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Preventive journalism A media and coverage of professional's risk situations avian influenza ANDI ANDI LATIN AMERICAN NETWORK UNICEF
Preventive journalism A media and coverage of professional's risk situations avian influenza ANDI – BRAZILIAN NEWS AGENCY FOR
PREVENTIVE JOURNALISM AND
COVERIAGE OF RISK SITUATIONS
President: Oscar Vilhena Vieira A media professional's guide Vice-President: Geraldinho Vieira to avian influenza Executive Secretary: Veet VivartaDeputy Executive Secretary: Ely Harasawa Published by
ANDI / ANDI Latin America Network ANDI LATIN AMERICA NETWORK
Management Council
UNICEF – Regional Office for Latin America and the Caribbean Alicia Cytrynblum (Argentina) Carlos Mamani Jiménez (Bolivia) Evelyn Blanck (Guatemala) Lucía Lagunes Huerta (Mexico) Mario Chamorro (Nicaragua) Marta Benítez (Paraguay)Oscar Misle (Venezuela) Adriano Guerra (coordinator) Paula Baleato (Uruguay) Rebeca Cueva Rodríguez (Ecuador)Roger Martín Guerra-García Campos (Peru) Technical and Journalism Coordinator
Veet Vivarta (Brazil) Virginia Murillo Herrera (Costa Rica) Ximena Norato (Colombia) Bruno Blecher and André Soliani Collaborator: Cláudio Tognolli Executive Coordinator of the ANDI
Latin America Network
November 2007.
Translation to English
Review: Beatrice Allain The content in this publication is the pro- duct of discussions held in the sub-regional André Oliveira Nóbrega workshops organized by the ANDI Latin America Network and UNICEF (Regional Graphic Design and Layout
Office for Latin America and the Caribbean) in Peru, Nicaragua, Barbados (Caribbean), Workshop Coordinators and Facilitators
and Paraguay. Guilherme Canela and André Soliani Contextualizing, oversight and agenda-setting:axes of quality coverage Understanding avian flu and the influenza pandemic Suggestions for framing the issue Priority to children and adolescents Database of Sources

This publication is in- buting toward more compre- tended to serve as a guide hensive and contextualized to journalists in different media segments on preventive, In the event of the threat of risk, and crisis communica- a human influenza pandemic, tion. Although the focus is on a preventive journalism can point potential future influenza pan- us toward a responsible agenda demic in Latin America arising by delineating the actual dimen- from avian flu, the pages that sions of the risk and helping to follow set forth concepts and avert public panic. Accurate news tools to assist journalists in coverage is an essential element other crisis situations, includ- in preparing Latin American and ing natural disasters, armed Caribbean countries to confront conflicts, environmental catas- a future pandemic.
trophes, and phytosanitary dis- This entails not only edu- cating people on the proper In addition to providing hygienic practices for preventing general information on avian infection, but also encouraging flu and its impact on popula- the public to take active part tions – particularly children in efforts to combat the spread and adolescents – the guide of the virus and disease by offers analyses and consider- demanding effective action from ations on the media's relevant role in the public debate. Far from presenting prepackaged solutions, the text below sets A human influenza pandemic out to identify avenues and in Latin America and the approaches capable of contri Caribbean could have de- Preventive journalism and coverage of risk situations national pages of newspapers. Compre- potential pandemic scenarios – based on hensive coverage of the subject capable of epidemiometric models – project as many helping to avert a crisis and prevent a as 2.5 million deaths throughout the more serious emergency is possible region in the initial eight weeks of (and desirable) today. a pandemic outbreak, half of them Providing reliable and qualified minors under age 15.1 information on the disease is im- The good news is that a pandemic portant for offering guidance on the has not yet occurred, nor has the Ameri- public response to the epidemic. The can continent been affected by the avian text below, a joint effort of UNICEF flu outbreaks evidenced in Asia, the (Regional Office for Latin America Middle East, Europe, and portions of and the Caribbean) and the ANDI Africa. In other words, there is still time Latin America Network, strives to to prepare for the threat. assist Latin American journalists in According to data from the United achieving this objective. It is a work Nations Food and Agriculture Organiza- in progress. As such, any suggestions tion (FAO), from the onset of the avian on improving its content can and flu crisis in 2003 through 2006 approxi- should be forwarded to the executive mately 200 million birds were sacrificed. coordinating committee of the ANDI Latin The damage was not simply confined America Network (www.redandi.org). to culled birds. Fears of contamination drove many people to substitute poultry with other meat sources, leading to a decline in poultry consumption and a consequent fall in the incomes of poultry farmers. FAO figures indicate that global poultry consumption in 2006 was 3 million tons less than initially forecast2 (see Chapter 3 for more information).
There is no need for the first case of avian flu, or of any other disease, to occur before devoting local coverage to the issue – above and beyond the occa- sional stories appearing in the inter- 1 The projection assumes an influenza virus as virulent as the 1918 Spanish strain.
2 WHO/PAHO recommends the consumption of cooked chicken meat, while underscoring that there is no evidence of infection from the ingestion of poultry.
Contextualizing, oversight and agenda-setting Contextualizing, oversight and Chapter 1
axes of quality coverage
1 The 20th century was virus ("Hong Kong"), produced marked by three influ- the smallest impact of the enza pandemics with varying mortality. The 1918- The risk of a new pandemic 1919 pandemic, referred to as has become more appreciable the "Spanish Flu" – now known and persistent since late 2003, to have been caused by the after avian influenza A/H5N1 A/H1N1 influenza virus –, pro- outbreaks became endemic in duced the most severe impact, bird populations in East Asia somewhere in the vicinity – and precipitated a number of of 40 to 50 million deaths3. serious cases in humans. In addition, the number of The A/H5N1 virus presents fatalities from the Spanish flu three of the four properties neces- among infants and children sary for a major pandemic, worldwide appears to have namely the susceptibility of nearly all people to infection, originally believed.4 immunological naiveté, and the The 1957 influenza pan- high lethality of the virus.5 demic ("Asian Flu"), triggered The fourth and final proper- by the A/H2N2 virus, had a ty – human-to-human trans- moderate impact in relation mission – has yet to be clear- to the prior outbreak (1918). ly established and remains the The third pandemic in 1968, lone missing prerequisite for a an outgrowth of the A/H3N2 possible pandemic outbreak.
3 Nicholson KG, Wood JM, Zambon M. "Influenza." Lancet 362 (2003): pp.1733-45.
4 Reid A. "The ef ects of the 1918-1919 influenza pandemic on infant and child health in Derbyshire," Med History 49 (2005): pp. 29-54.
5 Bartlet , JG. "Planning for avian influenza". Ann Intern Med 145 (2006): pp.:141-144.
Preventive journalism and coverage of risk situations Existing epidemiological studies do not • Provide citizens with quality and con- enable precise determination of when a textualized information capable of new microorganism such as the A/H5N1 ensuring effective participation in the virus will trigger a global catastrophe, but they do accurately predict the socio- • Serve as an oversight (or social con- economic, climatic, demographic, and cul- trol) agent over public and private tural conditions leading to such an event.
The ability to predict and prevent • Give publicity to important issues, catastrophes is not limited to the field of thereby assuring effective the engage- medicine. A number of scientific disci- ment of different actors and, most im- plines are often able to anticipate natural disasters. An example is the growing body of information regarding the impact of human activity on climate change News reports should include information and its implications for the future of that enables citizens to participate in the life on the planet. Therefore, even if public debate. A well-informed public has providing adequate warning of a catas- a greater capacity to exercise and press trophic event, such as a hurricane or for its rights. Contextualized information a new lethal virus, is impossible, ap- strengthens the accuracy and even the propriate preventive policies can still educational value of the news story. mitigate the ensuing loss of life and Below we offer a selection of tools to economic impact. develop news content with these elements.
Nonetheless, enhanced understanding of the processes that lead to catastrophes Statistics contribute to delineating the
cannot by itself prevent or minimize their real dimensions of a phenomenon
effects. In the absence of the necessary • Media coverage of avian flu that public policies to mitigate the risks iden- tified in technical and scientific studies, human infection – and the necessity added knowledge will serve only to ex- of direct contact with infected birds pose the negligence of decision-makers, for infection to occur – can help pre- while the media is left to count the dead vent widespread panic. The number and add up the economic costs. of fatalities from the virus remains Adopting preventive and risk con- small, when considered in relation trol measures is necessarily a task for to the twelve countries affected since the public sphere. The media plays 2003. Through August 31, 2007, a to- a pivotal role in this effort and in tal of 327 cases and 199 deaths were laying the groundwork for the response reported. The Chinese case is particu- to catastrophic events, specifically due to larly illustrative. Since 2003, the coun- try has recorded 25 cases of H5N1 Contextualizing, oversight and agenda-setting (avian influenza virus) infection and 16 fatalities out of a total population of 1.3 billion inhabitants. The World Health Organization maintains updated re-cords on the evolution of the disease across the globe (www.who.int).
