The new avian influenza virus is not the pride of Taiwan, China; experts urge not to let it take root and spread
Chin Chuan-chun, a professor at the Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, who took part in SARS prevention and control and in recent years has devoted himself to research on dengue fever and influenza, said in an interview with News&Market that our country is facing the strongest epidemic of H5 avian influenza virus in Taiwan's history. The government spent 4.5 billion yuan in compensation for this wave of avian influenza, yet failed to establish a cross-disciplinary and cross-university scientific research team, missing the opportunity to cultivate young talent for avian influenza scientific research and problem-solving.
Next month is the season when migratory birds fly north, and Asia is the world's largest hotbed of avian influenza viruses. "Taiwan has a global responsibility, and we absolutely cannot let a new virus emerge from Taiwan and continue to spread." The following is the second part of the interview with Professor Chin Chuan-chun; to read the previous part, please click here.
Q: How should Taiwan cooperate internationally to carry out regional prevention and control?
The academic community later analyzed the H5 avian influenza virus that circulated in Taiwan last year and found that the virus that first began circulating in Taiwan was very similar to those from South Korea and Japan. That first wave was very much related to wild birds. September to November should be when northern birds fly south, but in April and May southern birds are about to fly north. Therefore I solemnly appeal that we must cooperate with wild bird experts from China, Hong Kong, China, Japan, South Korea, New Zealand, Australia and Southeast Asian countries such as Thailand.
The University of Hong Kong, China's avian influenza surveillance data is second to none in the world. If Taiwan wants to compare viral gene sequences, it should seek out these experts. The U.S. National Institutes of Health subsidized many foreign scholars to do avian influenza surveillance from the very beginning, including the Netherlands, South America, Egypt in Africa and so on. Taiwan also participated in avian influenza surveillance under the U.S. National Institutes of Health; we obtained a four-year project and trained some young talent.
If surveillance is to be strong, international-level experts must be brought in. As soon as Thailand confirmed it had avian influenza, the government brought in international-level experts for meetings, and these experts later all became their advisors. After MERS occurred in South Korea, the academic community wrote to emerging infectious disease experts in all countries, asking them to serve as advisors to that country.
Although Taiwan has held international expert meetings on avian influenza, the most important thing is that surveillance must involve international cooperation. The science and technology advisors of the Executive Yuan and the Ministry of Science and Technology should have an expert advisory group and establish good cooperative relations internationally. The more you bring in scholars of international caliber, the more others know you are intent on solving the problem. An epidemic is not anyone's fault, but we must turn the negative into the positive. We absolutely cannot let the H5 virus become localized and take up long-term residence in Taiwan, nor can we simply think of relying on hot weather to let the epidemic subside.
Q: What information in Taiwan should be made more transparent and public so that the international community can jointly review it?
During the first wave of avian influenza, the gene sequences of those few virus strains from earlier were indeed published, but what everyone worries about is the present, because the virus keeps mutating. The less information is made public, the more nervous everyone becomes. Now newly restocked geese have died again. Is the virus in these dead geese different from before?
The government should publish every month the eight gene segments of the avian influenza viruses isolated from chickens, ducks and geese at poultry farms, especially since some counties and cities or some poultry farms simultaneously harbor two different subtype viruses. This absolutely must be published, because viruses may reassort, and we need to examine all possible combinations of the virus.
There are two important reasons for studying the virus. First, if the virus becomes localized, it will be very difficult to eradicate it by then. Second, avian influenza mutates a lot and quickly, and the virus will undergo genetic reassortment. Which amino acids exactly confer transmissibility? Which amino acids will allow infection of mammals? These can only be known by doing animal experiments such as in ferrets.
Therefore, if the sequences of avian influenza viruses are known to only a few officials and not made public, this obstructs the risk assessment that could be made. The H5N1 avian influenza virus was also understood only through research by many scholars in the Netherlands and the United States, which revealed which few amino acids are related to virus transmission.
