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Avian Flu: The China Perspective

The whole world is on high alert for Avian flu H5N1, as the highly virulent flu virus quickly spreads from Asia to the rest of the globe. China, in particular, is an area of concern.

I had a little bird
Its name was Enza
I opened up the window
and in flew Enza.

In 1918 and 1919, this was the last ditty you might want to hear—and not just on the playground. That year the world saw the loss of over 50 million lives—more than the death toll in World War I. The little "Enza bird," or influenza, also known as the Spanish flu, was the cause of it all.

Eighty years later, this little bird has begun to haunt us again. This time its name is "bird flu," or avian influenza (avian flu). A flu virus identified as H5N1, which has been on scientists’ radar screens since 1997 and particularly since its resurgence in 2003, causes the bird flu. Like the 1918 virus, however, the H5N1 influenza virus is unusually virulent, with the potential to cause a public health catastrophe.

According to the World Health Organization (WHO), the current outbreaks of the highly pathogenic avian influenza, which began in Southeast Asia in mid-2003, are the largest and most severe on record. Despite the death or destruction of an estimated 150 million birds, the virus H5N1 is still considered endemic in many parts of Asia. Starting in mid-2005, Russia, Kazakhstan, Mongolia, Turkey, Romania, Ukraine, and even Columbia in Latin America began to report H5N1 outbreaks in poultry.

In the current outbreak, more than 100 laboratory-confirmed human cases have been reported in six countries: Cambodia, Indonesia, Thailand, Vietnam, Turkey, and China. So far, the disease has manifested only after direct contact with infected poultry or surfaces and objects contaminated by their feces. The real nightmare for health experts, which has yet to come, is when the H5N1 virus mutates into a viral strain that can easily jump from person to person. This could set off a pandemic, potentially killing millions of people without immunity to the new strain.

"Made in China?"

Interestingly, chances are that this little bird—just as your shirt, pants, or your Christmas tree lights—is actually "made in China," according to a "bird flu hunter" based in Hong Kong.

Dr. Guan Yi, an associate professor in the Department of Microbiology at the University of Hong Kong, has specialized in the study of avian flu for years. Through research done in a laboratory at Shantou University in mainland China, Dr. Guan and his team have collected and analyzed more than 100,000 samples from birds throughout the country in the last five years. Dr. Guan said that scientific evidence showed that H5N1, the potent avian virus currently spreading worldwide, probably originated in southern China.{mospagebreak}

"Based on all existing scientific evidence, southern China is the birthplace of this disease. It has been repeatedly exported to other places from this location. The virus found in Eastern Europe is the same as we found at Lake Qinghai in China," Dr. Guan said.

Outside of mainland China, bird flu hit Hong Kong the earliest. In 1997, Hong Kong had the first recorded instance of human infection with H5N1. The virus infected 18 people and killed six of them. In early 2003, the virus caused two infections, with one death, in a Hong Kong family that had traveled to southern China.

Following the 1997 bird flu, Dr. Guan and his colleagues have traced the origin of the H5N1 virus back to a single goose in Guangdong, Hong Kong’s neighboring Chinese province.

This pattern is reminiscent of the 2003 SARS epidemic. It also originated in southern China and then spread to the rest of world, claiming about 800 lives as the result of a cover-up by the Chinese authorities.

"This is a huge tragedy and a bad joke. It is about the helplessness of human beings. Now the key question is, ‘Why? Why it is just from our region?’ This virus (first) occurred in southern China, and, what’s more, it has been around for as long as 10 years! This is something to which we have to give some reconsideration," said Dr. Guan.

Dr. Guan and his team published their scientific results in the prestigious scientific journal Nature, concluding that the genetic markers of the viruses found in the Qinghai outbreak pointed to southern China as the likely source. The publication of Dr. Guan’s findings, however, got him into trouble with the Chinese communist authorities. After the article appeared in print, China’s Ministry of Agriculture criticized Dr. Guan’s conclusions and the quality of his research. The authorities later shut down his laboratory at Shantou University.

Dr. Guan may not be the only one whose efforts to track down the source of bird flu are not welcome by the Chinese authorities.

A Japanese virologist stunned his colleagues at a meeting in Germany in mid-November when he broke the news of a confidential disclosure from a Chinese scientist that 300 people had died from H5N1 bird flu in China. As the head of virology at Tokyo’s National Institute of Infectious Disease, a WHO-collaborating center for bird flu, Dr. Tashiro said that he got his information through a "private channel," an unofficial, unpublished report about China’s H5N1 infection situation regarding humans that noted the deaths of 300 people.

