The Role of Civil Society in Pandemic Preparedness - Innovation in Global Health Governance - page 107

negotiations agenda and substantive issues. the fourth part summarises the main
intellectual approaches to infectious disease control, from which it distils the best
practices in order to propose a new integrated model of transnational, multi-actor
governance.
raising public awareness is one effective way to promote appropriate health
and agriculture actions, especially if it engages at-risk communities and sectors in
developing responses and solutions. all too often 'indifference becomes fear only
after catastrophe hits, when it is already too late to implement preventive or control
measures' (osterholm 2005). the next pandemic is overdue and inevitable (wHo
2005). the only question is whether an institution sturdy enough to withstand its
lethal blow will be built in time.
The Global Evolution of Avian Influenza
Globalisation has made the world a smaller place, but it has also made humanity
more vulnerable to microbial threats. ecological disruption, population growth,
increased human mobility, poverty, wars and famine, migration, urbanisation, and
global production and distribution channels of food have all served as facilitating
variables or disease amplifiers that have eased the epidemiological transition of
microbes into more pathogenic forms (Price-Smith 1998; see also evans et al. 2004).
Few microbes have caused more concern than the avian influenza virus, in particular
the H5n1 strain, due to its rapid genetic mutations, ability to acquire genes from
viruses infecting other species, and very high pathogenicity (wHo 2006). First
identified in wild geese in china's Guangdong province in 1996, the virus spread
rapidly through the country's large domestic duck population of 660 million, with
pigs serving as a 'mixing vessel' from which the virus could cross a species barrier
(wHo 2005). 4 The first human infection was documented during a massive outbreak
of H5n1 in Hong Kong in 1997 and traced to Guangdong, when the virus jumped
directly from birds to humans, killing 6 and sickening 18 others (Garrett 2005a).
Hong Kong's rapid destruction of its entire poultry population of 1.5 million (within
three days) probably averted a global pandemic (wHo 2006).
Yet H5n1 itself was not eliminated. It merely retreated to southwest china
and again in December 2003 in a super-virulent form—more pathogenic, resilient,
adaptable, and capable of killing a broader range of species, including rodents, tigers,
and humans. the outbreaks that followed in 2004 were the largest and deadliest on
record: never before were so many countries ravaged by the avian influenza at the
same time, and never with such a high fatality rate—both bird and human (wHo
2005). The lethal strain first infected flocks in Korea, thailand, and vietnam, and
then travelled to Japan, tibet, russia, including Siberia, to reach europe's south-
eastern shores by october 2005. It had infected 109 people and killed 59 of them
by May 2005, thus achieving a high morbidity rate (Garrett 2005a). by early 2005,
with more than 140 million chickens killed by the virus or destroyed and customers
shying away, outbreaks ravaged asia's poultry industry, with losses expected to