The University of Minnesota's Center for Infectious Disease Research & Policy (aka CIDRAP) published a pair of articles last week on avian influenza control efforts in Vietnam (Part 1; Part 2). They do some top-notch reporting on avian/pandemic flu, and these two articles are a prime example of this.
Part 2 in particular discusses the issues involved in getting citizens to comply with control measures. This confirms a lot of things that have been written and said elsewhere about Vietnam's approach to AI control, and why is has been successful thus far.
First, the organization of Vietnam's goverment and administration have been instrumental in ensuring that decisions that are made at the top actually get implemented at the local level, and they are implemented consistently across the country in a timely manner.
Second, the government manages to convey that policies are intended to help the people, and that it actually cares what happens to them in the course of implementing these policies. 
Providing compensation for culled poultry (at 75% of market value) is but one example.
Vietnam's Integrated National Operational Program for Avian and Human Influenza (the 'Green Book' -- PDF available on the World Bank's website) has many references to poor poultry farmers and the need to limit the social and economic impact experienced by them. It is estimated that at least 65% of households in Vietnam keep poultry, either to supply food for the household, to supplement income, or as a primarly/sole source of livelihood. Vietnam's is one of the few plans--possibly the only one--that takes the needs of the poor seriously. Even if this is primarily rhetoric, it's rhetoric that most countries don't bother to engage in.
As one example, from the CIDRAP article, Dr. Bui Quang Anh, an official in the Ministry of Agriculture, comments, "We are thinking of how to change the jobs of duck farmers in the countryside....The farmers are very poor. We should have something else for them to do." Hopefully governments everywhere are thinking similar thoughts, but somehow I doubt this is the case.
Of course, Vietnam is uniquely situated, since HPAI appeared early in that country (hence they have more experience dealing with it), and because poultry production is such an integral part of daily life for most households. It may be that Vietnam's success can't be easily reproduced in other countries, like Indonesia, where government is highly de-centralized.
But I think there are important principles that do carry over, not only to controlling HPAI, but also to responding to a pandemic if/when it occurs. First, if top-level policies are going to have a chance of being successful, they need to be implemented locally and consistently, and people need have a sense that the policies are going to be effective, that it matters that they comply (or else why bother?). Second, people need to be able to trust that policymakers are acting with their interests at heart, that even if measures prove inconvenient or burdensome, the government acknowledges this and will take measures to fix things.
Post script: While I'm thinking about Vietnam, here's a paper from Joachim Otte and colleages at the FAO's Pro-Poor Livestock Policy Initiative that clearly illustrates the relationship between avian influenza control measures and poverty: HPAI Control Measures and Household Incomes in Vietnam (PDF)
Comments