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Last Updated: Thursday, 17 November 2005, 13:29 GMT
Programme transcript

The following is a transcript of Panorama's "Bird Flu - your questions answered", first broadcast on 13 November 2005 on BBC One at 22:15 GMT

NB: THIS TRANSCRIPT WAS TYPED FROM A TRANSCRIPTION UNIT RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT: BECAUSE OF THE POSSIBILITY OF MIS-HEARING AND THE DIFFICULTY, IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS ACCURACY.


JANE CORBIN: For seven days Panorama has been on the road following up last week's programme where we investigated the threat of a global flu pandemic which could kill millions. Since then we've had a great many emails and text messages, questions you want answers to. So tonight on Panorama, with a little help from the latest TV technology, you quiz the experts round the world.

We're off to meet some parents who contacted us after last week's programme. They're worried about how they're families would be affected if a flu pandemic struck Britain, and how the NHS would cope. Zozi invited the Panorama crew into her home in North London. Two other parents who'd sent emails, Sue and Jason, joined us as we made final preparations to let them talk direct to the top government expert responsible for the UK's flu pandemic contingency plan.

And I can see the Chief Medical Officer, Sir Liam Donaldson, just taking his seat down here in Millbank. Good afternoon Sir Liam. We've got three parents here with me in Tufnell Park. We're in Zozi's house, in Zozi's living room to be exact, and actually, between us all, I think we've got 8 children, so there's lots of questions here about the family. I'm going to let Zozi start first please.

Zozi Gallus

Hello Sir Liam. I'm the mother of three children who are all at primary school, and I'm just wondering, when the first confirmed reports come through of some pandemic type flu, wouldn't the safest thing be for me, as a parent, to take my children out of school and look after them at home until the pandemic has passed?

Sir Liam Donaldson Chief Medical Officer Department of Health

There may be circumstances in which it might benefit our control of this pandemic to close schools for a while or even ask children not to come to school, but the problem is with a pandemic, it will be around for a long time. It's not just like a hurricane that hits our shores and then goes away. It will probably come in several waves, and one way or another, we expect around a quarter of the population to be affected, so eventually many children in the country are going to get it.

CORBIN: So Zozi, what did you think?

ZOZI: I still feel that the safest place is undoubtedly going to be the home, and I actually think I will¿ I mean I understand what he says about we don't know what type of strain it is and it'll come in waves, but from the point of view of protection of my children, to be honest I think I will just take them out of school.

CORBIN: Sir Liam, I've got Jason Milner here with me, he studied science at university and he's taken a keen interest in particular on the pandemic plan that the Department of Health has put on the website and has been publicising recently, and he's got some questions for you on that.

Jason Milner

The Intensive Care Society published a report back in September saying that the NHS probably didn't have enough acute care beds if a pandemic was to hit the UK. What have you been doing to address that situation?

DONALDSON: We will have a lot of pressure so we'll be working very hard to try and ensure that community services are strong, so that when people feel very ill but aren't at the stage of having their lives threatened, or getting very serious complications like pneumonia, that they're able to be cared for in the community and don't necessarily put the burden on the health service because we will need to keep as much capacity as we can for the people that really need it.

CORBIN: We had more questions for Sir Liam but for now it was time to move on. Lots of emails have come in to Panorama's website and texts too, from people wondering if it was safe to eat or even come into close contact with poultry. In last week's programme we reported from Vietnam on how a virulent strain of bird flu in ducks and chickens had jumped the species barrier into humans. Only 123 people in the Far East have caught the disease from being in close proximity to infected birds. But it raised questions from many of you about the safety of the food chain here. On a farm in Oxfordshire I met up with viewers Giles and Terry who wanted to know if chickens and eggs were safe to eat, and, if there was a flu pandemic, would ingesting the virus be the way to catch it. From the barn we sought answers for Terry Giles and other viewers with email questions from a Professor in Scotland who advises the Government on food safety.

