’s population. Current global manufacturing capacity (estimated at 300 million doses of regular trivalent influenza vaccine per year) is inadequate to meet the expected global needs during a pandemic and cannot be rapidly augmented.

Influenza pandemics are unique infectious disease events that can spread to every country in the world within months, resulting in a high and universal demand for preventive and treatment measures. Pandemics thus throw into sharp relief inequities in global access to vaccines and other medical interventions during an emergency. Based on past experience, countries with local manufacturing capacity are likely to meet domestic demand for vaccines and other critical resources fully before freeing supplies for the export market.

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Because the present total global manufacturing capacity for influenza vaccine is limited, any decision to manufacture a pandemic vaccine in large quantities prior to the start of a pandemic would, of necessity, compromise the capacity to produce vaccines for seasonal influenza. Seasonal epidemics of influenza predictably cause an estimated 250,000 to 500,000 deaths each year. In the current situation, the capacity to respond to seasonal influenza must be balanced against preparations for pandemic influenza. However, once a pandemic has been declared, all manufacturers would stop production of seasonal vaccines and produce only the pandemic vaccine.

WHO has produced advice on a broad range of preparedness measures that can be undertaken by countries, taking into consideration that adequate supplies of vaccine will not be available at the start of a pandemic in any country.

There is also uncertainty about the potential effectiveness of the current range of anti-viral drugs for AI which is currently being manufactured and stockpiled in a number of countries. The debate in the scientific community is whether such anti-virals, taken before infection with an influenza pandemic, would ultimately be effective against the particular strain of the AI-derived virus that generated any such pandemic.

On 24 August WHO announced it was establishing an international stockpile of antiviral drugs for rapid response to be dispatched to people in greatest need at the site of an emerging influenza pandemic. The WHO stockpile is meant to complement national stockpiles and WHO has called on wealthy donor countries to contribute to the stockpile. 1

The policy challenges relevant to international and regional vaccine and anti-viral preparedness for any future pandemic therefore include:

• Effectiveness of existing anti-viral drugs • Time constraints for the development of any effective vaccine specific to the mutation of the influenza virus that finally produces a pandemic • Capacity constraints for the manufacture of anti-virals and vaccines • Vaccine and anti-viral distribution (both national and international); • Price (including implications for developing countries) • Other forms of international medical assistance • The relationship between national health authorities and the WHO (including defined and

properly resourced coordination mechanisms and personnel) • The relationship between national governments at a political level in the coordination of regional and international responses to any pandemic.

4.2 Possible Closure of Borders to People Movement

While Australia has produced a National Pandemic Preparedness Plan, elements of government planning remain confidential. The same is true of countries in the region. Policy challenges in this area are immense, as are the foreign policy and trade implications including:

• How to determine whether and at which point Australia should begin border screening and/or (as an extreme measure) close its borders to international travellers; • Whether any of Australia’s principal tourism and/or education export markets (Japan, China, South Korea, Indonesia and Malaysia) will close their borders; and • How to plan for and where feasible make necessary contingency arrangements to minimise the

overall political, economic and social impact of any decisions to close borders.

1 WHO Press Release, 24 August 2005

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Julia Gillard’s discussions with the Health Minister suggest that the Government is currently taking reasonable measures as part of a rational plan on border controls that starts with appropriate screening and escalates from there in the event of a pandemic unfolding. It will be important to continue to liaise closely with the Government on the details of these plans given the profound public health, trade policy and general economic implications which flow from decisions on heightened border control.

4.3 Implications for the Australian Economy

With or without border closures, global markets are already beginning to factor in significant country risk elements in their medium term economic projections. For example, Citigroup’s Chief Asian Economist has warned that a widespread influenza outbreak in humans could hurt the supply and demand for goods for years after an outbreak and the Chief Equity Strategist for Investment Bank Credit Agricole told the New York Times in April this year that an avian influenza pandemic would lead to:

“regional panic and potentially global panic … there’s no way markets can discount this.”

The policy challenges in this area will include:

• The potential impact on the global airline industry, including major international operators such as QANTAS; • The impact on merchandise trade in goods as new quarantine regimes are imposed (and the impact of any such restrictions on the trade in essential items such as food and medicines). • Claims for compensation and/or subsidisation for affected industries; and • The overall impact on global and Australian economic growth.

4.4 Implications for the Australian Diaspora

There are currently approximately 760,000 Australians living abroad. Of these there are:

• 127,830 Australians residing in Asia overall; including • 45,868 Australians residing in South East Asia.

While a pandemic ultimately respects no geographical boundaries, there is a real policy question arising in terms of how to best support the health and other needs of Australians abroad - through the limited availability of Australian consular offices as well as limitations on the medical advice, travel support and other services they could provide. In addition, it is clear that some countries in which many Australians

reside have limited health services and will therefore have a limited availability of vaccines and anti-virals.

Earlier this year DFAT purchased its own stockpile of the anti-viral drug Tamiflu. DFAT has not made any definitive statement about what this stockpile might be used for. One possible use would be for its own staff and possibly also for consular clients.

4.5 Regional Political Instability

The decisions governments make to protect their citizens such as closing international borders, quarantining international travellers and stockpiling medicines, will also have an impact on their international relations and have the potential to become the source of significant tensions between

states. This maximises the need for global and regional governments to agree now to combat the challenge of any AI pandemic on a cooperative basis.

In addition any rapid spread of the disease and any resultant high mortality rates may lead to economic tensions, public panic and internal political crisis in certain affected countries. For example, Thailand’s

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Prime Minister Thaksin has already come under increased political pressure as a result of his Government’s handling of the AI threat.

