Avian and Pandemic Influenza

UNDER SECRETARY DOBRIANSKY: Well, good morning to all of you. Thank you for coming. Yesterday during his remarks to the High Level Plenary Meeting of the United Nations General Assembly, President Bush announced a new international partnership to address avian and pandemic influenza. And as the President stated, "If left unchallenged, this virus could become the first pandemic of the 21st century. We must not allow that to happen."

The International Partnership on Avian and Pandemic Influenza is a voluntary partnership based on a set of core principles that focus on enhancing preparedness, prevention, response and containment activities. It aims specifically to combat this threat and improve global readiness by undertaking the following types of steps: by elevating this issue on national agendas; coordinating efforts among donor and affected nations; mobilizing and leveraging resources; increasing transparency and surveillance; as well as building capacity to identify, to contain and respond to a pandemic influenza.

Preventing and containing avian flu requires that we take action. For example, from sharing samples to working together on medical countermeasures to building capacity and public health infrastructure in the most affected countries. And we also seek to take advantage of already ongoing work in the health community and identify areas that require greater international focus.

Now, international organizations such as the World Health Organization, the Food and Agriculture Organization, the World Organization for Animal Health as nongovernmental organizations and the private sector are instrumental in our overall ability to address this challenge in people and animals. We and all our partners seek action. So as to implement the core principles in the coming weeks, we plan to hold a senior officials meeting of all partners in Washington, D.C., to identify specific steps to achieve transparency, to improve donor coordination, build capacity and develop containment strategies. Our partners include developed and developing countries as well as of the lower* regions of the world as well as international organizations. And in fact, I'm pleased that a number of these partners could join today, including representatives from Argentina, Australia, Canada, Japan, Russia, Malaysia, Singapore, the United Kingdom (inaudible) as well as international organizations as the Food and Agriculture Organization and the World Health Organization.

I also want to recognize, it's a pleasure to have Ann Veneman, who is UNICEF's Executive Director, with us today in her current role. She is tireless in her efforts to improve children's health worldwide among her other goals. And as a former Secretary of Agriculture, she knows a great deal about these issues. We look forward to working with all of you.

I also am very pleased to be joined today by the Director General for the World Health Organization, Dr. Lee, whose leadership on these issues is critical to our efforts to protect the lives of people worldwide. And I'd like to turn the podium over to Dr. Lee to say a few words at this time.

DR. LEE: Well, thank you, Secretary Dobriansky. Well, human influenza pandemic is coming. We know that. And no government, no leader, can afford to be caught off guard. If we take measures now, we can stop, we can contain or slow the spread of this pandemic and save millions of lives. We must pounce on human flu outbreak, the pandemic outbreak, with all measures under our disposal at the earliest possible moment. Every country must act now. When the pandemics start, it will be simply too late. We can only do this with a broad and inclusive partnership. No one country and/or agency can do it alone. I applaud and support the leadership of President Bush for initiating the International Partnership for Avian and Pandemic Influenza. Years from now, those of us here will be able to say that we were present at the moment when nations joined together to stop pandemic influenza and saved millions of lives.

Thank you.

UNDER SECRETARY DOBRIANSKY: I'd like to suggest before we open it up for Q&A, I'd like to just ask two of our partners to also say some additional words. I'd like to recognize David Malone, who is the Assistant Deputy Minister for Global Affairs in Canada's Ministry of Foreign Affairs, to make a few remarks. David.

MR. MALONE: Thank you very much, Paula. Well, this U.S. initiative, the partnership that you've pulled together, is a very important step in addressing the risk of an avian flu pandemic. We're strongly in support of it. In fact, it's in the nature of global challenge that countries have to work together. None of us alone can solve global environmental challenges, energy challenges and so on. And I must say, Paula, you've done a great job at reaching out to partners throughout the world, particularly on this one.

It's also very important that we have Dr. Lee with us today and that we bear the Food and Agriculture Organization very much in mind. Obviously, animal health is nearly as relevant to this issue as is human health; one, in effect, will derive from another. And it's very good to have Ms. Veneman with us today too because UNICEF is tireless at meeting crises.