Well good morning Professor Pennington. Professor Hugh Pennington is at Aberdeen University. He's a microbiologist. We've got an email here saying is it safe to buy and eat chickens from the supermarket and someone here who has texted us is very concerned saying will you be able to buy turkey at Christmas?

Professor Hugh Pennington Food Safety Adviser

There is no bird flu in the poultry industry in the UK and so British poultry, from the bird flu point of view, is completely safe to eat. I'm not aware of any well described circumstances where anybody has caught flu from eating a sick bird and there are several reasons for that. You don't normally eat the flesh raw, it's cooked, and that kills the virus; the acid in your stomach kills the virus anyway so even if you ate it raw the virus would be killed. It doesn't grow in our intestines, the virus grows in our lungs basically, or even a bit higher up than our lungs, but in our respiratory tract.

CORBIN: I've got Terry and Giles with me who've got some questions about food and a knock on of avian influenza in the food chain.

Giles Garton

Professor, I just wanted to ask about the safety of eating eggs, if the egg yolk is still liquid, is that going to be safe to eat?

PROF PENNINGTON: Eating eggs even from a bird that has got bird flu is not going to infect you. The stomach is going to kill off¿ the acid in the stomach is going to kill off any virus that's there, and birds that are sick with bird flu wont be laying anyway, they're just too sick. You don't catch bird flu from eating eggs, even if you don't cook them, or if you whisk them up or anything like that, you're not going to be at risk of getting bird flu through the egg route.

Terry Murphy

How easy is it to transmit the virus if somebody is infected and they were to.. say.. cough onto food, would you then be able to eat the food and catch the virus that way?

PROF PENNINGTON: Very unlikely. Very unlikely. There wouldn't be very much virus on the food. I mean it's theoretically possible but I'm not aware of it ever having happened. Normally what happens is that you have to breathe the virus in.

CORBIN: Professor Pennington, thank you very much for joining us today and for putting some of those questions straight. Thanks very much indeed. Terry, what did you think, hearing the professor there?

TERRY: I'm happy with the food. I mean I ate chicken for my dinner last night and I had eggs for breakfast and I wont be changing that at all.

CORBIN: It was time to move on. We knew now, as far as the bird flu scare is concerned, it's safe to eat chickens in Britain. On Panorama's trip to Vietnam we'd met a British doctor, Jeremy Farrar, and seen how the bird flu virus destroyed a healthy lung.

JEREMY FARRAR: So there is essentially no lung there.

CORBIN: And what happened to that patient?

FARRAR: And this patient died about a day after this X-ray was taken.

CORBIN: There are no scientifically confirmed cases of the virus transmitting from person to person, but the virus mutates, and if it became able to spread easily between humans, then it could spark a flu pandemic. That worried viewers like the GCSE science pupils at Lady Margaret's school who'd watched our programme.

LOUISE: Some of it was actually quite shocking, because I don't think I really realised how real it was until I watched the programme. There was a doctor who was showing X-rays, he showed one by a man who was infected by bird flu, it was completely covered by white, the white was just like the infection completely taking over and blocking his lungs.

OLIVIA: So they can't breathe.. they can't¿

LOUISE: And what shocked me was how fast it all happened.

RHIAN: That's horrible.

Wow!

CORBIN: So, last week from the science lab we linked up with leading medical researcher, Doctor Alan Hay. Like many of you, the girls here wanted to know more about the bird flu virus in the Far East, the H5N1 strain.

OLIVIA GAMP-HAILL: How can the disease be passed? Can it be passed from human to human and, if so, is it highly contagious, can it be passed through coughing or breathing?

Dr Alan Hay Director, World Influenza Centre

A normal pandemic virus would become highly contagious and that's the feature of influenza that it passed very readily from one person to another. We would find it very difficult to contain a pandemic caused by influenza, but the H5N1 virus that people are focusing on at the moment does not readily pass from one person to another, and the majority of infections have been the result of direct exposure to infected poultry and not to someone else.

CORBIN: Perhaps the impression you're getting from some of the newspaper and media reports is that this thing is already spreading from person to person.