On November 16, 2005, the Chinese Health Department confirmed the first three human cases of bird flu in China; two of the infected died. Among them were a sister and brother in Hunan Province. Back in October, the authorities denied the presence of bird flu, saying only that the sister died of an unknown type of pneumonia. Because her body was cremated immediately, the actual cause of death will never be known. WHO insisted on sending medical personnel to check on the brother, who survived, and finally confirmed that the boy had had H5N1.{mospagebreak}

China has so far reported seven human cases of bird flu: three fatalities in eastern Anhui Province, two recovered cases in central Hunan Province and northeast Liaoning Province, one in the southern Guangxi Zhuang Autonomous Region, and one in the eastern province of Jiangxi. The most recent fatality was reported on December 29, 2005. The infected individual was a 41-year-old factory worker surnamed Zhou in Sanming City, Fujian Province. She showed symptoms of fever and pneumonia on December 6 and was hospitalized two days later. She died on December 21, according to a report released by the Health Ministry.

China’s Special Concerns

As the bird flu continues to spread across the borders of Asian countries to Europe and other parts of the world, fears of an ultimate pandemic are also starting to mount. To cope with such a possible pandemic, governments worldwide are trying to stockpile medicines and vaccines against the flu virus. Apart from these efforts, China is an area of particular concern for other reasons.

In China, domestic flocks are not only a major source of meat but also an important part of farmers’ domestic economy. Every family in the countryside raises domestic fowl and lives in close proximity to its birds. Because 80 percent of its population resides in rural areas, China presents a vast danger zone of opportunity for the avian flu virus to jump to human beings. Once in a human being, the real threat is that the virus could then mutate and acquire, if it ever happens, the ability to be spread from person to person.

To halt the spread of bird flu, the first step is to control the source of infection and break the chain of transmission once it is identified. It is necessary to cull and destroy all the remaining live domestic fowl in the epidemic area as soon as possible. Such a strategy appears to be just a matter of implementation, but in China it can be a daunting task to put into practice.

In most instances, the financial loss and damage to the family economy is too devastating for many low-income farmers to ever overcome, making the farmers usually very reluctant to report any suspected cases of avian flu. Nor is it to the benefit of local officials to insist on such a report because of the negative publicity and possible damage to the local economy. In some instances, those who reveal the presence of the epidemic can even face retaliation and punishment.

According to a report by the Chongqing Morning News on December 4, 2005, and later picked up by many other media outlets, Qiao Songju, a farmer who came from Jiangsu Province and raised geese and ducks in Lianyin Village in Anhui Province, received just such treatment. After learning of a sudden, massive death of geese and the villagers’ plan to transport the geese to other areas for sale, Qiao reported to the Ministry of Agriculture his suspicion that this was an avian flu outbreak. The Ministry confirmed the presence of the H5N1 flu virus and 126,185 fowl were subsequently eliminated. Qiao’s action caused resentment among the local farmers and also angered the local officials. Two days after the epidemic was publicized, the local public security department arrested Qiao on charges of being involved in fraud two years before. At the police station, Qiao was asked: "How much money did you get from the Ministry of Agriculture (as a reward)? Who encouraged you to report? Do you realize the severe losses you’ve caused?" Qiao said that he didn’t get any reward from the Ministry of Agriculture and denied that he had ever committed any crime.{mospagebreak}

In battling the avian flu, the government claims to provide subsidies to compensate for the loss to farmers. But farmers say that they are empty promises. Qiao complained to Agriculture Minster Ja Youlin, "If the government would give us full compensation, there would be no need for me to report." He said that many farmers are unwilling to report any outbreak because the subsidies fall too far short of making up for their losses.

Hu Jia, a famous AIDS activist in China, explains that either the government does not fulfill the promise or, when it does, officials at each level of government skim off a portion of the money, with only a small fraction ending up in the farmer’s hand.

Due to insufficient knowledge about avian flu, farmers usually do not pay much attention to the potential danger of infection in human beings. Farmers rarely bury their infected poultry after it has been destroyed. They either cook and eat it or sell to middlemen who collect the carcasses and then sell them to various restaurants. After special cooking, the difference between a diseased bird and a healthy one is almost indiscernible.

