Speech of Dr. A Ramadoss at avian Flu International Conference
4 Dec 2007

Following is the text of the keynote address by Dr. Anbumani Ramadoss

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Following is the text of the keynote address by Dr. Anbumani Ramadoss, Union Minister for Health & Family Welfare, today at the New Delhi International Ministerial Conference on Avian and Pandemic Influenza: 
“Welcome to incredible India and welcome to this almost incredible conference.  This conference is momentous.  It has woven so many of us together into a world that is truly united in the fight against Avian and Pandemic Influenza.  When India hosted the Asia Conference on Avian Influenza in June last year I had one apprehension.  Were we being over zealous by engaging with Avian and Pandemic Influenza so frequently?   One year down the line, our concern now is whether we all our doing enough to keep the pandemic at bay.
The global threat of Avian & Pandemic Influenza continues.  Over 61 countries have experienced outbreaks of Avian Influenza since 2003.  To date, millions of birds have been culled, and the economic cost to the affected countries has been colossal.  It is likely that the virus infections among domestic poultry have become endemic in some parts of the world.  While the number of people infected appears small, the case fatality rate is very high with over 61% deaths.  We will hear about these facts in greater detail as we progress with the Conference.
But, the question we need to ask upfront is whether as a global community we are really doing enough?  We could all draw solace from the UN System & World Bank Progress Report on the Global State of Influenza Pandemic Readiness and Capacity to Control Highly Pathogenic Avian Influenza released a few days ago.  The report confirms improvement in country responses to Avian Influenza.  The report, however, also underscores the need for greater effort in coordination of pandemic planning between countries.
This conference is a manifestation of that much-needed ‘greater effort’.  We are indeed encouraged that more than 600 delegates from 105 countries and 20 international and inter governmental organizations have congregated here.  We are immensely pleased to have with us seventy ministers from the public health and animal health sectors.  In a world that is so intrinsically connected, avian & pandemic influenza can only be controlled if all countries work towards this agenda.  Any country that lags in its efforts could become the weak link that negates the consolidated efforts of the rest of the world.  We acknowledge that the capacities to respond to the threat of a pandemic would vary from country to country, given the wide range of cultural, economic and political differences.  But we must stand together and move forward as one, in our commitment and resolve to fight this virus.  We can collectively achieve this by setting agreed-to milestones and work towards realizing them with sincerity and transparency.  
For example, most countries have prepared their plans for responding to an outbreak of Avian and Pandemic Influenza.  India has clearly defined Action Plans for both animal and human health.  We could agree that all of us will test these plans through mock drills or other similar mechanisms periodically.  Similarly, we all agree that we need to build capacity for a sustained response to the pandemic.  We now need to work towards actualizing this capacity.  In other words, it is now necessary for each country to develop its own road map towards creating such a capacity with clearly defined milestones to measure success and an action plan for doing so.
Before the conclusion of this conference, India would share with all of you, its vision of such a road map.  I am sure that you would find it to be a simple yet effective tool in creating national and global capacity to resist and fight the threat of an avian influenza pandemic.  This vision for the road map is based, amongst other things, on India’s experience in successfully containing the outbreaks in 2006 and 2007.
I take pride in informing you that during the avian influenza outbreaks in poultry, India maintained absolute transparency in sharing information promptly.  We did not quibble over issues of pathogenocity of the virus nor about the fact that in 2007 the disease was confined and localized to a small farm of less than 150 birds in the north eastern part of the country.  The containment measures mounted by the Government of India in the affected areas were greater than those known to be followed internationally.  For instance, given the nature of the outbreak and the involvement of backyard poultry, India took a bold decision to cull birds across a radius of 10 kms. in the 2006 outbreak.  We were, therefore, able to revert to the avian influenza free status within three to five months.
Prompt and reasonable compensation has been the hallmark of our containment operations. Our National Action Plan for Preparedness, Control & Containment of Avian Influenza, establishes the framework for the compensation mechanism.  The Plan recognizes that the programme of culling of affected birds will succeed only if a system of adequately compensating the poultry farmers is put in place and activated immediately after the outbreak of Avian Influenza is confirmed. The plan emphasizes that any expenditure incurred on compensation is more than justified by way of bringing about effective control of the disease. In addition compensation is paid for feed and feed materials destroyed in operations. The Government of India paid more than US $19, 47,619 as compensation for poultry and feed / feed material in 2006. More than US $2, 23,810 have been paid for birds culled in the 2007 outbreak.  