The international political dimensions of any AI pandemic have recently been underlined by Peter Cordingley, a spokesman for the World Health Organisation. Cordingley stated on 4 July 2005 that:

“It's still seen by many capital cities in the west as basically a lot of chickens dying and a few peasant farmers, so they think, where is the urgency?...Our reply is, if this develops into an uncontrollable pandemic in a year, it won't be farmers dying in the paddy-fields of Vietnam. People will be dying in Washington, New York, London and Paris.”

"We don't know what the fatalities will be …we can expect it to be very high.”

"There will be enormous economic dislocation. Stock markets will close, international travel and trade will be limited…we can't put a figure on this, but SARS in fact will be dwarfed by a flu pandemic if one happens."

(4 July, BBC)

5. Possible Regional Responses - Conceptualising the Challenge

It is important to categorise the type of regional response to the AI threat that could be most appropriate to minimise the risk of an outbreak and contain its spread and the consequent risk to Australia’s foreign, security and economic interests. The following potential action categories have been drawn from recent scientific and policy literature on Avian Influenza. It is intended to be an indicative rather than exhaustive set of priority areas for international development assistance.

5.1 Animal Health / Farming Practices

5.1.1 Education and reform of high risk farming practices in countries at risk.

Farming practices in many developing countries are a key factor contributing to the emergence and spread of the disease. Improved farming practices such as measures to limit contact between farm animals and wild animals and humans have the capacity to reduce the risk of infection both of farm animals and humans.

5.1.2 Enhanced hygiene and bio-security measures at live animal /wet markets.

Wet markets were identified as the source of the 1997 Hong Kong outbreak and are believed to have played a role in the spread of the disease in Vietnam in 2004.

5.1.3 Regulation of the sale, transport, import, export and slaughter of poultry.

Regulations imposing conditions on the sale, transport, export and slaughter of poultry are one way of improving hygiene and standards both of farms and markets.

5.1.4 Regulation granting Governments power to act to cull in the event of an emergency.

Given the need for rapid response to effectively prevent the spread of the disease, governments need to have in place instruments granting them the power to act - ie to slaughter birds or quarantine farms etc in the event of an emergency.

5.2 Surveillance and Early Detection

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5.2.1 Establishment of community-based surveillance networks.

Given the need for early detection, the development of village or community based networks provide the best and most immediate source of information.

5.2.2 Development of networks between key personnel and agencies internationally with responsibility for veterinary and human health.

Professional veterinary, healthcare and scientific networks can ensure reports of potential outbreaks or changes in the behaviour of the virus are transmitted as quickly as possible.

5.2.3 Compensation funds to provide financial incentives for farmers to report potential outbreaks of the disease.

Farmers require incentives for reporting potential outbreaks to compensate them for the potential financial risks they face if their flocks are culled.

5.2.4 Research and development of rapid diagnostic tests.

The World Health Organisation is currently doing good work in this area. However the system that has been laid out to date is far from comprehensive and requires a much greater injection of resources.

5.3 Vaccination

5.3.1 Research, development and use of vaccine for H5N1 strain in birds.

It is certainly currently possible to develop a vaccine against the current bird flu for use in birds. Such vaccines are currently being trialled in various countries in South East Asia. Results at this stage are unclear.

5.3.2 Research, development and use of vaccine for H5N1 strain in humans.

See section 4.1 above.

5.4 Research on the Virus

5.4.1 Increased research on the virus, in particular how it is spread and how it can be detected.

There is still more that needs to be learned about the disease in order to best respond to an outbreak and to develop a H5N1 specific vaccine.

5.4.2 Development of rapid diagnostic tests.

Rapid diagnostic tests would help contain the spread of the disease.

5.4.3 Improving laboratory capacity in affected countries.

In many affected or at risk countries, laboratory and scientific personnel is lacking. They require facilities, training, mentoring and support from developed countries.

5.4.4 Increased scientific cooperation between developed countries and countries affected.

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5.5 Public Health Preparedness

5.5.1 Improve preparedness of public health care systems generally.

The standard of public health care systems in many affected or at risk countries is very poor. This impacts on the capacity of the health systems to respond effectively to an outbreak and to prevent its further spread.

5.5.2 Education for medical personnel, including in local level village clinics.

Education and training for key medical personnel will be key to identifying a potential outbreak and minimising the risk of the spread of the disease.

5.5.3 Stockpiling protective equipment for medical personnel.

Preventative measures taken by medical personnel, for example the use of masks and gloves could help contain the spread of the disease between patients.

5.5.4 Stockpiling anti-viral medications for use by medical staff and general public.

Mindful of the practical impediments referred to in Section 5.1 above on the production and stockpile of effective anti-virals and/or vaccines, capacity constraints will continue to represent a real problem. Within these constraints, however, appropriate stockpiling of anti-viral medications should continue. Governments will also need to respond now to the manufacturing capacity constraints that currently exist.

5.6 International, Regional and National Coordination Mechanisms

There will need to be a clear-cut definition of precise national, regional and global coordination mechanisms - including the appointment of personnel with responsibility for the coordination of the overall policy effort, together with proper resourcing for the same.

5.7 Public Information Strategy

Much of the above deals with public health information, education and awareness prior to the emergence of any AI pandemic. This task will become more critical in the aftermath of the outbreak of any such pandemic. Because of the possibility of public panic, clearly developed national communications strategies will be necessary to keep the public properly informed on all relevant aspects of the threat as well as response strategies relevant to them.

