Ghana's bid and the Bird Flu

Health: Not a fun budget

Over between 20 to 50 million people were estimated to have died during the "Spanish Flu" outbreak in 1918 worldwide. That would have been, annihilation of the entire population of Ghana,Togo, Benin and Cote d'Ivoire of today. Meaning the people of these countries will be gone if any disease of the same magnitude occurred today.

The World Health Organization's (WHO's) records indicate that within the past 300 years humans had to battle infectious diseases of a global nature, about 10 times.

What is termed "shift,"(antigenic) being the bird flu from poultry to humans luckily will not begin from Ghana. With common symptoms of a bird flu in humans, as similar to other types of flu: fever, cough, sore throat, muscle aches and conjunctivitis.

The rare phenomena of the disease in humans was due to a mutation of the bird flu virus. Since its occurrance in the early 1900s in Italy, it subsequently re-appeared in 1957/58 (Asian Flu) later during 1968/69 (Hong Kong Flu).

Then another experience was recorded in 1997, "the outbreak killed six and led to the slaughter of 1.5 million chickens," also in 2002 it was thought that a mutant strain of the virus (species) jumped or "leaped" from birds into humans in Hong Kong.

Monitoring of the virus around the world (WTO) have been upgraded ever since. It is therefore an opportunity for the Health Ministry to source for the necessary funds, with a vision beyond a not yet functioning NHIS in Ghana.

In severe cases of avian flu, it can cause severe breathing problems and pneumonia, which could be fatal. The incidence of the bird flu is found to affect healthy individuals alike. Humans they say have no particular immunity.

But there are persons with the duo of HIV/AIDS and tuberculosis (TB) in Ghana. Pathology reports in 2002 showed that Respiratory Tract Infections (RTIs) recorded the highest percentage of death at Korle-Bu hospital with 1,295 patients dying out of 3,085 that reported with the disease. (Ghanaweb, 14/06/2004)

An action plan to fight the bird flu is to be discussed at a major conference by the WB/IMF has been arranged by WHO for 7-8 November, 2005 in Geneva. The World Health Organization has warned "that between 2 million and 7.4 million people could die from a global flu pandemic,"(AP Sept. 30, 2005).

What we need to know even before the said conference is, could it happen in Ghana? If it does how well will the country tackle it? The other dangers are that the bird flu has become so readily transmitted from person-to-person and there is the lack or shortage of vaccine.

Then comes the peculiar situation of Ghana in terms of health delivery, where its been reported by both the International Labour Organisation (ILO) and the International Organisation on Migration (IOM) that between one half to about three quarters of all doctors and nurses trained in Ghana have been lost to the west.

"Since 2003 about 64 persons were killed by bird flu in four Asian countries and the disease has spread to some ten countries" around the globe. In Indonesia the number of people confirmed or suspected of having been infected or exposed to bird flu was 85 by Sept. 30, 2005 the Health Ministry said in Jakarta. (Kyodo News, 10/06/05)

Whereas, "The draft report of the federal government's emergency plan predicts that as many as 200 million Americans could be infected and 200,000 could die within a few months if the avian flu came to the United States."

It is sad that even after the United States (US) announced an International Partnership on Avian Influenza at the UN's World Summit in New York nothing was mentioned in Ghana then after.

As a sequel to this, there was a planning meeting on October 7-8 in Washington. If no one attended from Ghana, I do still hope authorities in Ghana are keeping in touch.

This brings to mind the extent of preparedness of our Health Ministry. With supporting and well defined roles for the communications, education, information and environment ministries, emergency (National Disaster Management Organisation-NADMO, Fire Service, St John's Ambulance-National Ambulance Brigade).

Also the protective services the Police, Customs Excise and Preventive Service (CEPS), Immigration Service, possibly the military (as in President Bush's request to congress on October 5, 2005), also civil society, media and NGOs (Ghana Red Cross Society, Danida, DFID, Oxfam, Save the Children, Care, USAID, etc.)

All these organisations should seek and see to coordinate a National Pandemic Influenza Preparedness Plan for Ghana.

The above is what I call Ghana's bid. Unfortunately, no one bid's on something as devastating as a pandemic. "Pandemics are like hurricanes, tsunamis and earthquakes," Michael Osterholm said. (AP, Sept. 2005)

No one should think that it is just 'scare' since in the same way Ghana was spared from Severe Acute Respiratory Syndrome (SARS) strain of coronavirus found in masked palm civets, Chinese ferret badgers, and raccoon dogs all eaten as delicacies in parts of China. These are all species not eaten or found in Ghana.

The uncertainty of time of occurrence is very high. Just as the enormity of costs which could be measured as financial, human and even material (morgues, coffins, stadiums, land space, etc.) if it does occur.

It is capable of dislodging total gains made by the economy and the effects felt more so, than any fuel prices increases in we have seen in Ghana.

