**8. Conclusion**

The lessons learned from current and past AI initiatives are invaluable. Stop AI found that backyard farmers and women were the most likely to follow bio-security practices than other groups and men. Other initiatives found that containing the disease is much more challenging than assumed and bio-security of farms should be given the highest priority. Coordination among donors and agencies is critical and an area that needs to be further strengthened. In addition, prudent communications has the potential to reduce the risk of market collapse due to infection of AI and prevent more cases in both humans and animals.

While many lessons have been learned, there are still many gaps that need to be addressed to the problem of AI in Bangladesh. There needs to be a clear understanding of the epidemiology of the H5N1 virus. Research on the development of cheap and easily available quick diagnostic techniques needs to be expanded. In addition, more manpower is needed to improve the logistics of the Veterinary Service to carry out surveillance and respond to outbreaks of AI. Finally, improved coordination between stakeholders and donors is required to adequately address the problem of AI.

The need for clinical management of AI H5N1 may be decreased and possibly eliminated by managing H5N1 in live birds.

To achieve this goal, there are further steps that need to be taken. First a coordination, information, and cooperation model should be developed focused on increasing common understanding to prevent the threat of emerging and re-emerging zoonotic diseases of economic importance in the region. In addition, more emphasis should be placed on "risk" oriented communication rather than "fear" oriented communication. A cost-effective method for diagnosis and response should be developed, as well as increased capacity building. In spite of the challenges, with hard work, transparence, strong coordination, and willingness, focusing efforts on improving and sustaining animal health is a feasible approach for managing AI.

The current public health approach to avian influenza focuses on control and management after an outbreak has already occurred. However it would be possible to utilize resources more strategically by adopting a prevention-centered approach. By preventing an outbreak before it occurs, resources can be directed toward broader improvements in sanitation and hygiene practices that will positively affect not only avian influenza control efforts, but those of many other communicable diseases. In addition, focusing resources on prevention can avert significant morbidity and mortality.

Efforts to support a prevention-centered approach to pandemic avian influenza can be used to strengthen the nation's public health infrastructure, more broadly, which will ultimately result in greater public health and security gains than any reactionary response could possibly hope to. While the necessity has previously been to control and mitigate outbreaks once they have occurred, we are in a strategic position to move towards a more sustainable focus on prevention. It is time to seize the opportunity to get ahead of the threat and to focus resources on stopping outbreaks before they occur.