OLIVIA: Yes.

CORBIN: We need that to happen before it can actually become a pandemic, that has to happen first. Imogen at the back, you've got a question.

IMOGEN: Yes, if bird flu was to come over here what would the symptoms be?

DR HAY: Many of the cases that have been studied to date have been people who have been hospitalised with very severe illness, so these people have a high fever, they generally have infection of the lower respiratory tract which leads to pneumonia and they have many other symptoms, and this since roughly half of these people have died, clearly this leads ultimately to general failure and death.

CORBIN: Louise, you've got another question.

Louise Wellby

With all the media hype the public is hearing things like something I heard the other day that if the bird flu were to grip Britain, up to 50,000 people potentially might die. Now should people be worried potentially that something like that could occur?

Dr HAY: We have to take an influenza pandemic very seriously, and the number you're quoting, about 50,000 people dying is actually at the lower end of the scale that people are concerned about. Other estimates have been closer to three quarters of a million deaths in this country.

CORBIN: Well you heard what Doctor Hay said then, I mean what's your reaction?

Rhian Gisby

I didn't realise actually how many people could conceivably dye from something like bird flu. I thought it was going to be something like a few isolated cases or something that didn't really affect us ?? like that.

CORBIN: So that 50,000 figure worried you, and the 750,000 one worried you even more, did it?

RHIAN: Yeah, it was just a bit of a shock. I didn't realise that many people could actually¿.

CORBIN: Well they could but they might not. Anyway, thank you girls, very much. Great questions and good luck with the exams.

So if a flu pandemic hit the UK, how would the NHS cope? Who would get priority? That's what many Panorama viewers wanted to know. In last week's programme we heard it could take six months from the start of a pandemic to isolate the exact strain of flu and produce a suitable vaccine to protect the population. Our destination now was the town of Goole on Humberside. Goole has one of the largest GP practices in the country - 15,000 patients and high rates of chest and heart disease. We arrived at the local health centre from where Dr Paul Caldwell had emailed us with concerns about what would happen here in the event of a flu pandemic.

Dr Paul Caldwell

I'm very worried about the impact it would have on my patients and also the impact it would have on the workload of the practice, and also our staff. We are the ones going to get sneezed over and if we go off sick we can't help our patients.

CORBIN: We'd arranged to meet the GP and others from his surgery with the Health Protection Agency which advises the Government on the control of infectious diseases. Another Panorama viewer, Derek, joined us from Lincolnshire. A retired microbiologist, Derek is now preparing his own village for a flu pandemic.

Dr Caldwell, you're a GP here in Goole, perhaps you'd kick us off with a question for Dr Van Tam.

DR CALDWELL: My concern is where there's going to be a waiting room full of people who may be in the pre-symptomatic stage of pandemic flu yet are infectious, and our waiting room could he one of the most infectious places in the community. We would be so overwhelmed with people who have flu and people who are worried that they've got pandemic flu that normal general practice will cease.

Dr Jonathan Van Tam Epidemiologist Health Protection Agency

I completely agree with you that the pandemic will definitely not be business as usual and we can expect additional burden for everybody and of course general practitioners are amongst the people who will feel that, that we have to start thinking about how we deliver it now and thinking outside of the box about potential methods of delivery.

CORBIN: Derek is here and he's got some practical questions about protection to ask you.

DEREK SMITH What we're setting up in our local village is the attempt to train everybody to use a 25p piece of paper as a face mask. Now what is your feeling about the Government taking the initiative and saying to everybody, and particularly through schools, that these are a very good first line of defence in slowing down the transmission rate and therefore reducing the big impact of a pandemic.

Dr VAN TAM: First of all, if you've got pandemic flu the place where you belong is at home, and I think there's a real element of kind of shared community protection if we all stick to that message. The next thing is, we have examined the literature on surgical masks for warning community settings, particularly in SARS, and I have to say the evidence that they provided any benefit is pretty week, and certainly I have very significant concerns about how masks would be taken off by the general public, because if you take a mask off, and in the process of doing that you recontaminate your hands with the outside of the mask and then you touch your face, you might as well not have bothered.

