A Nightmare Scenario -
H5N1 Pandemic

By Mortimer B. Zuckerman
Should we sound the alarm for a worldwide epidemic that might not occur? There is no choice with the avian flu emerging from Asia. Last week's disclosure that an Indonesian man tested positive for the bird flu that has already killed more than 50 people in Southeast Asia was just the latest chilling news about the disease. Should it develop certain genetic changes, international health experts warn, bird flu could spark a global pandemic, infecting as much of a quarter of the world's population and killing as many as 180 million to 360 million people - at least seven times the number of AIDS deaths, all within a matter of weeks.
This is utterly different from ordinary flu, which kills between 1 million and 2 million people worldwide in a typical year. In the worst previous catastrophic pandemic, in 1918, more than 20 million died from the Spanish Flu. That's more than the number of people who died from the Black Death in the Middle Ages, and more people killed in 24 weeks than AIDS killed in 24 years.
There are three elements to a pandemic. First, a virus emerges from the pool of animal life that has never infected human beings, meaning no person has antibodies to fight it. Second, the virus has to make us seriously ill. Third, the virus must be capable of moving swiftly from human to human through coughing, sneezing or just a handshake.
For avian flu, the first two elements are already with us. Well over half the people who have contracted it have died. The question now is whether the virus will meet the third condition: mutating so that it can spread rapidly from human to human.
The new flu has already moved from chickens to other birds and on to pigs. The latter often serve as a vessel for mixing human and animal viruses because the receptors on the respiratory cells of pigs are similar to those of humans. This illustrates the dangers we face, because this mixture of bird flu and human flu, in an animal or a person, could cause the viruses to exchange genetic materials and create an entirely new viral strain capable of sustaining efficient human-to-human transmission.
That would be the tipping point to a pandemic.
Nobody knows just how close we might be to such a crisis, but experts are alarmed because we are singularly ill-prepared. Worldwide, we currently produce only about 300 million doses of flu vaccine a year to serve more than 6 billion people. A pandemic that began in Asia could race around the globe in days or weeks, given the number of airliners crisscrossing the oceans from Tokyo, Vietnam and Indonesia to New York, Los Angeles and London.
We should be doing a whole lot more.
First: We need operational blueprints to get various populations through one to three years of a pandemic. We must coordinate the responses of the medical community, of food providers, of transportation and of care for first responders from public health, law enforcement and emergency management at the international, federal, state and local levels.
Second: We must strengthen the World Health Organization so that it can be an accurate clearinghouse of information about the scope and location of the disease, should it begin to spread, and quell false rumors that could lead to global panic.
Third: We must track the human cases already documented so as to gain the very earliest warning of any transformation of the disease, and thus of an emerging pandemic. Days would be critical.
Fourth: The Bush administration must think of this as terrorism to the nth degree and immediately set up a senior-level emergency task force to develop a strategy. It could serve as a permanent framework for curtailing the spread of future infectious diseases.
Fifth: We must prioritize research money to develop a vaccine, expand the production of flu vaccine and stockpile antiviral medications. It would be irresponsible to begrudge time and money.
A pandemic could well bring global, national and regional economies to an abrupt halt in a world that relies on the speed and distribution of so many products. It could also lead many countries to impose useless but highly destructive quarantines that would disrupt trade, travel and production - something that has never happened with AIDS, malaria or tuberculosis. At home, many venues of human contact - schools, movie theaters, transportation hubs and businesses - would have to be shuttered.
Imagine the chaos. These killer viruses simply can't be isolated in any part of the world. If avian flu were allowed to develop into a pandemic, it would be a direct threat to our health, security and prosperity.
The word influenza derives from the Latin influentia, reflecting the belief at the time that epidemics were due to the influence of the stars. Today, we have moved far beyond that fantasy, but even so, the world is clearly not ready for an avian-flu pandemic. With the scientific consensus already shifting from if to when the next global outbreak takes place, we have no time to lose.




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