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Following is the speech (English only) by the Secretary for Health, Welfare and Food, Dr York Chow, at the luncheon hosted by the Hong Kong Association in London on April 24 (London time):
It is my great pleasure and also an honour to be here today, among old friends and new, to share with you a subject close to our hearts and a concern that has brought people around the world together.
Avian influenza and the risk of it becoming a pandemic have been widely discussed in recent months. I have been describing H5N1 as a terrorist that has no respect for geographical boundaries, and is capable of adapting itself to its environment in order to survive in different animal species, and thus poses a constant threat to humans. The virus normally infects birds and other poultry and less commonly, pigs and other mammals (e.g. tigers and cats). Via migrating birds throughout Asia and Europe, outbreaks have been found in poultry and wild birds in different parts of the world ﷿ in Asia, Africa, Europe and Middle East. It would not be an overstatement to say that H5N1 is endemic in the wild birds / poultry/ waterfowl population in some parts of the world.
Hong Kong was the place first to identify the virus when an outbreak infecting human and poultry occurred in 1997. We are always described as the place where this happened but it is because of the work of our great microbiologists who identified it, not because we were the source of the outbreak. The second outbreak, among poultry only and on a smaller scale, occurred in 2003, together with two imported cases from Mainland China. Since then there has not been any avian influenza cases in human in Hong Kong although the WHO, to date, has confirmed 204 cases of human infection with H5N1 avian influenza virus in 9 countries since December 2003.
There was much to learn from our experience of these previous outbreaks, and also from our experience with SARS, which was the most devastating infectious disease outbreak in Hong Kong in recent generations.
The infection in human in 1997 was apparently caused by an epidemic of H5N1 infection in the poultry population in Hong Kong. The outbreak ended with culling of all living poultry (which was around 1.5 million) in the territory. Through tests of all patients, their contacts, including nursing staff, it was discovered that although some human contacts did produce antibodies in their serum, they did not produce any symptom. Thus H5N1 was (and still is) primarily an avian virus, with the capability to be transmitted to humans, but so far, with no efficient human-to-human transmission. Learning from this outbreak and capitalizing on the skills of our team of experts and excellent laboratory infrastructure, we then shifted our strategy from a defensive mode to a more proactive approach and placed a series of measures targeting the sources of the virus and potential carriers. These measures were introduced in three stages, according to the scientific evidence and knowledge at the time.
Following the events of 1997, the Government of Hong Kong has already introduced the following measures :-
-The regulation of local farms, including tightened biosecurity measures.
-All imported chickens from the Mainland must come from registered farms with health certificates (for every consignment).
-The segregation of waterfowls and land based poultry.
-The imposition of stringent hygiene requirements on wholesale and retail markets.
-The banning of all live water poultry (ducks and geese) for sale in our retail markets.
With a resurgence in avian influenza in many neighbouring territories, i.e. Vietnam, Thailand, Indonesia and Mainland China. In 2003, additional policies were introduced to control poultry farming and imports:
-Vaccination for all imported (from early 2004) and local (from 2003) chickens. (We have also installed bird-proof facilities; the placing of sentinel chickens in each batch of vaccinated chickens and monitor of the health conditions of such sentinel chickens).
-The introduction of market rest days to break the virus cycle and reduce the viral load.
-The implementation of a comprehensive surveillance programme for avian influenza in poultry and birds (collection of swabs ﷿ droppings ﷿ including environmental swabs, conducting tests on dead poultry and birds).
-The introduction of a voluntary surrender scheme for licences/ tenancies of live poultry farmers, wholesales, retailers and transporters (total financial commitment of 趏70 million).
With the obvious spreading of H5N1 to poultry around the world, primarily through migrating birds, and the identification of the virus in our local wild birds and backyard chickens, we recently further tightened our policies :-
-This includes the reduction of the live chicken population in Hong Kong farms from 3.7 million to 2 million (2006).
-The banning of unauthorized backyard poultry keeping in Hong Kong (this has been implemented in February 2006).
The above measures have proved to be working well in respect of the poultry population in Hong Kong. In addition to the above, we have decided this month to develop a poultry slaughtering plant to put together poultry slaughtering activities, which now exist in wet markets, in different parts of our territory. The objective is to ensure full segregation between live poultry and humans, thus further minimizing the risk of human infection from avian influenza. The plant is expected to have a daily slaughtering capacity of 60,000 chickens at its maximum. Given that considerable preparatory work is involved, it is anticipated that the slaughtering plant would come into operation in 2009 at the earliest. Such a decision might have been done with ease in European countries, but it is considered a major revolutionary change in Hong Kong where many of our housewives still prefer and take pride in choosing their own live chickens for the dinner table in our wet markets.
While poultry and wild birds remain our concern as the first line of risk management, our primary focus is on the human dimension, i.e. the potential threat of an avian influenza pandemic. For an influenza pandemic to occur, the WHO has laid down three criteria that must be fulfilled.
-A completely new virus should emerge to which human have no immunity;
-The virus should be able to replicate itself inside the human body; and
-It has acquired the ability to transmit efficiently from one person to another.
