Media Conference on the Lancet Asia Medical Forum 2006

18 Jan 2006

By Prof K Satku, Director of Medical Services

Venue: Pan Pacific Hotel

Introduction

Over the decades, remarkable advances have been made in the management and control of infectious diseases and today, non-communicable diseases account for the major portion of the global burden of disease.  Nevertheless, the possibility of an infectious disease outbreak or a pandemic immediately evokes fear in us.  In the latter half of the last century, many were lulled into complacency, when, with the discovery of antibiotics and other agents the war against infectious diseases was declared to be effectively at an end. It was suggested that heart diseases and cancer will be the last frontiers in the war against diseases. Although HIV and other emerging or re-emerging infections gave cause for concern, it was SARS that rudely awakened us from this complacency.  SARS gave a new meaning to the word globalization when geographical boundaries melted away and the infection had spread within days to far flung regions of the world.  But even in those dark hours, when little was known of the cause of SARS, it was the use of simple, yet effective public health measures that triumphed.

Pathogenic micro-organisms, such as viruses and bacteria, are amongst the simplest of life forms and were here on earth before humans and I dare say will continue after us. Their short life cycle allows them to continually mutate and adapt to the changing environment far more rapidly than we do. From time to time, mutations in these microbes such as the influenza virus result in the creation of a new strain to which nearly everyone may not have any immunity. In such instances, the new form of the virus has the potential to sweep through the entire world, causing millions of people to fall ill and possibly even die, in what we call a pandemic.

Experts at the World Health Organisation (WHO) and elsewhere believe that the world is now closer to another influenza pandemic than at any time since 1968, when the last of the previous century's three influenza pandemics occurred.

Current Situation on Avian Influenza

The highly pathogenic Avian Influenza A/H5N1 first surfaced as a human disease in Hong Kong in 1997.  The avian influenza outbreak there which affected humans was rapidly contained with excellent public health measures which removed the source of infection. The virus appeared to have receded until its recent re-emergence in 2003.

The current outbreak of Avian Influenza A/H5N1 was first reported in poultry in South Korea in December 2003. Subsequently, outbreaks were confirmed in an additional seven Asian countries. The virus has already spread westwards to Russia, Kazakhstan, Turkey and Romania.

In many of these countries bird-to-human transmission has taken place. As of Jan 14, 2006, WHO reports a total of 148 confirmed human cases of avian influenza A H5N1. It is expected that more human cases may be confirmed in the current outbreak in Turkey as the investigations continue.

Avian Influenza A/H5N1 virus is now entrenched in Asia. The risk of further human cases appearing will persist as countries in the region have a large number of backyard farms, where domestic poultry are in close contact with wild birds and humans. This presents many opportunities for disease transmission and fresh outbreaks in both poultry and humans.  It is likely that it will take a long time for the virus to be eradicated from the region, notwithstanding efforts by countries to cull and vaccinate their poultry populations.

Concerns on the Avian Influenza Situation

The risk of a pandemic

While no one can predict when or if the avian influenza virus would spark off the next influenza pandemic, we cannot afford to ignore the warning signs. Indeed, all the pre-requisites for a pandemic have been met except for the establishment of efficient human-to-human transmission. Human cases are continuing to occur, and the virus has expanded its geographical range to include new countries, thus increasing the size of the population at risk.

Public health challenges in Asia

Most affected countries in Asia are developing countries and are resource-constrained. They face significant challenges to strengthen disease surveillance systems, health and veterinary systems and also laboratory capabilities and capacities. Most importantly, they face huge challenges in reaching out to their large rural populations, many of whom depend on their poultry flocks for food and for their livelihood. A general lack of awareness perpetuates high-risk behaviours, including unprotected close contact, home-slaughter and consumption of diseased birds.

This is where the greatest impact can be made in preventing an influenza pandemic from occurring. To succeed, countries must actively involve their people in disease prevention. People value their health and their families. They do not want to become infected with avian influenza if they can help it. Countries must therefore find better ways to equip their people with the necessary knowledge and resources to prevent infection. Access to antivirals, vaccines and other supportive measures will also increase the level of preparedness of countries to a possible influenza pandemic.

Unanswered medical and scientific issues

There are still many unanswered medical and scientific questions concerning human infections of H5N1 avian influenza. Knowing the answers to questions such as what is the extent of mild and asymptomatic H5N1 human infections, optimal treatment regimens and prognostic indicators will help us better predict the extent and severity of a pandemic caused by this virus. There are also issues of development of vaccines, new antivirals and better diagnostic kits which will help us better manage a pandemic when it occurs.

The Lancet Asia Medical Forum

The Lancet Asia Medical Forum "Preparing for Pandemic Influenza: The Avian Dimension And Other Emerging Threats" is a timely event as there is world-wide attention and interest in preparing for the potential influenza pandemic.  The topics covered in the Forum will help address questions on the epidemiology and the science behind the avian influenza virus to provide better understanding of the virus and how the world can deal with it effectively.

The Forum will offer a suitable platform for not only scientists and clinicians, but also policy makers and the industry, so that all stakeholders will be engaged and can respond together and effectively to a potential influenza pandemic.  

On a separate note as the Forum is being held in Asia for the first time, we are delighted that The Lancet has selected Singapore as their conference venue. The Ministry of Health gives its full support to this event.

I have written to my counter-parts in the Asia-Pacific region and have invited them to Singapore to attend this Forum. It provides us an excellent platform and opportunity to discuss and exchange views on our pandemic preparedness. We strongly believe that regional and international collaboration is the way forward to effectively control global emerging and re-emerging infections of public health importance.

I am also pleased to inform that our Minister for Health will grace this event and give an address at the opening ceremony

We have been on the edge for close to two years now. We have invested significant resources in preparing for the pandemic and continue to do so. It has been said by some that the pandemic we anticipate may not materialize in the immediate future. In that optimistic eventuality our efforts would have at least once again restored the appropriate emphasis to infectious diseases and public health in the health care delivery system. I am confident that this will allow us to better deal with any unexpected emerging or re-emerging infectious disease in the future.

Thank you.