Mon, Jan 16, 2006 page4

• In Laos, fighting bird flu may be the problem

  CARRIED AWAY Poorer countries struggle at the best of times with diseases taken for granted elsewhere, and some experts say too much focus on bird flu may just backfire

  • NY TIMES NEWS SERVICE
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  Khamla Sengdavong, the manager of a Laotian state-owned farm, still remembers his horror and dismay when bird flu suddenly killed a quarter of the farm's 2,000 chickens in five days in January 2004.

  "They bled from the nose and the backs of their heads turned purple and then black, and then they died," he said, gesturing with his hands.

  But bird flu seems to have disappeared almost as quickly as it appeared in Laos, and Khamla and others in this impoverished communist country on China's southern border have restocked their coops.

  Not one human case of bird flu was ever confirmed in Laos, and thousands of chickens have been tested in recent months without finding the slightest trace of the disease.

  Despite the apparent disappearance of bird flu here, it has consumed most of the time and attention of Laos' best doctors and veterinarians for the last two years.

  Pressed by UN agencies, the US, the EU and other big donors of foreign aid, top officials at the health and agriculture ministries have set aside previous priorities -- deadly scourges like tetanus, rabies, swine fever and poultry cholera -- to focus on a disease that could someday trigger a global epidemic but poses less of an immediate threat locally.

  As the global effort to combat bird flu has increased, Laos and other poor countries have become the front lines, expected to manage extensive programs to battle bird flu despite struggling to marshal enough doctors and veterinarians against diseases even in the best of times.

  Next week, those pressures will reach a new level when health ministers, leaders of UN agencies and top officials from the World Bank and other lending institutions gather in Beijing to raise as much as US$1.5 billion to fight bird flu.

  Almost nobody questions that a global campaign is needed to stop the disease.

  If the bird flu virus H5N1 evolves to be able to pass easily from person to person in the next few years, it could kill enormous numbers of people.

  But health experts are starting to raise questions about the trade-offs involved in such a huge effort.

  The danger, even some managers of bird flu programs are starting to say, is that donors focus so intently on a single disease that they unintentionally disrupt many other health programs.

  "We could overlook that people could quite literally be dying because of this," said Finn Reske-Nielsen, the top UN official in Laos.

  In separate interviews, Reske-Nielsen and two of Laos' top disease fighters -- Phengta Vongphrachanh, the country's foremost epidemiologist, and Somphanh Chanphengxay, the director of veterinary planning -- said continued routine testing had not yet shown a resurgence here of other diseases despite the preoccupation with bird flu.

  But they and other officials in Laos and at aid agencies elsewhere said participants in the Beijing conference would face a series of hard choices.

  Among the first of those trade-offs will be between short-term programs, useful mostly for fighting bird flu, and longer-term programs that may carry broader health benefits but will do less to stamp out bird flu this winter or next winter.

  The Asian Development Bank, a Manila-based multilateral lending institution like the World Bank, was one of the first organizations to start worrying about the bird flu trade-offs, partly because it has already had to make a hard choice.

  Indu Bhushan, the leader of the bank's bird-flu task force, said that after approving a US$40 million preventive health program in Vietnam last year, the bank decided this winter to turn the effort into a bird-flu project instead, saving time over having to design a program from scratch.

  The redesigned project will still address other communicable diseases, like dengue fever, because it may improve detection.

  But the project will no longer cover noncommunicable diseases like hypertension and diabetes, Bhushan said.

  He noted that the Asian Development Bank was also preparing US$68 million in new grants for bird flu that do not involve taking money away from other programs.

  But he said it would be important at a Beijing conference that donors not redirect large sums previously approved for other programs.

  "While emergency response is great, let's not get carried away here," he said.

  The emerging debate over spending on bird flu closely parallels the debate in the 1990s over whether donor nations were paying so much attention to AIDS in the developing world that they were neglecting diseases like malaria and tuberculosis.

  That debate has helped lead to increased aid for research into tropical diseases, mostly from rich countries and the Bill and Melinda Gates Foundation, a charitable organization.
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