MERS, Ebola, bird flu: Science’s big missed opportunities

admin   •   October 27, 2015   •   2476

The gloved hands of an army nurse are seen during a demonstration of an isolation chamber for the treatment of infectious disease patients, at the Germany army medical centre, Bundeswehr Clinc, in Koblenz October 16, 2014. REUTERS/Ralph Orlowski

The gloved hands of an army nurse are seen during a demonstration of an isolation chamber for the treatment of infectious disease patients, at the Germany army medical centre, Bundeswehr Clinc, in Koblenz October 16, 2014. REUTERS/Ralph Orlowski

Anyone who goes down with flu in Europe this winter could be asked to enroll in a randomized clinical trial in which they will either be given a drug, which may or may not work, or standard advice to take bed rest and paracetamol.

Those who agree could be helping the world prepare for the next potentially deadly disease pandemic as well as helping scientists who are now desperate to plug gaps in knowledge left by previous missed opportunities.

Scientists are largely in the dark about how to stop or treat the slew of never-seen-before global health problems of recent years, from the emergence of the deadly MERS virus in Saudi Arabia, to a new killer strain of bird flu in China and an unprecedented Ebola outbreak in West Africa.

They have been unable even to pin down where they came from.

That is because vital studies to analyze transmission routes and test experimental drugs or vaccines have simply not been done during epidemics, disease experts say.

It is a failure of science, they say, that should not be allowed to happen again.

“Research in all of the epidemics we have faced over the past decade has been woeful,” said Jeremy Farrar, director of the Wellcome Trust global health foundation and an expert on infectious diseases. “The world is at risk because there are huge gaps in our knowledge base.

“We don’t now have a vaccine for SARS if it came back tomorrow; we don’t know how to treat MERS; it took us six to nine months before we started clinical trials of vaccines for Ebola and in the meantime almost 12,000 people lost their lives; and during the H1N1 pandemic, the number of people randomized into clinical studies was very close to zero.”

“BYZANTINE PROCESS”

Bureaucracy, logistics and lack of forethought are the heart of the problem, according to Trudie Lang, professor of Global Health Research at Oxford University who has been working on ways to lower such barriers.

During the Ebola outbreak that swept through Guinea, Liberia and Sierra Leone, Lang’s team, which specializes in planning and operating trials in vulnerable populations in difficult settings, was tasked with setting up a clinical study of a potential Ebola treatment called brincidofovir.

“It normally takes 18 months to set up a trial, and we did it in 16 weeks,” she told Reuters. “But the problem was we were still behind the curve.”

In the 2009 H1N1 “swine flu” pandemic, when many governments had stockpiled antiviral drugs such as Roche’s (ROG.VX) Tamiflu and GlaxoSmithKline’s (GSK.L) Relenza and doctors prescribed them, often as a preventative measure without a confirmed diagnosis, no proper randomized clinical trials were conducted to find out for sure whether they helped.

This has left health officials with little or no concrete evidence on which to base treatment decisions when the next pandemic flu strain threatens the world.

“It is a huge pity we haven’t made the most of our opportunity to generate evidence,” said Chris Butler, a clinical professor at Cardiff University’s Institute of Primary Care & Public Health, who is now working on the European-wide winter flu trial he hopes will help plug the evidence gap.

There is little doubt that launching clinical trials in an outbreak is fraught with difficulty, partly because a new or rare strain of disease can infect so many and overwhelm health services and partly because there are many bureaucratic hurdles.

Lang’s team were awarded funds in September 2014 and by January 2015 were able to start the trial, but this coincided with a sharp drop in the number of patients with Ebola as the West Africa outbreak was beginning to plateau.

Scientists point to vast amounts of form filling, box ticking, contract drafting, committee meeting and agreement signing that are involved in setting up a clinical trial.

“There’s a huge industry around making triallists ‘walk through treacle’,” said Butler. “There’s a myriad of permissions needed. It’s a Byzantine process… which can take months.

