SPECIAL REPORT: When avian flu control meets cultural resistance

Editor's note: This is the second of a two-part special report on bird flu in Vietnam. Part one, "Vietnam's success against avian flu may offer blueprint for others," appeared Oct 25.

Oct 26, 2006 (CIDRAP News) – HANOI, Vietnam – Nguyen Van Tich's farm lies at the end of a narrow dirt road that runs under the tall edges of rice paddies and snakes between old bomb craters turned into fish ponds.

The tucked-away property, one of the largest in this 10,000-person district 20 miles from Hanoi, is new-looking and prosperous. In the 7 years they have owned it, 44-year-old Tich and his wife have stocked their 1.75 acres with citrus trees, coconut palms, pig pens, a duck pond, and a long brick coop filled with fuzzy chicks that skitter away from a stranger's shadow.

The couple went into debt to build the farm, and their care for their investment shows in the wire mesh that swathes the chicks' shelter and the vaccinations recently administered to their 1,000 ducks and hens—measures prescribed by Vietnam's central government to contain the threat of H5N1 avian influenza.

"I am a professional; [this farm] is my life," Tich said through an interpreter. "If I lose it, I lose everything."

The willingness of Tich, pictured at right,* and thousands of small farmers like him to follow the government's orders does much to explain Vietnam's dramatic change of fortune on avian flu, from one of the countries hardest hit by the virus to one of the most successful in controlling it (see part one of this series).

The Vietnamese government is openly proud of those results, and international animal and human health experts have applauded its apparent success. Yet some of those experts caution, and interviews with farmers and consumers confirm, that Vietnam's continued success is not guaranteed—because it may depend on new and stricter government prescriptions that the populace may find hard to accept.

"What is being talked about is trying to change really basic behavior that people have been engaged in all their lives," said Dr. Richard Brown, a World Health Organization (WHO) epidemiologist based in Hanoi. "It is going to be a slow process."

As the H5N1 outbreak expands, planners worldwide are acknowledging that scientific and political efforts to control the virus will fail unless they are accompanied by willing cultural change. Vietnam's attempts to create that change are being closely watched.

A model for success
Vietnam's success against avian flu has made the country an island of viral suppression in a sea of transmission—this year, according to reports from the World Organization for Animal Health (OIE), H5N1 has recurred in neighboring Cambodia, China, Laos, Myanmar, and Thailand.

And Vietnam's successful measures are stringent and strictly maintained.

In Ho Chi Minh City, for instance, raising chickens in the city has been banned, and chickens raised in the countryside are inspected twice before they cross the city limits—once by rural authorities and a second time at one of four municipal checkpoints. More than 2,000 trucks pass through the checkpoints each day; if the birds' paperwork is in order, the truck carrying them is allowed to proceed along limited designated routes to one of three new slaughterhouses.

If the birds do not pass inspection, they are confiscated on the spot. "We take them to the incinerator," Dr. Truong Thi Kim Chau, vice-director of the city's sub-department of animal health, said through an interpreter.

The country's health authorities do not take success for granted.

"The risk of bird flu still exists in Vietnam," said Dr. Bui Quang Anh, the Hanoi-based director general of the department of animal health in the agriculture ministry, pointing to the likelihood that the virus still circulates in ducks, geese, and quail within Vietnam, and the possibility of its being carried over the Chinese border in smuggled live chickens.

Strict additional measures
To counter that perceived threat, the ministry proposes strict additional prevention measures in its Integrated National Operational Program for Avian and Human Influenza, known because of its binding as the "Green Book."

The measures vary. One proposal is to permanently ban the raising of ducks, an integral component of the rice-growing economy because they are herded into harvested paddies to clean and fertilize them. Another is to take poultry raising out of the hands of the backyard growers, who make up 70% of producers, and concentrate the industry in large, biosecure farms.

Most controversially, for many Vietnamese, the government proposes to alter the way that chicken, a major food, changes hands. It is phasing out the markets where consumers choose live birds and have them slaughtered, and substituting birds killed in a modern slaughterhouse and sold shrink-wrapped and chilled in supermarkets.

The change—already instituted in Ho Chi Minh City and under way in the north—would alter much more than basic commerce. It challenges deep-rooted food preferences, because already-dead chickens are considered less tasty and nutritious. It could affect social patterns, because markets are where neighbors meet each morning. It touches even religious practice: Slaughtering and cooking chicken on behalf of family ancestors is a crucial observance during Lunar New Year.

"This is the big challenge in Vietnam," said Dr. Le Truong Giang, vice-director of Ho Chi Minh City's health department. "Not all the population agree, but more and more people agree with us."

But in Hanoi, Tran Thi Tuyet—a university graduate working in a silk shop to perfect her English—vigorously disagreed.

"We know bird flu is very dangerous," she said. "But Vietnamese people, we like to go to the market, we want to see the birds. Where I live, outside the city, there are many markets selling chickens still."

Meeting cultural resistance
In Vietnam's health agencies, and in the cities and villages, there are scattered signs that acceptance of anti-bird flu measures may not be complete.

The two-shot poultry vaccination campaign mandated last year by the agriculture ministry inoculated approximately 160 million birds—80% of the country's total—in late 2005, Dr. Anh said. But a repeat this year, meant to catch a new crop of birds, vaccinated 140 million, about 65%. And a campaign to halve the country's duck population, which stood at 60 million in 2003, has stalled at 40 million birds.

"We are thinking of how to change the jobs of the duck farmers in the countryside," Dr. Anh said. "The farmers are very poor. We should have something else for them to do."

On a mid-September morning in Viet Doan commune—where 1,500 ducks were culled in 2005—400 local farmers followed along eagerly as a team from CARE International staged games and contests with an anti-flu theme. The gathering was part of a program that the humanitarian agency has been testing in Vietnam since 2004 that coaches rural residents to evaluate their own understanding of avian flu and teaches them preventive measures, from handwashing to keeping poultry away from other animals.

"Some food shops in the commune have stopped selling poultry meat or duck's blood," said Dr. Nguyen Thi Tuyet Mai, a trainer on the program's staff. "Some farmers keep their poultry behind a fence. But it is difficult to change behavior; it requires a long time."

Tich, the farmer, did not attend the gathering. At his farm down the road, there was a modest fence, two strands of barbed wire slung loosely between low posts. A chicken flapped over it, landing clumsily in a mob of month-old ducklings (see left*)—ducklings that, under a strict interpretation of government guidelines, should not exist.

Asked about the ducks, Tich looked nonplussed. News of the ban, he said, had reached him only 10 days ago; he had bought the ducks 3 weeks before.

"What I heard is, the local authority just encouraged not to raise new ducks." he said through the interpreter. "It is not a policy."

Tich had complied with most of the policies in the government campaign against avian flu. In addition to vaccinating his adult birds and confining his chicks until they are a month old, he scours his chicken coops with disinfectant every time a crop is sold, wears gloves and a mask when he kills a bird for his own use, and buries dead chickens in a hole with lime instead of eating them or feeding them to fish.

But he seemed skeptical of the effort and expense in some of the further measures yet to come.

"Avian influenza is a very big concern for our family, because we have invested quite a lot of capital in our poultry," he said. "But if the government banned duck-raising, I might switch to raising other animals. I might not grow poultry anymore."

*Photos ©2006 Maryn McKenna. Used with permission.

Reporting for this story was supported by the East-West Center, Honolulu (www.eastwestcenter.org).

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