Canada has recent experience of a pandemic. We experienced SARS a couple of years ago. It was a tremendous shock to the country. It was a wakeup call on the salience of pandemics and it developed some experience in Canada with how to address these problems, particularly on the need to address them preventively.

For that reason and in partnership with others, Canada's Health Minister yesterday announced that we'll be hosting a ministerial meeting of 30 or so countries in Canada in the next month or so to address the risks of an avian flu pandemic, working very closely with WHO, as we always do. The types of issues they'll be addressing will include: human and animal health issues; capacity building in affected countries, because capacity in many of the affected countries is weak and we need to help them; improved surveillance and testing; and risk communication. Transparency is tremendously important when it comes to health risks and that's something that Paula has telegraphed tirelessly and that we all need to focus on.

Obviously, the health policy aspect of travel, tremendously relevant, as we saw with SARS as a number of precautions were taken, but also travel in many areas largely shut down.

Finally, vaccine development is important as well.

So these are all issues that the ministerial in Canada, which will involve a number of major governments, affected countries, will be looking at. With that, Paula, many thanks.

UNDER SECRETARY DOBRIANSKY: I have to say Canada's input has been crucial, WHO's input has been crucial. Let me ask our Japanese colleague, Mr. Takahiro Shinyo, the Director General for Global Affairs, to share his thoughts with you.

MR. SHINYO: Thank you very much. And ladies and gentlemen, I am very happy to say a few words on this influenza international partnership. As it is already said that, you know, the pandemic might happen and this is not only affect to the one certain region but it is affect to the whole human kind. And so that, in that sense, Vietnam was very much willing to take part in this initiative and I would like to welcome the United States and other countries initiative for the fight against this pandemic. Thank you very much.

As you might know that this pandemic could occur everywhere but I think the serious region is Asia. And this is fully* aware* of by many people and – so that, I think, as one of the members of Asia, I think we have the decision that Japan would contribute to how to, you know, prevent at least when the pandemic occurs, which I don’t want to, you know, cope with together with the Asian countries and also the (inaudible) communities.

Of course, this is an international partnership that the – it (inaudible) by the (inaudible) that the WHO has already wide varieties of, you know, the mechanism. And I think that we can do together and empower with or in harmony with existing mechanisms to find ways how to cope with this problem because I think the political awareness-building is, of course, much more important. And just -- Canada has announced that it will be hosting a health minister conference a month or so. And Japan is also concerning very positively to take part in that meeting.

Thank you very much.

UNDER SECRETARY DOBRIANSKY: Thank you so much. Japan has, I think, provided tremendous, not only insights but leadership in many ways on this issue.

I wanted to share with you the fact that Secretary Leavitt had planned on being here today and unfortunately could not be. But we have received a statement. I won’t take the time – it’s a bit of a lengthy statement but we do have copies at the back for you. I know he wanted to be here.

It’s worth mentioning that in terms of our U.S. team, this is an integrative effort involving, not only certainly HHS but also our colleagues from the United States Agency for International Development, the U.S. Department of Agriculture, the Department of Homeland Security, as well as the State Department in both the development of the partnership and also taking steps.

We have Dr. Charles Lambert, the Deputy Under Secretary of Agriculture for marketing and regulatory programs, is here. And also I recognize Secretary Veneman, who also graciously offered to join Q&A. There are aspects that relate to agriculture also to delve in.

Let me stop there and we welcome your questions.

QUESTION: Barry Schweib, Associated Press. Can you tell at this stage how much of a threat this poses to the United States? Is there a vaccine? Maybe I missed something. But is there something preventive that can be taken? And I guess that works.

UNDER SECRETARY DOBRIANSKY: Maybe – I was going to say I should let you take maybe the last one about the vaccine issue. We’ve been involved with the anti-viral treatments.

