Quotes of the Day

Bird cull in Turkey
Sunday, Jan. 15, 2006

Open quoteOut in the remote, impoverished Turkish town of Dogubeyazit, a chicken is more than just a bird. For the hardscrabble villagers, it's often the only source of dietary protein, and for their children, the only toy. So it was no surprise that 15-year-old Fatma Kocyigit and her 14-year-old brother Mehmet Ali played with the sick fowl their father had brought indoors for protection from the bitter December cold. The fun proved fatal. The children came down with high fevers and bleeding throats; when they went to a nearby hospital, they received ordinary medication for a cold and were sent home.

A week later, when the children did not improve and their father told doctors about the chicken deaths, they were transferred to a better-equipped hospital in the nearby city of Van. Blood samples from the Kocyigits were sent to Ankara for tests, which showed that the children had contracted the deadly h5n1 strain of bird flu that has killed about half of those in Asia whose infections have been reported to the World Health Organization (who). By then it was too late; Mehmet Ali died on Jan. 1 and his sister four days later, setting off the latest upsurge of fear that the lethal virus might be invading Europe.

The virus has already crept stealthily into the four corners of Turkey. As a stopover on migratory bird routes, the country has known for months that it was vulnerable to the natural spread of the disease. Last May, the Turkish Agriculture Ministry warned provincial officials to ban live-poultry markets. Few did. Then in October, 1,800 turkeys died on a farm near a wild-bird sanctuary in the northwest of the country. The area was swiftly quarantined, infected birds were culled and farms were disinfected efficiently enough to calm fears of a major outbreak. But in mid-December, when the Agriculture Ministry looked into the first reports of bird flu among fowl far to the east in Dogubeyazit, the press said that its inspectors failed to notify the Health Ministry of any risk. "Turkey ignored all the warnings," Erdal Safak, columnist at the mainstream daily Sabah, told Time. "The government wasted valuable time. There was no public awareness campaign, no precautions were taken along documented migration routes, and provincial vets were not adequately equipped."

In the week that followed the Kocyigits' diagnosis, the who says, at least 16 other Turks in nine of the country's 81 provinces were diagnosed with the h5n1 virus — the largest number of known cases to occur in such a short span. And the virus kept spreading. Soon the World Organization for Animal Health recorded another 28 suspected bird outbreaks in 14 provinces. "Clearly there was a poor understanding as to how much spread of h5n1 there was in poultry in Turkey," says Guenael Rodier, leader of the who team in Turkey. As the disease penetrated the eastern edge of Europe, governments across the Continent were asking tough questions about their own risk. So what lessons can they draw from the Turkish experience?

YOU'VE GOT TO MOBILIZE ASAP If you wait until people get sick, it can already be too late. Last week, teams of Turkish health workers in battered vans began to mount a nationwide chicken hunt, going house-to-house in white biohazard gear to search out sick birds. But in another snowy village outside Van, the Karatay family was still waiting for its fowl to be collected, a week after reporting the deaths of two chickens. "I do not understand why the officials take so long to get here if this disease is so serious," said Ali Karatay, a father of four. The government's chaotic response has unsettled his neighbors, who feel torn between protecting their families' lives and sacrificing their livelihoods along with their chickens. When Health Minister Recep Akdag finally arrived in Dogubeyazit, an angry crowd heckled him, calling out: "We need better hospitals!" and "Why has it taken you so long?"

For millions of Turks in rural Anatolia, awareness of bird flu's perils has been slow to arrive, especially in areas where there is little access to television. It was not until early January, some five days after the first Kocyigit child died, that the Turkish government launched a public-information campaign: setting up a telephone helpline, broadcasting health warnings on television and blaring the messages from mobile loudspeakers. One unmet challenge was to overcome farmers' reluctance to tell authorities about suspicious deaths. "They are afraid to report sick or dead animals," says European Union Health Commissioner Markos Kyprianou, "because that could mean the entire stock is destroyed." In the short term, Turkey will have to offer poor families compensation for birds that are culled. In the long run, though, countries like Turkey need to teach residents of rural villages and urban shanty towns that they can no longer raise poultry haphazardly in their yards and streets, where domestic birds can come into contact with the migrating wild birds that naturally carry the virus around the world.