The government will need an additional 5.0 trillion cedis to buy a reasonable quantity of vaccine for the population in case of an outbreak. Specially made flu masks could be the first line of defence and my come in handy and cheaper.

Only one drug maker, Roche in Switzerland is said to manufacture the Tamiflu antiviral drug priced at about 500,000 cedis per vaccine. Has become the only vaccine with efficacy tests continuing against the disease.

The is a "first come first serve" basis on which the company hope to meet the demand as nation scramble to have stocks available. Ghana, Africa and many developing countries are on the periphery of the market.

Amidst initial criticism from health officials in the UK, the coountry has been able to buy for stockpiling 14.6 million vaccine doses (antiviral drugs) that could cater for about one quarter of its population in the first few months of an outbreak. It is feared thee order may take up to two years to arrive.

The UK efforts and contigencies put in place was praised by no other person than a Ghanaian expert Dr Anarfi Asamoa-Baah, assistant director general for communicable diseases at the WHO, said: "From an initial review of the document, I note that this is a high quality plan."

"It shows that the UK continues to be at the forefront of preparations internationally for pandemic influenza." Ghana will be grateful if he advised us as well.

Could the unpredictable scenerio be the reason for the Ministry of Health's silence in Ghana? It is high time leadership, government and other stakeholders not only broke the silence over the bird flu threat on the news but create some form of awareness creation is necessary.

Ghana does have to make a case in view of the migratory birds and the fluid traffic (travellers, refugees, business people and goods) through our borders (ports and harbours) in the West African sub-region and the free trade zones policy (GFTZB) of Ghana.

Ghana has to set up animal disease surveillance systems and laboratories to provide diagnostic capabilities. Liberalisation has already fragmented the national veterinary services into numerous small companies with limited capacities.

Since the seemingly National Health Insurance Scheme (NHIS) of "Paracetamol, Septrin, and Malarax or the Quines," currently being replaced by Artesunate plus Amodiaquine as a substitute for Chroloquine, will be out-run in seconds. It has also been reported that drugs on the NHIS list are dearer than those from drug, pharmacy or chemical stores in Ghana.

This anomaly defeats the idea of the scheme and clarification is expected from the ministry. It may well ??e that such drugs are generics from Asia and not necessarily from the world renowned drug manufacturers like Chiron, Sanofi-Aventis, Wyeth, GlaxoSmithKline and Merck.

During meet the press series last month the Health Minister Hon Courage Quashigah challenged our environmental stewardship, food and probably the water we drink to be the major cause of aliment in the country. But could not present the details of the NHIS, as such it was put at bay for the time being.

It may be a fair assessment by the minister generally, but will not be acceptable for an Avian Influenza (Bird Flu) epidemic. It is a viral (H5N1 strain) disease that attacks not only all birds (wild and domesticted) species; chickens, ducks, geese, guinea fowls, turkeys, but also pigs to varying degrees of potency.

Ghana is said to be a birds paradise with about 722 species identified throughout the many bird sanctuaries across the country. Some of which are continental migratory birds from the northern hemisphere and could be possible agents for the disease.

These birds could be carriers of the bird flu into Ghana during the winter months in the north. Hence, they arrive in Ghana by Christmas until the rainy season before most will fly back.

As we are all aware Christmas (yuletide) is the period when all Ghanaian homes will come into direct contact or the other with chicken.

One will say this disease could be a case for arguing for and working towards our own sustainable but viable poultry industry with the Ghana government and the World Trade Organisation (WTO).

Although, one is not sure of any links of the virus with frozen chicken and chicken parts; said to be cheaper than live chicken sold in Ghana and usually imported from Denmark and the Netherlands.

I wish to pitch-in here, my concern as a former poultry farmer, for the attention of the Food and Drugs Board (FDB) to explain to Ghanaians the issue about the acceptability of why the yoke of the eggs we buy in Ghana today are whitish and not the usual pure yellow colour?

Birds are free flying and therefore have no boundaries hence, it is the real threat Ghana faces.

Avian Flu subtype H5N1 was again detected again in Vietnam and Thailand?fs poultry industry. The severe Avian Flu epidemic of the 2003-2004 resulted in the deaths of 23 people.

The World Bank launched a $5 million program last year to help Vietnam better monitor outbreaks in poultry flocks, improve response times, and increase public awareness.

During this year (2005) millions of poultry thought to have bird flu in Russia and Ibaraki Prefecture (over seven farms), Japan were killed, destroyed. The avian virus was thought to have spread recently from Asia into Siberia in eastern Russia and Kazakhstan, also appeared in Romania and Turkey recently.

The thoughts of bird flu is creating sleepless nights for world leaders who care hence, the incessant efforts being made by most health authorities (institutions) globally.

Many years have passed in Ghana when people were made to mark or mask their homes with a sign of the cross, in white (chalk) and red (paint) some years later, so as to be spared a misfortune.

It will be better not to create a myth of this real threat of the bird flu pandemic as I witnessed during my childhood, but will require all to be more proactive.