Origin and diversity of novel avian influenza a H7N9 viruses causing human infection: phylogenetic, structural, and coalescent analyses (H7N9 report)

Avian and pandemic human influenza policy in South-East Asia: the interface between economic and public health imperatives

Authors: Petcharat Pongcharoensuk,1 Wiku Adisasmito,2 Le Minh Sat,3 Pornpit Silkavute,4 Lilis Muchlisoh,2 Pham Cong Hoat3 and Richard Coker5 *

Institutions: Faculty of Pharmacy, Mahidol University, Bangkok, Thailand 2 Department of Health Policy & Administration, Faculty of Public Health, University of Indonesia, Depok, Indonesia 3 Department of Science and Technology in Economical and Technical Sector, Ministry of Science and Technology, Hanoi, Vietnam Health Systems Research Institute, Ministry of Public Health, Nonthaburi, Thailand and 5 Communicable Diseases Policy Research Group (CDPRG), London School of Hygiene and Tropical Medicine, at Mahidol University, Bangkok, Thailand

The aim of this study was to analyse the contemporary policies regarding avian and human pandemic influenza control in three South-East Asia countries: Thailand, Indonesia and Vietnam. An analysis of poultry vaccination policy was used to explore the broader policy of influenza A H5N1 control in the region. The policy of antiviral stockpiling with oseltamivir, a scarce regional resource, was used to explore human pandemic influenza preparedness policy. Several policy analysis theories were applied to analyse the debate on the use of vaccination for poultry and stockpiling of antiviral drugs in each country case study. We conducted a comparative analysis across emergent themes. The study found that whilst Indonesia and Vietnam introduced poultry vaccination programmes, Thailand rejected this policy approach. By contrast, all three countries adopted similar strategic policies for antiviral stockpiling in preparation. In relation to highly pathogenic avian influenza, economic imperatives are of critical importance. Whilst Thailand’s poultry industry is large and principally an export economy, Vietnam’s and Indonesia’s are for domestic consumption. The introduction of a poultry vaccination policy in Thailand would have threatened its potential to trade and had a major impact on its economy. Powerful domestic stakeholders in Vietnam and Indonesia, by contrast, were concerned less about international trade and more about maintaining a healthy domestic poultry population. Evidence on vaccination was drawn upon differently depending upon strategic economic positioning either to support or oppose the policy. With influenza A H5N1 endemic in some countries of the region, these policy differences raise questions around regional coherence of policies and the pursuit of an agreed overarching goal, be that eradication or mitigation. Moreover, whilst economic imperatives have been critically important in guiding policy formulation in the agriculture sector, questions arise regarding whether agriculture sectoral policy is coherent with public health sectoral policy across the region.

Keywords Influenza, pandemic, avian influenza, policy, South-East Asia, Indonesia, Thailand, Vietnam