5 months ago
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H5N1 avian influenza, or bird flu, continues to rip across the U.S. In just the last few months, it’s infected at least three people—all dairy workers—while spreading among chickens and cows in dozens of farms across several states.
Government officials and farmers have been responding to H5N1 since Feb. 2022 when the virus was first detected in U.S. poultry farms. When it spread to dairy farms in recent weeks, the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS) immediately surged their response efforts—ensuring the safety of our commercial milk supply, educating health care providers, scaling up testing, and ordering the production of millions of vials of H5N1 vaccine—with coordination support from the White House Office of Pandemic Preparedness and Response and National Security Council.
But new infections in farm workers signal more must be done to protect them. As in many infectious disease outbreaks, the risk of infection is not equally distributed. While the U.S. Centers for Disease Control and Prevention (CDC) currently says the risk to the public is low, farm workers exposed to infected animals are at higher risk.
The use of personal protective equipment is insufficient. The first dairy farm worker infected wore gloves but not eye protection and suffered conjunctivitis: inflammation within the lining around the eyes. While testing availability is being scaled up, testing uptake remains low, with the CDC reporting that only 44 people have been tested for novel influenza A (of which H5N1 is a subtype) as of May 31. The response is further complicated because many migrant farm workers are undocumented and have limited access to health care.
Three key actions could better protect farm workers during the H5N1 outbreak and help prevent this virus from igniting the next pandemic.
First, we must empower farm workers to control the virus.
In Feb. 2022, when I was President Biden’s lead health security official at the White House, we were alerted that bird flu was found on a turkey farm in Indiana. Within a few hours, I began chairing interagency meetings with senior HHS and USDA officials to coordinate the response. Over the subsequent months, we saw the virus spread like wildfire, leading to the death of millions of chickens and turkeys across 48 states.
Then, in Apr. 2022, I received an alarming phone call that a poultry worker in Colorado had been infected with H5N1. He experienced fatigue, was treated, and thankfully recovered. This was a warning shot: a sign we needed to do more to help poultry workers control the outbreak on their farms.
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We asked HHS and USDA to take further action. We provided hundreds of millions of dollars in compensation to poultry farmers whose flock had been infected or culled. We further empowered poultry farm workers to implement biosecurity measures through the USDA’s “Defend the Flock” program, an effort to equip farm workers with personal protective equipment and train them to disinfect contaminated poultry houses. Some farmers went as far as installing sound cannons, loud alarms that scare off virus-laden wild birds that threatened to infect their poultry.
The spread of bird flu among commercial poultry farms plummeted. According to the USDA’s bird flu dashboard, the number of commercial poultry farms with bird flu dropped from more than 90 in May 2022 to fewer than five in May 2023. Less spread on farms means less exposure for farm workers, and fewer chances for the virus to mutate and potentially leap from animals to humans.
The USDA is applying lessons from its effective efforts with farm workers to defend the flock on poultry farms to control H5N1 on dairy farms. In May, it announced hundreds of millions of dollars of new funding to support the emergency response, and it will provide up to $28,000 to affected dairy farm premises over the next several weeks to do things like paying for treating infected cows, shipping test samples to labs, and heat-treating milk. HHS is also providing free gloves, eye goggles, and other protective gear to farm workers. Congress and legislatures in affected states should provide funds for as long as needed to sustain farm workers’ efforts to gird the herd against this virus.
Second, we must reach out to farm workers.
Building on investments made through President Biden’s National Biodefense Plan, the CDC has created a multi-pronged surveillance system to monitor for H5N1 in people. The CDC is expanding testing in public-health and commercial laboratories, educating health care providers, and monitoring hospitals and wastewater trends for any unusual spikes in influenza cases.
As testing availability expands, testing uptake must follow. This is key to detecting sick patients who may need treatment and facilitating serological studies that look for antibodies in people who were previously infected but not tested, which would give us a sense of how much silent spread exists.
To do that, we must reach more farm workers. Michigan's approach of using text messages to encourage farm workers to look out for symptoms and seek testing is a promising model of effective communication and trust-building. In early June, the CDC launched targeted social-media outreach in multiple languages to farm workers in affected communities with recommended actions they can take to reduce their risk of being exposed to H5N1, like wearing personal protective equipment.
Read More: How to Prevent Bird Flu from Becoming the Next Pandemic
A community-driven strategy would enhance these efforts. The recent additional $5 million investment by HHS to support actors at the state and local levels to reach these high-risk populations is a step in the right direction. But farm workers—especially migrant farm workers who are undocumented—lack adequate access to health care, and many understandably mistrust public officials. Funding from government, industry, and philanthropy should be expanded and directed to community-based organizations that farmers know and those with experience in providing health care to farm workers. Farm workers will seek testing if they know they will be cared for by providers they trust—and not punished or deported for doing so..
But outbreak-affected states should go further to reach farmers. Half of migrant farm workers are undocumented, and half of undocumented immigrants are uninsured. Of the states in which H5N1 has been detected on dairy farms, only Colorado provides state-funded health care coverage for all adults regardless of immigration status. Limiting undocumented farm workers’ access to health care ties the hands of outbreak responders. If states with H5N1 on dairy farms expand Medicaid or other state-funded health care coverage to include undocumented immigrants, they would reach more farm workers with influenza testing and treatment.
Lastly, we must prioritize farm workers for vaccination.
On May 30, the HHS Administration for Preparedness and Response announced that it had ordered the production of nearly 5 million doses of the H5N1 vaccine through its Strategic National Stockpile. This is a vital step to increase our readiness in case of increased animal-to-human or human-to-human spread. It’s also aligned with the National Biodefense Plan that President Biden launched in 2022, which prioritizes fully funding the stockpile and developing the capability to produce vaccines to cover all at-risk populations within 130 days of a pandemic.
Once these vaccines become available, important decisions will need to be made about who should be prioritized for vaccination. Several factors will be considered, including a group’s risk of exposure to the virus and likelihood of developing severe disease. Prioritizing at-risk farm workers in H5N1 vaccination deliberations will be key.
The H5N1 vaccines may take several weeks to be filled and finished. But we don’t have to wait. Regardless of whether farm workers are prioritized for H5N1 vaccination, we should increase efforts now to ensure farm workers are vaccinated against the seasonal flu come fall. While seasonal flu shots will not protect against H5N1 bird flu, it may decrease the risk of co-infection and possible shuffling of viral particles (so-called “reassortment”) that could lead to a novel pandemic-prone influenza virus. Increasing seasonal influenza vaccination rates among farm workers would also start to build a reliable vaccination program that can reach these communities and be scaled rapidly to get H5N1 shots into arms, if ever needed.
Ramping up these actions to protect farm workers will protect us all. By lowering their risk of getting sick, we lower our shared risk of this H5N1 outbreak turning into the next pandemic.