DR. LEE: Well, that clearly, the vaccine and the medicines are the two items on everybody’s mind when they talk about the flu that, you know, about the vaccine, the big issue is we cannot make a vaccine unless we see the virus. And we haven’t seen the virus. But we know that there is a (inaudible) direct* strain, most likely will be originated and modified from existing known H5N1 so that the NIH – U.S. NIH will work on this and the work is still going on and initial result was very good. So this work is going on in par with other efforts.

UNDER SECRETARY DOBRIANSKY: Let me take, if I may, just the first part of it and if I may, actually, because our colleagues from HHS are in the lead, I think, in terms of the spread issue. And so I will fight.

The Secretary mentions, to date, the avian flu has spread to ten countries and led to the death of over 140 million birds. Through migratory birds, the virus has now spread to Russia and is approaching Europe with no sign of slowing. Our greatest concern is that the virus has shown an ability to infect people. Half of the 112 persons who have been infected have died. If the spread of the virus becomes efficient and spreads person-to-person like the seasonal flu, an unprecedented pandemic could occur. So that’s how – not only us but others are affected.

QUESTION: Hi, Janine Zachario with Bloomberg News. I have two questions. Why is the Bush Administration making a push now on this, a few months after it really was really catching everybody’s attention? What’s new on it?

And secondly, the (inaudible) event was just announced that agreed with Health and Human Services to produce an avian flue vaccine. Apparently, it’s a $100 million contract, if anybody has any details on that?

UNDER SECRETARY DOBRIANSKY: I don’t know. If Dr. Lee on the second; but let me mention on the first issue.

First, in terms of our activity actually over the past year, the Department of Health and Human Services has invested some $5 million -- $5.5 million in programs to provide capacity particularly to those affected countries. More recently, there was some $25 million that had been allocated in an emergency appropriation. This was well prior to this announcement at this time. This is over a number of months ago and earlier this year. These monies are specifically dedicated to capacity building. We sent a team of experts from HHS, from the State Department, from USAID, specifically to go to Laos, Cambodia and Vietnam, three very much affected countries with very limited capacity. The $25 million will be devoted to building an infrastructure.

So simply put, we have taken actions heretofore. Also let me say, and that's something you might want to address, many of the international organizations have been working this. There have been a number of activities that have been taking place. The reason for this partnership is actually to bring these efforts together, to elevate the issue in areas where it hasn't been elevated, to better coordinate our efforts and mobilize resources, as well as to ensure -- and Dr. Lee highlighted this as did others -- the importance of transparency, the importance of being able to acquire samples.

Dr. Lee.

DR. LEE: Well, clearly that timing is everything. It is not now that we are starting something new, but this work has been going on for years. It's an example that we have this global network and this is outbreak so we collect this information daily in collaboration with many partners in the U.S., in Canada and Japan and in Vietnam, Thailand, all these countries. And then also we make a judgment and we made a very important judgment that this is coming and what will be the consequences of this human pandemic flue when it comes. So that this is nothing new and it is nothing to do with one administration, but we all know -- and I'm very gratified that in the United States at the highest level now they raise this issue and launch this initiative.

About the vaccine, clearly this is linked with NIH has supported the research and we have two -- we can take two positions on the facts. One is that we haven't seen the strain so we have to wait, and the other one is using the best scientific minds in the world and in the United States and everywhere that what can we do. So that we, based on this scientific evidence, that we come up with the vaccine and that also the (inaudible). I haven't seen the (inaudible) but these are clearly the one decide to make a -- try to produce this vaccine, clearly that developing vaccine is not enough because somebody has to pay. Unless somebody pays, nobody will produce it. And nobody produce it, we don't have it. And even the existing weapons, this vaccine, they partially protect. What I mean is they not 100 percent but it is clearly, because of the differences between the (inaudible) strain and this one. Still, it was able (inaudible) lives and we have something in hand rather than (inaudible) work one day. So this is a very important development.

Thank you.