6. What are Regional Countries doing?

The following synopsis is not exhaustive and is drawn from publicly available information including the relevant government agencies in each country and reports on regional preparedness by the UN Food and Agriculture Organisation (FAO), the World Organisation for Animal Health (OIE) and the World

Health Organisation (WHO).

6.1 Thailand

Since December 2003, Thailand has reported 17 cases of human infection, 12 of which were fatal.

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Since the 2004 outbreaks, control measures introduced include the improvement of the poultry- raising system, the control of poultry movements and the registration of poultry raisers. The Government has provided training for farmers in poultry farming in a closed environment and in the bio-security system. Poultry farms, slaughterhouses, and poultry markets are required to meet hygienic standards. Research studies are being undertaken on the development of vaccinations against the virus and against possible mutations.

The Ministry of Public Health has arranged surveillance and rapid response teams nationwide. Laboratories have been developed to accommodate rapid tests. A bird flu hotline number, 0-2590-3333, now operates around the clock at the Department of Disease Control. Health volunteers have assisted in checking various infected areas for quick operations against the virus.

6.2 Vietnam

Since December 2003, Vietnam has reported 90 cases of human infection, 40 of which were fatal.

Vietnam has established regulatory controls relating to breeding, slaughtering, transporting and trading in animals for food but gaps remain between legislation and enforcement. Plans are also on foot for a mass vaccination program for domestic poultry and the Government is developing plans for a national compensation policy, the restructuring of the poultry industry and has strengthened its veterinary services system. Vietnam has built a new Virus Reference Laboratory to improve diagnostic capacity.

6.3 Cambodia/Laos

Since December 2003, Cambodia has reported 4 cases of human infection, all of which were fatal.

Veterinary services are weak, and challenged by difficult road and communication infrastructure. Both countries require significant assistance in strengthening their veterinary services, laboratory capacity, surveillance, human capacity building, and epidemiology and disease information systems. Cross-border traffic between Cambodia and Viet Nam is known to introduce infected poultry, and border controls need to be further strengthened.

Cambodia’s National Animal Health and Production Investigation Centre has instituted a surveillance program using sentinel villages and wild duck flocks.

6.4 Indonesia

In July 2005, Indonesia reported 3 human deaths as a result of the virus.

The recently completed decentralisation process has fragmented the national-provincial flow of disease information and their control programmes. This institutional constraint hampers effective, rapid alert and response.

Indonesia’s smallholder farming system has made it difficult to apply effective culling and biosecurity measures. This has induced the country to undertake mass vaccination of domestic poultry to control the high-mortality disease in the smallholder farming systems.

The Indonesian Government has admitted that it does not have the funds to comply with the World Health Organisation’s recommendation that it conduct a mass cull of poultry and pigs within a 3 kilometre radius from the outbreak which killed three people on the outskirts of Jakarta. The Indonesian Minister for Agriculture Anton Apriyantono told the Jakarta Post that

“We only culled the infected animals as we don't have the money to carry out a mass cull”

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He explained that the mass cull would have cost Rp 800 billion ($A 107.2 million) but his ministry only had Rp 104 billion ($A 14.3 million) available in contingency funds.

6.5 China

Following the 1997 outbreak of AI in Hong Kong, which killed six, the Government introduced an extensive range of regulatory measures on the production, importation and sale of live birds.

Following recent outbreaks of AI among wild birds, Chinese officials have adopted control measures including culling and vaccination of birds, movement restrictions and the sealing off of affected areas.

7. What is the International Community doing?

7.1 World Health Organisation (WHO)

The WHO has established a global influenza program, to provide global influenza surveillance. The programme has a network of laboratories commissioned to study circulating influenza viruses, collected from around the world, and document changes in the viruses’ genetic make-up. The WHO Global

Influenza Surveillance Network consists of 113 national influenza centres located in 84 countries, and four WHO collaborating centres for influenza reference and research, located in London (England), Atlanta (USA), Melbourne (Australia), and Tokyo (Japan).

WHO has been working with individual governments to develop pandemic preparedness and action plans, it also produces guidelines and policy advice to governments on the handling of the disease and provides training on disease diagnosis and surveillance.

From 4 -6 July the World Health Organisation (WHO), the UN Food and Agriculture Organisation (FAO) and the World Organisation for Animal Health (OIE) held consultations in Kuala Lumpur, Malaysia on “Avian Influenza and Human Health: Risk Reduction Measures in Producing, Marketing and Living with Animals in Asia”.

The consultations led to the development of a multi-point plan designed to reduce the risk of the H5N1 avian influenza virus spreading from poultry to humans. The conference appealed to the international community to come forward with funds to make it work and help stave off the risk of an influenza pandemic. It estimates $250 million will be required.

The relevant extracts from the WHO report are reproduced below.

World Health Organisation

Avian Influenza and Human Health

Sector 1: Industrial integrated system with high level biosecurity and birds/products marketed commercially

Sector 2: Commercial poultry production system with moderate to high biosecurity and birds/products usually marketed commercially

Sector 3: Commercial poultry production system with low to minimal biosecurity and birds/products usually entering live bird markets

Sector 4: Village or backyard production with minimal biosecurity and birds

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consumed locally.

In order to reduce the risk of avian influenza to human health, it is essential to consider the countries according to their current situation.

For countries at most risk there is an urgent need for:

Vaccination

• stamping-out of defined infected flocks to remain the primary measure to control HPAI in case of outbreaks. • implementing vaccination programmes (as part of a multi-element response) in particular in sector 4 farms. • coordinating vaccination programmes with surveillance and monitoring activities for virus

circulation and evaluation of programme efficacy. • vaccination to be carried out with appropriate products, manufactured and quality-controlled to ensure compliance with international standards referred to in the OIE Manual of

Standards for Diagnostic Tests and Vaccines. • sector 4 farmers in areas where HPAI is endemic, to identify sources of suitable expertise and funds. In such circumstances, and given that vaccination of backyard chickens will benefit the wider poultry sector and reduce risks to human health, there is justification for

financial support from governments.

