Q&A: Avian Influenza
China is a key battleground in the fight against avian influenza, which scientists fear might evolve to spread between humans, triggering a global and deadly pandemic. In a recent interview with The Wall Street Journal, Jia Youling, the national chief veterinary officer of China and the director of the veterinary bureau of the Ministry of Agriculture, gave the most detailed public account yet of China's efforts to eradicate the disease.
Last week, news articles appeared in the Hong Kong and international press suggesting China was trying to obstruct an independent scientist from conducting flu research in China. Dr. Jia, 57 years old, accepted the Journal's request to respond to allegations by the scientist, influenza expert Guan Yi of the University of Hong Kong. The following is a transcript, which has been lightly edited for length and clarity.
-- Matt Pottinger
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The Wall Street Journal: Guan Yi, an avian influenza researcher working in southern China, says the government has pressured him to halt research on the flu virus at his laboratory in Shantou, Guangdong province. Can you comment on whether this is the case, and, if so, why?
Dr. Jia: The State Council on Nov. 12, 2004, circulated administrative rules about laboratories handling microscopic pathogens. The rules went into immediate effect. This is a law -- we call it a regulation in China -- announced by the State Council, so it's compulsory. Labs which fail to meet the requirements will be closed in six months. So on May 12, all labs which failed to meet the requirements were asked to stop related activities. We conducted a series of inspections throughout May, so this absolutely isn't targeted at just Guan Yi's lab, but at others as well.
This law came about because of severe acute respiratory syndrome. None of the SARS cases that took place in 2004 were caused naturally; rather, they all sprung from laboratories. Every country has strict management over researching risky, highly pathogenic microbes and strict management of labs. Some countries even forbid research of pathogenic germs altogether. Scientists from such countries go overseas to do research. But I know some countries are taking advantage of technical cooperation projects with China and with under-developed countries in order to conduct [risky experiments involving viruses] without taking adequate biologic safety measures. This is very dangerous and unethical. The law we announced is helping obstruct this phenomenon.
In the case of Guan Yi, he has worked in American labs to conduct bird flu research. In the U.S., the lab requirement for handling a highly pathogenic bird flu virus is "bio-safety level 3-plus," meaning the lab's safety precautions must go beyond even those of a bio-safety level 3 lab. [China defines lab bio-safety levels in accordance with international standards, with BL-1 labs being the most basic, and BL-4 labs being the safest.]
Hong Kong has a BL-3 lab where Guan Yi has worked; he knows that none of the other labs in Hong Kong are allowed to do this sort of work. Then why don't you do research in Hong Kong [instead of] coming to the mainland and doing these very dangerous tests in a lab that hasn't met necessary requirements? It's not that he doesn't know these regulations, and it's not that he hasn't worked at proper labs. He knows completely the regulations concerning lab safety. For him to be doing research in China in violation of Chinese regulations is, I think, in defiance not only of global principles and rules, but also in defiance of the mainland's laws and regulations. This is the legal and international basis for our stopping his activities.
[Dr. Guan's Shantou lab] hasn't even reached the standard of BL-2. It hasn't been certified by the government. Even if it reaches the BL-3 level and is eligible for doing high-pathogenic microbe research, he would need approval for every round of research. That is what the law calls for. We've been [to the lab] three times. His lab lacks even basic biologic safety conditions, posing a serious threat to the environment and to neighboring residents. This is irresponsible.
The Wall Street Journal: What labs are allowed to conduct this kind of research in China? If Guan Yi established a BL-3 lab, would the Chinese government approve it?
Dr. Jia: The Ministry of Agriculture has approved three labs to do animal pathogenic microbe research. All of them are re-registering themselves now. Harbin's national reference lab is building up a BL-4 lab and, when it is completed, all high-risk tests will be moved there. The Harbin lab is now isolating and attacking the virus, while the other two are doing related research….
Are three labs enough? Well, the U.S. sends its 'mad cow' samples to a reference lab in Britain; the Philippines sends H5N1 samples to Australia's reference lab; and Southeast Asia's H5N1 samples have been sent to BASF lab in France. Yet Guan Yi says sending all [Chinese avian flu samples] to Harbin is unfathomable.
