
“The World is Watching”: Dr. Luciana Borio on the U.S. Response to Bird Flu
Just four months ago, for the first time ever, the United States confirmed the presence of H5N1 bird flu in dairy cattle. Since then, H5N1 has spread between cows, with infected herds reported across 13 states. Genetic evidence suggests that infections in U.S. cattle originated from a single spillover event from birds into cows in late 2023, about four months prior to the first documented case.
The rapid progression from initial spillover to the unprecedented outbreak in cattle has prompted significant concerns within the public health community, especially following the identification of isolated H5N1 cases in humans exposed to infected birds or cattle. At present, there is no evidence of transmission directly between humans. However, there is a major concern that if H5N1 continues to circulate in dairy cattle and poultry—which are in close and continuous contact with humans—the virus will have an opportunity to evolve in ways that could enable sustained human-to-human transmission. With limited or no immunity to H5N1 in humans, many are left wondering how to proceed in the face of an uncertain, but increasingly concerning, public health threat.
Biodefense and infectious disease specialist and NTI board member Luciana Borio, M.D. joined Jaime Yassif, Ph.D., Vice President for Global Biological Policy and Programs at NTI, for a conversation about challenges, opportunities, and priorities for marshalling an effective response to H5N1 bird flu. Dr. Borio provided a set of recommendations for moving forward and pointed out that steps taken to promote preparedness now will not only address current H5N1 risks, but also will serve as investments in addressing any future pandemic or public health emergency.
Establishing Leadership and Public Trust
Responding to the H5N1 outbreak requires collaboration to promote information sharing and mitigate spread. “For this to work, everybody needs to be on the same side and tackle this together… federal [government], states, local [governments], scientists, farmers. [Contending with a] lack of trust is complicated because you cannot just stockpile trust,” explained Dr. Borio.
In addition, Dr. Borio highlighted the importance of response logistics, emphasizing that resource distribution is an undervalued but necessary piece of the puzzle. She noted that a sufficient stockpile of medical countermeasures does not guarantee that people will receive equipment or vaccines efficiently. The federal government is responsible for providing leadership and resources to support local governments and for building up testing and clinical trial infrastructure for a rapid response.
In the wake of COVID-19, Dr. Borio pointed out, “people are just exhausted, [and] the folks who are working these emergencies are exhausted. Asking people to do more with limited resources is going to be challenging.” There is a desire within the federal government to, at least publicly, avoid drawing attention to the current outbreak. Ultimately, she explained, reluctance to declare a public health emergency may impact the effectiveness of the response. In many cases, a public health response may seem heavy-handed at the outset, but early action is needed to prevent exponential spread of the disease.
Building public trust, including among farmworkers, is necessary for public health interventions, such as widespread testing, to be successful. Dr. Borio acknowledged the importance of respecting the priorities of farm owners, who are not incentivized to report outbreaks if the process requires revealing identifying information. She stressed that there are often trade-offs between competing values and priorities, such as privacy and a robust public health response. The goal is to find ways to balance those competing priorities and strive for solutions that can meet the needs of everyone as much as possible.
Making Informed Decisions
Incorporating and adjusting the U.S. government response based on new data, whether collected through diagnostic testing, clinical trials, or basic research, will be crucial. “Since this [H5N1] emerged, what I find to be remarkable is that we continue to learn so much about a virus – even flu virologists are surprised by how much our understanding is growing by the day,” Dr. Borio noted. “This virus can totally surprise us, and I fear that it will continue to do so.”
Cautioning against “[relying] on dogma for flu […] or in general in biology,” Dr. Borio stressed the impossibility of predicting how the virus will evolve in the future. Drugs, vaccine technologies, or mitigation measures that have worked well for the seasonal flu or succeeded during the COVID-19 pandemic should not be relied upon without thoroughly testing their effectiveness for H5N1. Dr. Borio emphasized the importance of “[approaching] the outbreak with tremendous scientific curiosity and humility.”
Viruses constantly adapt and evolve in new ways that alter infectivity and severity of symptoms. By collecting data, experts can maintain awareness of the circulating strains and measure their capacity to infect human cells. Dr. Borio explained that the U.S. government must invest in vaccine development that is specific to the current outbreak and based on an objective evaluation of vaccine designs to achieve the most robust immune response. Before calling for the adoption of public health measures that may be burdensome, such as protective equipment for farmworkers, the U.S. government should test the effectiveness of such measures and evaluate their utility.
Dr. Borio concluded her remarks by reminding us “we can’t forget that the world is watching.” There are global implications for how the U.S. responds. Despite the many unknowns and particularities of this H5N1 bird flu strain, there are countless past lessons that the U.S. can apply, to live up to being the global leader in preparedness and response.
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