Improving Biosecurity

• upgrading of sector 3 farms through improved biosecurity (e.g., by fencing, netting, species segregation), increased surveillance and banning certain high risk farming practices (e.g., use of contaminated water, recycling of poultry faeces).

However, while the above priority actions are necessary in the less biosecure farms and communities, in all sectors there still remains a need for:

HPAI epidemiology, diagnosis and vaccination measures

• undertaking joint medical/veterinary epidemiological analysis to better understand risk contamination pathways between infected animals and humans. • strengthening veterinary services to improve capacity to implement services including surveillance sampling and analysis. • additional research to be undertaken in areas such as epidemiology, vaccines and rapid

diagnostic tests.

Legislation

• strengthening legislation in key areas of outbreak management as a short-term priority concern. • overcoming the significant gap between legislation and enforcement, particularly in the less developed countries, by strengthening veterinary services, human resources and

infrastructure and by ensuring adequate financial resources are available to authorities to address this important public health function. • ensuring a number of supporting elements must also be in place to enable legislation to be effectively enforced. One very important supporting element in the short term is the

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implementation of incentives such as adequate compensation to support notification and stamping out measures.

Education

• establishing an education strategy is particularly important to reduce the public health risk, especially in sectors 3 and 4. Implementing effective education as a particularly important means of reducing the risk to those producing, marketing and living with poultry, especially in sectors 3 and 4 farms.

Taking action in the wet markets of Asia

• taking action at an appropriate level (national, provincial, local authority or market level) to enhance the biosecurity of the wet markets in Asia in order to reduce their role in the emergence and persistence of avian influenza.

CALL TO ACTION BY COUNTRIES OF THE REGION AND SUPPORT FROM THE INTERNATIONAL COMMUNITY

Countries are urged to take guidance from the findings of the Consultation in developing, modifying and implementing their national avian influenza prevention and control programmes.

As a consequence of the significant public health concern associated with the avian influenza situation in animals there is also an urgent need for more investment in preventing, controlling and eradicating avian influenza disease in Asia. There is an urgent need for assistance from the international community to enable infected countries to put into place vaccination programmes and initiate improved biosecurity in sector 3 and 4 farms. At the same time, there is a need for the long-term sustainability of such programmes from national funds to be addressed.

Without substantial national and international financial and technical support, avian influenza will continue to be a significant public health and animal production issue in many countries in Asia and the risk of a human influenza pandemic occurring will remain.

7.2 UN Food and Agriculture Organisation (FAO)/ World Organisation for Animal Health (OIE)

In May 2004 FAO and OIE signed an agreement to develop an initiative called Global Framework for Progressive Control of Trans-boundary Animal Disease which will serve as a global umbrella for the development of an AI global strategy.

In April 2005 they also launched a Network of Expertise on Avian Influenza (OFFLU) to conduct research on AI flu, provide expertise to the countries and Regional Organisations and improve the collaboration, particularly in the exchange of HPAI virus strains between veterinary and human health research laboratories.

The OIE has a global network of over 150 Reference Laboratories and Collaborating Centres which collect, analyse and disseminate scientific veterinary information.

OIE also collects, analyses and disseminates scientific veterinary information and provides expertise and policy guidelines and advice to national governments on the control of animal disease.

7.3 ASEAN

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ASEAN has a Sectoral Working Group on Livestock that advises on issues related to livestock development and trade. Currently, ASEAN has specifically created an Animal Health Trust Fund to tackle regionally the problem of trans-boundary animal diseases in a long-term sustainable way.2

Following the SARS crisis, ASEAN also formed an ASEAN Expert Group on Communicable Diseases (AEGCD). The group discussed effective ways to contain the spread of the disease, and explored strategies to improve surveillance, treatment and prevention of it. It also held a regional workshop to strengthen laboratory and quality control systems for supporting surveillance and outbreak

investigation.

ASEAN has established ASEAN Disease-Surveillance-Net - a web-based network of information on laboratory capabilities, country experts, training opportunities, surveillance and outbreak reports. The aim of the website is to provide real-time and accurate epidemiological information on the outbreak of infectious diseases in the region.3

The ASEAN +3 Health Ministers meeting on Avian Influenza in December 2004 led to the creation of the ASEAN Task Force on Highly Pathogenic Influenza (HPIA).

The 2005 ASEAN Regional Forum Chairman’s statement referred to AI:

“The Ministers shared their concerns about highly pathogenic avian influenza and recognized its growing threat to both human and animal health as well as to the broader security of the region. The Ministers expressed the importance of conducting robust surveillance and continued, immediate and transparent reporting of avian influenza cases in affected countries to ensure that avian influenza does not become the next influenza pandemic. The Ministers also underscored the importance of developing national pandemic influenza preparedness plans.”

8. What are other Donor Countries doing?

8.1 United States

In January 2004, USAID provided $US250,000 to WHO for the purchase of personal protection equipment for public health workers, hospital staff and those involved in the slaughter of livestock, laboratory equipment to improve the capacity to conduct rapid diagnostic techniques, enhanced surveillance, and increased WHO organizational capacity.

In addition, USAID has provided personal protection equipment to Vietnam, including manual sprayers to assist in decontaminating hospital rooms and equipment, as well as protective clothing, gloves, boot covers, and scrub and tub decontamination sets.

