In comparison to malaria and diarroeal diseases (which together kill over 3 million people every year), bird flu has killed very few people. However, the World Health Organization (WHO) has warned that the H5N1 virus may mutate into a new human flu virus (against which humans have no immunity). The emergence of such a virus would cause a flu pandemic, and kill millions of people around the world. So bird flu needs to be taken seriously.

On 23 March, the Daily Star reported that the UN Resident Coordinator, Louis-Georges Arsenault, has urged the Government of Bangladesh to approve and implement the National Avian Influenza and Human Pandemic Influenza Preparedness & Response Plan (hereafter referred to as "the Plan") which has been prepared with WHO and FAO assistance.

As the Bangladeshi public knows very little about this vitally important document, I will attempt to summarize it and to recommend some urgent actions necessary to its implementation.

The goal of the Plan is clear: "to minimize the risk of human pandemic influenza." The Plan aims to stop the spread of the bird flu virus (by culling or vaccinating poultry in infected areas) before it has a chance to mutate into a new human flu virus.

The Plan primarily involves the Ministry of Fisheries and Livestock, and the Ministry of Health and Family Welfare. Three "periods" of danger to the public are anticipated, each with a different government response.

1. Pre-Pandemic Period: Bird flu primarily infects birds; it will first be seen on poultry farms, backyard poultry, and wild birds before there are any human cases. The Pre-Pandemic period is the period during which bird flu is diagnosed in poultry or wild birds but not in humans. During this period, people own backyard poultry or work with live poultry will be at risk.

During the Pre-Pandemic Period, the Plan focuses on supporting the Ministry of Fisheries and Livestock in stopping the spread of the H5N1 virus among the poultry population. The Directorate of Livestock Services (DLS) will collect samples from farms with high mortality and will have them tested. If testing confirms bird flu in poultry, the DLS will attempt to "stamp out" the outbreak by culling all poultry (including healthy birds) within a wide radius of the infected farm. "Appropriate compensation" will be paid to farmers whose poultry are culled. If outbreaks in poultry continue even after successive attempts at stamping out, the Government will authorize vaccination of poultry to limit the spread of the H5N1 flu virus. During this period the Plan also supports the institutions of the Ministry of Health and Family Welfare in the diagnosis of human cases of bird flu.

2. Pandemic Alert Period: Some humans will eventually become infected through contact with sick poultry. However, the number of human cases will be very few, as the virus cannot easily spread from one human to another. The Pandemic Alert Period starts when the first human infections have been diagnosed. During this period, people who own backyard poultry or work with live poultry will still be the ones at risk.

During the Pandemic Alert Period, the Plan focuses on supporting the Ministry of Health and Family Welfare in diagnosis and treatment of influenza type H5N1 among humans. Specific measures include improving diagnostic facilities, stockpiling antiviral drugs to treat human patients, and stocking "personal protective equipment" so that health care personnel attending patients can be protected from infection.

3. Pandemic Period: In the worst-case scenario, the H5N1 bird flu virus could mutate into a new human flu virus. That would be the beginning of a pandemic. Large numbers of human cases would be diagnosed as the virus would spread between humans (not only from infected poultry to humans). Once the pandemic begins, everyone will be at risk, but most particularly health care personnel and family members of infected people.

During this period, the Plan focuses on minimizing the effect of the pandemic. In fact, there will be little to do other than ensuring the availability of personal protective equipment for health-care workers and ensuring the availability of antiviral drugs for treatment.

It is important to understand that the Pandemic Period is not yet inevitable. The primary goal of the Plan is to stop the spread of the H5N1 virus (by stamping out or by vaccinating) before a pandemic starts.

In order for the Plan to be implemented, the following measures need to be taken immediately.

a. Communication with Poultry Farmers: The Plan assumes that poultry farmers will report mortality to government veterinarians (the DLS). The DLS will test samples from sick birds and cull all poultry in areas infected by the H5N1 virus.

Farmers will only report possible flu outbreaks to the DLS if they are promised compensation for birds which are culled. The Plan acknowledges that "an appropriate compensation package" should be paid to farmers. However, until the details of that package are decided by the DLS and communicated to poultry farmers, it will be impossible to implement the Plan.

Farmers must be informed about the Plan and must be promised fair compensation in return for their cooperation. Otherwise the Plan will fail. This communication effort should start immediately.

b. Increase budget for compensation of farmers: The budget for compensation of farmers in the Plan is only US$300,000 (three lakh dollars) each year. The experience of other countries which have undertaken stamping-out programs illustrates that a more reasonable budget for compensation would be US$ 1 million each year.

Conclusion: The Plan is generally well-thought out. However, to stop bird flu, farmers must be reassured that they can expect compensation in exchange for cooperating with the Plan. More funds also need to be allocated for compensating farmers whose flocks are culled.

Kazi Zahin Hasan is a freelance contributor of The Daily Star.