I. INTRODUCTION

1. The recent episode (2003-2005) of Highly Pathogenic Avian Influenza (HPAI), caused by the H5N1 virus (Hemagglutinin-5 Neuroaminidase-1), had detrimental impacts on socio-economic development of several ASEAN Member Countries. The disease resulted in tremendous losses to ASEAN poultry industry and posed a threat to public health. It has also created a panic in various other regions all over the world over a potential human influenza pandemic which would be caused by mutation of the H5N1 virus into new strains that could be transferred between humans and threaten lives of  millions of people.

2. To-date, globally, there have been 192 cases of human infections and over 200 million poultry lost, either died because of the avian influenza (AI) disease or culled. Of the 192 human cases, 109 have died.  Out of these fatalities, 66 were in two of the ASEAN Member Countries (24 in Indonesia and 42 in Viet Nam).

3. Why then the scare when the total number of human fatalities to-date is very much  less than those who died daily caused by HIV/AIDS, tuberculosis and other infectious diseases?  For certain, H5N1 can kill humans.  Fortunately, as explained by virologists, bird-to-human transfer of the H5N1 virus can only occur through close contact because the virus can only attach itself to and attack the cells of the alveoli located in the inner-most part of the lungs, but not to the cells of the upper parts of the respiratory track such as the trachea and bronchi.  If, however, the H5N1 virus mutates itself into a strain that can attach itself to and also attack the cells of the human trachea and bronchi, then the human-to-human transfer can occur easily and the potential of a human influenza pandemic looms high.  The chances of the H5N1 virus transforming into a strain that will be more virulent is not altogether impossible.  Furthermore, it could be that the H5N1 need not have to mutate to be able to jump from human-to-human, but it just need to be a little more resistant  to  environmental conditions to be able to do so.  And, this too is not impossible.

4. Preparedness is all the more necessary when considering that the true source of the H5N1 virus is wild migratory birds which are, for known reasons, untouchable!   The infected chickens or poultry are only the secondary sources of the AI.  On the hand, the antiviral drug, Tamiflu and Relenza, are still not the perfect prevention or cure for the disease. Tamiflu will help only if it is administered to the patient within 48 hours of contracting the virus, which means diagnosis must be quick, a capability that is still lacking in most countries. 

Moreover, availability of the drug is limited as a result of regulated manufacture due to high cost of production and rather short shelf-life.

5. In view of the above situations, ASEAN Member Countries, as a group and in close collaboration with other countries and relevant international organizations, would need to be ready and always on top of the situation in their efforts to combat the AI.   Past experiences with other diseases show that human nature is such that people may become complacent and just live with the disease over time.  When these happen, preventive and eradicative efforts will be become all the more challenging and difficult.

II. INSTITUTIONAL MECHANISMS AND COORDINATION ARRANGEMENTS

6. Since its early outbreaks and strong indication that it can cause fatalities in humans through close contact, ASEAN Member Countries have responded and worked closely with a number of other governments and international agencies to address and control the AI disease. At regional level, two ministerial level ASEAN bodies in the animal and human health sectors, namely: ASEAN Ministers on Agriculture and Forestry (AMAF) and ASEAN Health Ministers Meeting (AHMM), have directed their respective senior officials,  working groups and experts (i.e. ASEAN Sectoral Working Group on Livestock (ASWGL) and ASEAN Highly Pathogenic Avian Influenza (HPAI) Task Force  from the animal health sector, and the Senior Officials Meeting on Health Development (SOMHD) and ASEAN Expert Group on Communicable Diseases (AEGCD) from the public health sector), to formulate a coordinated multi-agency and multi-sectoral approach to prevent, control, and eradicate HPAI in the region; and tasked them to work closely with international organizations, such as the FAO, OIE and WHO, so as to synergize the work of ASEAN Member Countries as well as that of the various regional and international agencies.

III. KEY INITIATIVES FOR REGIONAL COOPERATION

(a) Animal Health Sector

7. In response to the re-emergence of the avian influenza in late 2003, the 26th Meeting of AMAF, held on 7 October 2004 in Yangon, established the ASEAN HPAI Taskforce to serve as a network to formulate and help in the implementation of definite measures and areas of cooperation to control HPAI in the animal health sector.  The 4th Meeting of the AMAF+3 (ASEAN + China, Japan and the ROK), held on 8 October 2004 in Yangon, also expressed support for the establishment of the HPAI Taskforce and for  the sharing of experiences and expertise in HPAI control.

