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Study Finds Europe Bird-Flu Defenses Vary Widely
posted by admin on 13/04/06

A study slated to be published in a prominent medical journal has raised politically sensitive questions about how prepared some European countries are for a possible bird-flu pandemic among humans. 

The study by the London School of Hygiene and Tropical Medicine, entitled "How prepared is Europe for Pandemic Influenza?," is slated to be published in an upcoming issue of The Lancet. A draft of it dated February 2006 was reviewed by The Wall Street Journal. 

Co-authors Sandra Mounier-Jack and Richard Coker ranked 21 European countries according to their national plans for coping with a human outbreak of avian flu. France, the Netherlands and the U.K. topped the list, while Lithuania, Portugal, Latvia and Italy were at the bottom, according to one broad measure. 

The researchers collected preparedness plans that were publicly available as of late last year and evaluated them with a checklist of 169 criteria, including how antivirals and vaccines would be distributed and who would get them; whether masks and school closures would be recommended; and whether restrictions would be placed on international travel. 

The study, funded by Swiss drug maker Roche Holding AG, also specifically addressed how much of certain countries' populations would be covered by their stockpiles of antivirals such as Roche's Tamiflu. An early draft of the study singled out France and the Netherlands, for instance, as having enough antivirals to cover 53% and 30% of their populations, respectively. 

In a recent opinion piece in the European Journal of Public Health, Ms. Mounier-Jack and Dr. Coker noted the marked differences in the amount of antiviral drugs stockpiled in different countries and called for a stronger role for the European Union in coordinating a response to the possible health threat. 

Scientists and public-health officials have been warning for years that the particularly lethal strain of avian influenza that has emerged in recent years could quickly mutate into a form that spreads easily between humans, sparking a global pandemic. Those worries have prompted governments around the world to prepare for an outbreak. 

The strain, H5N1, has killed at least 109 people in nine countries since late 2003. Most, if not all, of those people appear to have contracted the disease from birds. So far, H5N1 hasn't developed into a major health threat for humans. 

The study's findings generated controversy when presented at a recent meeting of Europe's top public-health officials in Vienna. 

"It doesn't look too good for some of the countries," said Gudjon Magnusson, a director at the World Health Organization's regional office in Copenhagen, who was in Vienna and reviewed the report. Fueling the concern, he said, was the fact that politicians in countries with low rankings for their preparedness could face repercussions. 

Dr. Magnusson said critics of the study's methodology pointed out that the researchers reviewed only plans that were posted on the Internet or otherwise publicly available, potentially missing national legislation that deals with disasters without specifically referring to bird flu. 

Concerns were also raised in Vienna that the authors had overlooked plans that had been updated or released more recently. An early draft of the study included plans published through November 2005, but the H5N1 strain of bird flu has arrived in Europe in force only during the past few months. 

Some of these concerns may be addressed in the final version of the paper, but the authors declined to provide the most recent version of their study prior to publication. 


European countries ranked on the quality of preparedness for an outbreak of avian flu 

Top Five Bottom Four
1. France 17. Poland
2. Netherlands 18. Italy and Latvia (tied)
3. U.K. 20. Portugal
4. Germany 21. Lithuania
5. Switzerland   
Source: London School of Hygiene and Tropical Medicine 

Some health officials point out the difficulties of using written plans to generalize about a country's preparedness for a pandemic. 

"It's like looking at the wiring diagrams of a Maserati and a Ferrari and looking at which one handles better on the road without turning on the ignition," said Angus Nicoll, influenza coordinator for the European Centre for Disease Prevention and Control in Stockholm, who was sent an early draft of the study for review. However, he called the study "a useful piece of work." 

Ben Duncan, a spokesman for the center, added that some new member states of the European Union "are, in fact, much better prepared than Coker's study suggests." 

Roche's role as a source of funding for the research raised some eyebrows in Vienna. Countries whose stockpiles of Roche's Tamiflu were small or nonexistent generally rank lower in preparedness in the study. 

Ms. Mounier-Jack said Roche's backing of the study didn't represent a conflict of interest and that the authors' aim was for "countries to learn about each others' strengths." Dr. Coker added that funding from the private sector was important to this research because "individual countries aren't going to fund this," referring to the research as "very sensitive."
The findings presented in at least one version of the paper laid out each country's ranking. But partly as a result of the anxiety those rankings caused, Dr. Coker said, the version of the study to be published in The Lancet doesn't show individual rankings. 

Instead, it puts countries in one of three groups that are then ranked more broadly against each other. 

Write to Nicholas Zamiska at

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