UNDER SECRETARY DOBRIANSKY: And if I may just add one other point to this because of the issue of new and now, it's also an issue of these deaths, there were a number of deaths -- a few -- that occurred over the last years to the present time. The experts have honed in on this because of the concern that you have large populations of birds being infected. They have migrated to other areas, have carried the virus, and the fact that recently there was an increase in several countries of the number of human deaths. So we have, as Dr. Lee focused on, I think internationally, no less the United States, has focused on this, has tracked this. Our experts have tracked this. But now there is a concern that if this is not addressed at its source that this can become a pandemic. And that's henceforth why the coordinated focus, international partnership and activities.

DR. LEE: Well, really, I just want to add (inaudible) and (inaudible) strain which we haven't seen yet. Clearly that H5N1 is a very toxic virus which killed more than half of the people who got infected. If you look at the 1918, the so-called Spanish flu that more than 20 million people, some people say that up to 60 million people died. In the last - the pandemic flu in the '50s and '60s, about 5 million people died. In the last (inaudible) less than 1,000 people died but it is a problem, economic, social and political, and all the problem posed was just that if you calculate it in money it's some tens of billions of dollars. So that clearly we cannot afford to have -- we cannot afford to face this kind of unprepared. We hope clearly that the (inaudible) that the ongoing effort (inaudible) hundreds of millions of chickens were caught already in Vietnam and Thailand, in Laos and all these countries, in Japan and Korea, Russia (inaudible), so that clearly these efforts -- and this is (inaudible) other countries sacrifice made by these farmers, sometimes, you know, under-compensated, not compensated, but these are the contribution with this effort if we can slow down, and also if we at this initial stage we deploy all the medicines and vaccines and then contain, stop it, that's the best scenario. But we have to be prepared and my hope and prayer is that this final strain -- the difference is right now existing H5N1 is not very efficient, hasn't yet acquired this ability to transmit among the humans, but when it acquires this ability, and there's some evidence that this will be the case, that the -- I hope it will be simply less toxic than the H5N1 which has killed more than half the people infected.

MODERATOR: Okay, so we'll go ahead and go to Washington. Please state your name and affiliation, and then afterwards we're going to head to the back and go to Mark Turner.

QUESTION: My name is Andrew Sudarska*. I'm with the Russian News Agency ITAR-TASS. My question to Dr. Lee and maybe others, there was some outbreaks of avian influenza in Russia, I think in six major regions, most notably in Siberia, and my understanding is that you monitor situation very closely. My question to you, how close is your calculation with your Russian counterparts in terms of putting the situation under control? Thank you.

DR. LEE: Well, clearly, this avian flu is in Russia as well as Kyrgyzstan. It really raised the situation a few more noticed (inaudible) and another critical issue is if this is only the problem of chickens or ducks that we have some control, but the issue is also wild bird is involved and we know that also some ducks share this virus that don't show any sign of sickness. But this pose another problem and about the Russia situation, yes, we are in close touch with expert and also that they have taken a huge sacrifice by killing chickens (inaudible) others. Thank you.

QUESTION: Hi, Mark Turner from the Financial Times. Just a couple of technical questions. How much money are you looking for to gather for this partnership? Roughly how many countries do you think that are going to join it? More specifically, this is all basically in terms of a kind of health/humanitarian kind of thing. How much does the U.S. and also other countries perceive this is a fundamental security threat? Ahead of the world summit that's taking place now at the UN, these panels on high-level threats and so forth, even to sort of suggest that the bio-security might begin to be one -- a greater security threat than nuclear. Is this something that you guys see in this way? And how much of a failure was it that the UN summit failed to address the bio-security threat? Thanks.

UNDER SECRETARY DOBRIANSKY: Well, let me respond to, first, the issue about countries. A number of countries have already committed to the partnership and international organizations. I mentioned some who are present here. Others, just to share, include -- I mean, this is just some indication -- Cambodia, India, New Zealand, Nigeria, Thailand, Vietnam. These are some of the countries. The door is open. To answer your question specifically, the door is open in this partnership.

In terms of resources, as I indicated, we plan to host in Washington in several weeks a senior officials meeting with a very specific purpose. One of the specific purposes of that meeting is to take stock of the situation worldwide, to have a collective assessment of not only what is the needs and priorities, but how in terms of resources, what's the level of resources. Already -- and you can address this -- the WHO has been doing some very significant work in this area of trying to provide an overall estimate and is working on a report toward this end. And Dr. Lee can say something about that.

