China's Biological Warfare

For Over a Year, China Has Withheld Samples of a Dangerous Chinese Flu Virus
Despite an international agreement, U.S. health authorities still have not received H7N9 avian flu specimens from the Chinese.
By Emily Baumgaertner

Health workers attending to an H7N9 avian flu patient in Wuhan, China, in 2017. 

For over a year, the Chinese government has withheld lab samples of a rapidly evolving influenza virus from the United States — specimens needed to develop vaccines and treatments, according to federal health officials.
Despite persistent requests from government officials and research institutions, China has not provided samples of the dangerous virus, a type of bird flu called H7N9. 

In the past, such exchanges have been mostly routine under rules established by the World Health Organization.
Now, as the United States and China spar over trade, some scientists worry that the vital exchange of medical supplies and information could slow, hampering preparedness for the next biological threat.
The scenario is “unlike shortages in aluminum and soybeans,” said Dr. Michael Callahan, an infectious disease specialist at Harvard Medical School.
“Jeopardizing U.S. access to foreign pathogens and therapies to counter them undermines our nation’s ability to protect against infections which can spread globally within days.”
Experts concur that the world’s next global pandemic will likely come from a repeat offender: the Chinese flu. 

The H7N9 virus is one candidate.
Since taking root in China in 2013, the virus has spread through poultry farms, evolving into a highly pathogenic strain that can infect humans. 

It has killed 40 percent of its victims.
If this strain were to become highly contagious among humans, seasonal flu vaccines would provide little to no protection. 

Americans have virtually no immunity.
“Pandemic influenza spreads faster than anything else,” said Rick A. Bright, the director of Biomedical Advanced Research and Development Authority, an agency within the Department of Health and Human Services that oversees vaccine development. 

“There’s nothing to hold it back or slow it down. Every minute counts.”
Under an agreement established by the World Health Organization, participating countries must transfer influenza samples with pandemic potential to designated research centers “in a timely manner.”
That process — involving paperwork, approval through several agencies and a licensed carrier — normally takes several months, according to Dr. Larry Kerr, the director of pandemics and emerging threats at the Department of Health and Human Services.
But more than one year after a devastating wave of H7N9 infections in Asia — 766 cases were reported, almost all in China — the Centers for Disease Control and Prevention is still waiting for several viral samples, the National Security Council and the W.H.O. confirmed.
Scientists at the Department of Agriculture have had such difficulty obtaining flu samples from China that they have stopped requesting them altogether, according to a government official who spoke anonymously because he was not authorized to discuss the matter.
At least four research institutions have relied upon a small group of H7N9 samples from cases in Taiwan and Hong Kong. (All four asked not to be identified for fear of further straining ties.)
The Chinese embassy in Washington did not respond to multiple requests for comment. 

The Chinese Center For Disease Control and Prevention also did not reply to inquiries regarding the transfer.
When the H7N9 virus first appeared in China, researchers say the Chinese government at first provided timely information. 

But communication has gradually worsened.
Yet a sudden spike in infections during the 2016-2017 outbreak wave demands intense research, said scientists aiming to understand the virus’ evolution.

Health workers culling chickens in Hong Kong in 2014 following an outbreak of avian flu.
Recent trade tensions could worsen the problem.
The Office of the United States Trade Representative in April released a proposed list of products to be targeted for tariffs — including pharmaceutical products such as vaccines, medicines and medical devices.
So far, none of those medical products have landed on the final tariff lists. 

But lower-level trade negotiations with China concluded on Thursday with few signs of progress, increasing the likelihood of additional tariffs.
The United States relies on China not only for H7N9 influenza samples but for medical supplies, such as plastic drip mechanisms for intravenous saline, as well as ingredients for certain oncology and anesthesia drugs. 