By reporting on public opinion • Another useful tool to contextualize news content and public service customer sa- involves identifying the data on existing infrastructure tisfaction surveys, the media can to deal with the phenomenon. An important question make an important contribution to on this point: of the total number of hospitals in the improving upon how government country, how many are prepared to receive infected and society frame issues. In São patients in the event of a pandemic? Paulo, for example, the govern-ment was pressed into allocating additional resources for street Legislation spells out the rights of citizens and
lighting after the press reported defines responsibilities
on a series of studies concluding • Countries have made a commitment to the World that poorly lit streets were more Health Organization (WHO/PAHO) to prepare a na- of a contributing factor to crime tional containment plan laying forth the measures to than the lack of police patrols. control disease outbreaks and hot spots. This commit-ment confers specific responsibilities on each country's Source: Facing The Challenge – Children´s rights and human de- agencies. Providing readers with all the information velopment in Latin American news contained in the plan is a valuable editorial strategy. media, ANDI (2006) Diversifying the range of sources and giving voice
to all actors
• When reporting on avian flu, journalists should
consult, not only to government sources but also poultry farmers, independent epidemiologists, domestic poultry breeders in poor communities, poultry exporters and importers, feed producers, supermarkets, consumer protection associations, border control authorities, and others. SOCIAL "WATCHDOG"
Media outlets serve as a pivotal check and balance in
democratic societies. In performing this watchdog
function, they can contribute to ensuring citizens are
kept informed on the progress of government projects,
as well as the responsibilities mandated for the various
spheres of government.
Preventive journalism and coverage of risk situations Verify government plans and actions to
health inspection system operate? Is control the disease
there ongoing surveillance of borders, • The coverage of avian flu requires, ports, and airports? Can the country's as a first step, verification of the true health system support potential cases capacity of each country to respond to of human influenza? Have sufficient the risks of an epidemic: How does the budgetary resources been allocated to An absence of voices
While the plurality of voices in a story of sources and viewpoints in the is a major indicator of the quality of reporting. The Brazilian print media's the coverage, it is not by itself suffi- performance on this question – cient to guarantee the quality of the which ANDI has tracked since 1996 information. Two other elements – is illustrative of the overall difficul- must be considered as well: the num- ties newspapers have to include diffe- ber of media sources consulted for the rent viewpoints on a given issue. The story and the inclusion – or not – of data on Brazil reveals that only 1.28% differing points of view regarding the of published news pieces on children event, scenario, or opinion addressed and adolescents meet this criterion. in the news piece.
On the issue of the Latin Ame- rican print media's coverage of Source: Direitos, Infância e Agenda Pública – Uma children and adolescents, a com- análise comparativa da cobertura jornalística parative study coordinated by latino-americana, ANDI and ANDI Latin America ANDI and the ANDI Latin America Network (2006). Network of news content published in 2005 found an average of one cited source per story. This deficiency in the coverage extended to every country in the survey and confirmed the lack of diversity Contextualizing, oversight and agenda-setting meet national contingency plans? Have the plans been completed and are they being implemented? • The inefficiency of the state in certain areas, the absence of integrated and systematized data, and the lack of transparency undermine strategic plan- Two studies conducted by ANDI ning by governments, leaving the media and the in 2001 on media coverage of public in the dark.
issues related to child and ado-lescent health reveal that Brazilian journalists largely fail to underpin Issues not covered by the press are unlikely to receive ade- their reporting with relevant indicators, a clear measure of quate attention from public decision-makers or from the the inadequate quality of some general public. The media can contribute toward defining news pieces. The data reflects the priorities of decision-makers. To this end, one of its a tendency identified in studies functions is to introduce issues into the public agenda in a performed by agencies of the pluralist manner.
ANDI Latin America Network Because they are still viewed as distant threats, on press coverage in other avian flu and pandemic influenza are not on the public countries of the region. In the Brazilian case, of the 993 news agenda in Latin America and the Caribbean. In pieces on children's health (47 general, authorities and journalists alike have shown media outlets), 39.4% inclu- little interest in the issue.
ded statistical data and 5.1% cited legislation. The survey of Missing from the agenda
news content on adolescent In 2007, ANDI partnered with John Hopkins Univer- health found that 34.5% of sity to sponsor a series of workshops in Lima, Managua, the 670 stories provided Barbados, and Asuncion on "Strategic Communication statistical indicators, while 3% cited legislation. for Avian Influenza and Human Pandemic Influenza" for journalists and information sources in Latin America and Source: "A Cobertura sobre Saúde the Caribbean. During the event, participants were asked to relativa à infância e a adolescência: complete a brief survey questionnaire.
uma análise comparativa do material veiculado por 50 jornais brasileiros", When asked about the relevance or centrality of avian Guilherme Canela (ANDI) flu at present, a majority of respondents considered the issue to have minimal, null, secondary, or marginal importance. Few identified a possible avian flu pandemic as a priority of governments in the region. Indeed, even those responding affirmatively to the question included caveats indicating that to the extent priority is attached to the issue it is either limited to specific sectors of government or not echoed in the media and/or society.
Preventive journalism and coverage of risk situations APPROACHES TO COMMUNICATION:
preventive, crisis, and scientific
Many people believe effective reporting on epidemics,
based on quality journalism, requires a scientific approach
containing data and figures, explanations concerning the
Article XIX: "Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regard- less of frontiers." Source: Universal Declaration of Human Rights drafted by the United Nations (UN) and signed in 1948. Access Map – Abraji Study on the Right of Ac-cess to Public Information in Brazil (Mapa do Acesso – um estudo da Abraji sobre o direito de acesso a informações públicas no Brasil), a sur-vey conducted by the Brazilian Association of Investigative Journalism (Associação Brasileira de Jornalismo Investigativo – Abraji), reveals the aversion of government agencies to full disclosure, a tendency identified in a large portion of Latin American and Caribbean countries.
Journalists participating in the study organized a group of 42 volunteers in 24 Brazilian states and the Federal District. The objective was to establish contact with institutions to request specific data: for example, per diems paid out by the executive branch or monthly per diems for magistrates. The survey, which was released in May 2007, indicated an utter lack of transparency on the part of government agencies. A mere 3.6% of the 125 state agencies surveyed – representing the executi-ve, legislative, and judicial branches – supplied the requested data, even when confronted with legisla-tion requiring disclosure of the information. Contextualizing, oversight and agenda-setting characteristics of the virus and how vacci- Other cases call for risk/crisis com- nes work, among other matters.
munication, as when, for instance, an In fact, scientific journalism in cases initial case is confirmed (in animals or such as avian flu should be incorpora- humans) and the threat of an epidemic ted as a transversal issue in the context becomes imminent.
of the relevant news coverage defined by Therefore, while preventive journa- each country. Certain situations require lism is designed to warn of and anticipate that preventive journalism be practiced threats by reporting on the measures taken before a crisis arises. to avert future crises or mitigate their helps to save lives in Africa When providing basic information the content broadcast by the mass on health matters, the media could media and more responsible repro- ductive behavior in Africa, resulting, improving the quality of life of for example, in greater awareness and disadvantaged persons. According expanded use of contraception.
to CARE, a non-governmental organization, 21 children a minute die every day from malnutrition or Source: Facing The Challenge – Children´s rights easily preventable diseases.
anda human development in Latin American news In a 2005 address, "Global Forum media, ANDI (2006) on Media Development," Warren Feed, executive director of Commu-nication Initiative, an NGO, offered examples on how increased and more qualified information can produce positive results in a number of areas.
In regard to health, he cites a com- prehensive study establishing a strong and recurrent correlation between Preventive journalism and coverage of risk situations impact, risk/crisis journalism performs the important mission of providing balanced information to the public, thereby avoiding sensationalist coverage that could spark widespread panic.
In both cases, it is essential to make proper use of scien- "In Latin America as well as other tific information and perform investigative reporting that regions of the planet, there is a ensures in-depth information and the most comprehensive strong tendency for the readers coverage possible.
of science news to be defined as ‘scientifically illiterate,' even though [as discussed above] the CHALLENGES OF SCIENTIFIC JOURNALISM
scientific knowledge of a large Scientific journalism is not meant for scientists, but for portion of media professionals ordinary readers. More than other specialized areas of news is not much different than that of reporting, it must be didactic, particularly in the case of the general public." critical issues such as a high-risk disease. Some important rules for avoiding errors and confusion and preparing clear Source: Elementos Fundamentais para a Prática do Jornalismo Científico, and objective pieces are set forth below.
Cláudio Bertoli Filho (2006) Understand, then "translate" to the reader
Make technical information accessible to the public in a
manner that is readily understandable to readers, viewers,
and listeners. To this end, reporters must ensure they
understand the information they have collected. The
disproportionate use of quotation marks in explaining
essential concepts is a clear sign journalists do not fully
grasp the information they have been given. In addition,
particular care must be taken when using data and figures.
A misplaced decimal point or a missing zero can comple-
tely transform the meaning of the information reported. In
these cases, thoroughly reviewing all content prior to publi-
cation is a valuable exercise.