And then in terms of the issue of threat, we see this as a threat. There are many health issues that, in fact, are, I would say, national security issues because, clearly, a threat such as this can cripple, literally, not only an individual country but, in this case, countries. Dr. Lee referred to, and I think he's quite right, about the impact this has economically, can have economically, socially. I notice that in Secretary Leavitt's statement he talks about the pandemics, the three that swept the globe in the past century. He mentioned that it killed approximately some 20 to 40 million people worldwide. Clearly it is a global health catastrophe. It can have significant ramifications on security and the security of not only our country but others.

MR. MALONE: On the security points, Mark, as you know, the Security Council has recognized AIDS, particularly in Africa, as a security threat because it has undermined the integrity of a number of states. We certainly hope avian flu never comes to that. But as Paula was saying, if a pandemic actually undermines the fabric of societies, then you have a very serious security threat. So the AIDS example is a relevant one in terms of even the practice of the Security Council.

DR. LEE: One issue is in the past the pandemic that poor countries have access to these vaccines after the pandemic passed. It was their time to take a vaccine. But in coming pandemic, we hope, we all hope, that can be the case -- that it will not be the case. So that clearly that because (inaudible) is also important issue and right now this medicine which is also antiviral medicine which is produced by only one country in the world and which is rather very expensive, many countries are sitting around this table already ordered the big quantity of this medicine. But in the WHO with that the accompanying rush we had 30 million capsules of the (inaudible) that is not to replace any countries' stockpile but that is to rush to the site of initial outbreak. But again, the issue is which countries can afford to have this but how we can also make the poor countries have access on this life-saving drug. When I went to Africa, the question was would it come to Africa. Yes, of course, because now that Africa, Washington, Toronto, Sydney, it's just one flight away. So that in this interconnected world, no part of the world is safe from this. So clearly this concern has to be somehow (inaudible) and no country can say that we are safe because we are far way from the site of now the avian flu.

UNDER SECRETARY DOBRIANSKY: The partnership has meant to pull together some ongoing activities as well as new activities especially to build capacity because there is a dire need to build capacity in a number of areas and in a number of countries and to pull together our resources more effectively toward that end.

QUESTION: (Off mike.)

UNDER SECRETARY DOBRIANSKY: A global stockpile of emergency drugs?

DR. LEE: There is clearly now that many countries, now Japan (inaudible) ordered -- these countries have the common flu and Switzerland has already enough drugs for one quarter of their population, and then many other countries and France is also taking very strong measures on this. But so that our position is, like the smallpox vaccine, a certain portion of smallpox vaccines were allocated for international use through the coordination of WHO in time of necessity, which I hope it will never come. So that we are now creating and we will at the ministerial meetings and other meetings that the -- about the need to have some international allocation, international portion of the medicine allocated for international use because it is for the interest of everybody that some portion can be rushed to the site rather than waiting. This is a (inaudible) and waiting for (inaudible) come at the gate. So this is our position. I'm sure that many countries understand the position. Thank you.

UNDER SECRETARY DOBRIANSKY: Okay, we have time for one more question. I'm going to hand it over to Kyodo News.

QUESTION: Toshimitsu Sama with Kyodo News. Thank you. I just want to know the level of cooperation with China because I think that Secretary Dobriansky didn't mention China as partner countries and I think China was criticized about their transparency when it – when the (inaudible) two years ago over there.

So I’d like to know how you report the cooperation from China?

UNDER SECRETARY DOBRIANSKY: In fact, the day before yesterday, one of my colleagues at the White House gave an on the record press briefing. I understand there was a statement released by the White House, but let me give a snippet of this.

This is a result of President Bush’s meeting with President Hu Jintao. They talked quite a bit about the topic of avian flu. And that the key to protecting ourselves is early warning detection and containment. President Hu pledged China’s cooperation and listed some of the things that China is doing internally to step up their efforts; pledged to increase work between our health and agricultural experts and the ministry of health and the ministry of agriculture in China; and also to strengthen international and multilateral cooperation on this. I’m sharing with you precisely from that discussion that took place at that level.

