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(CNN) — Editor's note: Tom Frieden served as director of the US Centers for Disease Control and Prevention from 2009 to 2017 and is currently president and CEO of Resolve to Save Lives and a senior fellow for global health at the Council on Foreign Relations.
The US response to H5N1 (avian flu) has taken too long, showing how dangerous the gaps in coordination and trust can be. With three reported cases in the US and clusters of cases in cattle herds from Michigan to Texas, and Idaho to North Carolina, it is clear that this virus is circulating among animals. We need to get this right to protect people, animals, and our economy, and to restore confidence in public health.
The emergence of H5N1 was predicted more than 20 years ago. Although it was smaller in scale and therefore less of a problem, Finland stopped H5N1 in animals last summer before it could spread to humans. This story, along with six other outbreaks that never made the news, is featured in our new Epidemics That Never Happened report.
The US has done a lot to scale up testing production, evaluate vaccines, track related virus drains, and provide information on efforts. Finland has done three things in particular well, all of which are relevant to the US virus response.
Rapid response. Within 24 hours of the first case being reported on the mink farm, Finland confirmed that the animals had tested positive for highly pathogenic H5N1 avian influenza. The virus was known to have been circulating among birds in Finland at the same time that it had been circulating among birds in the United States for the past two years. Human and animal health experts immediately worked together to trace the infection, including testing at-risk workers on farms with infected animals.
In the United States, H5N1 has been circulating among cattle since at least late last year. In the United States, the extent of spread among animals and humans is unknown even today due to insufficient testing and tracing. The 7-1-7 goal for epidemic detection and response should guide us: 7 days to detect a suspected epidemic, 1 day to notify public health authorities, and 7 days to complete an initial response. This approach allows us to stop epidemics before they spread. The Finnish response achieved this goal. In the United States, the time from emergence to detection of H5N1 in cattle was nearly 100 days instead of 7, and even now, several months into the epidemic, it is not clear whether the 7-day goal for initial response was met. This requires communication and public health measures in affected communities, as well as effective coordination mechanisms. We must improve the link between human and animal health and strengthen animal public health.
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Trust. Farmers already had a high level of trust in the Finnish Food Agency due to the success of the program over the years, and it had begun a surveillance program where any abnormal symptoms in livestock were quickly notified. Farmers were immediately compensated for the value of livestock that would have had to be culled to stop the spread of the disease, strengthening trust in the government in the farming community. This trust will undoubtedly help Finland's next move: vaccinating frontline workers against H5N1. Finland is the first country to do so.
Trust in the U.S. government is low, especially among rural Americans who are on the front lines of the pandemic. In May, the U.S. Department of Agriculture announced it would provide funds to farms to help prevent the spread of the virus in dairy cows. This would include covering veterinary costs for H5N1-positive cows, compensating farms to provide personal protective equipment for employees, and paying farm workers to participate in USDA and CDC studies. More may need to be done to protect our nation's agricultural sector.
Coordinated government response. Finnish health and agriculture authorities worked closely together, paving the way for a fast and effective response. The joint response strengthened detection, coordination of industry associations, and prevention of worker infection. Finland quickly passed new legislation to ensure the powers to implement effective control measures.
In the United States, government agencies have an uneasy relationship due to differences in priorities, legal authority, agility, and politics. There are multiple agencies involved: USDA monitors cow health, Food and Drug Administration monitors milk safety, and CDC monitors human diseases, including those that come from animal contact. Coordination seems to be improving, but government directives must be tailored to the specific needs of each community. Given the size and diversity of the country, a national mandate may not be realistic.
There is a lot to learn, and no time to waste. First, local, state, and national authorities must work together. This requires multiple federal agencies, such as the CDC, USDA, and FDA, and their state counterparts to transparently share information with each other and the public in real time. Second, Congress must provide resources to prevent and respond to pandemic risks, including the systems, workforce, and infrastructure, so we are prepared to stop new events before they become epidemics. And, perhaps most importantly, we must quickly build relationships with farmers and workers by serving their needs and addressing their questions and concerns.
Even if one country responds successfully to H5N1, it is not enough. Microbes know no borders. All countries, including the United States, need an effective response. My organization's most recent “Epidemics That Didn't Happen” report highlights how countries with responsive health systems prevented outbreaks from becoming epidemics through careful planning, early detection, and rapid action.
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