The Thais Know How to Do It

The outbreak began in a single chicken in November 2004, and within hours a team from the Ministry of Agriculture had descended upon the tiny village of Chart Charoen in northeast Thailand. Dressed in spacesuit-style protective gear, team members hunted out every bird in the village, slaughtered them all and buried the carcasses in a huge pit. That scene has been repeated countless times throughout Southeast Asia, where bird flu has become entrenched, but in Chart Charoen there was a critical difference. Instead of protesting the destruction of their flocks or hiding their poultry, as owners often do in other bird-flu areas, the villagers were quick to help. "Everyone cooperated, because we understand the health risks," says Rampai Gansa, a local housewife and health volunteer. Thanks to a determined government control program that has reached even the most remote communities, virtually every Thai knows the danger bird flu presents — and how it can be fought.

In Thailand, the world's fourth-largest poultry exporter before avian flu exploded at the end of 2003, more than 60 million birds have been killed by the virus or culled, while 22 people have been infected and 14 have died. But an ambitious and wide-ranging national response has drastically reduced both avian and human cases since the peak of the outbreak in the autumn of 2004. As H5N1 spreads to Europe's doorstep, learning from Thailand's methods could help other countries keep the disease under control.

Step 1 is early detection. Many of Thailand's 250 million chickens live in small household farms scattered throughout the country. Official surveillance could easily miss those birds, but a broad network of community health volunteers — ordinary Thais like Rampai — has been enlisted to look for possible outbreaks. The volunteers disseminate information about the disease and its symptoms to villagers who normally have little contact with doctors or government officials, let alone space-suited flu teams. In addition, the Thai government has made a special effort to educate the most vulnerable groups: a UNICEF-produced series of comic pamphlets warns rural children — who make up the majority of bird-flu cases — to stay away from chickens that appear sick.

After surveillance, swift laboratory work is Step 2. Thailand's strong public-health system formed an innovative partnership with the U.S. Centers for Disease Control in 2001 to launch the International Emerging Infections Program (IEIP). Under the program, Thailand has obtained advanced laboratory technology from the U.S., as well as training for Thai epidemiologists and volunteers. That makes for faster reaction times when the disease strikes, and "speed is essential in trying to contain any outbreak," says Dr. Sonja Olsen, the IEIP's acting director. In rural hospitals in Sa Kaeo province, which borders Cambodia, patients who are initially diagnosed with pneumonia — the sort of severe respiratory disease that could be confused with bird flu — are now immediately tested for bird flu. Their blood samples, nasal swabs and chest X-rays are double-checked for the H5N1 virus at sophisticated labs in Bangkok and Atlanta, allowing doctors to catch an outbreak almost before it begins.

Yet even these defenses are not bulletproof. Last fall, after more than a year without any human H5N1 cases, five Thais were infected, and the disease flared up again among poultry. Critics charged the government had let down its guard, but William Aldis, the World Health Organization's Thailand representative, believes the outbreak shows how tough an opponent bird flu remains. "It was a good wake-up call," he says. "As long as there is disease circulating in poultry, you can't let up your surveillance."