Confirmation of a virus, according to the law, should be done by a national reference lab or international reference lab approved by the World Organization for Animal Health. Without confirmation, [positive test samples] could only be a cacophony of unofficial stories or one-sided claims that aren't recognized by the state.
From what I know, a lot of countries are paying more attention to lab safety. Even the Long Island lab in the U.S. has been moved from the Department of Agriculture to the Homeland Security Department to prevent the virus from being used as biologic weapon by terrorists. They have been very strict with lab administration and all scientists are abiding the rules. I think this is what a law-abiding, virtuous and knowledgeable scientist should be able to do.
The Wall Street Journal: In the journal Nature, Guan Yi and his colleagues have this month published research that, among other things, provides genetic evidence of a link between the avian flu virus involved in the ongoing outbreak among migratory birds in China's western Qinghai province and the virus involved in last year's outbreaks in southern China. Dr. Guan's team has also discovered the avian flu virus this year in ducks and chickens in four southern Chinese provinces. This is the first time we've heard of the virus being discovered this year in these parts of China. But you've publicly expressed skepticism about his results.
Dr. Jia: As I stated before, none of the authors [of the Nature article] have been to Qinghai to collect samples, so the source of his data is uncertain. This is first. Second, he said he has isolated the virus in southern China. According to China's animal epidemic prevention law, any unit or person should immediately report to local authorities upon discovering the virus, because if you don't report it and there really is an outbreak it will cause severe losses for the public and local farming industry. Timely reporting is an obligation and responsibility; cover ups and under-reporting are not allowed. Since Guan Yi started working in southern China, we haven't received any single report from him. If he is a scientist with conscience and responsibility, he should rush to the local authorities to report: 'there is a virus here, be careful.'
The Wall Street Journal: Guan Yi's team is out there hunting for this virus. But what about the government's own surveillance efforts? Is the government as proactive as independent researchers like Dr. Guan, or is it simply relying on local authorities to be forthcoming about cases of bird flu when they occur?
Dr. Jia: The Chinese government is paying incredibly close attention to surveillance. Each year, we test more than two million samples for the bird flu virus. At a meeting convened by World Animal Health Organization (OIE) and the U.N. Food and Agriculture Organization in 2004, we handed in a report on Chinese government's bird flu controls at the request of the OIE. In this report, we mentioned we tested 2.868 million samples in 2004, in which 11 came back positive [using a technique called polymerase chain reaction, or PCR]. Meanwhile, the ministry has done 13,400 samples by itself, and isolated five H5N1 viruses. After we published this report, we were highly praised by the international community for our surveillance work. The international community thinks both the quality and quantity of our surveillance work are high. We haven't heard of any country [in Asia] that has done as much as we have.
At the same time, the Ministry of Agriculture has circulated a document on surveillance plans from 2004 to 2008, which have requirements providing detail down to the county level on how to examine pastures, poultry farms and pig farms. The Ministry has 304 surveillance stands and 146 border surveillance stands in charge of collecting epidemic information and reporting in real time directly to the ministry. The ministry's reporting system links up the entire country, with the exception of Tibet.
The Wall Street Journal: Isn't there a risk that conflicts of interest will prevent local officials from reporting bird flu to the central government? During the SARS epidemic, for example, I once witnessed stall keepers at a live animal market receiving a tip off about an upcoming inspection by agriculture officials. The tip off allowed the stall keepers to hide their wild animals, including civets and other species believed to harbor the SARS virus, before inspectors arrived.
Dr. Jia: Such problems exist. But [in the case of bird flu surveillance] we go to the farms directly; there's no opportunity for farmers to move animals. We have to see chickens in the market, otherwise we cannot collect samples. We stipulate a minimum number of samples that [authorities] have to collect to fulfill their task. Of course, it can't be avoided that local protectionism will exist in some places, but in addition to surveillance, we also conduct investigations. We have just completed an antibodies examination in 31 provinces, which involves cross-province checks. The Ministry of Agriculture assigns one province to check another.
Guan Yi says he has checked 100,000 samples. If he's responsible, he should give the samples to the government to confirm his results. If your only motive is to publish a paper, and what you've written hasn't been confirmed, the significance is low. If your only motive is to publish a paper while ignoring the interests of local people and failing to report cases in a timely manner -- perhaps even helping trigger an epidemic -- can you live with that on your conscience?... If a veterinarian in Europe discovered an epidemic but didn't report it [to authorities] in order to get published, could he still keep his veterinary certificate? This is a globally acknowledged truth, not one mandated by China.
