The H5N1 avian flu virus continues to rage across the United States, infecting at least three people in the past few months — all dairy workers — and spreading to chickens and cows on dozens of farms across several states.
Government officials and farmers have been responding to H5N1 since the virus was first detected in U.S. chicken farms in February 2022. When it spread to dairy farms in recent weeks, the U.S. Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) quickly responded. Rapidly increased response effortsWith coordinated support from the White House Pandemic Preparedness and Response Office and the National Security Council, we worked to ensure the safety of commercial milk supplies, educate health care workers, expand testing, and order the production of millions of vials of H5N1 vaccine.
but New infections among agricultural workers “This indicates that further measures need to be taken to protect animals. As with many infectious disease outbreaks, the risk of infection is not evenly distributed. The US Centers for Disease Control and Prevention (CDC) currently says the risk to the general public is low, but the risk to farm workers exposed to infected animals is high.”
Insufficient use of personal protective equipment. First dairy farm worker infected She was wearing gloves but no eye protection, and developed conjunctivitis (inflammation of the mucous membranes around the eyes). Although testing is becoming more widely available, uptake remains low, and the CDC Only 44 people As of May 31, over 1,000 people have been tested for swine flu A, of which H5N1 is a subtype. The response is further complicated by the fact that migrant farmworkers, many of whom are undocumented, have limited access to health care.
Three key measures can better protect farmworkers during an H5N1 virus outbreak and prevent this virus from causing the next pandemic.
First, we must empower farmworkers to control the virus.
In February 2022, while I was serving as President Biden's Health and Security Advisor in the White House, we were alerted that avian influenza had been found at a turkey farm in Indiana. Within hours, I chaired an interagency meeting with senior HHS and USDA officials to begin coordinating a response. Over the next few months, the virus spread like wildfire and we saw millions of chickens and turkeys die across 48 states.
Then, in April 2022, we received a startling call that a poultry worker in Colorado had been infected with H5N1. He became ill but was treated and fortunately recovered. This was a warning sign, a sign that we needed to do more to help poultry workers contain outbreaks on their farms.
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We have asked HHS and the USDA to do more. They have provided hundreds of millions of dollars in compensation to farmers whose chickens were infected or culled. And they have also provided the USDA with “Protect the Flock” ProgramEfforts include equipping farm workers with personal protective equipment and training them on how to disinfect contaminated chicken coops. Some farmers have even gone so far as to install sound cannons, loud alarms to scare away wild birds that could carry the virus and infect poultry.
The spread of avian influenza on commercial poultry farms has dropped sharply. USDA Avian Flu DashboardThe number of commercial poultry farms with avian flu outbreaks has fallen from more than 90 in May 2022 to fewer than five in May 2023. Fewer infections on farms reduces the risk of infection for farm workers and reduces the chances that the virus will mutate and jump from animals to humans.
The USDA is applying lessons learned from its effective work with farm workers to protect chicken flocks to control H5N1 on dairy farms. Hundreds of millions of dollars in new funding To support the emergency response, the Department of Health and Human Services will provide up to $28,000 to affected dairy farms over the coming weeks for treatment of infected cows, shipping test samples to laboratories, and heat-treating milk. HHS is also providing gloves, goggles and other protective equipment to farm workers at no cost. Congress and legislatures in affected states should provide funding for as long as necessary to support farmworker efforts to protect cows from this virus.
Second, we must reach out to agricultural workers.
President Biden's National Biodefense ProgramThe CDC: Multifaceted Surveillance System Surveillance for H5N1 in humans. CDC is expanding public health and private laboratory testing, educating health care workers, and monitoring hospital and wastewater trends for unusual spikes in influenza cases.
As testing availability expands, so too must acceptance of testing, which is key to detecting sick patients who may require treatment and to facilitate serological studies that look for antibodies in people who have been previously infected but not tested, which can provide insight into how much asymptomatic spread there is.
To do this, we must reach more agricultural workers. Michigan's approach of using text messages to remind agricultural workers to watch for symptoms and get tested is a promising model for effective communication and building trust. In early June, the CDC sent out social media messages in multiple languages to agricultural workers in affected areas recommending actions they can take to reduce their risk of exposure to H5N1, including wearing personal protective equipment.
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Community-driven strategies would strengthen these efforts. HHS’s recent investment of an additional $5 million to support state and local level officials to reach these high-risk populations is a step in the right direction. But farmworkers, especially undocumented farmworkers, have poor access to health care, and many understandably distrust public officials. Funding from government, industry, and philanthropy should be expanded and directed to community-based organizations known by farmers and those with experience providing health care to farmworkers. Farmworkers will seek testing if they know they can receive care from a provider they trust, and won’t be penalized or deported for getting tested.
But states hit hard by the outbreak need to do more to get help to farmers. Half of migrant farm workers are illegaland Half of illegal immigrants are uninsured. Of the states where H5N1 has been found on dairy farms, Colorado is the only one that offers state-funded health care to all adults, regardless of immigration status. Limiting undocumented farmworkers' access to health care ties the hands of those responding to the outbreak. If states where H5N1 has been found on dairy farms extended Medicaid and other state-funded health care to undocumented immigrants, more farmworkers would be able to receive flu testing and treatment.
Finally, agricultural workers should be given priority in vaccinations.
On May 30, the Department of Health and Human Services' Office of Preparedness and Response Announced The government has ordered the production of approximately 5 million doses of H5N1 vaccine through the Strategic National Stockpile, a key step to strengthen preparedness in case of animal-to-human or human-to-human spread of the virus. This is also consistent with President Biden's National Biological Defense Plan for 2022, which has been launched by the National Institute of Biological Sciences. Provide adequate funding for the stockpile Develop the capacity to produce a vaccine to cover all at-risk people within 130 days of the pandemic's outbreak.
Once these vaccines are available, important decisions will need to be made about who to prioritize for vaccination. Several factors will be considered, including risk of exposure to the virus and likelihood of developing severe disease. Prioritizing at-risk farmworkers in considering H5N1 vaccination will be key.
H5N1 vaccines may take several weeks to replenish and be ready. But there is no need to wait. Whether agricultural workers are a priority for H5N1 vaccination or not, efforts should be stepped up now to get agricultural workers vaccinated against seasonal influenza in the fall. Although seasonal influenza vaccination cannot prevent H5N1 avian influenza, it can reduce the risk of coinfection and the possibility of transfer of virus particles (so-called “reassortment”) that could lead to novel pandemic-prone influenza viruses. By increasing seasonal influenza vaccination rates among agricultural workers, we can also begin to build a reliable vaccination program that can reach these communities and rapidly administer H5N1 vaccines when needed.
Strengthening these measures to protect farmworkers also protects us all: by reducing the risk of farmworkers getting sick, we reduce our collective risk that this H5N1 outbreak will develop into the next pandemic.