The first two criteria are already here; there is, as yet, no evidence of the third, i.e., efficient human-to-human transmission. We all need to work jointly and selflessly as an international community to prevent any effective human-to-human transmission from happening; or in the unfortunate event that it happens, to contain such a transmission. This should be the overriding objective, for the social and economic impact of an avian influenza pandemic would be unprecedented and beyond imagination (the WHO estimates that globally the loss could amount to over 趏500 billion).
In Hong Kong, the strategy is, as mentioned above, to reduce the risk of human infections by separating humans from poultry; to enhance emergency preparedness, fostering collaboration with Mainland and international health authorities, and fortifying public health infrastructure.
Emergency Preparedness
Hong Kong's Preparedness Plan for an Influenza Pandemic was developed with reference to WHO's Global Influenza Preparedness Plan, and it sets out a clear command and response coordination structure to ensure the government's swift decision taking in handling outbreaks. Possible outbreak scenarios are categorized into three levels, namely, Alert, Serious and Emergency. They are based on different risk-graded epidemiological scenarios relevant to Hong Kong and each of them prescribes a given set of public health measures. Such measures are population based and envisage cross-sectoral approaches and span activities such as disease surveillance, investigation and control measures, provision of laboratory support, adopting infection control measures, antiviral stockpile. We currently maintain about 9 million doses of antiviral (including Tamiflu and a small percentage of Relenza, about 40% of our target stockpiling level (targets similar to the UK Government's), influenza vaccination programmes, adopting port health measures, risk communication and public education. I will not go into the details, but as an example, in view of the human cases outside Hong Kong in our neighbouring territories, we are now at the Alert Response Level. We have extended temperature screening for incoming travellers at Airport and land borders, and we maintain a very close liaison with WHO to keep abreast of developments in the Region. In tandem with the Government's Preparedness Plan, other Non Government entities including the business sector have also developed Preparedness Plan pertinent to their needs. (Examples include the HK Monetary Authority, the Airport Authority, Airline companies etc).
An integral part of the Preparedness Plan are exercises and drills. A number of exercises at the territory wide, hospital and individual department levels have been conducted. In November last year, a major exercise involving the Chief Executive of the HKSAR was conducted and a similar exercise involving the Mainland Government is also planned for later this year.
Collaboration
Hong Kong's relations with long-time strategic partners outside Hong Kong have grown from strength to strength. There is an epidemic intelligence exchange with the Beijing Ministry of Health and the Guangdong health authorities. Experts in Hong Kong's Centre for Health Protection (CHP) have also been invited to participate in some of the case investigations in the Mainland. A strategic alliance has been formed between the Health Protection Agency of England and Wales and the CHP, and I have just signed an MoU on Cooperation in Public Health with the French Ministry of Health and Solidarities. CHP maintains close contacts with the WHO and other relevant international bodies. Furthermore, our public health experts have visited neighbouring Asian regions (Thailand, Vietnam and Indonesia) where avian influenza outbreaks have occurred, to better understand the situation. We also participate actively in global endeavours to share experience and explore opportunities for multilateral collaboration within the WHO framework.
Public Health Infrastructure
Our Centre for Health Protection (CHP), established in 2004, comprises multidisciplinary experts from various organizations, e.g. public health professionals from the Department of Health, infection control professionals from the Hospital Authority. The infectious disease infrastructure has been strengthened with additional isolation facilities; we have now 1,500 beds in hospitals, and enhanced training for medical staff. The CHP also works closely with Hong Kong's resourceful microbiologists and other public health experts in the academic field. Specially equipped and world-class P3-level laboratories and advanced communication networks are also in place.
Our preparedness notwithstanding, the developments over the past two years have fully demonstrated that avian influenza respects no boundaries. We believe that only those who are well prepared can respond effectively and no single location can handle the influenza pandemic challenge alone.
I note that in UK and Europe, preparedness is also going full steam ahead. With the detection of avian flu in wild birds in Europe and, more recently, in Scotland, communities in Europe have shared similar concern. National preparedness and response plans and working documents which address key issues of transnational relevance for preparedness and response planning have been introduced, surveillance enhanced, drills and exercises conducted, and antiviral stockpiling is forging ahead.
WHO's pandemic preparedness policies have guided the development of many of Hong Kong's preparedness plans. WHO's principles, at this stage focus on ﷿
-First, to reduce the opportunities for human infection (early detection of a pandemic alert);
-Secondly, to expedite vaccine development and expanded capacity; and
-Thirdly, which is more important, preparedness plans in every country.
In order to prevent or minimize the effect of a new global pandemic, it is crucial to identify early cases of human-to-human infection, and if necessary isolate those patients and contacts, make an accurate diagnosis, segregate the community, and give effective treatment and prophylaxis promptly. An international team with expertise is necessary, to be mobilized and coordinated to support the country with the first pandemic outbreak.
I believe that the WHO's leadership is cardinal in pulling together such international efforts, in terms of resources, expertise, and support, to help the world in managing the avian flu challenge.
Ends/Monday, April 24, 2006
Issued at HKT 23:30
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