Can we take one more? Yes, sir.

QUESTION: P. Parameswsaran, AFP. WHO’s biggest fear is that H5N1 may mutate. And in acquiring this capability of making it highly infectious as well as lethal, do you think the (inaudible) come now for – to prepare for this?

DR. LEE: Well, (inaudible) came sometime ago. I mean, right now, it did not fear – the biggest fear that this will evolve – it will acquire capacity – it will acquire capacity but it’s time – it’s just an issue about timing and all of us, internationally, tried very hard to stop or to slow down this process by culling all of the infected chickens and treating people (inaudible) so that’s – for example, if there’s one human case, infected directly from the poultry, we know within a few days. So that these capacities are built over the years and the issue is we -- also international support, we need to provide these affected countries, potential – those countries that will be affected should have a capacity building. So this is a very critical issue and to do this, we need the international partnership so that – for example, everybody should know what everybody else is doing. That is a very important issue.

And then about China, clearly during before and after the (inaudible), it was like a day and night. I mean, clearly they changed their (inaudible), they changed the whole attitude on this issue. And from WHO’s point of view that the China is a key country and we have a good dialogue on this issue that if I don’t really (inaudible) in terms of transparency and accountability, we have a good relationship with China on this issue.

Thank you.

UNDER SECRETARY DOBRIANSKY: Let me just, if I may, just before we close, I’ve got – Secretary Veneman, did you earlier, you had indicated, would you like to just say something before we close? And then I also offer it to any of our partners.

MS. VENEMAN: Well, thank you very much and thank you to the United States Government and Paula Dobriansky for – and President Bush, obviously -- for their leadership on this issue. It’s very critical; I think we’ve heard a lot today about the importance of working together internationally to address this issue.

In my previous role as Secretary of Agriculture, we certainly had to deal with various kinds of bird flus and other bird infections, including exotic Newcastle* disease and we know how critical it is to address these issues at the very source. And that’s why this partnership is so important. Not just to anticipate a pandemic but to prevent it by addressing the issues of agriculture.

In my new role in UNICEF, we also have a key interest in this issue because we know that children have been affected. We also have – one of the agency’s that has the most people on the ground that can help to educate people with the right messages. And so we stand ready to assist in that cause and we very much appreciate cooperating with this partnership.

UNDER SECRETARY DOBRIANSKY: Thank you. And just finally, I don’t know if any of the other partners – with your permission, yes, please.

DR. LEE: Well, somebody asked me about the security. I guess this kind of pandemic and the disease could be (inaudible) because it’s substituting and according to (inaudible) security. And let you know that the (inaudible) one of the most important issues to be discussed among the nations. And to do with, of course, the national security when it comes to the matter of the lives of the people because your country must protect the people’s lives.

But, at the same time, I think it also is the issue of – dealt with by the (inaudible) Security Council and this morning I was (inaudible) Foreign Minister (inaudible) Security Council at the meeting. And, well, I think the Japanese and also the U.S. delegate also, you know, raised the issue of the importance of this pandemic issue or the influenza. We discussed also in the context of the (inaudible) Security Council.

Thank you very much.

UNDER SECRETARY DOBRIANSKY: Thank you. I’m going to close (inaudible).

MR. MALONE: Thank you. I just wanted to come back to the point whether this initiative, the partnership the ministerial of Canada will be hosting is sudden. In fact, it’s not. For those who follow the work of the World Health Organization, for those who follow the work of the FAO, they will know that these issues have been very alive for months and, in fact, in the case of the WHO, years now. It’s simply that these various initiatives and the urgency of the issue is crystallizing political attention, which is what Dr. Lee and his colleagues have been seeking to do for some time now.

Simply, also to flag that the press release on the Canadian ministerial is available in the back of the room and it describes some of the Canadian thinking on this issue, which is completely compatible with the partnership.