“It gives me a headache just thinking about all the approvals” from ethics committees, sponsors, lawyers, research and development leaders and clinicians, he said.

Legal agreements are needed between the suppliers of the product — the experimental drug, vaccine or other intervention — and the people running the trial, the funder and hospitals, clinics or health centers where patients will be recruited.

In an infectious disease outbreak scenario, particularly a fast-moving one like with flu or Ebola, these legal issues can be compounded by competition for access to patients.

During the Ebola epidemic for example, Lang says, there were five or six different research groups seeking to set up and run clinical trials in the three most affected countries, each of which already had limited health systems that had been overwhelmed and crushed by the outbreak.

“It was ludicrous,” she told Reuters. “Because essentially we all had to fight over the same patients. It was like a land grab, and by that time the (new) cases were going down.”

THINKING AHEAD

Part of the threat of any disease outbreak, be it Ebola in Africa, the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS) epidemic, Middle East Respiratory Syndrome (MERS) in Saudi Arabia or the new H7N9 bird flu in China, is the unknown.

Yet Lang and others say there is nothing to say the sorts of clinical trials needed in an epidemic cannot largely be drawn up, agreed, signed and sealed ahead of time.

“We need to have protocols ready to go, we need to have a task force of research staff in each region on standby to be deployed into the next outbreak trials,” she said.

Legal contracts, for instance, cover broadly the same things for any trial — data sharing and storage, patient confidentiality, informed consent, the timing and publication of results, and the pricing, production and availability of the product if and when it proves useful.

And in a rapidly moving outbreak which may be too swift and deadly to allow for months of organization, a coordinated approach would overcome the problem of having multiple research groups with not enough patients.

This would be both scientifically and ethically preferable, said Lang, since if a trial has to be stopped because it runs out of participants with the relevant disease, then everyone who has taken part until then has run a needless risk.

“The main issue is that this needs to be done in days rather than weeks or months,” she said. “That basically means research has to be embedded in the immediate response to an outbreak, and not come as an afterthought.”

(Reporting by Kate Kelland, editing by Timothy Heritage)

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Philippines now free of H5N6 bird flu – DA

Robie de Guzman   •   January 19, 2021

MANILA, Philippines – The Philippines is now free of Avian Influenza (AI) or bird flu, the Department of Agriculture (DA) said Tuesday.

In a statement, the DA announced that the World Organization for Animal Health (OIE) declared the country free of the last remaining A(H5N6) strain of Avian Influenza on January 8, 2021.

The department said the country was able to resolve the outbreaks of AI A(H5N6) in a commercial layer poultry farm in Pampanga, and backyard poultry farms in a village in Rizal, in less than a year after the poultry virus reemerged in the country.

In its report to the OIE, the DA Bureau of Animal Industry (BAI) said the affected farms showed no further evidence of the presence of the AI virus during the monitoring and surveillance.

“We had not detected any case of AI A(H5N6) among the poultry and other bird population in the last 90 days after the completion of cleaning and disinfection in the affected farms, surveillance and monitoring, and completion of the 35-day restocking period with sentinel animals in Pampanga and Rizal,” the DA-BAI said.

The recurrence of A(H5N6) was confirmed by the DA-BAI Animal Disease Diagnosis and Reference Laboratory on July 10, 2020, after the owner of the commercial layer farm notified the Pampanga provincial veterinary office about the sudden drop in egg production, cyanosis (dark bluish or purplish coloration of the skin and mucous membranes in chickens), and mortalities.

Another case was detected in Rizal, as reported by a farmer on August 26, 2020, to the municipal veterinary office of Taytay.

The backyard farm had approximately 500 heads of free-range chicken and 300 heads of Muscovy ducks. The clinical signs — such as wry neck or torticollis, cyanosis of extremities — and death were observed since August 10, 2020.