CORBIN: Mothers in Goole, like many around the country who contacted Panorama, are worried about what would happen to the very young.

Sonia Knox

What would I do to protect the children, they're my main concern. I mean they've got to grow up a bit, and it's knowing when it's going to come, it's waiting for that, it's just basically a waiting game, isn't it, really.

CORBIN: We've got a lot of texts here and emails from mothers of babies and young children wanting to know how should they protect their babies, should they even let them come into contact with ducks and chickens? I mean we've got some questions here about that.

Dr VAN TAM: This is an issue that's completely separate to pandemic influenza. The risk is considered to be extremely small as far as the UK is concerned, and I would have no reservations about children mixing with chickens, ducks and going to ponds and so forth. Providing they follow strict hand washing once those kind of activities are done.

Pippa Harrison Nurse Practitioner

Hello Dr Van Tam, it's Pippa Harrison, I'm a nurse practitioner prescriber. We do advocate the vaccination of patients over 65 and with chronic diseases for seasonal flu. Do you think we should be targeting a wider audience to create cover.

Dr VAN TAM: We don't actually expect seasonal flu vaccines to offer any protection. The reason for that is that the virus that might cause a pandemic is completely different to the viruses that currently circulate at the moment.

CORBIN: Dr Van Tam, I've got Helen and Robert here, they've both got some health problems and they've got a question to ask about pandemic flu as well. Helen.

HELEN: I'm an asthmatic and my husband he has got a chronic heart condition. We're worried, very worried in fact, how it would affect us, the pandemic flu.

Dr Jonathan Van Tam Epidemiologist Health Protection Agency

We're in a situation where we can't predict how people with chronic illnesses are going to be affected by a pandemic virus were it to emerge. But if you look at normal seasonal flu, we know that people with high risk underlying medical conditions, you know.. they are at increased risk from flu and that's why we do our best attempts to vaccinate them every year, and there's a degree of probability that people with high risk conditions will be more severely affected, but until we start to get some cases, it isn't possible to pin that down accurately.

CORBIN: At the moment they do have priority for the seasonal flu vaccine but Helen, what's your worry about the pandemic?

Helen Smith

I'm very worried I'm afraid because we didn't think we'd survive if we got it, anyway. Would we have priority, people with illnesses, or not?

Dr VAN TAM: There is no categorically agreed priority list for a pandemic vaccine at that point and I think that's the right decision because until we start to see cases, and we start to see in whom the pandemic is most serious, until we see that, we can't make a sensible or sane decision about who he priority list should be. So the only group I think I could single out for priority in terms of vaccination would be frontline health care workers.

CORBIN: Doctor Van Tam, if you could give one message to the general public, what would it be?

Dr VAN TAM: It would be that I know it for a fact that the United Kingdom has done far, far, far more in terms of pandemic preparedness than almost every country in the world, and that we are, if not the best, certainly in the top three worldwide.

CORBIN: And what do you think, Paul, hearing Dr Van Tam say that?

Dr Paul Caldwell

In some ways that's reassuring but what comes out is that there are too many unknowns, too many uncertainties about for me to be particularly reassured at this moment in time.

CORBIN: Derek, what do you think, having heard what Dr Van Tam said?

Derek Smith

If Britain is amongst the best prepared in the world, and the pandemic is bad, then heaven help the rest.

CORBIN: Helen?

HELEN: I'm 90% scared but I'm all for the paper masks.

CORBIN: You think that would really help, despite what he said?

HELEN: Yes, I do.

ROBERT: Me, I think it would and all.

CORBIN: Robert, what do you think about the news that you might not necessarily be on a priority list, that health workers are going to come first.

Robert Smith

It's a bit scary, it scares me, you know, but they come before me because they've got more patients to see. I mean I'm only one, he's got hundreds to look at.