The Wall Street Journal: You mentioned China conducting more than two millions samples for bird flu last year. But a delegation of World Health Organization and FAO officials who recently visited Qinghai province, the site of the ongoing avian flu outbreak in migratory birds, raised concerns about the lack of testing going on there. They praised several aspects of China's overall response to the outbreak, but said they were surprised to find that only a handful of birds, all of them dead, had been tested, while live birds that might be harboring the virus aren't being tested. Also, why have only four people been tested for avian flu?
Dr. Jia: There is some misunderstanding about this… [the area of the outbreak] has about 100,000 migratory birds staying on a peninsula; [the bird population] is very dense. We want to check some living birds to see whether they carry the virus but it's hard to catch them. The local forestry department told us these are protected animals, so we mustn't hurt them. International rules call for non-interference in the life of wild animals; if they get sick, it is up to them to recover or to die -- Mother Nature maintains the ecological equilibrium. Our job is to prevent the virus from spreading to people or to poultry; the focus is prevention. We've collected samples of dead birds and found the H5N1 bird flu strain. We tested one, and then tested a dozen or so more; the work hasn't stopped. But the conclusion is always the same: from the first to the last, we found H5N1. So we have full knowledge of the situation.
We have vaccinated all the more than two million poultry in Qinghai… and gone from farm to farm to see whether there are any signs of disease. We've collected more than 6,000 samples from the two million poultry in Qinghai. All domesticated birds near the Qinghai Lake have been slaughtered so as to block the contagion reaching poultry and other animals. The Food and Agriculture Organization said what we've done in Qinghai should stand as a model for other places when find bird flu epidemics occur in migratory birds. I think we have done all we can do, the only think we haven't done is test live migratory birds, because in catching them it is easy to harm them; the forestry department is also worried.
Surveillance in humans is not under our authority [but the responsibility of the Ministry of Health], so we're not in the position to comment on that.
The Wall Street Journal: Independent scientists played a critical role in discovering the SARS virus. In doing so, some scientists have admitted privately that they had to skirt strict mainland Chinese regulations to get their research done. Does China welcome independent scientific research into diseases? Under what conditions?
Dr. Jia: If labs are eligible, we encourage scientists to take part. But the preconditions are to ensure biologic safety, abide laws and report epidemic in time. Independent scientists should follow regulations in collecting, storing and transporting samples. …
Last year, we discovered viruses too, including 11 positives in waterfowl and five [isolated] viruses. This year, we've tested more than 400,000 samples and also found viruses in [six] water birds and migratory birds, but they are only carrying viruses [-- the birds haven't exhibited flu symptoms]. … Carrying a virus should be distinguished from an outbreak. But if we find that an animal is carrying the virus we will still kill it in order to prevent the invisible spread of the virus. Water birds, or ducks and geese, often carry the virus but don't show symptoms. Chickens, on the other hand, virtually always fall sick. So I very much doubt Guan Yi's claim to have found H5N1 virus in a healthy live chicken bought at a market. We don't think it's all that possible because it's never been observed anywhere else in the world. One hundred percent of chickens infected with the [H5N1] virus will develop avian influenza, and more than 90% will die. It's not like H5N2, which might be carried by a chicken without symptoms: some will die, some fall sick and some have no symptoms.
The Wall Street Journal: Part of the reason there's been skepticism in the overseas media about China's efforts to control bird flu is that people still remember China's initial handling of SARS in 2003. The government was extremely reluctant to admit it had an epidemic on its hands.
Dr. Jia: The first announced H5N1 case was a goose in Guangdong's Foshan city in 1996. We reported the virus as soon as we discovered it. Other [countries] may not have found the virus, but that doesn't mean they don't have it. Yet now all research states that Guangdong is the source of H5 -- because China discovered it. Guangdong is close to other countries. Those countries might not test for the virus, or might be incapable of testing for the virus. But this doesn't mean they don't have it. But labeling southern China as the origin isn't fair. That's why we have become very cautious, and why we announce cases when we have proof. In accordance with international rules, we report once we've made a definite diagnosis. …
But we need to be very careful. For example, we have found the Qinghai virus to be particularly virulent. So we should be on high alert as migratory birds prepare to make their return trips, covering China and other countries. We ought to target this -- the prevention of what could happen -- rather than spreading blame. Moreover, the reason China has always been the subject of doubt in international circles is that China has vast territory and an enormous poultry population… But we've taken effective measures to handle epidemics. All poultry within three kilometers of an outbreak should be culled. Even Japan and many other Asian countries haven't taken such steps. We have adopted a combined strategy of culling and vaccination.