Probability versus fact
Science does not work with absolute certainties, but with
processes and probabilities, which can be difficult to trans-
late into news stories. Journalists are interested in knowing
if a pandemic will arise. For their part, scientists operate
on the basis of probabilities greater than zero for such an
occurrence. Clearly articulating this scientific method in an
article is a challenging task.
Contextualizing, oversight and agenda-setting Check the technical information
Although they report on technical issues, journalists are
not trained to ascertain whether the information supplied
by sources is based on solid science. How do journalists
avoid publishing false information disguised as scientific
"By diversifying sources, jour- fact? In this instance, it is worth reiterating the following nalists avoid the risk of tying rule: diversify sources to ensure different viewpoints. It is themselves to a single voice, always important to seek out divergent opinions and con- to a single version. Experience sult sources recognized by the academe.
teaches that al sources have interests, whether economic, Independence from sources
political, ideological, or even Journalists depend on sources for information and even personal. When confronted scoops. This dependence should not prevent them from with a researcher, a scientist, casting a critical eye and pursuing divergent opinions.
or a technical expert, journalists tend to presume that words and PREVENTIVE JOURNALISM: BEFORE THE FACT
intentions are impartial within this very specialized environ- The purpose of preventive journalism is to offer use- ment… As the poet might say, ful information to the public on the origin, develop- "a happy deception." ment, and outcome of risk or crisis situations, from armed conflicts to environmental disasters. One of its Source: "O Jornalismo Científico e functions is to indicate the conflict resolution efforts o compromisso das fontes", Wilson Costa Bueno (2005) undertaken, and to report on those elements that can prevent similar crises in the future.6 With regard to avian flu or pandemic influenza, preventive journalism must go beyond simply dissem- inating the hygienic measures for preventing infection. Prevention has a broad and strategic nature. Some ex-amples follow: Is the medical infrastructure capable of meeting a
future pandemic?
Preventive coverage must address whether the country
will be unprepared for a future pandemic due to the
absence of an adequate emergency plan. This requires
verifying several factors: number of hospital beds, drug
stockpiles, number of medical ventilators, available supply
of doctors, nurses, nursing assistants, etc.
6 El periodismo preventivo y los observatorios de medios, Javier Bernabé Fraguas, journalist and professor at the University Com-
plutense of Madrid.
Preventive journalism and coverage of risk situations What factors can hinder or
beverages, which generally conflicts facilitate efforts to combat a
with preventive efforts. This occurred possible pandemic situation?
in the 1991 Peruvian cholera epidemic. Another important element of preven- In the department of Cajamarca, the tive coverage involves analyzing the epidemic spun out of control follow- cultural, political, or geographic aspects ing the traditional Carnival festivi- that could hinder or facilitate efforts to ties in February of that year (see chart combat a future pandemic. Some sugges- on page 19). tions are laid out below: • In rural and Andean communities, • Verify whether a special plan is in domestic poultry breeding is com- place to assist persons in areas monly left to children; in the event with limited access, such as the of contamination, what risks would Amazon rainforest. those boys and girls face? Would their • An important feature of local festi- parents be prepared to instruct them vals is the consumption of food and on the necessary protections? "Contrary to what was reported in All because the article's editor a September 24 article appearing sought a synonym for the Portu- on page 2-10, Pneumonic plague is guese word "perdigoto," which can transmitted by saliva." The correction mean either saliva droplet or parrot carried in the September 28, 1994 chick. The difficulty, poor judgment, edition of the Brazilian daily Folha de or apprehension of admitting igno- S. Paulo does not specifically state the newspaper's error. Readers interested rance of particular issues can lead in understanding the facts in ques- to serious errors in the reported in- tion were forced to consult the Sep- formation. In these cases, consulting tember 24, 1994 edition. In fact, the various sources and asking questions article had reported that the disease of those familiar with the subject is a was transmitted by parrot chicks! necessary exercise. Contextualizing, oversight and agenda-setting Does the government budget allocate
to address a future pandemic prior to its resources to emergency contingencies?
emergence – otherwise there will simply On the political and economic front, not be enough time to develop effective journalists need to investigate whether news coverage.
sufficient budget appropriations have been earmarked to cover emergency con- Accuracy of technical and
tingencies in the event of a pandemic. In the first half of 2006, the Inter- Readers must be informed of the true American Development Bank commis- dimensions of the risk in order to pre- sioned a study from the Pan American vent panic or behaviors that could cause Health Organization to assess the ca- greater harm. In the initial stages of a pacity of Latin America's health net- crisis, accurate information is rare. In work to confront a potential influenza cases of isolated disease outbreaks, there pandemic. The results of the study are are only suspicions, which must be con- available at www.iadb.org/sds/AvianFlu/ firmed by accredited laboratories. Jour- nalists need to know how to address these periods of uncertainty, when very JOURNALISM IN RISK OR
often the work of sources and the inves- tigative efforts of journalists themselves Risk and crisis situations are an integral may be hampered. part of journalism, which aims to keep abreast of the most relevant Disseminate possible solutions
developments. However, the inherent to the challenge
rush to press tends to generate errors. Reinforcing a narrative of fear gen- In the case of a pandemic, this could erates a sense of helplessness among exacerbate public panic. The primary the population and exacerbates pub- challenge when faced with a risk or crisis lic panic. News coverage should not scenario is to balance the need for speed simply provide an inventory of the with the quality of the news reported. crisis (number of sick and dead, eco- Maintaining the public's confidence in nomic impact, and the difficulties the news reported by the press is critical of combating the disease). It should under these circumstances. also offer positive information ca- It bears noting that there could be a pable of mobilizing the population short window between the initial stages to confront the epidemic. For ex- and the peak of a human influenza ample: How can the public prevent pandemic arising from avian flu contamination? How can individuals – estimates place the most probable ensure the safety of the food they eat? duration of a pandemic at eight weeks. The How can people participate in volun- media and journalists must be prepared Preventive journalism and coverage of risk situations Take into account the concerns of
authorities, and serious safety questions could arise regarding the disposal of The press should develop news reports culled birds.
that are of interest to different sectors of society. As an example: an outbreak of Mutual trust helps avoid rumors
avian flu would invariably cause serious It is important in a crisis to establish damage to small poultry producers. a relationship of mutual trust between In the midst of a crisis, the issue may sources and reporters, as well as the seem superfluous to the ministry of media and its audience. The absence health, yet poultry farmers have a le-gitimate concern in knowing how they of trust increases the risk of fueling would be compensated in the event it hearsay and conjecture, which could becomes necessary to sacrifice birds. aggravate the crisis. Media profession- Without the cooperation of poultry als should never withhold data to avert farmers, the true number of infected public panic, nor should they publish birds could be concealed from health questionable information. Contextualizing, oversight and agenda-setting Communication versus crisis situations:
the importance of coordinated action In emergency health situations, such bowed to the pressure of the sea- as epidemics and pandemics, a co- food industry and fishermen. The ordinated communication strategy result was an increase in cholera among the various social actors – cases just as officials had begun to government, business, civil society bring the epidemic under control.
organizations, and media outlets – is In addition to potential con- critically important insofar as con- flicts of interest with different sec- flicting positions and attitudes can in- tors of the economy, other factors terfere with or even distort the actions can also hamper prevention efforts. undertaken to deal with the crisis.
The actions of the media in crisis The case of the 1991 Peruvian epi- situations are a decisive factor in this demic serves to illustrate the impor- process. In the initial stages of Peru's tance of coordinated action. In the cholera epidemic, for example, a midst of the cholera outbreak that number of outlets resorted to sensa- claimed more than 2,000 lives in just tionalist reporting, triggering public five months, the Ministry of Health panic and hindering the efforts of the and health experts urged the popula- agencies tasked with responding to tion to refrain from eating raw food, the emergency.
particularly fish and shellfish. Despite By the same token, once the initial the warning, then President Alberto impact of the epidemic had passed, Fujimori undermined his own min- the press devoted diminishing atten- istry when he appeared on televi- tion to the issue, instead reserving its sion savoring a raw seafood dish. headlines for other matters – even Fujimori's primary concern lay in as the national emergency peaked – protecting the domestic and ex- including cabinet shuffles and sto- port seafood industry, which had ries on terrorism.
begun to slump soon after the outbreak. Therefore, although the Strategies for emergency cases
president's actions further endan- The larger the scope of the emer- gered public health, he had clearly gency, the more comprehensive the Preventive journalism and coverage of risk situations communication tools and tech- • The media's agenda and the is- niques employed must be. To ensure sues it prioritizes in its cover- the relevant messages are transmit- age vary considerably and conti- ted to at-risk populations, it is es- nuously shift.
sential to outline the objectives that • Not infrequently, a widespread political actors, the media, and the epidemic is treated as a routine public (in this case, understood as matter or loses its news value. public opinion) will have to carry out. Some of the central questions related to communication in large- • People should not wait for magical scale health emergencies are pro- solutions to confront the crisis.