Media Not Transparent

Media transparency is another area of particular concern in China. Asia Times compiled a "Top 12" list of online news items that were blocked in China in 2005. Avian flu is listed as number nine. Asia Times reported that the Chinese media did not confirm the avian flu breakout until after the news was posted on the Internet and widely reported by the media outside of China.

An article entitled "Avian Flu: China Should Confess to the World" in Asia Times on November 21, 2005, revealed that China kept a secret policy on avian flu before 2004. Since 2000, many research groups in China have already been investigating avian flu viruses, including H5N1 and another less virulent virus (H9N2), and vaccines. The article also quoted a report by First Financial Daily on November 11, 2005, that Chinese scientists have isolated three clones of the H5N1 virus in addition to other virus subtypes from sick poultry between 1995 and1999. The results were published in the fourth 2002 issue of Biological Bulletin.

China has also tried to prevent foreign media from visiting the avian flu epidemic area. On February 4, 2004, Reporters Without Borders revealed that Chinese police detained TV reporters from France 2 TV for two hours in a Beijing suburb, alleging that the reporters had videotaped the vaccination process of domestic poultry without permission. In outbreaks of avian flu in other provinces at the end of January, China also prohibited foreign media, including European TV ARD, France 2 TV, and BBC, from visiting those areas.{mospagebreak}

In a commentary article published in First Financial Daily on October 31, 2005, Hu Shuli, the outspoken chief editor of Caijing (Finance, one of the top financial magazines in China), criticized the practice of China’s domestic media reporting on avian flu outbreaks only after the news is well known outside the country. She also complained that local officials had stymied her journalists’ attempts to explore the death of a 12-year-old girl in Hunan Province, the first possible human H5N1 influenza case publicly reported in China.

Scientists have long been mystified by the low number of cases in humans reported in China, which has had such severe bird flu outbreaks in 11 provinces across the country that it recently announced plans to vaccinate 14.2 billion chickens, geese, and ducks. Far smaller countries with less severe bird flu outbreaks have reported many more human cases. Vietnam has reported 91 cases of bird flu in humans, with 41 deaths, whereas China has just recently started to report human cases, with seven cases of infection in humans resulting in three deaths.

In an aired phone interview, a resident of Anhui Province said: "We did not know this at first. A student was sent to a hospital that specialized in respiratory diseases. We were just told that it was pneumonia. The doctor, who said that the student had gotten infected from domestic poultry, could do nothing about this disease. Later I asked, ‘What pneumonia? Isn’t it just bird flu?’ He laughed and said he had to listen to his superiors, listen to his leaders, and follow the official newspaper. I said, ‘Aren’t you the expert?’ He laughed and said it was not convenient for him to say anything. He could say nothing, and if I continued to ask, I would be asking for trouble."

"Quite honestly, some provinces have the virus and they still haven’t announced any outbreak. I can show direct evidence, even though China is still trying very hard to block my research. The government doesn’t do any surveillance studies, but they say there is no outbreak." Dr. Guan told Reuters, "In the eyes of Chinese officials, any honest information about bird flu could be a threat to their jobs." Dr. Guan continued, "The leaders say they are working very hard, because they don’t want to sacrifice their political futures. But for the international community, they have nothing to share. They don’t want to lose their prestige, their power, or their position—like the Health Minister who lost his job in the SARS outbreak. They want to mask things. That’s why they only allow one laboratory to do any work. Then they have only one version, and they can manipulate the figures."

"The outside world has no way of verifying the information," the Hong Kong newspaper Apple Daily commented in an investigative report in November. "The Beijing authorities are imposing a tight blockade on news from the epidemic-affected areas," the newspaper said. "There are now numerous clues indicating that some people are covering up the epidemic situation or are too afraid to make the epidemic situation known to the public."{mospagebreak}

On Thursday, December 29, 2005, China’s Foreign Ministry spokesman Qin Gang pledged at a regular press briefing that China would continue to strengthen its cooperation with the world community to deal with the challenge of bird flu. But Qin still did not respond to WHO’s requests to share more samples of bird flu collected from animal and human cases with the international society, which would help to develop anti-bird flu drugs and vaccines and trace the mutation of the virus.The article is partially based on the script of a TV program "China Today" by Journey to the East.

Xiao Yang is a reporter for Journey to the East, a TV program, and Wei Zou is a correspondent for Chinascope.