It is a matter of satisfaction that during the outbreaks, both the concerned ministries - the ministries of public health and animal husbandry worked in perfect co-ordination. The joint monitoring mechanisms worked well and even on technical matters, both departments shared their concerns on all key issues. I must also acknowledge that in India, the lead role for handling the outbreaks was played by the Deptt. of Animal Husbandry while the Public Health Ministry played more of a supportive yet strategic role in providing prophylactic cover of anti viral drugs to the cullers and labourers working in the operations, with constant monitoring of their health status. 
In India we recognize the importance of these two sectors working together and we have continued to work as an extended team for avian influenza.  One of the most significant achievements has been the modification of our World Bank funded Integrated Disease Surveillance Programme to include surveillance for animal diseases as well.  There is another facet of such co-ordination that is between the Union Government and the provincial States. Animal Husbandry and Health are provincial subjects in the Indian federal framework. But the Union Government assumed a lead role in co-coordinating and monitoring operations. A nationally regulated system of surveillance with weekly disease reporting has been activated. The Union and the State Governments share the costs of compensation.
Communication is one of the major pillars for combating any outbreaks. An important decision taken jointly by the two concerned ministries was to be completely transparent in our actions and to keep the public informed about the situation by regular interaction with the news media. Daily joint briefings were held by both ministry focal points and the media had access to cover the sites and report directly on what was happening.  While the media interest was the highest during the first outbreak, by the time of the third outbreak, the media and the public who were by then better informed about Avian Influenza, reacted with moderation.
Government of India in partnership with UNICEF and other Consultants has developed an evidence-based national communication strategy and materials for prevention and outbreak scenario related to Avian Influenza. It primarily focuses on backyard poultry farmers and their families at risk and includes use of mass media and inter-personal channels. The campaign approach is non-judgmental and is designed to alert families to the risks associated with poultry diseases, including H5N1. 
The communication strategy also advocates building the capacities of the frontline workers within Health and Animal Husbandry departments to become effective communicators.  We also feel the need for a global trans-disciplinary, integrated communication network on HPAI and pandemic influenza.  It is encouraging that WHO, FAO, OIE and UNICEF are already working jointly in this direction.
Thile India achieved freedom from Avian Influenza in November 2007, we continue to maintain a constant vigil for any outbreaks. Our surveillance network is being strengthened further. Laboratories for animal and human health have been identified and equipped. All guidelines have been circulated to the States and territories; training of rapid response teams has been done on priority. A large cadre of medical doctors both in the public and private sector has been trained for the clinical management of human cases of avian flu. Veterinarians in the public health sector have also been trained. Our pharmaceutical companies are producing ‘Oseltamivir Phosphate’ an antiviral drug for avian flu. During the outbreak in 2006, there was a public scamper for this drug in India. To prevent its misuse and also to ensure that it is administered only under medical supervision, we have banned the retail sale of Oseltamivir Phosphate. In India, this drug would be available only through the government public health system. Our pharma companies are however free to accept export orders to meet the requirements of other countries. 
An important concern is the need to raise the level of bio-security in poultry holdings.  However bio-security measures do not come without a cost.  Effective measures need a commitment and financial investment from governments, the private sector and the commercial farms. Bio-security is equally important for the large commercial breeders as well as for the small, back-yard poultry holders. To ensure affordability and compliance of implementing such strategies, we may need to develop simple and affordable bio-security measures and to provide institutional support at the community level to mobilize prevention and control actions.  
We are acutely aware that resources are scarce and there are competing claims for these from other health issues. By pooling our resources, we could perhaps ward of the threat of a pandemic and at the same time tackle many other infectious diseases that are linked to poor hygiene. The World Bank has projected that for a reasonable level of preparedness for avian and human influenza, developing countries would need to spend at least US$2.2 billion over a two to three-year period, while international organizations would require at least $325 million annually to support these activities.  The current gap for mobilizing resources for country programmes is $960 million, or more than 40% of the identified needs.  From the Beijing and Bamako pledges, $649 million is still available to help fill this gap, but these resources are in the form of loans, while grants would be a more appropriate form of financing for this global public good.  While this gap must be minimized, I would urge that we need to look at low cost options also. As explained earlier, empowerment of the community is emerging as the most powerful tool in preparing for the pandemic and all countries and organizations need to focus on this aspect.
I have tried to draw attention to issues we will be deliberating upon in this conference in the hope that at the end we will all carry back with us our own vision of what we will be doing over the next one year. When we meet next, hopefully in 2008, we should be able to look back with satisfaction that we have moved closer towards One World- not only united but better prepared for the fight against the avian flu virus”.