Some of these are delivered through a just-in-time production model; there are no stockpiles, which could prove dangerous if the supply was disrupted, health officials said.
Scientists believe top commerce officials in both governments view the viral samples much like any other laboratory product, and may be unfamiliar with their vital role in global security.
“Countries don’t own their viral samples any more than they own the birds in their skies,” said Andrew C. Weber, who oversaw biological defense programs at the Pentagon during the Obama administration.
“Given that this flu virus is a potential threat to humanity, not sharing it immediately with the global network of W.H.O. laboratories like C.D.C. is scandalous. Many could die needlessly if China denies international access to samples.”
For over a decade, epidemiological data and samples have been used as trade war pawns.
China hid the 2002 outbreak of severe acute respiratory syndrome, or SARS, for four months and then kept the findings of its research private. 

Some provinces withheld information about cases even from the central government in Beijing.
In 2005, Chinese authorities insisted an H5N1 influenza outbreak was contained, contradicting University of Hong Kong scientists who offered evidence that it was expanding. 

Those authorities hesitated to share viral samples from infected wild birds with the international community, concealing the scope to avoid a hit to their vast poultry industry.
Indonesia followed suit, refusing in 2007 to share specimens of H5N1 with the United States and United Kingdom, arguing that the countries would use the samples to develop a vaccine that Indonesians could not afford.
Those episodes led to the 2011 development of the W.H.O.’s Pandemic Influenza Preparedness Framework, which aims to promote sample exchanges as well as developing countries’ access to vaccines.
But for countries like China, bearing the burden of a novel virus is paradoxical. 

Outbreaks are expensive — the wave of H7N9 infections in 2013 alone cost China more than $6 billion, according to the United Nations — but they can provide a head-start in developing valuable treatments.
“In a sense, China has made lemonade from lemons — converting the problem of global infectious disease threats into lifesaving and valuable commodities,” Dr. Callahan said.
And now, as the H7N9 virus evolves, United States authorities worry that the Chinese have obfuscated the scale and features of this outbreak.
The Chinese government has refused to share clinical data from infected patients, according to scientists, and claims to have all but eradicated H7N9 through a single poultry vaccination campaign.
“Influenza is going to do what it does best, which is mutate,” Dr. Kerr said.

Plagues of China

Hard to detect, China bird flu virus may be more widespread
Reuters

A quarantine researcher checks on a chicken at a poultry farm in Xiangyang, Hubei province, China, February 3, 2017.

BEIJING – Bird flu infection rates on Chinese poultry farms may be far higher than previously thought, because the strain of the deadly virus that has killed more than 100 people this winter is hard to detect in chickens and geese, animal health experts say.
Poultry that have contracted the H7N9 strain of the avian flu virus show little or no sign of symptoms. 

That means any infection is only likely to be detected if farmers or health authorities carry out random tests on a flock, the experts said.
But in humans, it can be deadly.
That’s different to other strains, such as the highly pathogenic H5N6 that struck South Korean farms in December, prompting the government to call in the army to help cull some 26 million birds.
But that strain didn’t kill any people.
There have been multiple outbreaks of bird flu around the world in recent months, with at least half a dozen different strains circulating. 

The scale of the outbreaks and range of viral strains increases the chances of viruses mixing and mutating, with new versions that can spread more easily between people, experts say.
For now, H7N9 is thought to be relatively difficult to spread between people. 

China’s Center for Disease Control and Prevention has said the vast majority of people infected by H7N9 reported exposure to poultry, especially at live markets.
“There are very few, if any, clinical signs when this (H7N9) virus infects birds, and that’s the main reason we’re not seeing reporting coming from poultry farms in China,” said Matthew Stone, deputy director general for International Standards and Science at the World Organisation for Animal Health (OIE).

INTENSIVE OUTBREAK
As many as 79 people died from H7N9 bird flu in China in January alone, up to four times higher than the same month in past years.
While spikes in contamination rates are normal in January – the main influenza season – the high level of human infections has prompted fears the spread of the virus among people could be the highest on record – especially as the number of bird flu cases reported by farmers has been conspicuously low.
The high number of human infections points to a significant outbreak in the poultry population that is not being detected, says Guan Yi, director of the State Key Laboratory of Emerging Infectious Diseases and the Center of Influenza Research at the University of Hong Kong.
“If we have so many human infections, naturally it reflects activity, an intensive outbreak in chickens. They are highly associated,” he said.
China has the world’s largest flock of chickens, ducks and geese, and slaughtered more than 11 billion birds for meat in 2014, according to the United Nations’ Food and Agriculture Organisation (FAO).
The last major bird flu outbreak in China, in 2013, killed 36 people and cost the farming industry around $6.5 billion.