For any public health event such as disease or nuclear energy, the most important thing for government officials is to win the people's trust and make all information transparent. Last year all the data on dengue fever in Tainan was open data; the public will educate one another, and this can also help the government achieve rapid prevention and control afterward. Many things cannot only be top-down. Smallpox was eradicated globally entirely through cooperation among experts from various countries. Disease control must be not only top-down but also bottom-up. This is also the professional spirit most emphasized in public health: safeguarding others' health as if it were your own.
There should be an Executive Yuan-level platform incorporating cross-disciplinary talent in epidemiology, statistics and so on
Q: This avian influenza has dealt Taiwan a severe blow. What areas of epidemic prevention can be improved? Is there a more proactive approach to epidemic prevention?
The government spent 4.5 billion yuan in compensation for this wave of avian influenza, but unfortunately no Executive Yuan-level platform was established at the time. During the SARS epidemic, experienced talent from all sides was mobilized. Taiwan had relatively more infectious diseases in the early period, so those with experience are mostly over 50 years old. During SARS in 2003, we immediately became alert to this crisis and at National Taiwan University specifically brought in young professors and students. Besides physicians, there were also talent in infectious disease epidemiology, virology, immunology, occupational health, health policy, statistics and so on. The Ministry of Science and Technology, the academic community and the public health community mobilized very quickly. After SARS, the infectious disease department and public health worked closely together. The people trained in this wave have now risen up, already in their 30s, playing important roles as vanguard troops in cross-national epidemic prevention cooperation around the world.
Avian influenza is even more difficult, because the incubation period is short, the virus mutates quickly and extensively, there are many host species it infects, and waterfowl show no symptoms when first infected, unlike SARS which causes fever. Therefore different experts must be brought in even more. But some veterinarians believe only veterinarians understand it. However, when the epidemic is widespread, it should be cross-disciplinary. In the past, veterinarians mainly focused on testing and vaccines, with more in private practice treating cat and dog diseases, but relatively little research on surveillance, epidemiology, and zoonotic infectious diseases.
There should be research programs for high-risk groups for avian influenza. For example, many people assisted in culling last year, and these frontline epidemic prevention personnel should be continuously monitored for whether they have antibodies to avian influenza virus in their bodies. But now the government wants all research to be done officially, and universities have no chance to cultivate talent, yet official manpower is insufficient. In fact, responsibility zones can be divided, with the government handling some regions and leaving the rest to academia. Human medicine already does this. For example, National Taiwan University and Linkou Chang Gung are responsible for surveillance of human influenza viruses in the north, Taichung Veterans General Hospital in the central region, and National Cheng Kung University and other institutions in the south monitor virus mutations, and they regularly and frankly hold public meetings for discussion.
Some officials always think academia's ideas are too advanced and hold back, but viruses will find their own way to survive. What interests me is cultivating epidemic prevention talent that solves problems. Publishing gene sequences is not for publishing research either; to be honest, such papers cannot be published in any top journal, and in the end you cannot take them to the grave. But Taiwan has a global responsibility, and we absolutely cannot let a new virus emerge from Taiwan.
When a small number of top agricultural officials view problems negatively, they instead lose a great opportunity to listen to many sides, make a comprehensive judgment, and immediately drive the virus to complete eradication. After all, epidemic prevention requires frontline combat and the long-term accumulation of experience from successes and failures, so that during a pandemic the key points of epidemic prevention can immediately be grasped correctly. But in the past there were also many officials, legislators and control yuan members who bravely faced problems, learned humbly, and strove for improvement.
It is suggested that veterinarians could have a veterinary public health license to specifically help poultry or pig farmers with epidemic prevention. Non-veterinarians can also assist together, such as statistical talent for analyzing data and planning prevention and control strategies. I believe the Bureau of Animal and Plant Health Inspection and Quarantine and the Animal Health Research Institute have talent and have made great efforts to control it, but they must still constantly think about where the fish that slip through the net might be and open their minds. If the door is closed, the fire will burn longer and longer and fiercer and fiercer. Epidemics are forever our best teacher.