8. Subsequently, the 27th Meeting of AMAF, held on 29 September 2005 in Tagaytay City, the Philippines, endorsed the Regional Framework for Control and Eradication of Highly Pathogenic Avian Influenza (HPAI) proposed by the ASEAN HPAI Taskforce. The Framework covers eight (8) strategic areas on the prevention, control and eradication of HPAI over a period of three years (2006 to 2008), under the coordination of assigned Member Countries, namely:

 (i) Disease surveillance – coordinated by Thailand;
(ii) Effective containment measures – coordinated by Malaysia;
(iii) Stamping out and vaccination policy – coordinated by Indonesia;
(iv) Diagnostic capabilities – coordinated by Thailand;
(v) Establishment of disease free zones – coordinated by Malaysia;
(vi) Information sharing – coordinated by Singapore;
(vii) Emergency Preparedness Plans – coordinated by Malaysia; and
(viii) Public Awareness – coordinated by The Philippines.

9. A Work Plan for the Control and Eradication of HPAI in ASEAN Region detailing 14 proposed projects requiring an estimated total funding of $94,762,000 has been prepared, which has also been presented at the International Pledging Conference on Avian and Human Influenza in Beijing on 17-18 January 2006.  The 14 proposed projects, together with their estimated funding requirements are shown in ANNEX 1.

10. Recognizing the importance for ASEAN to show strong commitment and ownership in the regional disease control programme, the AMAF has established the ASEAN Animal Health Trust Fund (AHTF) with pledged contributions by all ASEAN Member Countries. An agreement has been formulated for signing by the AMAF. It will ensure that there is a robust framework for accountability, drawdown proposals and proper use and management of the Fund for long-term sustainability.

(b) Public Health Sector

11. On the public health sector, the ASEAN+3 Emerging Infectious Diseases (EID) Programme was endorsed in April 2004 by the AEGCD.  It was designed in consultation with SOMHD and with inputs from WHO. The National Centre of Epidemiology and Population Health at the Australian National University (ANU) and the Australian Bio-security Cooperative Research Centre for Emerging Infectious Disease have worked with the ASEAN Secretariat and health ministries in each ASEAN Member Country to implement the Phase I of the Programme; while China, Japan and the ROK (the Plus Three countries) participated by offering relevant expertise. The Programme focused on the following areas of collaboration between the ASEAN + 3 countries:

(i) Improvement of institutional capacity of ASEAN to coordinate and manage effective implementation of the program (coordinated by the ASEAN Secretariat);
(ii) Improvement of capacity of the ASEAN Disease Surveillance Network to meet the needs of ASEAN member countries in Emerging Infectious Disease Surveillance, Preparedness and Response (coordinated by Indonesia);
(iii) Improvement of capacity of national and regional laboratories in routine diagnostics, laboratory-based surveillance, preparedness and rapid response (coordinated by Malaysia); and
(iv) Improvement of national and regional capacity in epidemiological surveillance, preparedness, early warning of outbreaks and rapid response to emerging infections (coordinated by Thailand).

12. The first phase of the Programme was completed in June 2005. The second phase work Programme is under preparation as one of the four components of the Emerging and Resurging Zoonotic Infectious Diseases Initiatives Programme. This Phase 2 will run for three years from 2006 to 2008.

IV. COLLABORATIVE STEPS WITH OTHER COUNTRIES AND INTERNATIONAL ORGANIZATIONS

(a) Asian Development Bank (ADB) Grant Project for Combating Avian and Human Pandemic Influenza in Asia and the Pacific Region

13. The ADB has started a US$38 million grant project for combating avian and human pandemic influenza in the Asia and Pacific region, which is inclusive of a grant of US$10 million from the Government of Japan.  It is part of up to US$470 million in funds pledged by ADB to fight avian influenza, which will provide resources urgently needed to help control and reduce the spread of the highly pathogenic H5N1 avian flu virus among poultry and to increase the region’s preparedness for a potential human influenza pandemic. Basically, the Project aims to prevent or rapidly control infection at source among birds, strengthening early detection, reporting and controlling avian flu outbreaks, and rapidly managing cases of human influenza caused by the H5N1 virus.

14.  ASEAN (through the ASEAN Secretariat), in partnership with the FAO and the WHO, as well as other national and international initiatives,  will be involved in the initial implementation of the Project over the next 2½ years starting from mid-March 2006 under close coordination by the ADB.  In this regard, ASEAN will implement a Sub-project on Strengthening the ASEAN Secretariat Capacity for Regional Coordination in the Control and Eradication of HPAI in ASEAN, for which the ADB has agreed to provide a fund of US$338,000. 

