Avian Flu: How Scared Should We Be?

(3 of 5)

That's important, because other than direct evidence of sustained human-to-human transmission, the first tip-off to an imminent pandemic could be a prominent mutation in H5N1, perhaps as the result of genetic mixing between two types of flu viruses. Pigs and people would be the most likely incubators. But it's also possible, as a series of papers in Nature and Science concluded last week, that flu viruses from birds could clear the critical hurdles on their own. Researchers who managed to re-create the 1918 flu virus from snippets of lung tissue stored decades ago showed that perhaps a couple of dozen mutations in a more or less purely avian-flu virus were all that was needed to trigger that long-ago pandemic.

•WHAT WOULD A PANDEMIC BE LIKE?

Michael Leavitt, Secretary of Health and Human Services (HHS), recalls walking through 17 devastated cities in the weeks after Katrina and wondering what it would be like if there were disasters in all 50 states. "A pandemic is a substantially different emergency than a natural disaster," Leavitt says. "A pandemic takes place over the course of a year. It can happen in 5,000 venues at the same time."

There wouldn't necessarily be a lot of warning. An outbreak anywhere in the world could circle the globe in just a few hours. Shutting down airports, computer simulations have shown, results in at most a couple of weeks' delay in transmission. WHO says it is reasonable to prepare for 2 million to 7.4 million deaths, although the number could be higher.

•ARE WE READY?

Finally, an easy question. The answer is no. Only a fifth of the world's countries have a pandemic-response plan, according to the WHO; those plans vary greatly in comprehensiveness. Fewer than 10 nations have domestic vaccine companies trying to produce an avian-flu vaccine. Even common flu vaccines are notoriously unprofitable--among other things, they have to be thrown out each year--which is why U.S. companies have all but abandoned the field.

The U.S. Department of HHS began working on a pandemic-flu plan in 1993. It finally released a 50-page draft last year; a completed version is due later this month. A leaked 381-page draft obtained by the New York Times last week is long on dire predictions and short on chain-of-command specifics, according to the newspaper.

Secretary Leavitt admits that U.S. preparedness for a pandemic contains gaps and that a recent holdup has been negotiations with the drug industry over how to encourage vaccine development and production. Those talks got a high-level boost last week when President Bush met with six pharmaceutical executives. "The Katrina situation has really influenced him," says a White House official. "The hardest thing to wrap your head around and get data on is, What's the likelihood? Nobody really knows. But everybody believes that we've got to prepare for the worst." One possibility the White House is considering is a plan to spend $10 billion on stockpiling vaccines.