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Critics question Health Ministry earmarking $115 million to tackle threat of new bird flu virus   


A woman sells live chickens and ducks in downtown Hanoi on May 8, 2013. An ambitious plan prepared by the Vietnamese Ministry of Health to fight a new strain of bird flu has drawn criticism and warnings that it could lead, again, to a hemorrhage of large sums of money and resources. Photo: AFP

An ambitious plan prepared by the Ministry of Health to fight a new strain of bird flu has drawn criticism and warnings that it could lead, again, to a hemorrhage of large sums of money and resources.

Vietnam is looking to raise a total of around US$115 million to fight the mysterious H7N9 virus that has killed 31 and infected 129 people in neighboring China, the Ministry of Health said at a conference on Monday (May 6).

Of the total $115 million, $79 million would be sourced from international donors and the Vietnamese government contributing the rest, the ministry said.

Vietnam's 2012 annual income per capita is around $1,555.

The planned budget has surprised experts because it dwarfs the $5.5 million proposed by the Agriculture Ministry at the same conference for similar preventive measures, Tuoi Tre (Youth) newspaper reported Tuesday.

While the threat is real, experts are asking if Vietnam is overdoing its response. 

"˜Most lethal'

The Geneva-based World Health Organization (WHO) has described the H7N9 strain as "one of the most lethal" flu viruses. It has caused a deadly outbreak in China and should be taken as a serious threat to world health, experts say.

The number of deaths and infections in China give cause for concern as this already exceeds the number of influenza A (H5N1) cases reported by that country over the last decade, the WHO and the Food Agriculture Organization said in a recent joint statement.

"Genetic analysis of the H7N9 viruses isolated from patients has indicated that the virus contains several genes that make it more adapted to humans than H5N1," the statement said.

Recent pandemic viruses, including the H1N1 "swine flu" of 2009/2010, have been mixtures of mammal and bird flu - hybrids that are likely to be milder because mammalian flu tends to make people less severely ill than bird flu, Reuters reported. Pure bird-flu strains, such as the new H7N9 strain and the H5N1 flu, which has killed about 371 of 622 the people it has infected since 2003, are generally more deadly for people, the newswire said.

Experts say the H7N9, which was unknown in humans until it was identified in sick people in China in March, can circulate in animals without symptoms and has very high fatality in humans.

"It is a "˜stealth influenza'. You can look for it but unless you look very closely you don't know it's there until it kills," said Anton Middelberg, a flu vaccine researcher at the University of Queensland.

"As Vietnam is close to the primary outbreak it is obviously susceptible," Middelberg told Vietweek. 

Tough choice

The WHO has said it has no evidence that the new strain of bird flu is easily transmissible between humans. Experts are still debating if and when to start making a vaccine against the H7N9 virus.

Chinese scientists have confirmed that the H7N9 strain has been transmitted to humans from chickens, Reuters reported. But the WHO has said 40 percent of people infected with H7N9 appear to have had no contact with poultry, it said.

Vietnam's Deputy Health Minister Nguyen Thanh Long has said that before working out the proposed budget, his ministry had consulted international organizations.

The funds are to be used chiefly for importing medical machinery and equipment as well as other activities aimed at increasing awareness of the medical staff and the public, the health ministry said.

Experts in the field say the ministry is caught between a rock and a hard place.

If the pandemic does not occur, it risks irking the public for "squandering" huge amounts of money on medical equipment or importing vaccines.

But at the same time, it cannot afford to ignore the possibility of a pandemic.

"It would be costly if the public and government agencies are relaxed and not prepared," said Nguyen Thuy Anh, team leader for the Vietnam Avian and Human Influenza Project with the World Bank, a major donor to Vietnam. 

The record

The latest flu-fighting plan has drawn skepticism and criticism because of the health ministry's previous record.

In 2010, a government inspection team questioned the ministry's decision to spend hundreds of billions of dong in maintaining a reserve of antiviral drugs to fight the H5N1 bird flu epidemic in 2005-2006.

The team charged that the ministry had failed to carefully oversee the purchasing process and clarify all financial matters related to the plan.

According to the government inspectors, only 91 cases of influenza A (H5N1) were recorded between 2003 and 2005. Despite this, in November 2005, the ministry proposed the reservation of 30 million capsules of Oseltamivir, aka Tamiflu, by June 2006. The inspectors considered maintaining reserves for three million people excessive, given the circumstances.

The findings led to string of denials and legal threats from drug companies. A former health minister was held responsible for the fiasco.

In 2009, other than spending around VND1 trillion to buy medical equipment and machinery to fight the H1N1 "swine flu", the ministry decided only at the last minute not to buy H1N1 vaccines in bulk. A H1N1 epidemic never happened.

Tuoi Tre reported this week that a large part of medical machinery and equipment imported then has stayed idle because they were imported into Vietnam after the outbreak had already happened.

With the H7N9-fighting blueprint, experts are questioning the money earmarked for campaigns aimed at increasing awareness of healthcare personnel and the public.

A Tuoi Tre editorial said Wednesday: "It is already stifling just to look at the communication and advocacy activities in the cards: 7 international conferences, 4 overseas fact-finding trips, 76 national teleconferences, 20 epidemic drills"¦

The editorial asked: "How many of them are really necessary?"

Conscience counts

Despite the H7N9 outbreak being confined to China so far, it requires close collaboration and coordination between the animal and human health sectors to "take early action", said Scott Newman, senior technical coordinator with the Food Agriculture Organization in Vietnam.

"Attention should be focused on implementing surveillance systems that can rapidly detect the virus if it enters Vietnam either through animals or people," Newman told Vietweek.

Independent experts are cautious about assessing the flu-fighting budget proposed by the Vietnamese health ministry as excessive.

"It depends on how robust the systems for managing the money are, and what the strategy is," said Tran Tinh Hien, an expert on infectious diseases with Oxford University's research unit in Vietnam.

Overall, though, the experts say the plan reflects "reactive, short-term thinking."

"Reacting to a situation is only sensible if government also looks for technological or long-term solutions to mitigate the need for subsequent short-term reactive behavior," said Middelberg with the University of Queensland.

"[Vietnam] plans to fight H7N9. But what happens when this changes again?"

Hien, the Oxford expert, said it is not uncommon for Vietnam or any other country to come under scrutiny when they put forth major plans to fight a looming pandemic. Even the WHO raised a lot of hackles when it decided to declare the swine flu a pandemic in 2009, he said.

Only a handful of people are responsible for making such life-or-death decisions, both in global and national contexts, Hien said. He said what such persons can, and should do is to act in good faith.

"The [Vietnamese] health ministry is responsible for protecting public health."

And when it has to act and take a final decision, "it's always the conscience that matters the most."

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