15. This ASEAN Sub-Project aims to strengthen the capacity of the ASEAN Secretariat to facilitate and monitor the implementation of the ASEAN’s Work Plan for the Control and Eradication of HPAI in ASEAN Region. It will also promote collaborative arrangements among various initiatives in the region and beyond to enhance understanding and sharing of experiences in the control of HPAI. A consultant will be engaged to assist in the technical coordination and communication among ASEAN Member Countries as well as with other stakeholders. A series of regional workshops (tentatively, 3 workshops) will be organized to support ASEAN Member Countries’ efforts against HPAI and for preventing and preparing for a potential human influenza pandemic.  The key output of the project will be a comprehensive report on the various initiatives against HPAI undertaken by major stakeholders in the ASEAN Member Countries and in the region, with clear recommendations to improve coordination and ensure complementarity and synergy among the significant initiatives to control and eradicate HPAI in ASEAN.  

(b) Assistance from Japan 

16. On 27 March 2006, Japan signed a deal to give 7.5 billion yen (US$70.09 million) to ASEAN which will be deposited in the “Japan-ASEAN Integration Fund” (JAIF).  While the money is to help the ASEAN integration and narrowing the development gap, an amount of US$46.833 million will be used to fight avian influenza.  In the case of fighting avian influenza and prevention of human influenza pandemic, the assistance will include a stockpile of 500,000 courses of Tamiflu and stocks of influenza test kits, anti-septic solutions, disposable masks, disposable rubber gloves and disposable gowns for 700,000 persons, which are expected to be shipped to ASEAN between end of April to end of June 2006.

(c) AusAid’s Emerging and Resurging Zoonotic Diseases Initiative  Programme (ERZDRIP)

17.   This Programme is also relevant to the current regional initiatives addressing the avian influenza epidemic.  This AusAID’s initiative was launched in June 2005 and scheduled for completion in 2008.  It has four components, namely:  (1) Animal health;  (2) Human health (with a sub-component aiming to support the second phase of the ASEAN+3 Emerging Infectious Diseases (EID) Programme);  (3) Emergency preparedness;  and (4) Research. 

V. CONTINUOUS EFFORTS

18. ASEAN will continue to address the HPAI problem at different levels and platforms, mainly through public and animal health sectors. Institutional linkages within countries and across borders are being strengthened to ensure that national and regional coordination for early warning and response, laboratory diagnostics and epidemiological surveillance is in place.

19. Partnerships with all stakeholders in public and private sectors and civil society are being developed. Partnerships with the private sector, especially pharmaceutical manufacturers, are aimed at increasing the region’s capacity for stockpiling of vaccine and other treatment medications. Cooperation from sectors other than health and agriculture, such as information, tourism, trade and industry, foreign affairs, and finance, is essential to maintain public awareness and confidence, as well as to deal with the impact of the disease. Engaging the civil society is important because it is at the grassroots of our community and they can surely assist governments in increasing the effectiveness of containment measures.

20. From the experience with SARS in 2003, ASEAN learned that an effective means of prevention is to ensure our peoples are better informed on the causes of the disease, its main modes of transmission and preventive steps to take. Providing researchers and public information bodies with prompt, transparent and reliable information on avian influenza occurrences (either in poultry or human) is critical in lessening public fear of the virus. ASEAN overcame SARS by acting with transparency. Timely information was provided on preventive measures. Strict quarantine and monitoring measures were instituted. New equipment and technology for thermal screening at exit and entry points were shared freely. Hotlines were activated to ensure quick information-sharing. Therefore, sharing information, knowledge, success stories and lessons learned from each specific case experienced thus far will help institute better preparedness, surveillance and testing procedures in animal and human health systems.

21. Changing mindset in farming and poultry management practices are being encouraged. Farmers must avoid intensive and unhygienic poultry farming that leads to overcrowding of chickens, thus causing close contact with fecal and other excretions. Close monitoring and control of trade or marketing of live chickens, with no mixing of different avian species on farms and at live poultry markets, are no less desirable.  This means that bio-security practices in poultry production and maintaining adequate control over transportation of poultry products, especially live poultry, need to be standardized.

22. ASEAN Member Countries are committed to combating the spread of the avian flu. High-level meetings have taken place regularly to set directions in addressing the challenge. Several technical meetings were also convened to devise cooperative measures in dealing with both animal and human health aspects of the disease. WHO, the World Organization for Animal Health (OIE) and FAO will be closely consulted. At the national level, Member Countries will undertake efforts to allocate and mobilize resources to destroy the infected chickens and redress the shortage of vaccine needed. ASEAN will continue to exert leadership, coordination, and be on top of the situation.

ASEAN Secretariat
April 2006
(Damak)