Bangladesh Should Prepare to Tackle Future Spillover Events

Tara Banu (45) has worked in different poultry farms at Kuliarchar upazila in Bangladesh’s Kishoreganj district for the past 10 years.

She has seen how bird flu breaks out at one poultry farm and spreads to another, causing casualties in birds, reports BSS.

“The virus (H5N1) can transmit from one farm to another very fast and it takes a heavy toll on farm production as birds die after getting infected with the virus,” Tara Banu said.

Despite virus spillover, she works at these farms as usual, without practicing any safety measures to prevent the virus, which puts her at high risk of virus infection.

“The virus can transmit to humans from poultry but I do not feel any problem,” she added. 

Sonia Begum (25) works at a layer-poultry farm at Gobaria village under Kuliarchar upazila. She only uses shoes while working on the farm.

“I do not fall sick…I am not afraid of the virus. I stay at the farm 24 hours (every day),” she replied.   

Kabir Hossain (50) has been selling poultry in an unhygienic condition at Dhaka’s Kaptan Bazar for the last 33 years but he does not feel the need to use health safety gears to protect himself from avian influenza virus infection.     

“Sometimes, while handling poultry in large numbers, I use a mask to protect myself from dust but not for the virus. As I am yet to get infected with the virus, I do not use masks and gloves,” he said.

Kabir knows about bird flu but is not sure which poultry birds are infected with the virus when they arrive in live bird markets.   

“Our shop owners do not give us masks or gloves and that’s why we do not use those. But I think the bird flu virus could not affect us,” he added.

Omar Faruk has been working at a poultry meat processing shop at Tikatoli in Dhaka for 16 years. Along with other workers, he slaughters poultry birds manually in a dirty room and processes those at the same place too.

“I have been working here for a long time but I do not get infected with the virus. We have nothing to do if we get infected,” he said.

Ratan Akand (60), who has been involved in selling poultry at Kaptan Bazar for 35 years, said bird flu emerged in the poultry sector in 2007-2008 at a larger scale but has not been found in recent years.

“I know the bird flu virus can be transmitted to humans. But we feel we are safe now and that’s why we are not using safety equipment,” he said.

Although the farm workers, sellers and traders are not paying heed to avian influenza, scientists fear a potential pandemic coming from the poultry sector.              

“The H5N1 outbreak is still occurring in the poultry sector in the country each year but those are not too severe like that of 2007-2008,” clarified Dr Ahasanul Hoque, a professor of Department of Medicine and Surgery at Chattogram Veterinary and Animal Sciences University.

The first outbreak of highly pathogenic avian influenza in poultry was reported in Bangladesh in 2007. Since then, a total of 556 outbreaks of H5N1 in the poultry sector have been reported in the country until 2013, and the virus has now become enzootic in poultry due to weak biosecurity in the poultry sector linked with resource limitation and low risk perception.                

Dr Hoque said small poultry farms can be at the centre of a spillover event, where the zoonotic disease spills over from animals to humans, since there is poor biosecurity, wild birds bearing the virus can access these farms easily and there is free human movement too. 

He added that those who are directly involved in poultry handling are at high risk of virus infection. If an epidemic emerges from the poultry sector, the farmers and farmworkers will be affected more, while live bird markets will be the hotspots of virus transmission. “Live bird traders, transport workers and buyers are at high risk of virus infection.”

Dr Monjur Mohammad Shahjada, Director General of Department of Livestock Services (DLS), agreed. “As a zoonotic disease, there is a scope of avian influenza transmission to humans from birds. Poultry farmers, sellers, transport workers and consumers may be infected with the virus. Since the poultry sector witnesses overcrowding and poor biosecurity, there could be an outbreak in the sector,” he told BSS.

“We consider H5NI (avian influenza) as one of the most serious pandemic threats since the virus remains as endemic till now in many countries across the world, and it has the capacity for mutation,” Dr Giasuddin, former head of Animal Health Research Division and recently past director of National Reference Laboratory for Avian Influenza at Bangladesh Livestock Research Institute (BLRI), told BSS.  

“We are alert now as a pandemic could emerge from avian influenza. If the H5N1 virus and human influenza virus mix with each other, there could be a devastating situation,” he warned.   

Dr Hoque said there are 16 sub-types of avian influenza virus and of those, the H5NI and H9N2 are more dangerous as they are considered a threat to human health.

He said the nature of the avian influenza virus is that its strains change rapidly. “If the virus is able to develop the capacity of human-to-human transmission, it will put human health at risk,” he said.

“If avian influenza virus and human influenza virus are circulating at the same time in an area and a host (person) is infected with both the viruses, there will be a possibility of re-assortment and mutation of the two viruses. Then it could be a more virulent and dangerous one, whose pandemic potential would be more (higher),” said Nadia Ali Rimi, programme coordinator and associate scientist (Programme for Emerging Infections) at International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b).

She said there is no record of human-to-human transmission of the virus till now, but if a new variant of the virus emerges that could be transmitted from human to human, there could be a different situation.

Misperception behind virus spread

As a highly populated country, Bangladesh is highly dependent on the poultry sector to meet the protein demand of its growing population. Official data shows Bangladesh produced around 375 million poultry (in number) in 2021-22. In addition, it produced over 2,335 crore eggs against its demand of 1,785 crore during the same period.   