CONTROL CHALLENGE
The experts’ assessment underscores the challenge for China’s government and health ministry in monitoring and controlling the H7N9 outbreak in both people and poultry.
While, with few visible signs of infection in birds, it’s easier for farmers to flout the reporting rules and continue selling poultry at market, Stone at the OIE said China has a “very significant” surveillance programme at live markets.
The government promised on Thursday to tighten controls on markets and poultry transport to help battle the virus.
The agriculture ministry last month collected more than 102,000 serum samples and 55,000 virological samples from birds in 26 provinces. 

Of the latter samples, only 26 tested positive for the virus, according to data on the ministry’s website.
But the rapid rise in human infections and spread to a wider geographic area is likely to increase pressure on Beijing to do more poultry testing at markets and on farms.
The ministry did not respond to faxed questions on its surveillance efforts.
The National Health and Family Planning Commission said on Thursday the spread of H7N9 among people was slowing.
Some Chinese netizens have called for more timely reports on infections, and experts said China has been slow to respond to the human outbreak. 

The authorities have warned the public to stay alert for the virus, cautioning against panic.
Others played down the threat to humans, as long as they stay away from live markets.
“As scientists, we should be watching this outbreak and the effectiveness of any control measures,” said Ian Mackay, a virologist and associate professor at the University of Queensland in Australia. “We don’t have a vaccine available for H7N9 in humans, but we do have effective antivirals.”
“So far, the virus does not spread well between humans,” he added. 

“As members of the public, who do not seek out live poultry from markets in China, we have almost nothing to worry about from H7N9 right now.”

Plagues of China

W.H.O. Warns of Worrisome Bird Flu in China
By DONALD G. McNEIL Jr.

Culling birds in Hong Kong in 2014 after the H7N9 virus was discovered in poultry imported from China.

After a spate of deaths from bird flu among patients in China, the World Health Organization has warned all countries to watch for outbreaks in poultry flocks and to promptly report any human cases.
Several strains of avian flu are spreading in Europe and Asia this winter, but the most worrisome at present is an H7N9 strain that has circulated in China every winter since 2013.
China has reported over 225 human cases since September, an unusually high number. 

The nation’s Lunar New Year vacation starts soon, and as it does, live poultry shipments increase, and holiday travelers often spread the flu.
The fatality rate is not yet known, because some victims are still hospitalized. 

But Dr. Margaret Chan, the health organization’s director general, said this week that China had had more than 1,000 cases in the last four years, of which 39 percent were fatal.
“All countries must detect and report human cases promptly,” she said. 

“We cannot afford to miss the early signals.”
The flu typically infects people who raise, sell, slaughter or cook poultry, but human-to-human transmission is suspected in two cases that worry health officials. 

Both were older men with a history of poultry contact. 

One apparently infected a daughter who cared for him, and the other his hospital roommate.
Hong Kong’s health department this week warned residents traveling to mainland China to avoid live poultry markets. 

More than 9 percent of samples from markets in nearby Guangdong Province contained H7N9 virus, a “substantial” reading, the department said.
Swabs are typically taken in cages, sewage gutters, feeding troughs, and chopping and de-feathering machines.
Since November, nearly 40 countries have reported finding potentially dangerous flu strains in poultry flocks or in captured or dead wild birds. 

They include a new H5N6 strain, H5N8 and H5N5.
There have also been sporadic cases of H5N1, a strain with a 60 percent fatality rate that caused great alarm more than a decade ago. 

It has caused almost 400 confirmed deaths since 2003, but has not evolved the ability to transmit easily between people.
Since the highly contagious but relatively mild H1N1 “swine flu” circled the globe in 2009, “the world is better prepared for the next influenza pandemic,” Dr. Chan said, “but not at all well enough.”