Avian Influenza Pandemic Will Deepen the Health Crisis in Africa

March 1, 2006

Special for Mshale

With the discovery of the H5N1 (Asian, or “bird” Flu) virus in three northern provinces of Nigeria in February, Africans may face one of the most serious continent-wide threats in recent history. If it spreads beyond Nigeria, the virus – which is expected to destroy food crops (mainly poultry) and reduce productivity – can, coupled with impact of HIV/Aids and rampant Tuberculosis in Africa, destroy families and communities in a way that has not been witnessed in Africa in decades.

Already concerned with the HIV/Aids epidemic and Tuberculosis in Africa, the World Health Organisation (WHO) has warned that the spread of the deadly H5N1 strain of bird flu had the potential to spread across the continent within days of being discovered. In early February instances of the H5N1 virus were discovered in poultry in Nigeria’s Kaduna, Kano and Plateau states, with unconfirmed cases reported in Yobe, Nassarawa, Jigawa and in the Federal Capital Territory.

The immediate impact of the H5N1 virus on Nigerian society is expected to be devastating. In February the Nigerian newspaper, Business Day, published figures which suggested that the country may lose at least 112billion Naira (about US$9bn) if the country’s entire poultry population is wiped out.

Professor Babafunso Sonaiya of the Obafemi Awolowo University told Business Day that Nigeria had an estimated 140 million birds, at least half of which were free-ranging and, therefore, exposed to droppings of migratory birds who may carry the virus. Based on estimates by the Central Bank of Nigeria, the loss of the poultry population could significantly reduce the 2.95% contribution livestock makes to the Nigeria’s Gross Domestic Product (GDP). This immediate impact may be relatively small compared to what it may cost to prevent the spread of the pathogen to the rest of the country if it migrated to humans – given, especially, the impact of HIV/Aids and Tuberculosus on the continent.

The Impact on Africa

Beyond Nigeria the impact of the H5N1 virus, if spread to humans, could cripple or completely destroy local and regional political economies on the continent, and exacerbate the crisis in public health that the HIV/Aids epidemic that continues to spread across Sub-Saharan Africa. While Africa is home to 10% of the world’s population it is, also, where 60% of all HIV cases have been identified. In South Africa, which probably has the highest developed and most sophisticated public health program in Africa, HIV infections grew by 25% between 1990 – 2000 with almost 30 percent of all women who attended antenatal clinics in the country during 2004 testing positive for the disease.

A third element in the public health nightmare is the fact that of the estimated 40 million people living with HIV/AIDS, at least 30% are also suffer from Tuberculosis (TB). In Sub-Saharan Africa the proportion is even higher. The WHO explains that people infected with HIV are five to 10 times more likely to develop TB in a given year than those who are not. According to Dr Bernard Fourie, a scientist with South Africa’s Medical Research Council and former head of its TB research programme, there has been no decline in TB rates in Africa since the late 1980s, a factor which he links to the presence of HIV. The Director of the Stop TB Department of the WHO, Dr Mario Ravaglione explains that “TB … is not only the major killer of HIV-infected people, but a disease that is out of control on the African continent”. Both comments were made to the WHO and were published on the organization’s website.

Possibility of a Pandemic

The impact of an H5N1 Influenza pandemic, which the WHO considers to be virtual certainty, can be lessened with early warning systems in place. In the past influenza pandemics took societies by surprise. Health services had little time to prepare for sudden increases in detections and deaths. While vaccines were available for the 1957 “Asian Influenza” and “Hong Kong influenza” of 1968, both large-scale transnational pandemics, they arrived too late to alter the impact of the virus, resulting in devastating social and economic disruption and large-scale lose of life.

According to the WHO, the H5N1 virus has significant pandemic potential. The H5N1 strain has been monitored by health experts for almost eight years. The strain first infected humans in Hong Kong in 1997 – 18 cases, resulting in six deaths. Since mid-2003, the virus has caused the largest and most severe outbreaks in poultry on record. In December 2003, infections in people exposed to sick birds were identified. Since then, over 100 human cases have been laboratory confirmed in four Asian countries, Cambodia, Indonesia, Thailand, and Viet Nam, and more than half of these people have died. Most cases occurred in previously healthy children and young adults. The virus does not jump easily from birds to humans, nor is it believed to spread readily and sustainably among humans. Should the H5N1 evolve into a form as contagious as normal influenza, a pandemic could begin.

According to the WHO, the world may well be “on the brink of another pandemic”. Given the speed and volume of air travel the virus, once detected in humans in one part of the world, can travel around the world within weeks. Given, also, that most people will have no immunity to the pandemic virus, infection and illness rates are expected to be higher than during seasonal epidemics of normal influenza.

The WHO believe, moreover, that very few countries have the staff, facilities, equipment, and hospital beds needed to cope with large numbers of people. Supplies of vaccines and antiviral drugs, the two most important medical interventions for reducing illness and deaths during a pandemic, are expected to be inadequate in all countries at the start of a pandemic and for many months thereafter. Inadequate supplies of vaccines are of particular concern, as vaccines are considered the first line of defence for protecting populations. On present trends, according to the WHO, many developing countries will have no access to vaccines throughout the duration of a pandemic.

Those most vulnerable to the disease are the poor and the weak; in Africa, poverty and the prevalence of HIV/Aids and Tuberculosis could inflate the WHO’s estimation of as many as seven million deaths world-wide. For now, it seems, most poor countries, especially those in Africa, can only wait and hope for the best.

Ismail Lagardien is an independent writer and scholar. He is currently teaching a course on the Social and Historical Causes of Conflict in Africa at the University of South Carolina.