CORBIN: It was time to leave Goole and head off again. In last week's Panorama we explained that migrating birds had been blamed for carrying the bird flu virus from the Far East to Eastern Europe. The Government declared the risk of poultry here becoming infected was still low. But headlines about bird flu were affecting the farming industry. One in four of the chickens that end up on supermarket shelves begins its days in James Hook's hatchery, the largest in Europe. But Mr Hook has seen consumer confidence and sales of chickens fall as a result of publicity about the worldwide spread of the bird flu virus.

So these are day old chicks.

JAMES HOOK: These are day old chicks, yeah, hatched this morning ready to go out to a free range farm tomorrow.

CORBIN: James was joined in his barn by two viewers representing organic poultry farmers and bird enthusiasts. Waiting for their questions the UK's Chief Veterinary Officer in London.

Good morning Doctor Reynolds. Thanks for joining us. Panorama is actually down on Barley Park Farm this morning. We've got quite a big audience here, not just the four of us sitting round but a few sheep are watching too. I've got James Hook with me, he's the owner of T.V. Hook Hatcheries. Obviously he's in the chicken and the egg business and he, I think, is going to start off with a question to you.

JAMES HOOK: The risk now from the migratory birds, is that now receding?

Debbie Reynolds Chief Veterinary Officer, DEFRA

What is clear is that there are quite a number of gaps in our knowledge. At the moment we do not think that the areas which have been affected by avian influenza lead to a significant arrival of wild birds on migration. The season for migration is nearly finished, but on the other hand, there could be mixing of birds on mingling grounds and further development. So what we have decided in response to this is to step up our wild bird surveillance and we've got testing from birds that have been caught on migration study.

CORBIN: you've done tests on wild birds. You've got hunters who've shot birds, you've taken swabs. What do those tests tell us, has the avian flu virus arrived in migratory birds in Britain yet?

REYNOLDS: We haven't got any results ready to release at the moment, but there's nothing that I can report at the moment that changes the overall evaluation which is there's a low likelihood of imminent introduction.

CORBIN: So are you saying that the tests are negative, that there is no avian flu in those wild bird samples that you've taken?

REYNOLDS: What I'm saying is, we haven't got results which are ready for evaluation and release yet, so it would be premature to actually say anything about it at the moment.

CORBIN: So you're not ruling it out.

REYNOLDS: I'm not in possession of some particular factual piece of information that I'm not telling you at the moment. What I'm saying is, that as the surveillance is coming through, we'll use it to form that clearer picture and add it into our risk assessment.

CORBIN: Anna Jonas is with us from the Soil Association, she's the poultry adviser and she's got some questions for you Dr Reynolds.

Anna Jonas Soil Association

What I'd like to know is, why aren't we vaccinating all the birds in a thick area around any outbreak as part of our control strategy if the disease came to the UK?

REYNOLDS: At the moment conventional disease control by early detection, culling of the birds in the infected premises, tracing any dangerous contact, and restricting movement is an approach disease response. There does seem to be rather little evidence from what I can tell at the moment that vaccination is effective in actually stopping disease spread.

CORBIN: We've had a lot of emails from people just saying why, if in other parts of Europe has the order been given to keep hens.. free range hens indoors, why is it not time for us to do that in Britain? That's asked by Sandra in the Wirral, by Guy from London. Most people seem to think that's the obvious answer.

REYNOLDS: Taking what we know about the geography and the recent spread, there is a high risk of further spread. But if you look at where the United Kingdom is situated is situated in respect of migratory birds, there's a low likelihood of imminent introduction. So given that low likelihood, our assessment is it would be too soon to house birds, but people, however, need to be properly prepared. If the situation should change, they would be able to take the practical steps to reduce contact with wild birds, and reduce the spread of avian influenza if it arrived.

CORBIN: There are 100,000 pigeon fanciers in Britain and countless owners of pet birds, parrots and budgerigars. Dozens of them emailed us after last week's problem with worries about their birds' health and their own.

What's the situation with them?