GET A JUMP ON THE VIRUS At least scientists and doctors can profit from Turkey's troubles. "There will be huge lessons to come out of these outbreaks," says John Oxford, a professor of virology at London's Queen Mary's School of Medicine. "Even the dad whose children died can reassure himself of that." The most crucial item of scientific information: who officials say they have so far seen nothing to indicate that the Turkish victims contracted bird flu from other people, the potential nightmare that could lead to a pandemic.

Virologists at the National Institute for Medical Research (nimr) in London, which is home to the World Influenza Centre, analyzed the sequence of genes in the h5n1 virus that killed the Kocyigits. They found the structure of those genes was very similar to that found in the avian version. But nimr director and influenza expert John Skehel says he has also found a worrisome protein change in one of the human genetic sequences. "That mutation makes the virus prefer human cells," Skehel told Time. He cautioned that there are other factors — some still unknown — that will determine whether people eventually transmit bird flu to one another. But, he says, the protein mutation is "one of the things" that is required.

Scientists are intrigued, however, by the cases of two young brothers hospitalized at the Kecioren Hospital in Ankara. They tested positive for the h5n1 virus after exposure to sick chickens, but have not shown symptoms of the disease. Nevertheless, they are now being treated with Tamiflu, one of the antiviral drugs with some capacity to fight avian flu. The who's Rodier thinks that the boys' parents probably became suspicious about possible exposure to the virus before the disease could take hold, and whisked the boys to hospital. Such vigilance may hold the key to survival. Swedish researchers reported in the American Medical Association journal Archives of Internal Medicine that 650-750 people in northwest Vietnam admitted suffering flu-like illnesses after handling sick or dead chickens. While virologists say the study did not use blood tests to confirm the presence of h5n1, they think it could mean that some people may carry bird flu without getting sick. "It suggests more cases are not being picked up, and that the mortality rate is lower than the 50%" recorded by the who, says Oxford. That is not necessarily good news; he points out that a virus that kills at a lower rate but spreads quickly is more dangerous than one that kills at a higher rate but spreads more slowly.

GLOBAL THREAT, GLOBAL RESPONSE Fending off a potential pandemic is not just the job of infected countries. Last week, the U.N. warned that Turkey's neighbors were at risk from avian flu unless they also took immediate steps to protect themselves. Some tightened border controls and increased surveillance. But it is unclear whether next-door states like Azerbaijan, Georgia, Iran and Iraq have the knowledge or resources to do enough. It is far easier for the wealthy nations of the E.U. to mount a strong defense. Bans on Turkish poultry products remained in place throughout the E.U., and member nations pledged to spend $100 million to fight off the global spread of bird flu, focusing on the most needy countries. In the U.K., businesses have been urged by the government to develop contingency plans against a pandemic: the giant global bank HSBC estimates human-to-human transmission could make ill half its worldwide staff. The World Bank is calling for rich nations to donate millions — to pay for mass culling, compensation and animal vaccination — to the places where the disease has lodged, and wants the West to invest in research to speed up the development of effective antiviral treatments before human-to-human transmission takes off.

In Turkey, meanwhile, the virus may already be endemic: a permanent presence that would constantly threaten to invade Europe in the future. Even if everyone has learned the lessons of previous health and food-safety crises such as mad-cow disease and foot-and-mouth disease, avian flu defies traditional responses. Wild birds don't stop for quarantine controls, and they don't recognize borders.Close quote

  • ANDREA GERLIN
  • The H5N1 virus has crept onto Europe's eastern edge. What should the Continent's authorities learn from Turkey's troubles?
Photo: ANJA NIEDRINGHAUS / AP | Source: A new outbreak offers the chance to better prepare for a pandemic