Bird flu threat a ‘test of how our response systems work’

The continued and increasing spread of a particular H5N1 variant has health authorities concerned.
 
Labelled a ‘global zoonotic animal pandemic’ by World Health Organization (WHO) Chief Scientist Dr Jeremy Farrar, the virus has so far spread to every continent in the world – except Australia.
 
Having already led to the deaths of millions of poultry, it recently spread to mammals including domestic cattle and goats in the US, and also reached South America and Antarctica for the first time.
 
‘The great concern of course is that … [the] virus now evolves and develops the ability to infect humans, and then critically the ability to go from human to human,’ Dr Farrar said.
 
Sydney GP and AMA NSW President Dr Michael Bonning is also concerned. He told newsGP that Australia must apply lessons from the COVID-19 pandemic in preparing for bird flu’s inevitable arrival, and also highlighted the importance of establishing a Centre for Disease Control (CDC).
 
‘This was primarily an avian bird flu, but then it jumped over to the terrestrial mammals, and that’s a real challenge, because that’s getting closer and closer to us. It’s more likely we’ll see mammalian adaptation,’ Dr Bonning said.
 
‘The situation is a really important test of how our systems are working, the interoperability, and how they’re going to work together.
 
‘We saw really good examples of how we can make that work … going all the way back to H1N1 and particularly during the deadly flu years, we have learnt to work together.
 
‘But then COVID was really the breakout moment for us to learn to work as one country, where we coordinated our response and thought not about the invisible lines on a map, but about where people are and what they need to be safe, and to extend our protection.’
 
According to Dr Bonning, who is also a member of the RACGP Expert Committee – Funding and Health System Reform, Australia should adopt a whole-of-system approach to infectious diseases, including making the interim CDC permanent.  
 
‘We can’t just be relying on advice from overseas,’ he said.
 
‘We need to use general practice as part of our primary surveillance for new types of infections and do that alongside groups in one health space … because what we see and hear about in general practice from our patients is really important.
 
‘We should be focused on surveillance, but the bigger part of this for doctors is about the setup and operation of the Australian CDC, which has been a real priority that GPs can understand, and that they become an integrated part of our disease surveillance environment.’
 
The WHO says there is still no evidence that this H5N1 variant is spreading between humans. But while the risk is ‘relatively low’, there are fears it could have an ‘extraordinarily high’ mortality rate should it eventually make the leap.
 
From 2003 to 1 April this year, the WHO recorded 463 deaths from 889 human cases across 23 countries, marking an estimated case fatality rate of 52%.
 
Alongside disease surveillance across primary industries, veterinary circles, and human and environmental health, Dr Bonning said Australia’s natural sea barrier can also be used to advantage, with all of these factors presenting an opportunity to ‘start to fine tune a response to infectious disease coordinating’ across state, territory and Commonwealth levels.
 
‘We can be mindful of Professor Paul Kelly – interim head of the CDC – mobilising Australia’s response and surveillance so that we actually prepare for a day when [bird flu] becomes something else,’ he said.
 
‘COVID has given us the impetus to really build an Australian CDC which is something that the RACGP and AMA have been calling for, for a very long time, because otherwise primary prevention generally stays in the hands of GPs.’
 
The RACGP has also said GPs should have ‘formal and permanent representation’ in the governance of any future CDC.
 
Meanwhile, Dr Bonning said bird flu’s ability to impact livestock and farming communities means it is important GPs are ‘forewarned and prepared’ as they may be the first point of call, particularly if they have a relationship with farmers and there is no vet in town.
 
And while the threat of bird flu reaching Australia is still being monitored, he reiterates the need to be well prepared to ideally ‘keep it out of the country’ or at least mitigate any impacts it has on livestock and agriculture.
 
‘This fits into the model of trying to prevent problems before they occur,’ he said.
 
‘The active role of the Australian Government has been to coordinate this kind of preventive health care and disease control. As GPs, we can recognise the value of that preventive effort, and we want to support it.
 
‘This is one area where funding into a centralised response to improve prevention and disease control has massive potential but is also an efficient use of healthcare dollars to ensure that our industry and environment stays safe.
 
‘We are much better off if we are just prepared.’
 
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avian influenza bird flu disease surveillance H5N1 pandemic preparedness zoonotic disease