Debbie Reynolds Chief Veterinary Officer, DEFRAAvian influenza, the highly pathogenic form, is not in the United Kingdom at the moment and so people can take the normal, sensible hygiene precautions when they're handling these birds, and need to look out for any signs of illness which might mean that the situation for their bird has changed in any way and take advice from a veterinary surgeon if they're concerned.

CORBIN: Alan Noyce is with us Doctor Reynolds, he's from the Royal Pigeon Racing Association, he's got a question for you.

Alan Noyce Royal Pigeon Racing Association

Why have you stopped the sale of pigeons in shows? It is an awful lot of people's livelihoods involved, so why can't the major shows carry on?

REYNOLDS: Well a decision was taken Europe wide to ban markets and sales of birds to actually prevent the spread of avian influenza. My team is absolutely ready to see if on a veterinary risk assessment basis there are particular shows, particular gatherings or markets which are low risk and can continue.

CORBIN: Dr Reynolds, thank you very much for joining us. James, you've got answers there from the vet that she said, but I mean is that going to answer your problem of the way consumers feel about the product, about chickens, about eggs. Are you still concerned about that?

James Hook Poultry Farmer

Yes, I mean obviously as a farmer I am concerned that we don't dent people's confidence in our products. What I'm happy, or what I'm trying to do is reassure people that the problem is a bird problem and it's not a food safety problem. Sales have dipped, but we need them to come back again. People have been worried a terrific lot unnecessarily I feel.

CORBIN: If bird flu sparked a flu pandemic the whole globe would be affected. One of the people in last week's programme was Doctor David Nabarro, the United Nations Flu coordinator. This week he's been chairing an international conference in Geneva, gearing the world up as fast as possible for a flu pandemic.

[Clip from Geneva conference]

DR DAVID NABARRO: What we're going to be doing this morning is mapping out the needs, the gaps, the overlaps.

CORBIN: Amongst the questions we received were some from viewers involved with global charities. They worried that bird flu could devastate the poorest countries without proper systems to detect and stop it. Others have queries about travelling to places in the Far East, already hit by the virus. We're here today to link up with Dr David Nabarro who is the UN's flu tsar, the man with responsibility for coordinating the world's preparedness on influenza and we've actually had a lot of queries from people on our website, and they've texted us, you know, we're going here, we're going there, we're going to China, we're going to Cambodia, Malaysia, should we go - shouldn't we. First of all I'm like Steve Woods, he's one of our viewers, to put a question to you.

Steve Woods

Hello Doctor. My wife and I are planning a trip out to Vietnam this Christmas. Are we potentially putting ourselves into an area of risk unnecessarily?

Dr David Nabarro UN Influenza Co-ordinator

I would personally have not troubles at all about travelling to Vietnam. The chances of a human getting bird flu as a result of contact with infected birds, are only going to be significant if you do have close contact with birds in a farm or in a village, and if you are close to the killing of chickens in a market where birds are being sold. All in all I would say that the risk that you're facing is really very small indeed. We'd probably do more damage if we stay away from those countries, damage their economies and their wellbeing, than we do if we go there.

CORBIN: Dr Nabarro, other people have asked us on email, Jemima from Pool has asked us, and also William Morrison, all the way from British Columbia, they want to know how will we know when a pandemic flu has started?

NABARRO: What we have to do is encourage every country to be on the lookout for clusters of cases from unexplained flu-like illness. Specimens have to be taken from the people and they have to be contained in their homes to reduce their contact with others whilst there is an early period of concern. The specimens have to be tested as quickly as possible. This usually takes about a week. We would like then to feel that we've got an interval perhaps of a further two or three weeks within which to act, to fully contain what is then a pandemic and to try to make sure that it doesn't get out of control.

CORBIN: Andrew Pendleton from Christian Aid, I know you're interested in health services in Africa.

Andrew Pendleton Christian Aid

Has there been any talk of financial assistance, hard cash to countries in Africa and other developing parts of the world.