专访中国农业部兽医局局长贾幼陵
中国是对抗禽流感的一个主战场，科学家担心禽流感可能发展成为人与人之间的传播的疾病，从而导致全球范围内疫情蔓延。中国国家首席兽医官、农业部(Ministry of Agriculture)兽医局局长贾幼陵日前接受了《华尔街日报》(The Wall Street Journal)的专访，公开就中国根除禽流感的努力给出了最为详尽的介绍。
上周，香港和国际媒体上出现的新闻显示，中国正在试图阻止一位独立科学家──香港大学病毒学专家管轶──在中国进行禽流感的研究。应《华尔街日报》的邀请，贾幼陵就此做出了回应。以下就是具体的采访内容，略有删节。
问：在中国南方工作的禽流感研究专家管轶称，中国政府向他施压，要求他停止在汕头的实验室进行禽流感的研究，是否真有此事？如果是的话，中国政府为何要这样做？
答: 2004年11月12日国务院颁布了病原微生物实验室管理条例，要求公布之日起实施，这是一部法律，在中国称为法规，国务院颁布的，强制性的。实验室设施若在6个月后达不到标准将被关闭。今年5月12日，达不到有关标准的实验室将被停止有关活动，我们在5月份也连续地对有关实验室进行检查，决不是针对管轶一家，还有其他的。
这个法律跟去年SARS有关。2004年的SARS没有一起是自然爆发，完全是实验室造成的。任何一个国家对于有风险的、高致病的病原微生物都有严格管理，对实验室都有严格管理。有些国家甚至禁止进行活的病原微生物研究；那个国家的研究人员可以到国外去研究，但不许在本国研究，但是我也知道有些国家借助同中国和不发达国家的技术合作专案进行研究，在不发达国家进行研究和攻毒，在没有生物安全的条件下进行研究。这是非常危险也是不道德的。我们这部法律颁布后也对这样的现象进行了制止。
就管轶先生来说，他在美国的实验室工作过、研究过禽流感，那个国家对于高致病性禽流感的研究，实验室的要求是超生物安全三级，在生物安全三级的基础上又增加了防护内网。
香港有一个生物安全三级的实验室，管轶先生在那里工作过，他也知道香港其他的实验室不能搞这种工作，那你为什么不在香港研究，你跑内地来，完全没有达到规定的实验室来搞非常危险的试验。他不是不知道这样的规定，他也不是没在这样的实验室工作过，他完全了解关于实验室安全的各种规定，他在中国违反了中国的有关规定去做研究，我认为不仅仅是对世界公理准则的蔑视，也是对中国内地法律法规的蔑视。这是我们对于他的行为进行制止的法律依据和国际惯例。
(汕头的实验室）BL2都不是，没有经过政府的认定，即使达到BL3，能够有高致病性病原微生物研究的研究的资格，每次研究也要经过批准，这是法律的程式。我们曾经去过三次，他的实验室不具备基本的生物安全条件，对环境和对周围的居民都是很大的威胁，这是不负责任的。
问：在中国什么样的实验室可以进行此类研究？如果管轶建立了一个BL-3实验室，中国政府是否会批准呢？
答：从动物病原微生物的角度，农业部曾经批准了三个实验室，但现在都在履行重新认证的程式；哈尔滨的国家参考实验室，正在建设P4实验室，建成以后高风险的实验都要放到那儿做。参考实验室正在分离和攻毒，另外两个也正在作研究。…
三个实验室够不够？美国的疯牛病要送到英国的参考实验室，菲律宾的H5N1要送到澳大利亚的基隆实验室去确认，东南亚的H5N1要送到法国BASF实验室去研究。管轶说，都要送到哈尔滨实验室是不可想像的。
对于一个病毒的最后确认，按照法定程式，最后确定，在国内必须要经过国家参考实验室，在国际必须要经过OIE认可的国际参考实验室。参考实验室每个国家只能有一个，由这个参考实验室对所有实验室的研究和疫情进行确认，没有经过确认的，只能是一种杂说，野说，一家之说，是得不到国家认可的。
