Farmworkers are at greatest exposure risk for bird flu, but given few protections

Dairy farmworkers often spend 10 to 12 hours a day milking dairy cattle in crowded, wet environments. They are in constant, intimate contact with unpasteurized cow milk, a known carrier of H5N1, the viral strain of bird flu that jumped from poultry to cows back in March.

But despite being the most exposed population to the virus, farmworkers are also offered few protections. To prevent the spread of bird flu among the general public, experts say we need to first protect the health of farmworkers.

“I don't want us to ignore what is happening right now, which is that farmworkers are getting infected with this virus,” said Jennifer Nuzzo, an epidemiologist at Brown University.

Since the first herd was infected on March 25 in Texas, over 148 dairy cattle herds have contracted the virus across a dozen states (though experts believe there could be more) and so far, there have been four confirmed human cases in Americans, all of whom worked on dairy farms. Another case dates back to 2022 after a worker was exposed to poultry.

So far the symptoms experienced by the workers have been mild, but five cases shouldn’t be used to determine the severity of the virus, Nuzzo explained. Of the just over 900 people who have ever been infected with Avian Flu since 1997, nearly half of them have died, according to the World Health Organization.

“I don't think we can say anything intelligent about the virus based on that limited number of cases,” Nuzzo said.

To spread between humans at the rate needed to start a pandemic, bird flu would have to adapt to the right combinations of mutations. Nuzzo said it’s difficult to estimate how likely that combination is, but the priority right now should be to treat farmworkers who are already infected and at-risk.

“We shouldn't be in a position of waiting for farmworkers to become severely ill, or to die. We should be thinking about what we can do today to prevent that from happening,” Nuzzo said.

There has been overwhelming focus on the risk bird flu poses to consumers and the general public, such as how it may impact egg and dairy prices, which is valid but “slightly misguided,” said Elizabeth Strater, the director of strategic campaigns at United Farmworkers (UFW), the nation’s largest farm workers’ union. Strater agrees that the focus right now should be on treatment and prevention for farmworkers, which will benefit the public in the long run.

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“We know who is at risk, because we know who is getting sick. And that's the workers who have that very intimate contact with raw milk with infecting others and things like that,” Strater said. Many farmworkers also lack a social safety net — health insurance, job security, American citizenship, etc. — putting them at even greater risk.

Of the 150,000 dairy workers across the U.S. nearly one in five are immigrants and many are undocumented. They face a high level of job precarity and are unlikely to do anything that will put their job — and possibly their immigration status — at risk, explains Alexis Guild, the vice president of strategy at the nonprofit labor advocacy group Farmworker Justice.

“Workers are less likely to assert themselves, ask for protective equipment or go to a doctor when they're sick, because they worry about losing wages, they worry about being fired, and they worry about potential immigration consequences,” she said.

But experts say things like personal protective equipment (PPE), medical care, paid sick leave and job security are essential to farmworker health and stopping the spread of H5N1. Farmworkers have historically been excluded from basic labor laws like paid sick leave, so taking time off to get tested or seek treatment could put one’s job at risk.

Limited access to paid sick leave helped contribute to the spread of COVID-19 among farmworkers, many of whom reported being afraid of losing their job or being deported after taking time off from work to access health care services, according to a study by the National Center for Farmworker Health.

Thus far, human testing of bird flu has relied on a relatively voluntary approach. If somebody experiences symptoms, they are expected to go to the emergency room and get tested. But migrant workers aren’t likely to seek medical treatment for anything but a life-threatening condition, Strater explains.

“These are folks that are going to avoid testing, these are folks that are going to avoid state and federal agencies, and these are folks that are economically desperate so that they're not in a position to report symptoms or take the day off when they are sick,” she said.

To encourage testing, the Centers for Disease Control and Prevention recently announced that farmworkers would be compensated $75 if they got tested for avian flu. Strater said it’s something, but if they test positive and have to miss a week's worth of wages, $75 “won’t cover it.”

To test in a way that is safe and comfortable for farmworkers, their employment needs to be protected, Strater said. In the short term, UFW pushing for PPE, paid sick leave and greater financial compensation for testing while ensuring that farmworkers understand the risk H5N1 poses to their health.

Down the road, both Strater and Nuzzo hope farmworkers will be among the first to receive the vaccine for Avian flu once it is developed, which is similar to a strategy recently proposed in Finland.

“Think about it like a protective ring around the source of the infection and separating that from the general public,” Strater said.