• Successful experiences – such as participation in social networks and preventive practices – can • The consistency of the narrative contribute to combating the si- and messages articulated by the principal political figures • In emergencies, direct and inter- is a key component in emergen- personal communication should cy situations.
be emphasized.
• Clearly underscoring the le- gitimacy of the government au-thorities, experts, and/or actors Source: Carlos Reyna – sociologist (Workshop on a Future Human Influenza Pandemic arising from responsible for enacting measures Avian Flu – UNICEF, Lima, Peru, April 2007) to deal with the crisis is essential.
• It is important to be prepared to address other issues that could encroach on the public agenda. Media:
• Media outlets play an essen-
tial role in providing the public with information and guidance on emergencies, although it can also generate distortions and even panic.
Understanding avian flu and the influenza pandemic Understanding avian flu and the Chapter 2
influenza pandemic* *Sources: World Health Organization/Pan American Health Organization.
2 Given the substantial strategy of responsible cover- information – mostly age of the issue, a list of experts available on the Inter- and institutions that could net – on avian flu and a possible be used as an initial reference pandemic influenza, journal- base on the issue in the Latin ists should be highly selective American and Caribbean con- and critical in their research to text is provided at the end of ensure the public contextualized this guide, as well as a selection and reliable information.
of links containing relevant In covering a pandemic, documents and information journalists would ideally have for journalists.
access to a large number of sources and, to the extent pos- 1. What is avian flu?
Avian flu was originally diag- interviews with a view to nosed over 100 years ago. cross-checking and compar- Today there are approximately ing the available data. To as- 15 known strains (see Glos- sist media professionals with sary definition) of the virus. this task, we have prepared The animal epidemic currently a summary of the primary affecting 56 countries in Asia, aspects related to avian flu – Africa, and Europe is caused based on studies carried out by by the H5N1 type A influenza WHO and other scientific in- virus. The virus has the poten- stitutions –, including charac- tial characteristic for transmis- teristics, forms of transmission, sion to human beings. There symptoms, risks, and impacts. have been 300 cases of bird- Because access to qualified to-human transmission of the information sources is a central H5N1 subtype.
Preventive journalism and coverage of risk situations 2. How are human beings infected by avian flu?
Of all the viruses that affect birds, H5N1 is of greatest con-
cern to humans. It has caused the largest number of serious
illnesses and deaths. H5N1 has jumped the barrier between
species and infected humans on several occasions. The phe-
It is important to underscore that nomenon was first observed in Hong Kong in 1997 when epidemics do not stem solely eighteen persons were infected, six of whom subsequently from the virus. News coverage died. From 2003 through early August 2007, WHO repor- should address the other causes behind the spread and growing ted 320 cases of human infection and 194 fatalities, for a intensity of diseases such as in- mortality rate of 67%.
fluenza: lack of basic sanitation, The evidence indicates that the primary source of human poor water quality, precarious infection is direct contact with dead or sick birds. Poverty housing and working conditions, exacerbates the problem. Inhabitants in poor areas where malnutrition, the inefficiency of food and income are scarce consume dead birds, even when public health agencies, the ab- their cause of death is unknown. Human infection likely sence of preventive policies, etc. results from the inhalation of secretions (while cleaning or To this end, the factors required maintaining aviaries) or slaughtering or handling contami- to ensure minimum healthy living conditions need to be included nated animals. There is no evidence of transmission from the on the agendas of news organi- consumption of eggs, or frozen or cooked poultry.
3. How does the virus spread in birds?
Highly contagious, avian flu spreads through contact with
infected animals, their secretions and feces. The virus can
also spread through equipment, clothing, feed, water, and
other contaminated objects. Poultry farmers are urged to
thoroughly wash their hands before and after coming into
contact with birds. They should also frequently disinfect all
shoes and boots, clothing, cages, boxes, egg crates, and other
aviary equipment. Furthermore, wild birds contribute to in-
fecting domestic birds and spreading the virus.
4. Is it possible to contain the spread of the virus?
Immediately upon identification of a suspected case in
an aviary, WHO recommends a timely and rigorous epi-
demiological investigation of the animals and breeders in
question. If an infection is confirmed, the contaminated
or exposed animals must be sacrificed. Among the actions
that should be adopted are decontamination of the affec-
ted farms and the implementation of vigorous sanitary and
Understanding avian flu and the influenza pandemic biosecurity measures. In addition, contam- have the capacity to produce vaccine at inated persons should receive immediate scale. Another problem is that after the medical assistance.
new vaccine is developed and produced it will have to be distributed and applied. 5. Do migratory birds contribute to the
The pandemic will likely spread before a spread of avian flu worldwide?
vaccine is made available. Moreover, several The role of migratory birds in the path- strains of the virus could emerge. It is not ogenic spread of avian flu is not yet fully known what specific mutation will arise understood. Based on more recent out- and infect humans. Therefore, governments breaks, it is believed some wild birds may must monitor the types of viruses in carry the H5N1 virus on their migratory circulation to ensure the most adequate routes and in this way contaminate do- vaccine is produced quickly and in sufficient mestic birds.
quantity for each pandemic event.7 6. What are the primary symptoms of
8. What drug treatments are available
avian flu in humans?
for infected humans?
The incubation period for H5NI virus is There are two drugs – oseltamivir (Tami- longer than that of common influenza, flu) and zanamivir (Relenza) – capable of whose incubation is approximately 2 to 3 mitigating the severity and duration of the days. Current data indicates that the in- seasonal influenza virus. To be effective, cubation for H5N1 varies from eight to however, these treatments must be admin- seventeen days. Initial symptoms are istered immediately (48 hours following similar to common influenza, including the onset of symptoms). In cases of hu- high fever (above 38º C or 100º F) and man infection by H5N1, drug treatments muscle aches. Other symptoms reported can improve survival prospects, provided among patients are diarrhea, vomiting, they are administered early.
abdominal pain, chest pains, and bleeding (nose and gums).
9. Will there be a sufficient stockpile
of drugs?
7. Are there vaccines against the virus?
Antiviral stockpiles will be insufficient in Not yet. Several studies are underway every country at the outset of a pandemic, to produce a vaccine against the most primarily in developing countries.
contagious form of H5N1. However, it will be very difficult to develop an effective 10. What is the difference between
vaccine before the virus mutates and its pandemic influenza and avian flu?
new characteristics are understood. In Avian flu encompasses a broad set of in- addition, only a few countries in the world fluenza viruses that primarily affect birds. 7 Francisco Ivanildo de Oliveira Júnior, a Master in infectious disease at the School of Medicine of the University of Sao Paulo (USP).
Preventive journalism and coverage of risk situations In rare cases, these viruses can infect other 11. Are influenza pandemics common?
species, including pigs and humans. The History demonstrates they are rare vast majority of avian influenza viruses but recurring events. In the 20th cen- do not infect human beings, nor do con- tury, there were three pandemics: the taminated individuals transmit the flu to 1918 Spanish f lu, the Asian f lu of 1957, other individuals. and the Hong Kong f lu of 1968. The Pandemic influenza occurs with the 1918 pandemic claimed between 40 emergence of a flu virus subtype that and 50 million lives worldwide. The has not previously circulated in humans. other two were less severe. The 1957 The H5N1 virus has pandemic potential f lu resulted in 2 million fatalities, because of its ability to mutate and adapt while the 1968 event produced ap- into a contagious strain for humans. If proximately 1 million deaths. A pan- the virus mutates, it will no longer be an demic occurs when a new inf luenza avian virus, becoming instead a human virus emerges and begins to spread influenza virus.
in humans as easily as the common Putting an end
Endemic Disease: Continued presence
lation, its previous experience with or of a disease, or of an infectious agent, lack of exposure to the disease, and the in a specific geographic zone. location and time of year in which the Epidemic (or outbreak): The oc-
outbreak occurs.
currence in a community or region of Epizootic Disease: Contagious di-
a large number of cases of an illness sease affecting a large number of ani- in excess of normal expectancy. The mals. The term has become obsolete number of cases indicating the exis- and replaced with epidemic. tence of an epidemic varies according Pandemic: epidemic affecting hu-
to the infectious agent, the size and man populations across several coun- characteristics of the exposed popu- tries and continents. Understanding avian flu and the influenza pandemic Keeping an eye
How can avian flu affect a flock?
• Poorly prepared vaccines.
• Purchase or gift of one or more • Contact with infected manure domestic birds, even if not sick. • Humans, particularly veterinaries and livestock experts or people Do the feces of nursery birds
who deliver animal feed. Contam- pose a danger?
ination can occur through contact Yes, they pose a risk to animals and with an infected farm, a live bird humans. Infected birds excrete the market, a slaughterhouse, a labora- H5N1 virus (and other potentially tory, etc. Individuals may carry the dangerous pathogens) in their fe- virus on their clothes, shoes, boots, ces. It is impossible to prevent birds vehicles (wheels, for example), and in the same cage from coming into contact with chicken feces, al- • Purchase of other animals (pigs, though it is possible to protect dif- for example) from farms with ferent species by housing them in infected poultry.
separate locations.