据我所知，很多国家对于实验室安全越来越重视，甚至美国长岛实验室已经从农业部拿出去了，由国土安全部管理，防止生物安全变成生化武器被恐怖分子所利用，他们对实验室的管理都是非常严格的，所有科学家都自觉地遵守。我想任何一个守法的，有道德的，有知识的科学家应该是能够做到的。
问：在这个月的《自然》杂志上，管轶和他的同事发表研究报告，其中提供了目前中国西部青海省的候鸟禽流感疫情和去年中国南方的禽流感疫情之间存在联系的基因证据。管轶的研究团队今年还在中国南方四省的一些鸭和鸡身上发现了禽流感病毒。这是我们首次听说在中国这些地方有禽流感疫情。不过您公开对他们的研究结果提出了质疑。
答: 对于这个说法，我曾经说过，作者没有一个人去过青海采样，所以他的病料的来源是不确实的。这是第一，第二，他说在南方分离到病毒，按照国家动物防疫法的规定，任何单位和个人如果发现病毒要立刻向当地报告，因为你不报告，如果真有疫情，会对当地老百姓、当地养殖业造成重大损害；要及时报告是义务和责任，谁要是瞒报或是不报，都是法律所不容的。从管轶在中国南部开展有关工作至今，我们没有接到过他一起报告。如果他要 是一个有良心的、有责任心的科学家，他发现了，他应该赶快告诉当地，这个地方有，你们要小心。
问：管轶的团队正在四处寻找禽流感病毒，中国政府采取了哪些监控措施呢？中国政府是否像管轶这样的独立研究者一样积极主动？或者只是单纯依赖地方政府，在禽流感发生的时候再针对发生的疫情采取措施呢？
答：中国政府对于这个监测工作非常重视。我们每年的禽流感检测都超过200万份样本。我们2004年在OIE/FAO召集的会议上，应OIE要求，提交了中国政府禽流感控制报告，在这个报告中，我们说了2004年，我们监测了286.8万份样本，其中有11份样本病原学[PCR]检测呈阳性。同时我们农业部还直接组织了监测样本13400份，共计分离到5株H5N1病毒。我们这个报告在国际上发表之后，国际上对于中国的监测时高度评价的，认为我们的监测数量和质量都是很高的，恐怕，我们还没有听说哪个国家能够跟我们相比。
同时，农业部正式向各省下发过一个档，对每个县都有要求，计划实行期是从2004到2008，对多大的牧场怎样检查，种禽场、蛋禽场、肉禽场、猪场都有规定。农业部有304个监测站，有146个边境监测站，负责随时搜集有关疫情，直接报告农业部。农业部的报告体系在全国除西藏外都直接联网。
问：是否有这样的可能、地方政府因为某些利益冲突而不向中央政府报告禽流感疫情？比如在SARA爆发的时候，我曾在一个鲜活动物市场亲眼目睹，摊贩们在农业部官员来检查前提前得到了通知，得以在检查团到来之前，将他们售卖的野生动物，比如果子狸和其他可能会带有SARS病毒的动物，藏匿起来。
答: 有这个问题，但是我们都是直接到这个场，到养殖地，他不能把它搬走，市场也必须见到鸡，否则没办法采样啊，采样是规定的数量，采不到样是完不成任务的。当然我们不可避免有些地方有地方保护主义，但是我们除了监测以外，还有检查，我们刚刚对31个省的免疫抗体情况进行检查，农业部直接组织这个省去检查那个省，另外一个省检查这个省。
管轶说他检查了10万份，他如果是负责任的，那你检查了，把样本交给政府确认，所以你仅仅是为了发表文章，你的文章没有经过确认，它的意义也是低的；如果你仅仅是为了发表文章，不顾当地老百姓的利益，你发现了没有及时报告，引起了疫情暴发，那你良心上过得去吗？… 如果一个欧洲的兽医发现了疫情没有报告，反而拿去发表，那他兽医的资格还能保住吗？这是世界公理，不是中国的规定。
