Vietnam, which is facing wide spread of bird flu virus strain H5N1 among fowls and humans, should center her anti-disease efforts on a three-pronged approach that prioritizes enhanced public awareness and higher response capacity at grass-root levels, Hans Troedsson, representative of the World Health Organization (WHO) in Vietnam, told Xinhua in an interview on Wednesday.

The first prong is giving more information and education through media to let as many people as possible know better about the danger of bird flu and ways of avoid contracting it, Troedsson said, confirming that "media can play an very important role in explaining what people need to do and how they protect themselves. "

"A large portion of the population (of Vietnam) is not fully aware about the situation and how to protect themselves. A lot of farmers, a lot of households.. I think the commitment of the central government is very good, commendable, really. However, at grass-root levels, provinces and districts need to have more work done for better awareness and preparedness."

The second prong is to have "more direct communication with community leaders," he said, explaining that a village head or a district leader will have timelier and more effective communications with households in the areas they are responsible for.

The third prong is trying to change the bird flu-related behavior of residents, or enhance knowledge among communities, especially households. "We need to know much more about knowledge, attitude and practices among people. We need to do more studies, looking at what do people know about avian influenza," he stressed.

In addition, Vietnam should "try to build up the so called rapid response capacity in provinces," Troedsson said, noting that officials and citizens must be able to respond to bird flu outbreaks not only at central level but also provincial and district levels by having more "animal health and public health authorities or professionals in small teams."

When something unusual happens somewhere, the local authorities can immediately send the teams there to "look at the case, make assessment and take first measures if necessary such as quarantine and provision of Tamiflu (a kind of bird flu medicine)", the WHO official said, noting that the teams, at the same time, will report the case to higher level like the National Institute for Hygiene and Epidemiology in case of bird flu outbreaks among humans.

"Now, the virus (H5N1) is widely circulated, widely spreads in the environment and among the poultry. It is a big health and agriculture problem," he stated, noting that the number of bird flu patients in Vietnam this year is higher than last year.

"The surveillance system is not perfect, but it is being improved.. Almost 13 million households, or more than one third of the population have some kind of poultry raising.. The virus circulates in the environment widely. According to the government' s figures, up to 70 percent of the duck population in the southern region are infected with H5N1. Many people are exposed to the virus, and might contract it," Troedsson stated.

According to him, the recent fatality rate among local bird flu patients is lower than in the past, thanks to timely diagnosis and improved treatment capacity, not because of the lethal virus becoming milder. In the past, many patients sought care too late, when their lung had been severely damaged, he said.

Troedsson praised Vietnam's effort in mass vaccinating poultry nationwide with the vaccines imported from China and the Netherlands, saying "This is very, very important because the aim is to try to reduce the amount of virus in the environment. That is going well."

Regarding H5N1 vaccines for humans, he said that developers in the United States and Japan are making most progress. A US developer has already come to clinical trials with very encouraging results.

"They have high immunity respond in clinical trials. The problem they found was that they need quite high doses of vaccines to get the immunity to respond. Here we come to the biggest problem with the vaccine issue: production capacity," the WHO official stated.

Because of such issues as clinical trials, bio safety and production capacity, it will take Vietnam 6-12 months from now on to start manufacturing the vaccines, provided "everything goes well," he said.

"Overall, my view on this, also WHO's view, is that countries need collaboration to face global challenge on vaccine production. The first thing is to develop vaccines as soon as possible," Troedsson stated, noting that they should ensure the sufficient amount of vaccines.

Regarding H5N1 found in Vietnam, he said: "It has not changed much since the last two years, since we have experienced avian influenza."

The WHO is probing into a recent research by the Pasteur Institute in Vietnam's southern Ho Chi Minh City which says the virus has undergone some changes, the WHO official said, noting that "changing is the nature of the virus."

The changes have not made the virus more virulent or allowed human-to-human transmission, he stressed. However, there have been suspected cases, though few, in Vietnam and Thailand.

"We know that it (H5N1) has a capability, very, very limited capacity, of human-to-human transmission. But, it doesn't go beyond the so-called first-generation human-to-human transmission, " he stated, explaining that the virus might transmit from the first person to the second, but not from the second to the third.

Vietnam has detected 92 human cases of bird flu infections, including 42 fatalities, since December 2004, he said.

(Xinhua News Agency November 17, 2005)