In the Heart of Bird Flu

When avian influenza strikes a poultry farm, its onset looks something like this: First, seemingly healthy chickens stop running around. Then their heads begin to droop. Fifteen minutes later, they fall over dead. It’s a familiar sight for a group of Cummings School veterinarians, practitioners of Tufts-pioneered techniques for controlling livestock epidemics, who have come to Indonesia to try and slow the spread of bird flu.

Here in the flu’s epicenter—the locus of 49 human fatalities as of mid-September—villagers and small farmers are reeling from the plague that has thinned their flocks. Some islands have gone critical. “It’s almost as if you cannot get any more virus into Java, Sumatra, Bali, and, likely, Sulawesi,” says Christine Jost, V96, F03, an assistant professor who is part of the Tufts contingent. “The place is saturated.”

If there is anything to feel good about, it is the equally rapid spread of participatory epidemiology (PE), the disease-control approach pioneered by Jeffrey Mariner, V87, and other Tufts veterinarians. In a program administered by the U.N. Food and Agriculture Organization, Jost and Mariner, sharing the role of chief technical adviser, began training Indonesian veterinarians in PE in January, organizing them into two-person “search-and-response” teams to collaborate with rural communities (that’s the “participatory” part) in spotting avian flu and halting its advance. Four Cummings staff veterinarians—Ibrahim El Mardi, Sayed Noman, Eric Brum, V04, and Alison Turnbull, V06, MPH06—recently joined the effort.

By September, the Tufts veterinarians had trained some 240 search-and-response team members posted in nine provinces on Java, Sumatra, and Bali. They expect to have 1,300 team members in 12 provinces by May 2007. Encouraged by the results, the Indonesian government has adopted the Tufts strategy, as have the World Health Organization, USAID, the World Bank, AusAid, and Development Alternatives Inc. Other countries in the region are expressing keen interest.

The beauty of PE is its ability to tap the knowledge of the world’s top experts on the health of chickens: the farmers who own them. The teams home in on infection by speaking with farmers at length about their flocks. This “active surveillance” is in marked contrast to the passive role most decision makers are accustomed to, which, says Jost, “means waiting in your office for someone to come in and report a problem.”

The training opens people’s eyes immediately, she says. Within an hour of starting their field practice in Sumatra’s Lampung province, an area that had had no recent reports of disease, government vets were astonished when farmers showed them chickens keeling over from avian flu. “This was a profound experience for our team members,” Jost says.

Until recently, Indonesia, like many countries in the region, practiced “nontargeted” vaccination, with government officials tramping through flocks and often spreading the disease along with the vaccine. Another failed tactic, large-scale culling, merely enraged poultry owners. The Tufts way is to rally communities to solve their own problems.

The “focal cull”—killing only sick birds and their immediate neighbors—is one enlightened remedy. Another is teaching farmers to inoculate their own flocks, using “ring vaccination,” where chickens in the area surrounding a flu site are injected to form a buffer zone. The teams also try to discourage risky practices like dumping carcasses in canals and spiriting chickens away from disease-ridden areas.

Nothing can eradicate avian flu overnight. Rather, says Jost, the Tufts team is taking a “long-term development approach,” gradually uncovering clues about how and where to fight the disease. “We have surveillance reports coming in from communities that had refused to talk to government vets only a week before,” Jost says. From such cooperation will come better solutions.