问：你提到中国去年为禽流感检测了200多万份样本，但世界卫生组织(World Health Organization)和联合国粮农组织(FAO)官员近期考察了发生候鸟禽流感疫情的青海省，他们担心中国政府未能在当地进行检测。这些官员们称赞了中国应对禽流感疫情所做的一些努力，但表示，让他们感到惊讶的是，他们发现只有一些已经死亡的鸟接受了检测，而那些可能携带病毒的活著的鸟却没有被检测。另外，为什么只有四个人接受了禽流感检测呢？
答: 这个有误解。WHO说到监测的候鸟的数量，因为当地有10万只候鸟，只是一个是在半岛上，密度很大，我们想查活的带不带病毒，但是捕捉起来很困难，当地林业部门告诉我们这是保护动物，不要伤害它们，按照国际上规范要求，要不干预野生动物的行为，它发了病了，自生自灭，大自然维持生态平衡。我们要防止这个病毒到人，到家禽，这是我们的工作；我们的工作重点是防范。我们采到了死鸟的样本，查出了这是H5N1，查到了一个，又查到了十几个，工作一点没停顿，一直在对死掉的鸟进行检查，结论都是一样，第十几个和第一个都证明是H5N1，同时我们也在查粪便，所以我们对它的情况是了解的。
我们对整个青海200万只家禽都进行了免疫，对家禽的普查数量达到500多万份，就是两遍，反复查；一个一个农户去看，有没有发病的症状。对家禽的采样，采集了6000多份，青海一共就200多万只，但对家禽的监测是6000多份。而且对于距离青海湖近一点的家禽全部给与捕杀，这样就阻断了禽流感向家禽和动物的传染，FAO说我们做的工作可以成为其他地方发现候鸟疫情时的一个典范。我觉得我们能做的都做了，唯一没做到的是对活鸟的监测，因为捕捉它容易伤害它，林业部门也怕；对于人的监测，不是我们管，我们没有资格说。….
问：独立科学家们在发现SARS病毒方面发挥了重要的作用。一些科学家私下承认，为了进行研究，他们不得不想办法规避中国大陆严格的法规。中国是否欢迎对疾病进行独立科学研究？有那些限制条件？
答: 如果实验室条件符合要求，我们鼓励科学家参与，前提是保证生物安全，符合国家法律，发现疫情后及时报告。独立科学家采取、保存和运输样本都要有规则，谁都可以参与。…
同样，我们去年也监测到病毒，包括11株水禽的阳性和5个病毒。今年，我们监测了40多万份样品，也发现了水禽和候鸟带毒的现象；但只是带毒。… 要把带毒和疫情区分开来。但是我们发现了带病毒的，为防止隐患，也要处理掉；水禽包括鸭和鹅经常带毒不发病，鸡一般会发病。所以我非常怀疑管轶说的在市场上监测到带H5N1的健康的活鸡，我们认为不太可能，因为全世界没有发现过。带毒的鸡100%发病，90%以上死亡。H5N2就不是，鸡可能带毒不发病；一部分死亡，一部分发病，一部分没有症状。
问：海外媒体一直怀疑中国为控制禽流感疫情所做的努力，部分原因是人们对中国政府2003年处理SARS疫情的最初做法记忆犹新。当时中国政府极力否认出现了疫情。
答: H5N1第一个发现的病例是在1996年广东佛山的鹅。我们发现了就说了，其他地方没有发现，不等于没有，现在所有的研究都说广东是H5的发源地，因为中国说了，查到了，广东和其他国家非常近，他们没有查或没能力查不等于没有，这就把源头放在华南，这是不公平的。所以后来我们就非常慎重地，确著地，有证据我们就公布。按照国际规定，只要确诊就报告。…
但是我们要小心，比如说青海的这次禽流感我们发现毒性很强，那它回归的路，包括中国沿途，包括其他国家，都要高度紧惕，目标要放在这上面，防止可能发生的事情，而不是给谁乱戴帽子。另外，中国之所以总是被国际上怀疑，因为中国国土面积大，家禽数量多…但我们在处理疫情上，措施是到位的，发现疫情周围3公里都要扑杀，日本都没有做到，亚洲很多国家都没有。我们采取的是扑杀加免疫的办法。…