• Dogs coming into contact with Wild ducks frequently introduce dead birds on infected farms.
low pathogenic avian flu in free-range • Wild birds during migration domestic flocks or open-air cages from an infected area to a disease- through fecal contamination. Birds free area. Migratory birds may can be protected from wild birds and contaminate farms through contact their feces with mesh or netting. with domestic birds or through In the event nursery birds come their infected feces on the ground into contact with wild birds, they or in water ponds.
should be monitored for highly • Ducks moving from rice fields to pathogenic avian flu symptoms, in- lagoons or water ponds.
cluding: respiratory problems, watery • Domestic birds that must find their diarrhea, swelling of the head, neck, own food outside the farm.
and eyes, or reduced decreased or poor • Contact with water ponds.
egg production.
Preventive journalism and coverage of risk situations There are two ways in which neighboring farms, or, for that mat- humans can come into contact with ter, your farm, are free of infection.
the feces of nursery birds: directly, Birds or humans may have through the skin, or indirectly, moved from the infected area before through clothing or individuals who the disease was observed or the initial have been in infected locations.
case reported.
• Gloves, boots, and other protec- A farm will remain disease-free tive clothing should always be if the following principles are followed: worn in establishments where • Maintain birds in good condition.
birds are bred (or have been bred • House birds in protected areas.
recently). For examples, stables, • Control access to the farm.
chicken coops, lean-tos, and other structures. • When leaving a location, gloves, boots, and clothing should be *These guidelines are laid out in Guide for the removed and disinfected. Prevention and Control of Avian Flu in Small-Scale • Hands should be thoroughly Poultry in Latin America and the Caribbean pub- washed with soap (or vigorously lished by the United Nations Food and Agriculture Organization (FAO). The full text is available at www. scrubbed with ash, if soap is not available).
(spanish language version) • It is particularly important that individuals without gloves or oth-er types of protective gear wash and disinfect themselves How can farms be protected in
disease-free regions or countries?
In the case of avian flu, at virtually no
time is the risk of disease zero. While
no known cases may have been re-
ported in your region or country, the
risk of disease exists. This scenario is
defined as one of low or medium risk.
Reports of avian flu cases in an adjacent area does not mean that Understanding avian flu and the influenza pandemic f lu virus – through coughing and 14. Wil the virus's spread be
sneezing – leading to a high number of infections.
Because the majority of humans lack immunity to the virus, infection and 12. What is the risk of a pandemic?
disease rates will tend to be higher than Experts have monitored the H5N1 in seasonal epidemics of the common strain for several years. The virus first flu. In the event of a pandemic, a large infected human beings in 1997 and has portion of the population will require caused serious outbreaks in domestic medical treatment. Only a few countries birds since 2003. In December 2003, have sufficient personnel, equipment, and infections were diagnosed in individu- hospital beds to handle a large number of als exposed to sick birds. The majority suddenly ill people.
of cases occurred in previously healthy children and young adults. Fortunately, 15. Will the number of fatalities be high?
the virus is not easily transmitted from Historically, the number of fatalities dur- birds to humans. ing a pandemic has varied significantly. Mortality rates are basically determined 13. Could the virus have global effects?
by four factors: the number of infected individuals, the virulence of the virus, the A highly contagious virus could spread underlying characteristics and vulner- throughout the world. While some abilities of the affected populations, and countries could perhaps delay the virus's the effectiveness of preventive measures. arrival through travel restrictions and Accurate mortality predictions cannot reinforced health surveillance, prevent- be established before the pandemic virus ing its penetration will be difficult. Pre- emerges and begins to spread. All mortal- paring for an epidemic requires devel- ity projections are purely speculative. oping a preventive policy that includes investments in animal and public health STRATEGIC MEASURES TO
infrastructure, building drug stockpiles, PREVENT AND CONFRONT
training health workers, purchasing hos- THE CRISIS
pital equipment, in addition to mobiliz- The World Health Organization pub- ing and providing guidance to the popu- lished a series of recommendations and lation on facing the crisis.
strategic actions to respond to the threat The influenza pandemics of the 20th of an influenza pandemic. The actions set century circled the globe in nine months, forth different stages of defense. WHO at a time when most international travel works with health ministries and organi- was by ship. Given the speed of air zations to support surveillance of influen- travel today, the virus could spread in za strains circulating in various countries. less than three months. A sensible surveillance system capable of Preventive journalism and coverage of risk situations detecting the emergence of the virus is essential for the timely detection of a pandemic risk. The recommendations are aimed at avoiding the ele- ment of surprise by perfecting an early warning system in the event of a pandemic. The objective is to delay the spread The population should be mobil- of the virus and accelerate the development of vaccines.
ized to face a pandemic actively. Public participation can contribute to thwarting the spread of the vi- Planning and participation
rus, thereby reducing the number Developing a plan can help contain the transmission of the of victims and the social and eco- virus, reduce the number of human infections, limit hospi- nomic costs.
talizations and deaths, ensure essential services remain in In crisis situations, information is operation (transportation, waste collection, electric power, a critical tool for preventing panic. water, etc.), and mitigate the socioeconomic impact in the The media plays a central role in event of a pandemic.
this ef ort, not only by providing It is essential that all of society participate in the plan. guidance on hygiene and public health, but also by encouraging The plan should be based on a multisectoral approach and dif erent social actors to engage in involve all areas and levels of government. In addition, the public actions designed to control collaboration of scientists and experts from different areas, the epidemic.
including public policy, legislative, animal health, public health, laboratory analysis, and communication, is vital. Assuring cooperation in the event of an emergency requires a commitment by individuals to prepare and execute a preventive policy and fight the epidemic. Through its associations and organizations, the larger commu-nity can contribute important knowledge on the critical factors underlying the development of an efficient plan, including the geographic characteristics of the region, local resources, and even cultural and ethical matters that could hamper the actions of health services.
WHO summarizes the main points that should be included in the planning process: • Strengthened epidemiological surveillance for human and animal influenza.
• Procurement of antivirals and production of vaccines.
• Protocols on the proper use of antivirals and vaccines; organization of health assistance networks.
• Individual and collective biosecurity guidelines and measures for health services. • Protocols on laboratory diagnosis. Understanding avian flu and the influenza pandemic • Communication, inspection, and surveillance actions at ports, airports, and border crossings.
ALL STAGES OF THE PANDEMIC
The World Health Organization has defined six phases of
In a pandemic, WHO will provide a pandemic outbreak. The purpose of the classification is regular updates, when necessary, to alert countries of viruses with pandemic potential.
through www.who.int. Journalists Another objective is to prepare contingency plans can register to receive automatic and mitigate the social costs of a pandemic. According to alerts on new updates. The WHO's classification, the global community is presently updates will provide the most at stage 3 of an avian flu scenario. Increasing or decreasing recent information collected the pandemic alert level involves consultations by WHO by WHO, including number of with a committee of outside experts to examine all the cases, proposed actions, and continuous risk assessments.
available data. The committee will submit its recommen-dations to the Director-General of WHO, who will then render a decision on whether the pandemic alert level should be reset.
Interpandemic period
• PHASE 1 – No new influenza virus subtypes have
been detected in humans. An influenza virus subtype that has caused human influenza infection may be present in animals. The risk of human infection is considered low.
• PHASE 2 – No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease.
Pandemic alert period
• PHASE 3 – Human infection(s) with a new subtype
reported. But no human-to-human spread or at most rare instances of spread to a close contact with a human case.
• PHASE 4 – Small cluster(s) with limited human-to-hu- man transmission (fewer than 25 infections) lasting less than two weeks. Spread is highly localized, suggesting that the virus is not well adapted to humans.
• PHASE 5 – Increased spread among humans, with large Preventive journalism and coverage of risk situations cluster(s) of human cases (25 to 50 hu- caused by properly cooked poultry man cases), lasting two to four weeks. meat or poultry products.
While human-to-human spread is still • Avoid contact with surfaces and objects localized, the virus is becoming better contaminated by the secretions or feces adapted to humans. Although not yet fully transmissible, there is substantial • Avoid consuming raw or undercooked poultry-based foods or eggs.
• Avoid purchasing, maintaining, or transporting live animals in contam- • PHASE 6 – Increased and sustained inated countries, especially ornamen- transmission in the general population. tal or domestic birds.
• Wash hands frequently with soap and WHO TECHNICAL
water or a disinfectant.
RECOMMENDATIONS
WHO's pandemic alert is now at Phase 3
Recommendations for populations in
(a new influenza virus is causing human disease, but is not yet easily spread in • Exercise caution, particularly when humans). In this phase: slaughtering contaminated animals; • WHO recommends restricting travel • Avoid direct contact with infected birds to affected countries. or with surfaces or objects contaminat- • WHO recommends barring or sepa- ed by their feces or secretions. The risk rating travelers from countries affected of exposure is highest during slaughter, finishing, cutting, and preparation.
