Gaps in surveillance and cuts by the Trump administration to medical research threaten to undermine efforts to contain a highly contagious form of bird flu that has killed staggering numbers of animals across the globe and poses a deadly threat to humans, according to Massachusetts scientists who spoke at a public forum Wednesday.
Several of the state’s leading infectious-disease experts painted a sobering picture of the nation’s readiness to combat a strain of avian influenza, known as H5N1, that has infected dozens of people nationwide and is showing no signs of abating. A human pandemic may be closer than once thought, said the experts, members of a Harvard Medical School-led team called the Massachusetts Consortium on Pathogen Readiness, and inadequate testing and difficulties in accessing federal data could hinder efforts to contain it.
“I think we are living next to a volcano and it may erupt,” said Dr. Jacob Lemieux, an assistant professor of medicine and infectious disease specialist at Massachusetts General Hospital. “It may not, but we need to prepare for the possibility of a pandemic.”
The rise of the bird flu in Massachusetts and nationwide comes at a precarious time for public health, as the Trump administration has moved to slash medical research funding, curb health communications, and slash its workforce.
Some federal webpages used by policymakers to track the spread of infectious diseases such as HIV were taken offline in January, though many have since been restored. The Trump administration has also fired hundreds of workers from the Centers for Disease Control and Prevention, including some workers responsible for training public health laboratory staffers and supporting outbreak response efforts, according to news reports.
The Massachusetts infectious-disease experts described the bird flu as highly contagious and deadly in mammals and birds, and raised concerns that not enough is being done to contain it.
The proposed cuts to the National Institutes of Health, the nation’s largest funder of biomedical research, would undermine efforts to develop a vaccine against the virus, one of the experts warned. The United States has stockpiled millions of doses of vaccines, but those need to be updated to match the evolved strain of the virus, said Dr. Kathryn Stephenson, a professor of medicine and an infectious-disease expert at Beth Israel Deaconess Medical Center. The NIH has been vital to vaccine research and development efforts, she said.
“All of this infrastructure is so critical,” Stephenson said. “Of course, it makes a difference in what we’re doing when we don’t know what our funding is going to be... So that paralyzes our work.”
Their warnings echo those made by infectious-disease experts at the start of the COVID-19 pandemic, when the nation was hit by wave after wave of deadly infections and lacked the proper infrastructure to respond. Similar to five years ago, scientists are scrambling to understand how a dangerous virus mutates and why some hosts are more vulnerable. For instance, scientists are puzzled about how and why the virus has killed tens of thousands of sea lions across the globe, from Maine to Chile.
“The reality is also that the conditions are worsening,” Lemieux said. “There’s been ... a tremendous spread in a new class of hosts, the dairy cows. And there have been sporadic and, data would suggest, possibly increasing episodes of spillover.”
H5N1 is a variant of the influenza virus that sickens millions of people every winter. However, because humans have not previously been infected with H5N1, they have not built up immunity, and so it holds potential to be more dangerous.
The risk of severe illness and death is high. Globally, more than 950 human infections of H5N1 have been reported since 2003, of which more than half were fatal. However, experts have said the strains of the virus that are circulating now are causing less-severe infections in humans than prior strains.
“This virus is always changing, so the same virus that is causing mild infections in humans today may be a different virus tomorrow,” said Dr. Jonathan Runstadler, a veterinarian and chair of the Department of Infectious Disease and Global Health at the Cummings School of Veterinary Medicine at Tufts University.
The virus is constantly evolving and could potentially become easily transmissible from person to person. If this occurs, it could be the start of a new influenza pandemic, as was the case with the 1918 and 2009 H1N1 pandemics. In recent years, the virus has evolved to infect more than 100 mammalian species, including coyotes, bears, and foxes.
There have been 70 documented human infections in the United States in the the past year, but no official reports of human-to-human transmission, according to the CDC. Most of the cases have been mild, and have been detected among farmworkers exposed to sick poultry or dairy cows. However, a few recent cases have been severe. Two people, in Wyoming and Ohio, were recently hospitalized; and a man died in Louisiana in January after being exposed to sickened birds in a backyard flock.
In Massachusetts, the bird flu outbreak is the largest the state has ever seen. It’s now considered widespread, afflicting both wild and domesticated birds in several municipalities. State health officials have said the virus is likely present in places where there has not been a confirmed case; and they have advised that people avoid handling birds or other animals that are dead or appear sick. So far, there have been no reported human cases in Massachusetts and it has been absent from dairy farms.
“I think we’re in the ‘4 to 5 out of 10′ range right now," said Dr. Robert Goldstein, the state Department of Public Health commissioner, when asked to rate the risk level to the broader population. “I do think we need to have a healthy worry about this, but the risk to humans in this moment remains low.”
Among the challenges with detecting the bird flu among humans is that many of the symptoms are fairly common. They include coughing, fatigue, and headaches. Conjunctivitis, also known as pink eye, has emerged as a common symptom among those infected, researchers have found.
With some animals, the virus has caused obvious neurological symptoms. Infected foxes have shown signs of twitching, circling, and seizing. On Wednesday, one of the experts played a video of an infected duck writhing uncontrollably on a beach. He also flashed a map showing that large swaths of the globe, including much of Africa and South America, had not begun surveillance of the virus. In the United States, much of the testing of poultry and dairy farms has been voluntary, which limits its tracking value, Runstadler said.
“There are large blank areas [on the global map], and those blank areas are not where surveillance is being done and negative results are being recorded,” Runstadler said. “That’s a problem obviously for tracking disease.”
The outbreak is also hitting people in the pocketbook. Across the country, poultry farmers have moved to cull their populations of chickens and turkeys in an attempt to contain the damage, which has reduced supply and driven up egg prices. In the Boston area, egg prices have soared by more than 50 percent since the fall.
Chris Serres can be reached at chris.serres@globe.com. Follow him @ChrisSerres.