In March 2005, Democrat Senator Barack Obama successfully amended the Foreign Assistance Act to include $25 million in international assistance funds to prevent and control the spread of avian influenza in Asia. The funds have been allocated to:

• Support disease surveillance among humans, laboratories and training on Avian Influenza laboratory and field techniques in Asia;

2 FAO/OIE Global Network Appendix 9 3 http://www.asean-disease-surveillance.net

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• To conduct active case detection of human disease in Cambodia, Laos and Vietnam;

• For detection of animal disease in Burma, China and Indonesia;

• Improve in-country communications to assist these populations to taking steps to prevent infection and disease;

• Provide technical assistance to Vietnam for the safe development of an H5N1 vaccine;

• Establish rapid response teams for Vietnam, Cambodia, and Laos to respond to a crisis by identifying disease and instituting quarantine, isolation and any other control measures that are necessary. These teams will be supplied with materials to be stockpiled in South East Asia, so that they will be equipped with proper personal protective equipment when they conduct case investigations.

The US Departments of Agriculture and Health and Human Services and the U.S. Agency for International Development are providing bilateral technical and epidemiological help to select countries.

In 2004-05 the Department of Health and Human Services provided $US 5.5 million in technical help and grants to the region and the World Health Organization for influenza pandemic preparedness, including emergency support in the form of experts and laboratory reagents from its Centers for Disease Control and Prevention.

The Department of Agriculture, with the Asia-Pacific Economic Cooperation forum, held a symposium on avian influenza response, preparedness, and human health emergency in San Francisco in July 2005. The U.S. Agency for International Development has sent stocks of personal protective equipment to the region to be used if an outbreak begins to spread rapidly.

The US has also strengthened and expanded its own surveillance network in East and South East Asia. Officials from the Department of Health and Human Services have been deployed to the region to work with local researchers, clinicians, and governments.

The US Center for Disease Control and Prevention has also been a key element of the US Government response to the threat of Avian Influenza. The CDC has worked with WHO to investigate outbreaks and provide laboratory diagnostic and training assistance. The CDC has also developed and distributed a detection kit for the current strain of the virus.

8.2 United Kingdom

The UK Department of Health is working with the WHO and, with the US, has provided £500,000 towards enhanced international influenza surveillance in South East Asia. A UK epidemiologist is working in South East Asia with the WHO to help maintain levels of surveillance.

While the UK has published a vast amount of information about its own domestic preparedness and contingency planning, there is very little information about its international assistance activities. This suggests that either the UK’s international assistance has been minimal or details of it are not publicly available.

9. What is the Australian Government doing?

The Government’s efforts have been focused in large part on preparing for an outbreak of the disease in Australia rather than preventing an outbreak in the region or containing its spread.

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In early 2004, Foreign Minister Downer made a number of statements which evidenced a degree of complacency about the potential impact of AI on Australia and on the level of support Australia could provide the region to combat AI.

On 28 January 2004, Downer was asked by Neil Mitchell about the seriousness of the threat to Australia:

MITCHELL: We'd be pretty lucky to avoid it though, wouldn't we; to avoid it entirely?

DOWNER: Well, I'm not a scientist but, I suppose it's conceivable it could come to Australia but I think that's, frankly, a little unlikely and I haven't been advised that there's a real threat that it will come to Australia.

The day before, Downer exhibited a similar level of complacency about what Australia could do to assist the region against any emerging AI threat. In an AM interview on 27 January, Downer said:

27 January 2004, Downer AM Interview

MARK WILLACY: The avian influenza that's hit the Asia Pacific region - the Chinese, are they being straight on this issue? They say they've got no cases at the moment, but are they being straight, given their record on SARS, that was something they denied they had any problem with as well?

ALEXANDER DOWNER: Well, I don't have any information to suggest they're not being, and I think it's quite an interesting question to ask, because the Chinese, as you say, were tardy in how they responded to SARS, and then they realised their mistake, and the Chinese Government became very decisive in responding to SARS.

Now, I think in this broader, on this broader question of avian flu, countries in the region must learn from the SARS experience, and that is 'fess up as soon as you find a case, as quickly as possible, make sure everybody knows about it and deal with it, and deal with it on a regional and cooperative basis.

Now, the Thai Foreign Minister is convening a meeting, a half-day meeting for regional countries affected by the avian flu, and that's good, and I hope there's going to be an effective regional response.

Australia will do what it can, which might not be very much, but we will certainly do what we can to try and help our regional partners address this issue. We have a lot of expertise, so we might be able to help them, but there needs to be a regional effort to combat this problem, otherwise we're going to go back down the path we went down with SARS.

Downer’s relative complacency on AI was reiterated a few weeks later when asked about the spreading of the AI threat to North East Asia:

19 February 2004, Downer, Doorstop

JOURNALIST: Minister how would the bird flu affect the Australian trade with Asia, China, Japan? I understand Japan has two cases so far.

DOWNER: Well it’s obviously got the potential to have - it has had some effect on our chicken trade. We are not importing chickens from a number of countries in the region that have been affected by bird flu or avian flu, but other than that it shouldn’t have any effect, we hope it won’t.

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I just make this point - we hope very much that it won’t have any affect on tourism and business in Asia more generally.

9.1 AID Program

In answers to parliamentary questions, the Government outlined 17 initiatives funded by AusAID to combat Avian Influenza and other emerging zoonotic diseases since 2003.

Total funding is $18.2 million. NB Some of this funding is SARS-related.

It should also be noted that $12 million has been announced by the Government in the period since Labor began publicly arguing the case for an integrated regional response to the AI threat beginning in March 2005.

