H5N1 doesn’t have to be a repeat of Covid-19’s ‘public health versus the economy’

The Biden administration announced new programs on May 10 to incentivize dairy farmers and workers to collaborate with public health efforts to investigate and mitigate the H5N1 avian influenza outbreak among dairy cattle. Farmers and agriculture officials have called such testing “overreach,” telling public health officials to “back off.” But the Biden administration’s new programs are a first step toward creating trust and collaboration between public health and industry.

Farms don’t want to be identified as H5N1 hotspots for fear that they might end up with milk or beef they can’t sell. The industry has already suffered a financial blow with affected dairies taking as much as a 20% hit to their income, and U.S. cattle prices are dropping as traders fear the outbreak could hurt demand.

The USDA already provides financial assistance to livestock, farmed fish, and honey bee farmers who have suffered losses due to disease, animal attacks, and extreme weather. These same funds will be used to compensate dairy farmers whose cows are infected or need to be taken out of milk production. But to qualify for such compensation, dairy farms will have to agree to participate in enhanced epidemiological surveys and other public health measures.

In addition to compensating for lost milk revenue, the U.S. Department of Agriculture will also provide up to $28,000 per farm to support various biosecurity measures, including heat treatment of contaminated milk before disposal, veterinarian costs, shipment of specimen, lab testing, personal protective equipment, and uniform laundering.

It’s unclear how the USDA will calculate compensation for lost milk revenue. Dairy farms vary tremendously in size, from under 100 cows to more than 15,000. Compensation proportional to the number of cows on a farm might be more persuasive.

Dairy milk processors and retailers could also be motivated to ensure that the farms from which they source their milk are cooperating with public health officials on surveillance, testing, and mitigation measures. A model for this is the Milk with Dignity program, which focuses on improving working conditions in the dairy industry. Participating dairy farms agree to standards for wages, working hours, housing, and worker health and safety. Independent third-parties verify that the dairy farms are complying with these standards. Participating retailers in turn commit to sourcing milk from dairy farms that participate in the program.

Consumers also have a role to play here, by demanding that retailers source their milk from farms that are working with public health authorities.

Other forms of industry support may also be needed. If contaminated milking equipment is found to be an important vector for transmission, farmers may need incentives or compensation to purchase more milking equipment and hire more farmworkers to maintain the same throughput while allowing for time to sterilize equipment between milking. Currently, only five minutes is allocated to milk each cow, and they need to be milked two to three times per day.

It’s also unclear why an indemnity program didn’t already exist for the dairy industry. Poultry farmers are compensated for poultry they’re forced to cull when H5N1 avian flu is detected on their farms. They are also given incentives to test and detect H5N1 infections quickly to prevent its spread to other farms. They are only compensated for poultry they cull, not those that die from infection. And this program doesn’t account for the costs of restocking, downtime, and the delay until the farm becomes profitable again. These programs, however, have been criticized for subsidizing highly profitable big commercial farms without putting pressure on them to do more to change farming practices that may lead to more infectious disease transmission.

This is a moment for the USDA and other public health agencies to step back and take stock of whether other risks may exist across the agriculture industry, what incentives may be needed to encourage cooperation with public health officials in the future, and how the farming industry can be encouraged to mitigate risks now.

The CDC will compensate dairy farmworkers $75 for taking part in epidemiologic studies of H5N1 avian influenza, though it’s unlikely that will incentivize many workers to participate. It’s a notoriously exploitive industry. The working conditions on dairy farms are grueling and dangerous. With few Americans willing to take these jobs, most milkers are foreign-born Hispanic workers, many of whom are undocumented and don’t have health insurance. Many speak indigenous languages, not Spanish, much less English, making it even more difficult for them to report health and safety violations and access health care and social services. Many can’t access health facilities because there isn’t good public transportation in rural areas and they can’t get a driver’s license in many states.

The risks of their work are normalized, and many don’t understand that there are ways to reduce and prevent injuries. Despite various chemical and biological risks, including not only H5N1 avian flu, but also exposure to formaldehyde, chlorine, Q fever, and antibiotic-resistant bacteria, it’s uncommon for dairy workers to wear masks or goggles. And if even if they understand how to report unsafe working and living conditions, dairy workers are excluded from protections under the Fair Labor Standards Act, Migrant and Seasonal Agricultural Worker Protection Act, and the Occupational Safety and Health Act.

Workers who take time off for being sick may be punished with loss of income, housing, and their jobs. And because few have a pathway to legal status in the U.S., the greatest fear for many is being deported. They do not want to come to the attention of any government official. Even the one dairy worker in Texas who was known to have H5N1 avian flu refused follow-up testing, and his close contacts also refused testing.

President Biden has used his executive powers to grant work permits to migrants newly arrived in the country, and many farmers support providing work permits to undocumented farmworkers to help address labor shortages.

In the absence of legal protections, paid sick leave, and at least temporary legal status in the U.S., it’s unlikely that many dairy farmworkers will be willing to participate in research to protect the American public’s health. Many questions remain.

The overall risk to farmworkers still isn’t understood. Based on prior human infections, it’s estimated that the mortality rate for H5N1 avian flu among humans may be above 50%. We don’t know what proportion of farmworkers and cattle may already have been infected, and how well prior infection protects against future infection with H5N1 avian flu viruses. We don’t know how the virus may be mutating with each infection and adapting to human hosts or becoming more transmissible, more virulent, or more resistant to existing antivirals. We don’t know if the virus is spreading only through contact with milk, or also through the air. We don’t know if wearing goggles and masks will reduce the risk of H5N1 avian flu infection among dairy farmworkers, or if other measures like better indoor ventilation and air filtration or disinfection of milking equipment might be more effective.

One of the lessons of the Covid-19 pandemic should have been that controlling an infectious disease isn’t just a question of having diagnostic tests, treatments, and vaccines. It’s also about creating systems that allow people and industry to do the right thing for their own health and for public health without having to take a hit — whether that is losing revenue or wages, jeopardizing a job, or risking deportation. The H5N1 avian flu outbreak needn’t be a rerun of Covid-19’s “public health versus the economy” battle. There’s a lot at stake for the U.S. and the rest of the world. No one wants the U.S. dairy industry to become a Wuhan wet market for the next global pandemic.

Céline Gounder is an infectious-disease physician and epidemiologist, an editor at large for public health at KFF Health News, and host of the podcast “Epidemic.”