U.S. faces mounting criticism over bird flu response
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A growing number of high-profile public health experts are raising alarms over what they say are lackluster efforts to track and contain the spread of bird flu across U.S. dairy farms.
Why it matters: If this is a test of whether the U.S. is better prepared to respond to a potential pandemic threat after COVID-19, we're not getting high marks.
The big picture: It's been nearly three months since the H5N1 bird flu virus was found to have spilled over to cows, but experts say we're far from having a reliable picture of how widely it's spreading.
- Bird flu has been detected in 92 dairy cattle herds across 12 states, according to the Centers for Disease Control and Prevention. Three U.S. dairy farm workers have had confirmed infections that were mild.
- While officials say the risk to the general public remains low, a big worry is whether the virus eventually mutates in a way that allows it to easily spread between humans.
Zoom in: Officials have been testing cows and farm workers for the virus, as well as conducting wastewater surveillance to get a better picture of where it's circulating.
- But there's little doubt among experts that the U.S. has been missing cases in cows and humans. Farmers have been reluctant to participate in surveillance, and only 45 dairy farm workers in the U.S. have been tested as of June 13.
- Doctors say limited availability of bird flu tests could also make it difficult to detect potential cases who show up in their offices.
Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security, told Axios there's not even enough information to know whether cases among cows are trending up or down.
- Michael Osterholm, director of the University of Minnesota's infectious disease research center, said it's also important to figure out how long it takes for infected herds to clear the virus to get an idea of the risk window for workers.
- The CDC recently traced the spillover from birds to cows to a single event in late 2023. But additional data from farms could show whether there have been other spillover events, Osterholm said.
What they're saying: "The H5N1 is very likely changing but we don't know—USDA and CDC are flying blind," Eric Feigl-Ding, an epidemiologist and senior fellow at the Federation of American Scientists, wrote Monday on X.
- "We failed — through two administrations — to develop and implement an effective surveillance strategy with COVID, and we are repeating the same mistakes," Jerome Adams, surgeon general under former President Trump, told Politico.
- "It's been shocking to watch the ineptitude of just doing the surveillance, being able to talk about it, tracking the infections, understanding where we are," said Seth Berkley, former CEO of Gavi, the Vaccine Alliance, according to Stat.
The other side: There are key differences between the initial COVID and H5N1 responses, said CDC principal deputy director Nirav Shah.
- Scientists already have two decades of research on this bird flu strain, providing a strong understanding of how it generally behaves. There are also medications that work and an on-the-shelf vaccine that can be manufactured quickly, he said.
- "That puts us in a different position," Shah told Axios, adding that the CDC "would like to pull every lever possible" to increase testing in humans.
- USDA in a statement said: "The comprehensive support options USDA has recently announced, which reflect feedback received from state partners and industry stakeholders, underscores the Department's commitment to a comprehensive response to H5N1 in poultry, cattle, and other animals, as necessary."
Between the lines: States have struggled to get cooperation from farmers, and not even new federal incentives for bird flu testing and prevention have significantly improved participation.
- It took years to create more robust bird flu surveillance in the poultry industry, and doing the same among dairy farmers would also likely require a cultural shift, experts said.
- Shah pointed out that many dairy farm workers are undocumented immigrants or migrants who are mistrustful of the government or reluctant to miss work if they test positive.
The bottom line: The response so far hasn't instilled much confidence that public health's ability to combat a potential pandemic threat has improved since the U.S. was caught flat-footed by COVID.
- "The fact that we're having this much of a problem with this one really doesn't bode well for the next one," Johns Hopkins' Adalja said. "And there will, there's always going to be a next one,"