Despite the risks inherent to those employed by this industry, misperceptions about bird flu abound as many people think that the virus will not be able to affect them. So, people do not take health safety measures while culling, slaughtering and handling poultry, saying the virus could not cause any harm to them.

“That’s why they do not take the issue seriously,” Dr Hoque said.

The human infection rate of H5N1 virus is very low in Bangladesh and its severity is also low here. Only eight cases of humans being infected by birds have been registered so far, and only one person has died so far after getting infected with the H5N1 virus.

“Virus infection rate was supposed to be very high and rapid in Bangladesh’s live bird markets, which are highly crowded areas, but we are not getting many infections there,” said Rimi from (icddr,b).

She said commoners, bird traders, and workers are not noticing the virus as the symptoms of avian influenza are similar to normal influenza and that is why they are not going to doctors for treatment.

“Perhaps, they are getting infected with the virus but we do not know it. As they are not going to doctors, there is no scope for reporting. People are not dying or suffering from the virus. So, the commoners are not paying heed to it,” the icddr,b scientist said.

At the same time, scientists and policymakers are also not giving proper importance to the issue since the human infection rate from the virus is very low, he said, adding “We are conducting research to know why the virus is not spreading fast in our country. There could be some reasons behind it but those are yet to be discovered.”

Biosafety measures weak

The virus transmits fast in overcrowded areas as it can be transmitted in the air. Poultry farms, particularly the small ones, lack biosecurity, and hygiene is not maintained properly there, accelerating the possibility of a virus outbreak. Farm workers do not seem very aware of how to ensure biosecurity at farms and prevent possible virus outbreaks.

Once bird flu breaks out at poultry farms, farmworkers dump the dead birds on roadsides indiscriminately, putting other farms at risk of infection.

Dr Hoque said Bangladesh has a biosecurity policy and guidelines but there is no proper implementation of those.

However, Khandaker Mohsin, general secretary of Bangladesh Poultry Farm Protection National Council, said they have been trying to improve biosecurity at the farm level and protect the workers from virus infection.

“We have already provided training on biosecurity for around 800 poultry farm leaders across the country,” he added.

One health approach 

Dr Hoque said the One Health approach must be followed to prevent zoonotic diseases together as it is very important to prevent a future pandemic.

The One Health approach, put forward by the World Health Organization, recognizes that animal health, environmental health and human health are interlinked – and solutions must address all of these factors to be effective.

“Data of zoonotic diseases should be shared with each other. Public health, livestock and environment sectors are working together to establish the One Health approach,” he said.

But, Hoque said, the authorities concerned have been facing various challenges in taking inter-disciplinary coordination and collaborative actions to deal with the threat of spillover events.

“The culture of One Health is yet to be established in the country. There is a lack of workforce development at the One Health Secretariat set up in Bangladesh. The motivation at policy level is poor and the policymakers must be made more aware. So, ensuring the ‘One Health’ approach is a big challenge for us,” he said.

Noting that the One Health approach is very important to address zoonotic diseases, Dr Shahjada said the World Bank is coming up ahead to fund in the country to promote ‘One Health’.

The Department of Livestock Services (DLS) has held a meeting with the World Bank and it agreed to provide funds to Bangladesh to initiate a programme involving health, livestock and environmental sectors to establish One Health.      

“Now we have taken the One Health approach. The issues of human health, animal health and environmental health were dealt with separately in the past. We are jointly conducting surveillance today. The avian influenza issue has been included in our pandemic preparedness programme. We have been working jointly. We are going to undertake a new project on prevention of avian influenza,” Dr Shahjada said.

He too finds ensuring involvement of policymakers in the One Health approach is a big challenge as it was absent in the past. “To address the issue, we will arrange an international conference on One Health in 2023”.

“The government has the One Health Secretariat but it lacks manpower and finance at the public level. The activities of the One Health Secretariat have not reached the field level yet. It is a big challenge for us,” he added.

Preparedness to prevent spillover

Dr Shahjada said the DLS aims to provide training for small and marginal farmers on biosecurity so that they can save their farms from H5N1 infections. “Poultry birdsare being inoculated regularly. We are now talking about the production of vaccines for the H5N1 virus. We have already talked to the Asian Development Bank (ADB) to this end and an ADB team visited our laboratory,” he said.

The Bangladesh government has taken an initiative to prepare the Pandemic Preparedness Plan to address the threat of future spillovers.

“We have been working on it. We have already prepared the draft of the Pandemic Preparedness Plan. After consultations with the stakeholders concerned, the plan will be sent to the technical and advisory committees for scrutiny, and then it will be submitted to the steering committee of the government for approval,” Dr Shahjada said.

But, experts observed, the measures Bangladesh has taken are not enough to deal with the potential spillover of avian influenza.

Giasuddin suggested strengthening the surveillance system and laboratory capacity to address a future pandemic. “There is not enough allocation for virus surveillance in Bangladesh. Code-based allocation must be provided,” he added.

“Laboratory capacity must be made up to the mark to deal with future spillover events. Skilled human resources should be developed. One Health Comprehensive Contingency Plan should be prepared,” said Dr Hoque.

The regulatory measures are also poor in Bangladesh, Giasuddin said, asking the authorities concerned to update rules and regulations of the livestock department.

“Skilled manpower should be hired too to enforce these rules and regulations,” he suggested.

This story was produced with support from Internews’ Earth Journalism Network.