Year Funding $A Administering Organisation

Country/ies Targeted Activity Description

April 2003

$1.7 million

World Health Organisation: Western Pacific Regional Office

Regional Asia WHO: capacity building to help prevent and control outbreaks of SARS in the Western Pacific region, including provision of additional research expertise as well as the procurement of medical equipment unavailable in China.

May 2003

$500,000 WHO China A further $500,000 was provided for SARS

prevention and control in China through existing bilateral rural health projects.

April 2004

$1 million WHO Global WHO Geneva: strengthening the

operations of the Global Outbreak Alert and Response Network.

April 2004

$500,000 WHO Western Pacific Regional Office

Regional Asia WHO Western Pacific Regional Office: employing experts in epidemiology, animal health, virology, laboratory and public health to address Avian Influenza outbreaks as well as to procure supplies and equipment and to produce training materials.

April 2004

$150,000 WHO South East Asia Regional Office: East Timor, Thailand and

Burma.

WHO South East Asia Regional Office: enabling technical support and the provision of essential supplies to address Avian Influenza, particularly diagnostic kits and personnel protective equipment for East Timor, Thailand and Burma.

April 2004

$350,000 DAFF, CSIRO Animal Health Laboratory Geelong

Regional Asia DAFF, CSIRO Animal Health Laboratory Geelong: responding to the epidemiological and diagnostic needs arising from the Avian Influenza outbreak.

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April 2004

$325,000 WHO Indonesia Indonesia WHO Indonesia office: providing epidemiological and other technical assistance, including antiviral supplies and training.

June 2004

$1 million WHO Indonesia Indonesia WHO Indonesia office: strengthening Indonesia’s surveillance and response capacities for diseases such as Avian Influenza.

July 2004

$650,000 ASEAN Secretariat ASEAN Region ASEAN Secretariat: helping to build capacity to deal with infectious disease outbreaks through the ASEAN-Australia Development Cooperation Program.

April 2005

$200,000 WHO Cambodia Cambodia WHO Cambodia: strengthening Cambodia’s surveillance and response capacities for Avian Influenza.

April 2005

$6 million WHO WPRO, ASEAN Secretariat, DAFF

Regional Asia WHO WPRO, ASEAN Secretariat, DAFF: strengthening the regions ability to identify and respond to outbreaks of emerging and resurging zoonotic diseases.

May 2005

$75,000 DAFF Indonesia, East

Timor and South Pacific

DAFF: providing workshops and training to promote sharing of information, lessons, and advice to help facilitate more efficient and effective responses to Avian Influenza for Indonesia, East Timor and South Pacific participants.

June 2005

$1 million WHO Global WHO Geneva: strengthening WHO’s

Global Outbreak Alert and Response Network and Global Influenza Program

June 2005

$750,000 DoHA Indonesia,

Vietnam and China

DoHA: establishing and managing a regional network of Australian epidemiologists based in Indonesia, Vietnam and China.

June 2005

$3 million WHO Indonesia Indonesia WHO Indonesia: assisting the Indonesian Government to set up rapid response and surveillance teams, to ensure hospitals are ready with trained personnel and equipment and to improve the capacity of both human and veterinary laboratories.

June 2005

$500,000 WHO China China WHO China: strengthening preparedness for potential influenza pandemics and to develop early warning and response capacity to deal with emerging public health threats.

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June 2005

$500,000 WHO and FAO DPR Korea DPRK : $250,000 each to WHO and FAO to help DPRK respond to Avian Influenza

None of these Australian contributions appear to be part of an integrated strategy for dealing with the AI threat. Rather they appear to be a series of one-off announcements.

What follows is our best attempt to categorise Australian Government regional efforts to date within the conceptual framework outlined.

9.2 Animal Health/Farming Practices

It is unclear whether the Australian Government through its aid program has made any efforts to change high risk farming practices, improve bio-security at live animal markets in Asia or assist governments in at-risk countries with improved regulations for the sale, transport, import, export and

slaughter of poultry.

Some of these matters may have been addressed through the $750,000 that was allocated to DAFF in May 2005 to provide workshops and training to “promote sharing of information, lessons, and advice to help facilitate more efficient and effective responses to Avian Influenza for Indonesia, East Timor and South Pacific participants.”

9.3 Surveillance and Early Detection

It seems that a large proportion of the funds allocated to combat AI in the region has been used to enhance surveillance capacity and early detection measures, particularly in Indonesia and to a lesser extent Cambodia and China. It is not clear whether any of the funds have been used to establish community based surveillance networks or programs to provide incentives for farmers to report outbreaks of the disease.

Following are the projects which appear to relate to surveillance and early detection measures:

• April 2004, $1 million to WHO Geneva to strengthen the operation of the Global Outbreak Alert and Response Network.

• April 2004, $350,000 to DAFF and the CSIRO Animal Health Laboratory Geelong to respond to the epidemiological and diagnostic needs arising from the Avian Influenza outbreak.

• April 2004, $325,000 to WHO Indonesia office. Part of the funds was used to provide “epidemiological and other technical assistance”.

• April 2005, $200,000 to WHO Cambodia to strengthen Cambodia’s surveillance and response capacities for AI.

• June 2005, $750,000 to DoHA to establish and manage a regional network of Australian epidemiologists based in Indonesia, Vietnam and China.

• June 2005, $3 million to WHO Indonesia. Part of these funds was used to assist the Indonesian Government to set up rapid response and surveillance teams.

• June 2005, $500,000 to WHO China to strengthen preparedness for potential influenza pandemics and to develop early warning and response capacity to deal with emerging public health threats.