• WHO alerts travelers to countries • Avoid contact with dead migra- affected by avian flu that vaccinations tory birds or wild birds manifesting are not required because an effective disease symptoms.
vaccine against H5N1 strain has not • Countries located along migratory routes should be alert to the initial • WHO underscores, however, that per- disease symptoms in wild and do- sons wishing to protect against human mestic birds. Recent cases have sug- influenza should receive the vaccine.
gested the possibility that migratory birds are spreading highly pathogenic Travelers to contaminated regions
• Avoid live bird and animal mar- • Be alert to symptoms such as fever and kets, farms, and bird sanctuaries in respiratory disease in persons who may contaminated areas. have been exposed to the virus. Initial • Consume poultry only if cooked at symptoms of H5N1 virus infection are 70º C (160º F), at a minimum. To date, similar to those of many other com- there is no evidence of infection mon respiratory ailments.
Understanding avian flu and the influenza pandemic Epidemics in flocks
• Quarantine all contaminated animals.
• Destroy all infected animals or those potentially exposed to contamination.
• Vigorously monitor traffic among farms.
Questions regarding the meas- • Vaccinate all persons coming into contact with the birds ures taken by member countries against human influenza (avoid gene transfer).
should be directed to national • All persons involved in the slaughter of birds should use authorities, not WHO. Questions protective equipment and antiviral prophylaxis.
concerning animal health should • Perform timely and vigorous epidemiological investiga- be directed to the International tions with the medical and veterinary services immedi- Organization for Animal Health ately upon identification of a suspicious case. (www.oie.int/eng/en_index.htm) or the United Nations Food and Agriculture Organization (www.fao.org).
Preventive journalism and coverage of risk situations framing the issue
Priority to children and adolescents
3 Amid so much doubt and family educational level, the ab- conjecture on the extent sence of or inadequate breast- and impact of a future feeding, pollution, and second- influenza pandemic in Latin hand smoke inhalation.9 America and the Caribbean, one The flu virus spreads quickly in thing is certain: children and enclosed spaces. Boys and girls un- adolescents would be among the der age 2, the elderly, and persons most vulnerable to the virus – with chronic or immunosuppres- likely accounting for the highest sive diseases are at highest risk.
number of victims.
In certain cases, such as the In the avian flu outbreaks of avian flu outbreak of Decem- Africa, Asia, and Europe, chil- ber 2005 to January 2006, only dren and adolescents were the children have been infected. The most affected segment. Half of ten infected founded children the 205 H5N1 infections be- in Turkey, four of whom subse- tween January 2003 and April quently died, ranged from 3 to 2006 were under age 20, ac- 15 years of age.10 cording to the Epidemiological Because children and ado- Bulletin of WHO/PAHO.8 The lescents are more vulnerable to mortality rate was high among the flu and cannot effectively 10 to 19 year-olds. defend themselves, they must be Several factors contribute to a priority of preventive poli- acute respiratory infection in cies and assistance efforts in the children: nutritional state, low event of an epidemic or any other birth weight, household size, crisis situation.
8 WHO/PAHO, Epidemiological Bulletin. 26;30 (June 2006)9 Eitan N. Berezin, Brazilian Pediatric Society10 Weekly Epidemiological Record (October 2006) Suggestions for framing the issue This is one of the principles set forth in the Convention Chapter 3
on the Rights of the Child adopted by the United Nations General Assembly on November 20, 1989, and ratified by the vast majority of nations. The Convention became inter-national law in 1990, and its provisions were incorporated in the national constitutions of various states, among them Latin American and Caribbean countries on the rights of the child • Preventive coverage of an influenza pandemic should stress the threat to the child and adolescent population ARTICLE 3
with a view to mobilizing 1. In all actions concerning children, whether society and government to undertaken by public or private social welfare develop protective measures institutions, courts of law, administrative au- • It is important to consult phy- thorities or legislative bodies, the best interests sicians and experts to clearly of the child shall be a primary consideration. spell out the primary actions 2. States Parties undertake to ensure the child such to prevent the virus in children protection and care as is necessary for his or her and adolescents.
well-being, taking into account the rights and duties of his or her parents, legal guardians, or other individuals legally responsible for him or her, and, to this end, shall take all appropriate legislative and administrative measures.
3. States Parties shall ensure that the institutions, services and facilities responsible for the care or protection of children shall conform to the standards established by competent authori-ties, particularly in the areas of safety, health, in the number and suitability of their staff, as well as competent supervision View full text at: www.onu-brasil.org.br/doc_crianca.php Preventive journalism and coverage of risk situations Protecting the rights of children and adolescents is an efficient means to stop the perpetuation of poverty – an essential element of any development strategy. A few simple steps can help prevent avian flu In its report "Poverty Reduction infection in children and adolescents. Some of Begins with Children," UNICEF these are provided below: argues that children should be • Keep children away from farms and nurseries the principal target of poverty with birds suspected of infection.
reduction efforts. Why? A reveal- • Children in rural areas – who often maintain, ing fact: because low income feed, and collect the eggs of domestic birds – families tend to have more chil- need to be educated to identify flu symptoms dren than higher income families, in birds and notify the responsible adult of boys and girls are dispropor-tionately represented among suspicious cases.
the poor. No other age group • In the event of contact with suspected registers an equivalent level of animals, wash hands with soap and water.
• Eggs and poultry should always be prepared at a high temperature.
• Proceed to a hospital or health clinic in cases of suspected infection.
Contamination:
• Avoid sharing utensils such as silverware or
• Another indispensable practice is to cover the mouth when coughing or sneezing to avoid airborne transmission of the virus through saliva.
Suggestions for framing the issue EPIDEMIC SCENARIOS AND THE
COLLAPSE OF HEALTH SERVICES
In a hypothetical pandemic influenza, intensive care
units (ICU) and medical ventilators throughout Latin
America would collapse within one week, according to an
assessment by WHO/PAHO.
• Preventive news coverage The conclusions are based on the infection rates of the should include consultations 1957 and 1968 flu epidemics, in which 3 million people with physicians and scientists died. It bears noting that the two epidemics were consid- on home treatment options: ered "moderate" by experts in the field.
What kind of guidance should be of ered to families? What The WHO/PAHO scenario presumes 25% of Latin are the principal precautions America's population would contract the virus and that should be taken, particu- a death toll of 300,000. In the first eight weeks of the larly with children and adoles- contagion, almost 1.5 million people would be hospital- cents? How can relatives and ized, representing a hospital bed occupancy rate of 80% neighbors be protected from throughout the region.11 infection? What are the appro- In the event of such a scenario and given the difficulty priate medications? What are of increasing hospital capacity, experts such as Carissa Eti- the recommended hygienic enne, assistant director of WHO/PAHO, argue that one and dietary measures? alternative is to maintain infected patients in their homes. Another valuable approach is to identify the strategies A preventive effort would be necessary in this case to coordinated by the local health prepare families to deal with the epidemic by providing ministry or secretariat: Are them guidance on care for the sick.
the population and medical personnel receiving guidance ECONOMIC AND SOCIAL IMPACT
on preventing and responding The poultry sector is a US$ 18.5 billion industry, to the disease? Are the pri- representing almost 15% of agricultural production mary hospitals in the city and/ in Latin America and the Caribbean and nearly or country prepared to take in infected patients? Are drug 1% of GDP. Its multiplier effect on the economy stockpiles sufficient to treat is also significant, primarily on grain (corn and soy) production, the basic components of birdfeed.12 The poultry production chain employs 4 million workers, while poultry meat consumption contrib-utes to food security in Latin American and Caribbean countries, accounting today for close to 40% of total meat consumption. Rich in protein, chicken 11Oscar Mujica, "Assessing the Impact of a Pandemic," WHO/PAHO (03/20/2006) 12 Inter-American Development Bank Preventive journalism and coverage of risk situations meat is an excellent low-cost option for low-income populations. Annual chicken production in the region is approxi- mately 16.1 million tons, 25% of global production. Brazil, the single largest exporter of chicken meat, brings in US$ Raising poultry on smal farms, 3.2 billion from its international sales. whether as a source of additional The figures provide some idea of the economic damage income or for household con- an avian flu outbreak would inflict on the incomes of sumption, is a part of life in many small poultry producers, rural and agribusiness workers, Latin American and Caribbean countries. It is important to contact farmers, merchants, and other agents of the region's poultry the Ministry of Agriculture, poultry production chain. farmer associations, and Agricul-ture Secretariats to ascertain the Food security
number of poultry farmers, pro- An Inter-American Development Bank (IDB) assessment es- duction volumes, etc.
timated the cost of an avian flu outbreak in Latin America at US$ 1.6 billion. By contrast, only US$ 247 million in invest-ments would be required for capacity-building and prepar-edness efforts for the region's public animal health services. The projections refer only to an outbreak scenario; the con-sequences of a pandemic would be far more severe (see chart on page 37). It is important that countries ensure assistance for producers who could face significant income erosion. In addition, poultry production plays a strategic role in food security insofar as it provides a low-cost source of animal protein.13 The majority of Latin America's rural population – esti- mated at approximately 200 million – is engaged in raising chickens and other fowl.14 An avian flu outbreak or an influenza epidemic could generate a number of economic impacts: workforce reductions, falling poultry consumption, decreased sales and business, reduced investments, interruptions in basic services, among others.
