Bird flu has arrived in Bangladesh. That is not quite a surprise. Focal/local bird flu epidemics have occurred in past several years in Asia, some close to borders of Bangladesh. The only surprise is it took so long.
   Given the large number of poultry farms (one estimate puts it at 170,000 tiny, small, medium and large poultry farms in the country), realistically speaking the situation will likely get a bit worse before beginning to get better and eventually come under control. But only if we act with speed and even on war footing. Hope never prevents accidents while preparedness and preventive action might.
   The current epidemic of bird flu has three dimensions: cross-infection within poultry farms requiring early detection, strict quarantine (domestic and external sources of infection), and other sanitary measures; infection of humans through unprotected close contact and high exposure, and careless handling and processing of poultry; and human-to-human transmission of infection and rapid uncontrollable spread in entire populations. This has not occurred so far but remains quite possible and probable.
   Countries that had several focal bird flu outbreaks in past years have not met disaster. But that is no cause for comfort or complacence. Indonesia reported human infections and even deaths.
   We can learn from their experience but containment and control action is for us to take.
   Apparently, the interim government has quickly got into action without hiding and hesitation. That said it is also essential for the poultry industry (not to forget the many small-scale backyard poultry enterprises) to join hands voluntarily and with a sense of enlightened self-interest and duty. There will be painful losses but recovery is possible before damage beyond repair has been done.
   Just to elaborate, departmental directives must be converted into actual implementation actions. Permissiveness and indifference, concealment or compromise cannot be tolerated (as it had been in some past emergency response to disease outbreaks). The culture of non- accountability and neglect, benign or malign, must now be unlearnt and quickly. This epidemic is a national mini-emergency; it requires exceptional measures, for example, field staff irrespective of departmental affiliation and local governments to join hands and carry out clearly assigned tasks and duties.
   The impact of the present outbreak has two dimensions. First, direct economic impact on the industry by large-scale loss of production, income and employment, should the epidemic spread.
   Bangladesh poultry is a thriving growth industry but not yet a major contributor to national income; not yet graduated to major export industry. Let us not blow the immediate economic impact out of proportion though it could be significant; it is not a calamity for the industry.
   Economics apart, the possible public health impact is significant. Human suffering and death due to bird flu infection are tragic and traumatic enough.
   In a congested overpopulated country like ours, the danger of bird to human infection is high. Realistically, the situation could well get worse before getting better and coming under control.
   The culprit bird flu virus has been isolated and identified in laboratories and bears the code H5N1. Like most other viruses, it is fragile and is killed by heat. But like most others, it adapts easily to the environment and keeps mutating (changing stripes if you like) frequently.
   Therefore, if this virus accidentally mutates within the human body and jumps the barrier to acquire ability to cause human-to-human transmission that will be very bad event; that could trigger a worldwide human influenza pandemic.
   World pandemics of human influenza occurred in the last century, spread across continents and killed the millions of people — old and young, rich and poor alike. Today with so much more travel and trade within and between countries, a fresh pandemic could travel wider and faster and take a bigger toll of human lives.
   Thus, leading public health experts including those in the World Health Organisation have been issuing warnings urging preparedness and intensive control first and foremost in countries. They are warning without meaning to raise alarm. But the fact is: it is not if but when that fateful mutation of the virus and jumping the barrier will come.
   But is there total inevitability of the public health consequences of any disease pandemic? One could well argue that given today’s knowledge and tools provided by science and technology, such impact could be modified and minimised if there is a political will and public support. Who knows, science could come up eventually with effective prevention and control of disease pandemic.
   By the way, strong preparedness and response do not solely depend on money or manpower though both are important. Informed and motivated leaders, business and trading communities, and local community leaders have a duty and obligation to mobilise to launch nationwide response to this because if uncontrolled the current epidemic could threaten national security itself. Public information and education will support a massive civil defence effort.
   To be illustrative, it is not for the department of livestock or health alone to do an effective job. Seamless surveillance, early detection and effective control require government departments to join hands with NGO field staff, schoolteachers and community leaders. Government, industry, media and the huge number of field personnel (Bangladesh has an enviable health infrastructure) must be mobilised but mobilised without too much fanfare or noise but quietly applied to actual work.
   Some would like to feel secure if drugs and vaccines were available. But it takes time to isolate the specific virus strain and manufacture tested and safe vaccines. Even with rapid development effort it could take months if not years before vaccines have been developed, tested and proven, before laboratory to market availability of future vaccine takes place.
   Now that it is ‘official’, it is mandatory to contain bird flu spread to new areas by all possible means. Natural contamination is very hard but spread to, and by, humans in close contact with poultry birds and wild birds are definitely possible. That said, the poultry industry must not be short-sighted; it is in their long-term interest that the owners cooperate and do so fully without demanding compensation as a condition. Loans can be offered to rebuild closed farms.
   All who handle poultry in firms, trade and processing must be given protective clothing; transportation should be safe and disinfected. Public information and education must be geared up using non-conventional channels.
   Economic losses might make owners hide small outbreaks and unscrupulous traders are not unknown. These must be detected by strong surveillance and prompt culling of seized birds mercilessly if necessary.
   The present government gives evidence of strong commitment; if it has the will it has the power; if necessary and only as necessary it can take technical and material help from outside agencies. Expert technical advices need to be adapted to local conditions and feasibility tested. In principle and in practice, such advice and support are best used to implement nationally determined and prioritised strategies and actions; external partners can best direct their help into national stream of action.
   External assistance will never be substitute for national and local action.
   And there should be clear immediate, short-term and long-term country-level actions to best use external help. For example, WHO could help establish national reference laboratory to isolate and identify flu and other viruses. The Institute of Public Health laboratory did not grow strong and capable. The challenge is an opportunity to make the institute capable in the medium term and thus reduce dependency on outside reference laboratories.
   This is a case where public health is at grave danger and greater good of all must overweigh even huge losses for a few. The poultry industry may not be huge but not fringe industry either; anything done timely to save it will be worth many times the expense.
   The writer is no expert in livestock. As a public health professional with international experience, a few steps come to mind. These are: seamless surveillance for early detection, notification; isolation, quarantine and complete culling of poultry in all infected farms; public education on hygiene and handling of poultry birds; disinfections and other safe practices in farms and markets to protect all workers and handlers of poultry and poultry meat; restriction of imports from known infected sources and strict quarantine of infected farms; establishment of norms and standards of the poultry industry, workers’ safety, food hygiene and safety in processing and marketing; permanent disease surveillance machinery with protocol of procedures; isolation of infected humans and their contacts, treatment and cure, and if necessary quarantine of notified neighbourhoods; and quick and appropriate channelling of external assistance into prioritised action plan — both short and long term, and to build capacity of national reference laboratories.
   As stated before, to minimise, if not eliminate, chances of infection of humans with bird flu is to minimise the chances of virus jumping the barrier to human-to-human transmission — the precursor of a global human influenza killer pandemic in the future. That is not only a national duty but also our international obligation.
   Epidemics will come and go. Building national capacity and capability will endure for the future. A wise nation converts challenge into opportunity to build and prosper, not cry for help and forget as soon as the present crisis is over. That need not be an excuse to lapse into old ways and habits.
   This government has no obligation to either engage in propaganda or to hide facts. Let it do the job with exemplary discipline with which the people informed would willingly cooperate. In knowledge-based society, evidence, and not rhetoric, is the greater confidence builder.