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Some of the Government’s aid funds appear to have been used to provide training to scientific and medical personnel. It is not clear what the Government has done to develop education programs and strategies for farmers, at-risk communities, industry groups or people most at risk of infection or to raise community awareness generally.

Following are the projects which appear to contain an element of education:

• April 2005, $500,000 to WHO Western Pacific Regional Office included production of training materials.

• April 2004, $325,000 to WHO Indonesia included an element of training.

• May 2005, 750,000 to DAFF to provide workshops and training to participants from Indonesia, East Timor and South Pacific.

• June 2005, $3 million to WHO Indonesia appears to include an element of training for medical and laboratory personnel.

9.4 Vaccination

The CSIRO has been involved in the development of an H5N1 vaccine.The World Health Organisation (WHO) Collaborating Centre for Reference and Research on Influenza in Melbourne has been involved in the development of seasonal influenza vaccines for the Southern Hemisphere.

The Australian Government has signed agreements with two pharmaceutical companies, CSL Ltd and Sanofi Pasteur Pty Limited, to supply the normal seasonal influenza vaccine for the next three influenza seasons (2005-08) as well as pandemic vaccine production capacity. These companies have the capability to produce pandemic vaccine if given a seed virus and will close down normal operations to do this for Australia.

9.5 Scientific Research on the Virus

In the 2005-06 budget the Government announced $23.2 million over four years for the WHO Collaborative Centre for Reference and Research on Influenza in Melbourne.

The Centre, one of four worldwide, is the main source of flu expertise in Australia and provides advice to WHO on influenza activity and trends in the Southern Hemisphere, including recommending strains for inclusion in the annual Southern Hemisphere seasonal flu vaccines.

9.6 Public Health Preparedness

It appears that part of the Government’s funding has been spent on improving public health preparedness including education for medical personnel, stockpiling protective equipment and anti-viral medication.

• April 2005, $500,000 to WHO Western Pacific Regional Office included procurement of supplies and equipment.

• April 2004, $150,000 to WHO South East Asia Regional Office included the provision of essential supplies to address Avian Influenza, particularly diagnostic kits and personnel protective equipment for East Timor, Thailand and Burma.

• April 2004, $325,000 to WHO Indonesia office included purchase of antiviral supplies.

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• June 2005, $3 million to WHO Indonesia appears to include provision of equipment and training to hospitals.

Only 12 per cent of Australia’s 2005-06 Overseas Development Assistance program is spent on health.4

10. Labor’s Policy to date

Labor has made a number of policy statements through media releases and speeches since March this year.

In a Parliamentary speech on 8 March 2005 Labor called for a Comprehensive Regional Strategy on Avian Influenza which would:

• Help Australia identify gaps in regional capacity to deal with a future pandemic; • Target appropriate assistance through AusAID’s annual $1.8 billion aid budget to fill gaps once identified; and • Particular priority in this strategy was placed on capacity constraints among our nearest

neighbours in Indonesia, East Timor and PNG.

On 19 June 2005 Labor expanded this position by calling upon the Government to also take the lead in the establishment of a Global Taskforce aimed at coordinating aid delivery to South East Asia from potential donor states. Labor argued that both a global and regional strategy should focus on the core elements of surveillance, diagnosis and containment and noted that these were not being addressed in a number of South East Asian countries through lack of resources. This followed two visits to the region by the Shadow Foreign Minister - one in March for discussions with foreign policy and national security officials in Thailand, Cambodia and with the ASEAN Secretariat; the second in May with AusAID and Thai Agriculture Ministry officials in Bangkok. Following these visits, Labor also noted publicly that:

• Vietnam had acute resource needs and at a recent OIE Conference had made direct and urgent appeals for all forms of international assistance; and • Cambodia had virtually no functional set of capabilities to deal with the AI challenge.

On 14 July 2005 Labor once again noted the inadequacy of prevention, identification and treatment systems in Vietnam and Cambodia - and then added Laos and Burma to the list. In the context of a comprehensive regional strategy on AI, Labor specifically called on the Government to:

• Establish a regional compensation fund for chicken farmers across South East Asia to provide the financial incentives necessary for farmers to admit to incidents of Avian Influenza; and • Expanded Australian assistance with the provision of appropriate diagnostic laboratory services based on Australia’s already significant scientific and diagnostic capabilities - such as CSIRO’s

Australian Animal Health Laboratory in Geelong.

On 17 July 2005, Labor built on the above by also calling on the Government to place the need for a regional strategy on AI on the agenda of the inaugural East Asian Summit scheduled for Kuala Lumpur in December. Labor called on the Government to take a leadership role for Australia in the preparation of such a detailed strategy.

4 2005-06 Budget Papers, Statement by Minister for Foreign Affairs, 10 May 2005

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Throughout Labor’s public advocacy of regional policy options to deal with the AI threat, Labor has constantly argued that any effective strategy for dealing with the threat cannot simply be met onshore but must be addressed offshore as well. Furthermore, Labor has consistently argued that in dealing with AI, it must be conceived, argued and organised as a matter of not only national health policy but also of foreign policy and national security policy. Because the stakes are so high, Australia’s overall policy response to AI must be driven from the highest levels of the Australian Government if they are to be effective.

11. Labor’s Five Point Regional Plan to Combat Avian Influenza.

The following represents a future framework for Australian regional policy responses to the AI threat in South East Asia.