NABARRO: This is uppermost in our minds. We're designing an action plan for dealing with flu issues around the world that we certainly expect within the next month to have the financing plans sorted out, whether they're at the level you want, Andrew, I can't say for certain but I for one will be pushing very hard for equity and for ensuring that poor countries get the resources they need.

CORBIN: Sumi, you're from Oxfam. Now obviously is the pandemic comes, there are concerns about how do we treat it, and where is the developing world in the queue for drugs and things.

Sumi Dhanarajan Oxfam

Absolutely Jane. Dr Nabarro, our first concern will poor people in developing countries have access to the vaccines and the medicines available?

NABARRO: The WHO has got a stock pile, it's 3 million treatments, but the production capacity in the main manufacturing plant is absolutely saturated and we're pushing very hard for it to increase capacity, and we hope that as capacity increases there'll be a chance to get essential antiviral medicines made available for organisations like WHO and for countries in dire need, particularly those that are very poor that need it for their frontline workers.

CORBIN: Well Steve, you heard that, what's your response to what you heard today from Dr Nabarro?

STEVE: I am very much reassured and very much look forward to a good holiday. I think the concerns that these guys have brought up really pale our ideas and worries into insignificance.

CORBIN: Do you feel that he answered your question about whether there'll be extra money?

ANDREW: Well I guess the experience that we've had this year where we've seen so many frontline promises from world leaders and very little action on publicly, doesn't fill you with a lot of reassurance really. So I mean I don't doubt Dr Nabarro's commitment, it's very clear that he's extremely committed to this, but this is really a time for world leaders to act.

CORBIN: Ed, what did you think when he talked about Africa? Obviously they seem to have realised what the problems are.

Ed Watkiss Farm Africa

My main concern is the issue of how are they going to actually detect when the virus comes into the country. We're going to have a lot of these wild birds coming in to very isolated areas in Africa and they're going to be potentially infecting very isolated communities. So we're talking about these teams rushing in, but who is going to alert these teams?

CORBIN: So you didn't feel there's an answer there at all.

ED: I didn't feel an answer. I think he was taking the second step rather than looking at the first step of how are we actually going to tell. We have reports in Ethiopia, presently they have money for 20 tests to detect Avian flu. That's the current situation.

CORBIN: In the whole of the country?

ED: In the whole of the country. So what are we going to do? What are they going to do? What is WHO going to do to increase that capacity to detect it?

Dr David Nabarro UN Influenza Co-ordinator

I would like to reassure people on one count, that is that I've seen more convergence on dealing with this issue between governments around the world than I've seen on any other issue in international health in the last 30 plus years, and that does mean that I think it is worthwhile for as long as possible for people to put confidence in the potential capacity of world governments to deal with both the current bird flu epidemic and the threat of a human pandemic.

CORBIN: Our journey was almost over, but there was one aspect of last week's problem which had attracted more emails on our website than anything else. The fact that stocks of the antiviral drug, Tamiflu, were limited. It's our only defence at present against a flu pandemic. The government has ordered enough for one in four people, but the UK stockpile wont be complete until next September. We were back where we began at Zozi's house where Sue was eager to tackle the Chief Medical Officer about Tamiflu.

Sir Liam, we've got Susan Black here. She's a mother of one daughter, medical student actually, and she's concerned about the business of the antivirals, the Tamiflu and how people are going to get it, who should get it and who should not. Susan, go ahead.

Susan Black

What procedures are in place for you to get Tamiflu to ill people very quickly in a pandemic?

Sir Liam Donaldson Chief Medical Officer Department of Health

Tamiflu is drug which needs to be given in the first 48 hours of an attack of flu if it's going to reduce it's severity and shorten the length of time that somebody becomes ill. We need to have much more flexible ways of getting the drugs to the people that need it, and we're going to be relaxing the rules for prescribing. So pharmacists, nurses in the health centre as well as doctors, will be able to help in seeing whether people fulfil the diagnostic criteria and then they'll be able to get the drugs.