As a result of the swift action of the farm owners, sanitary control and containment operations to prevent the further spread of the virus were carried out immediately, the DA said.

“We appreciate the rapid response and collaboration of the local government units of Pampanga and Rizal and DA Regional Field Offices III and IV-A,” the DA-BAI said.

The agency also thanked the affected farmers — for their prompt reporting that led to the early containment of the disease — the poultry stakeholders, and partners from the Department of Health for extending support to the prevention and control of AI.

To recall, the Philippines also resolved the outbreak cases in 2017 and in 2018.

Agriculture Secretary William Dar said this is a welcome development considering that poultry meat is a highly popular animal protein source among Filipinos, like pork and beef.

“I congratulate the DA-BAI and the local governments of Pampanga and Rizal, whose swift action resulted in limiting the further spread of the AI A(H5N6) strain to other areas,” Dar said.

The DA-BAI, however, reminds poultry farmers and industry stakeholders to remain vigilant and report any unusual mortalities to their respective farm veterinarians or nearest government veterinary or agriculture office.

PH temporarily bans poultry products from Australia amid bird flu outbreak

Aileen Cerrudo   •   August 19, 2020

The Philippine government has implemented a temporary ban on poultry products from Australia following the bird flu outbreak in the said country.

Department of Agrarian Reform (DAR) Secretary William Dar issued Memorandum Order No. 40 series of 2020 on August 14 which was released to the media on Wednesday (August 19). The memorandum states the ban of importing poultry products including chicken meat and eggs from Australia.

On July 31, the Australian government reported an outbreak of highly pathogenic avian influenza H7N7 in Victoria, Australia.

Meanwhile, meat processors raised concerns over possible shortage of mechanically deboned chicken (MDM) due to the said temporary ban. According to the Philippine Association of Meat Processors Incorporated (PAMPI), MDM is a common ingredient for emulsified products like meatloaf, hotdog, siomai and others.

The DA recently implemented a temporary ban on poultry products from Brazil after a batch of frozen chicken wings from said country reportedly tested positive for the coronavirus disease (COVID-19).

Due to this, PAMPI spokesperson Rex Agarrado said this could affect canned goods companies.

“The travel time in the Philippines to Brazil or Brazil to the Philippines is five to six weeks; eight weeks if you go to Cebu. You will realize that in a matter of time, 6 weeks from now, 7 weeks from now, you will see some brands not being available in the market anymore,” he said.

Bureau of Animal Industry (BAI) Director Ronnie Domingo, however, assured the supply of imported chicken in the country will not be affected by the import bans. Domingo also said there is a 150-day surplus of chicken in the country.

“Marami po tayong bansa na kinukuhanan ng manok. Labing apat na bansa po iyon. Hindi po natin sinarado po iyon at ikalawa, sobra po ang manok natin this year, (We get our chicken supply from numerous countries. There are 14 of them. We also have a surplus of supply this year)” he said. AAC (with reports from Vincent Arboleda)

DA-BAI assures no broilers affected by bird flu in Pampanga

Marje Pelayo   •   July 30, 2020

MANILA, Philippines — The Department of Agriculture (DA) through the Bureau of Animal Industry (BAI) reported a confirmed case of bird flu or a highly-pathogenic avian influenza (HPAI) strain, specifically A(H5N6), at a poultry layer or egg-producing farm in San Luis, Pampanga.

Upon confirming the report, the department immediately sent a composite team of veterinarians and animal health officers to the area to apply emergency control measures to contain the spread of the bird disease. 

The team also conducted disease surveillance around the infected farm.

“The team humanely culled a total of 38,701 head of layers and disposed off of them properly, employing the protocols under the Avian Influenza Protection Program of the Philippine Government,” DA-BAI Director Ronnie Domingo reported.

All personnel involved in the disease control measures were strictly monitored by the health office of San Luis, said Domingo.

Domingo has assured that there were no reports or detection of A(H5N6) among broilers, the primary source of poultry meat, in the area.

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