11.1 Regional Ministerial Forum on Avian Influenza

The first step should be to assess accurately the capabilities and level of preparedness in the region across the various categories of policy-based and program-based response. This requires an audit of current capabilities across the region, including:

• surveillance strategies • diagnostic facilities • public health preparedness • veterinary health preparedness • public education • biosecurity measures and farming practices • regulation • vaccine and anti-viral availability • contingency planning • administrative coordination

The second step should be to identify specifically policy and capability gaps in each regional state.

The third step should be to establish, resource and then war-game the most appropriate regional coordination arrangements to ensure the smoothest possible implementation of an agreed regional strategy - both prior to the emergence of any pandemic and subsequent to any such pandemic unfolding.

The best mechanism for achieving these three objectives would be for Australia, Thailand and the ASEAN Secretariat to convene a Regional Ministerial Forum on Avian Influenza. This forum should be held at foreign ministerial level given the complex interface between the various national agencies involved in preparation for and any response to an AI pandemic. These agencies would include:

• Agriculture Ministries; • Health Ministries; • Quarantine Agencies; • Immigration and Border Control Agencies; • Natural Disaster Management Authorities; • Police and other relevant National Security Agencies; and • Aid Agencies.

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Such a forum should be conducted along the lines of the Bali Ministerial Forums on counter terrorism and people smuggling. A critical additional benefit that such a forum would bring would be to create the inter-agency and cross-border networks, coordination structures and command and control systems necessary to respond effectively to the AI threat. This was one of the critical value-addeds delivered by the Bali Ministerial Forums.

On the question of which countries should be invited to this Regional Ministerial Forum on Avian Influenza, the starting point should be the potential participants in the East Asian Summit, namely:

• The ten countries of South East Asia • China

• Japan

• South Korea • India

• Australia • New Zealand

Other countries (such as Russia, Bangladesh, East Timor and PNG) should also be invited as should potential donor states such as the EU, the US and Canada.

There is great urgency about this. This Regional Forum should be convened by early October at the latest - as a necessary precursor to further work at the subsequent APEC and East Asian Summits.

11.2 Establishment of Community Level Surveillance Networks

Given the recent studies on the importance of early detection in preventing the spread of the disease into a pandemic, one possible area for technical assistance would the development of village level surveillance systems which would involve providing means of communication ie through the use of prepaid mobile phones, radios or internet access to one key person per village who would be responsible for monitoring and reporting the health of both the animals and people in the village. This

sort of network would obviously have uses beyond the detection of avian flu. UNICEF runs a similar program which is designed to combat high mother and infant mortality rates.

11.3 Diagnostics Assistance: Expanded Role for the Australian Animal Health Laboratory at Geelong

CSIRO, through the agency of the Australian Animal Health Laboratory should, in consultation with the ASEAN Secretariat and other donor governments such as Japan, offer to provide a joint coordinating function across the region on the provision of adequate diagnostic services to establish as early as possible the incidence of AI.

Discussions within the region indicate that the provision of local diagnostic services is inadequate, uneven and in some cases non-existent. Early diagnosis is critical to an overall containment strategy.

The AAHL is one of the most sophisticated laboratories in the world in the safe handling and treatment of animal diseases. The laboratory is an OIE reference laboratory for Avian Influenza and other emerging animal diseases. Labor was informed in Bangkok by Thai officials that they placed great store in the capabilities present in the AAHL and would greatly appreciate further assistance from them.

The AAHL has an ongoing research program in new diagnostic tests, vaccines and therapeutics. It also provides accurate and timely diagnostic tests critical to the success of any eradication campaign.

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The CSIRO has the added advantage of being an Australian Government agency and therefore has an easy line of interface with the Australian Government.

11.4 Regional Compensation Fund

Australia should lead an international donor fund to establish a region-wide compensation fund to assist national governments to properly compensate chicken farmers for the destruction of infected flocks.

Australia cannot ignore the statement made recently by the Indonesian Agriculture Minister that Indonesia did not have the money necessary to carry out a mass cull. It should be noted that he said a mass cull would have cost $A107.2 million but his ministry only had $A14.3 million available in contingency funds.

It should also be noted that Hong Kong’s early success in 1997 in containing the AI outbreak of that year is generally attributed to its mass cull of its chicken flocks at that time.

Surveillance, early diagnostic identification of disease outbreaks, containment and targeted flock destruction are critical policy tools in the fight against AI.

An early needs assessment should be undertaken across the region in terms of the possible size of a compensation fund. Australia should then take the lead in building a consensus among donor states to create such a fund. Australia should also then agree on a protocol with the ASEAN Secretariat on the proper governance of such a fund to avoid misuse.

11.5 Agreements with host countries for Australians Abroad

Australia should also begin negotiating appropriate agreements with other countries around the world for the proper provision of medical assistance and other emergency assistance to Australians resident abroad. This is potentially an enormous task. It is likely to take three forms:

• Agreements with national health authorities on the proper provision of medical assistance to Australians in the lead up to or following the outbreak of any AI pandemic; • Agreements with other countries which carry consular responsibilities for resident Australians where Australia itself does not have a resident diplomatic or consular post; • Preliminary agreements with host countries and other national embassies with consular

responsibilities for Australians abroad for the facilitation of emergency travel for distressed Australians to approved destinations.

12 Cost

The cost for the above plan will be met within the existing Australian Overseas Development Assistance Budget for 2005-06, specifically the Humanitarian and Emergency Program. In the Budget the Government boosted its funding for humanitarian and emergency programs by $24.4 million to a total of

$155.4 million in 2005-06.

This program focuses its humanitarian and emergency efforts on the Asia-Pacific region, but retains the ability to respond flexibly, when required, to emergencies further afield. Given its sufficiently broad criteria it would be appropriate to fund the AI initiatives totalling $50 million via this program.