Estimates of economic losses to Latin American and Caribbean countries from an influenza pandemic are mere speculation inasmuch as they are conditioned by various 13César Falconi, Inter-American Development Bank14WHO/PAHO Suggestions for framing the issue At some point
The Ministry of Health of a mem- of the viral genes stem from avian ber-state of WHO receives infor- flu, while the remainder derive mation on a possible outbreak of from humans. The information acute respiratory illness in a remote is immediately passed on to the provincial village. A response team Ministry of Health where the is dispatched to the province, cases were initially detected, and whereupon it discovers the out- notification is made through the break had begun almost one month WHO Global Influenza Surveil- earlier, identifying 50 cases over lance Network.
that period. All age groups are af- Additional cases are diagnosed fected. Currently, there are 20 pa- in adjacent areas. The new flu tients in a local hospital. Pneumo- virus begins to make headlines, be- nia and acute respiratory failure coming the principal issue of the have claimed 5 lives.
day. WHO calls on countries to Surveillance in the affected intensify their influenza surveil- zones is stepped up, and 9 new lance and control efforts. The cases of infection are detected. upper echelons of government The samples collected from se- throughout the region receive dai- veral patients and analyzed in a ly briefs as surveillance measures national laboratory indicate type increase. In the following months, A influenza virus, although the outbreaks occur in neighbor- subtype cannot be ascertained. ing countries. Although cases are The viral samples are forwarded diagnosed in all age groups, mi- to the WHO Influenza Reference nors appear to be dispropor- Center for more thorough analysis, tionately affected. One in five which for the first time identi- fies the type A flu virus and H5N1 The virus spreads quickly, and subtype in humans. Subsequent countries begin imposing travel res- gene studies indicate that most trictions and quarantine measures. Preventive journalism and coverage of risk situations Schools close. Generalized panic healthy children succumb to the ensues as the public discovers that virus in a matter of days. antiviral drug stockpiles are insuffi- Several airports are closed due to a cient and no effective vaccine exists. lack of air traffic controllers. In the A week later, there is information following six to eight weeks, health of a virus outbreak in passengers and other basic services are affected on an airline arriving from some as the pandemic spreads through- of the affected countries, after they out the globe.
are found to manifest respiratory Are you prepared to prevent or reduce the number of deaths, Several weeks later reports social upheaval, and economic surface of the first virus out- repercussions of a flu pandemic? breaks on other continents. School and work absences mount. The telephones at health agencies ring Source: Epidemic Alert and Response, WHO off the hook. The spread of the Verification List for the Influenza Pandemic Pre- new virus is headline news in paredness Plan (2005) http://www.who.int/csr/ the print and electronic media. Citizens seek vaccines, but are unable to obtain them or antivi-ral medications. Police depart-ments, public service providers, and public transportation authorities face a shortage of workers, leading to service interruptions.
There is an immediate drop in hospital and health clinic personnel when doctors, nurses, and other staff fall ill or refrain from going to work out of fear. Hospital ICU units are filled to capacity, and there is a shortage of medical ventilators for patients suf-fering from pneumonia. Parents are distressed as they watch their Suggestions for framing the issue factors (extent of the epidemic, number of infected humans, mortality, economic losses).
The scenarios developed by the Inter-American Develop- ment Bank (IDB) project an economic cost of US$ 12 billion to $US 85 billion, and 2 million deaths. These projections, however, cannot account for the full extent and effect of • Investigate whether child a potential pandemic from a socioeconomic standpoint.
labor is employed on com-mercial poultry farms and fi- IMPACTS ON MINORS
nal ways to mobilize society to In addition to facing greater exposure to the action of eradicate the practice.
viruses, children and adolescents are the primary victims Ask experts how families can protect themselves against of the social and economic impacts arising from epidemics. avian flu. Have them clearly The most tragic is orphanhood.
set out the necessary pre- In some of the poorest regions of Asia, Africa, and cautions to avoid infection in Europe affected by avian flu outbreaks, children had birds and people.
the highest infection rates – particularly girls, who in • Provide smal poultry farm- many areas are responsible for maintaining, feeding, and ers with simple, low-cost collecting the eggs of domestic birds.
measures to prevent and The impact of avian flu on children's lives goes far control the disease.
beyond the immediate risk of the disease to their health. Poultry farmers must have knowledge of the character- For many families, the contamination of domestic birds istics of the disease so as to resulted in the loss of an important source of food and ensure they recognize it and income. This can adversely affect the health of child- notify the proper authorities. ren and adolescents and directly threaten their ac-cess to education. When incomes fall drastically, fami-lies can no longer ensure their children's attendance in school nor provide them with basic healthcare.15 Effects of the crisis
Emergency situations place a severe burden on basic
and child protection services. In addition to the
deaths they cause, natural disasters, epidemics, and
armed conflicts leave children exposed to disease,
malnutrition, abuse/violence, and abandonment. In
many countries, children are in a state of permanent
crisis due to extreme poverty and a lack of health and
education.
15"Avian Flu and Influenza Pandemic," UNICEF, www.unicef.org/ceecis/media_3962.html Preventive journalism and coverage of risk situations Let us consider, as an example, the case of Peru, recently affected by an earthquake that claimed approxi-mately 500 lives and injured at least 1,000 people. One of UNICEF's primary concerns two weeks following the disaster was to get schools throughout the country re- "Despite the shortcomings and opened. The earthquake destroyed more than 1,000 school deficiencies of the public health buildings, forcing the Ministry of Education to set up network, the world is better prepared today to respond to an epidemic. Thanks to a cen-tury of advances in scientific development, we now have the capacity to diagnose and de- velop new treatments. During the Spanish flu, many people died due to complications from the virus, including bacterial infec-tions. There were no treatments The AIDS example can help illustrate the available for these complications. It was the pre-antibiotic era." extent of the potential impact on the lives of boys and girls arising from a pandemic. Data Francisco Ivanildo de Oliveira Júnior, from UNICEF reveals that more than 15 mil- Master in Infectious Disease at the lion children worldwide have lost one or both School of Medicine of the University parents to AIDS. Less than 10% of children ei- of Sao Paulo (USP) ther orphaned or vulnerable to the virus receive support from government agencies or institu-tions. Less than 10% of pregnant women have access to services designed to prevent vertical transmission of HIV. According to UNICEF, less than 5% of child- ren with HIV receive adequate treatment. In ad-dition, a large proportion of children orphaned by the epidemic still receive no support. They have no access to public health and education services, primarily because of discrimination.
Suggestions for framing the issue The resumption of classes has verely affect the daily routines of children symbolic value. It communicates a and adolescents.
return to normalcy following a disaster. In the view of WHO/PAHO experts, UNICEF recommends that teachers such measures would have only limited pay special attention to their children effect in preventing infection after the onset during this transition stage. Many are of a pandemic. They could, however, prove not emotionally or physically equipped useful in slowing the spread of the virus. to refocus on their studies. Social distancing and potential Another important consideration in- quarantine or isolation policies are issues volved replacing school supplies lost in that would spark considerable discussion the earthquake.
during a pandemic. In addition to Additionally, families required psy- restricting the circulation of people, these chological support. Many people lost measures would separate families and their homes and were separated from cause significant distress in boys and girls.
their families. This is especially traumatic If economists, doctors, and epidemi- to children.