SUSAN: Sir Liam, are you thinking in terms of allowing people to have advance prescriptions or thinking of people who can perhaps go by proxy and obtain the drug for their ill relatives? Are we allowed, in other words, to stockpile Tamiflu and is there any system for allowing very vulnerable people to stockpile Tamiflu?

DONALDSON: These drugs will need to be given out fairly. They cannot give them out simply for people to use in advance when they're not ill. So we will ensure that the high risk groups get priority with the antiviral drugs, but at the same time, we want to make sure that the drugs are given according to quite strict criteria so that they're carefully used and so that our precious stockpile isn't going down with unnecessary treatments.

CORBIN: Sir Liam, I have to say that the vast majority of the emails that Panorama has received after last week's programme have been about Tamiflu, and everyone is pretty much saying the same thing, where can I get Tamiflu, shall I stockpile it here, you know, it's evident the ordinary man in the street says Terry Summers is unlikely to get antiviral tablets. Here's Robert in Irving saying.. you know.. how will we get this drug beforehand. I mean realistically how can you reassure people on this?

DONALDSON: Well I think we reassure them by saying that we are securing a supply for the estimated number of people who will be attacked by flu, and that is the safest and fairest way of doing it, to build up a stockpile of drugs so that they are allocated to the people who get the disease and they're prioritised to the people at highest risk.

CORBIN: The problem is, you've provided for one in four people to have the drug if they get the flu, but of course everybody thinking about it beforehand wants to protect their family and they want to get the drug in case it's them, so.. you know.. this is the problem, isn't it, you can only give it to one in four, you can only have a stockpile for one in four but of course 100% want it if they can get it because that's natural.

DONALDSON: If everybody went out haphazardly, ordering and buying Tamiflu, it would be very unequally distributed, and then probably large numbers of people who needed it wouldn't be able to get it, the supplies would run out, and then possibly we would see unnecessary deaths and people seriously ill who could have been treated. So we are in this together and I think if we pull together and react in a fair way as we've always done in the past crises, then I think we'll have a better outcome and we will have a much better chance of reducing the impact of this pandemic whenever it comes.

CORBIN: Now Martin Jones from Peterborough writes that his mother has bought Tamiflu from the internet for the whole family, and asks why are we having to resort to the internet to get these supplies.

DONALDSON: You aren't having to resort to the internet because the government is putting in place a stockpile of antiviral drugs to treat the estimated number of the population who will fall ill with flu. There are dangers in buying drugs over the internet, that they may be counterfeit or drugs that are not properly potent. So I would urge and advise all members of the public just to take account of the fact that the drugs that are going to be necessary will be provided, they'll be high quality, effective drugs, there won't be any doubts about that. They're being secured from a reputable supply and they will be allocated and distributed when the pandemic comes.

CORBIN: Susan?

SUSAN: It does make you wonder whether you shouldn't go out and get it first, as a lot of people are doing, getting the Tamiflu.

CORBIN: Will you get the Tamiflu if you can, will you stockpile some for you and your family?

SUSAN: Yes. Yes. If I can. If I can. But obviously an NH GP wont give it out. I'll have to find another means.

CORBIN: So you'll have to play for it privately.

SUSAN: Yes.

CORBIN: Or even go on the internet.

SUSAN: I wont do that.

CORBIN: So finally, just briefly, a quick answer from all of you. Reassured or not from what you've heard?

ZOZI: Somewhat reassured and somewhat alarmed.

CORBIN: Jason?

JASON: Definitely not, no, not by what he said today.

CORBIN: Su?

SUSAN: Certainly not reassured. No.

CORBIN: We've tried to answer as many of your questions as possible and you can find out more about bird flu via the Panorama website where you can also watch last week's programme on broadband whenever you want. We all now know that flu pandemics are an inevitable force of nature. Natural catastrophes, whenever they happen, become a test of government who we trust, and the way that we, as a society, react.

Next week we look at how ASBOs are increasingly being used to tackle disorder and violence, and the evidence that vulnerable children are also being caught up and damaged in the ASBO crackdown. That's ASBOs on trial next Sunday at 10.15.



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