ologists have thus far failed to share the same crystal ball to determine the extent Focus on prevention
and consequences of an influenza virus, An influenza epidemic could require so- on one issue they are of the same opin- cial distancing measures, such as school ion: prevention is the best means to pre- and workplace closures to reduce exposure clude or reduce the suffering caused by to the virus. All of these actions would se- a tragedy of this magnitude. Preventive journalism and coverage of risk situations Database of Sources Health and Sanitary
Pan American Health Dr. Albino Belotto
Health Surveillance and Disease Management Dr. Paulo Froes
Pan American Health UNICEF – Regional Office for Organization Latin America and the Caribbean Regional Advisor Child Survival and Immunization / Keiji Fukada
Health Regional Focal Coordinator of the Point for AI/HPI Preparedness Global Influenza Program and Response World Health Health and Nutrition Section Tel. 4122 791 2684 Dr. Mirta Roses Periago
Pan American Health Organization Health Expert Pan American Sanitary Bureau Inter-American Regional Office of the Development Bank (IDB) World Health Organization (202) 623-1972 525 Twenty-third Street, N.W. Washington, D.C. 20037 - USATel. (202) 974-3000 César Falconi
Chief Rural Development Unit
Dr. Octavio Oliva
Inter-American Development Bank (IDB) Database of sources Tel. (202) 623-3350 Tel. 1 202 974 3458 Tel. 4122 791 3982,[email protected] Animal Health
Inter-American Maria Zampaglione
Luis Barcos
Development Bank (IDB) World Organization for Regional Director for Tel. (202) 623-1718 Animal Health (OIE) the Americas World Organization for Animal Health (OIE) Cynthia Sharf
Mario Bravo
United Nations (UN) World Bank (IBRD) Moisés Vargas Terán
United Nations Food and
Daniel Epstein
Nicole Frost
Agriculture Organization Pan American Health World Bank (IBRD) Animal Health for Tel. (202) 974-3143 Latin America Robert Cohen
UNICEF – Regional Office for Latin America World Health and the Caribbean Peter M. Sandman
Tel. 4122 791 2684, Expert in Risk Situation Sofia Castresana
and Pandemic Germán Rojas
Inter-American Institute 59 Ridgeview Rd. United Nations Food for Cooperation on Princeton NJ 08540-7601 and Agriculture Inter-American (press and public
Development Bank (IDB) Aviculture, Economics
relations offices)
Tel. (202) 623-1364 and Markets
Association of
Pan American Health Broiler Chicken
Maria Cheng
Washington, D.C. (USA) World Health Preventive journalism and coverage of risk situations Brazilian Agricultural and Agriculture (FAO)
Research Corporation
(Center for Avian and
Swine Research)
UNICEF – Press Center
ANDI – Brazilian
Brazilian
News Agency for
Aviculture Union
Children's Rights
Yahoo Bird
Brazilian Poultry
Alertnet by
Producers
Reuters Bird Flu
and Exporters
UNICEF (United Nations
Development Bank (IDB)
Google News
UNICEF – Country
news?hl=en&ned= Information Latin
Institute for
us&q=%22avian+ America and the
Cooperation on
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flu%22&btnG= www.unicef.org/ Ministry of
Avian Flu News
Industry, and
Avian and Pandemic
Flu (US government
www.mdic.gov.br The Communication
Ministry of
Agriculture, Food
Flu Observation Group
Supply and Livestock
UNICEF – Influenza
Global Disease
United Nations
Avian Communication
Alert Map
Organization for Food
Database of sources History of Public
First Outbreaks of
Health in Latin
H5N1 Avian Influenza
America and
the Caribbean
Guide for the Preven-
tion and Control of
Small-Scale Poultry
WHO Global
in Latin America and
the Caribbean – FAO
Ministry of Health
WHO Outbreak
Influenza Pandemic
National Health
Threat: Current Situation
Surveillance Agency
Documents
WHO Press Manual
of the Pan American
Health Organization and
the World Health
Pandemic
Avian Influenza:
Assessing the Threat
LATIN AMERICA AND
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Ministries of health/
governments
Ten Things You Need
Antigua and Barbuda
Avian Influenza:
to Know About
Food Safety Issues
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Frequently Asked
WHO Guidance on
Public Health Mea-
www.opas.org.br/ sures in Countries
Argentina
Experiencing Their
Preventive journalism and coverage of risk situations www.msal.gov.ar/ Chile (avian influenza)
Costa Rica
www.cubagob.cu/ Peru (influenza aviar)
El Salvador
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pages/home.asp Virgin Island
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Saint Chistopher
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Database of sources Trinidad & Tobago
Avian Influenza Portal St Vicent and The
Venezuela
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sr/links.htm Preventive journalism and coverage of risk situations an immune response Adjuvant: A substance added
– antibody generating.
to a vaccine to improve the immune response so that less Antiviral: A drug that is used
vaccine is needed to provide to prevent or cure a disease caused by a virus, by interfering with the ability of the virus to Antibiotic: A substance
multiply in number or spread produced by bacteria or fungi from cell to cell.
that destroys or prevents the growth of other bacteria or Asymptomatic: Presenting no
symptoms of disease.
Antibody: A protein produced
Avian influenza: A highly
by the body's immune system in contagious viral disease with up response to a foreign substance to 100% mortality in domestic (antigen). Our bodies fight fowl caused by influenza virus off an infection by producing subtypes H5 and H7. All types of birds are susceptible to the virus but outbreaks occur most Antigen: Any foreign
often in chickens and turkeys. substance, usually a protein, The infection may be carried that stimulate the body's by migratory wild birds, which immune system to produce can carry the virus but show no antibodies. The name antigen signs of disease. Humans are reflects its role in stimulating only rarely affected.
as opposed to clinical practice, which studies the same process, but at the Bacilli: Bacteria of the genus Bacillus
individual level.
that is saprophytic or pathogenic in humans and mammals.
Etiology: The branch of medicine
that studies the causes of disease
Carrier: A bearer and transmitter of
an agent capable of causing infectious
H5N1: One of dozens of avian influen-
disease. An asymptomatic carrier shows no za virus subtypes. Although relatively symptoms of carrying an infectious agent.
rare, several hundred cases of bird-to-human transmission have occurred. Contagion: A contagious disease is
Very few cases of person-to-person easily spread from one person to another transmission have been reported. by contact with the infectious agent that causes the disease. The agent may be Host: An organism on or in which a
in droplets of liquid particles made by parasite lives.
coughing or sneezing, contaminated food utensils, water, or food.
HPAI: Highly Pathogenic form ofAvian
Influenza. Avian flu viruses are classfied
based on the severity of the illness.
HPAI is extremely infectious among
humans. The rapid spread of HPAI, with outbreaks occurring at the same Enzyme: A substance that speeds up chemi-
time, is of growing concern for human cal reactions. Every chemical reaction in as well as animal health. See LPAI.
living organisms is facilitated by an enzme.
Epidemiology: The branch of science
that deals with the relationship between
the various factors affecting the inci-dence and distribution of disease in a Immune System: Includes all of the
mechanisms by which a multicellular It is a cornerstone of the public health organism protects itself against inter- field designed to ensure understanding of nal invasion by bacteria, viruses, the health-disease process in populations, or parasites.
Preventive journalism and coverage of risk situations Immunization: The process by which
bacteria, cyanophyceae, fungi, yeasts, an organism acquires, by natural protozoa, and viruses.
or artificial means, the capacity to protect itself from a specific Mortality: The number of persons or
bacterial aggression, whether viral individuals that die within a specific time or parasitic. Vaccination against period or particular region, country etc., various diseases is the most common or from a disease or epidemic.
example of immunization.
Mutation: Any alteration in a gene
Incubation: The period extending from
from its natural state. This change may the time an infectious agent enters an be disease causing or a benign, normal organism until symptoms of the disease variant. Specific mutations and evolution first appear.
in influenza viruses cannot be predicted, making it difficult if not impossible to Infection: Invasion by and multiplica-
know if or when a virus might acquire tion of a pathogenic agent in a host. the properties needed to spread easily among humans.
Infectious Agent: Any organism,
such as a pathogenic virus, parasite,
or bacterium, that is capable of invad-
ing body tissues, multiplying, and causing disease.
Pandemic influenza: A global in-
fluenza outbreak. Avian flu outbreaks
throughout the world continue to be geographically limited, for the Lethality: The ratio of deaths to num-
most part, and primarily restricted to ber of cases of a given disease. animals. However, if avian influenza becomes a pandemic virus that is fully LPAI: Low Pathogenic form of Avian In-
transmissible from person to person, fluenza. Most avian influenza strains are it is highly likely to spread throughout classified as LPAI and typically cause little the world due to low human immunity or no clinical signs in infected birds.
to the disease.
Parasite: An organism living in, with, or
on another organism.
Microorganism: Any microscopic
Pathogenic: Causing disease or capable
or ultramicroscopic organism, such as of doing so.
Pre-Pandemic Vaccine: A vaccine
the body, stimulates the production of created to protect against currently specific antibodies or altered cells. This circulating H5N1 avian influenza virus produces an immunity to the disease- strains with the expectation that it would causing organism. provide at least some protection against new virus strains that might evolve. Vector: An organism that transmits
or is capable of transmitting a parasite
Prevention: The set of measures or ear-
among hosts.
ly preparedness for (something) aimed at preventing (an undesirable event). Pre- Virus: A basic protein particle
paredness developed to prevent diseases.
capable of infecting living organisms. Viruses are obligatory parasites of the Prophylactic: A medical procedure or
interior of cells, which means they only practice that prevents or protects against replicate by invading and taking control a disease or condition (e.g., vaccines, of the cell's replication machinery.
Virulent: extremely lethal, causing
serious illness or death.
Seasonal flu (or common flu): A res-
piratory illness that can be transmitted person to person. Most people have Waterfowl: Birds that swim and live
some immunity, and a vaccine is availa- near water, including ducks, geese, ble.This is also known as the common flu or winter flu.
Strain: A group of organisms within a
species or variety.
Zoonosis : A disease passed from ani-
Symptom: A sign of an organic or func-
mals to humans.
tional change.
Vaccine: A preparation consisting
• US Government avian and pandemic of antigens of a disease-causing flu information - www.pandemicflu. organism which, when introduced into SDS, Edificio Boulevard Center, Sala 108.
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