You've called H5N1 an "enemy avian virus" and warned of a "pandemic struggle." Are you deliberately using language similar to the war on terror?
I chose those words, but not for that reason. It is a common public-health enemy that we are struggling with across the globe. A pandemic has the potential to disrupt society in a way that virtually no other set of circumstances—even war—can accomplish. Looking back over history, it's difficult to identify any other event that would cause the deaths of 20 to 50 million people in a year or less. Most disasters—tsunamis, hurricanes, tornadoes, even a prospective bioterror incident—don't reach that scale.
So far, H5N1 hasn't been easily passed between humans, and has killed only about 60 people. Do you worry about causing needless panic?
We're working hard to find the balance between preparedness and over-alarm ... If it isn't H5N1, history tells us there will be another flu pandemic. Our challenge is not to prepare for H5N1 alone. It's to be ready whenever a new pandemic occurs.
Does the timing of your visit to Asia have anything to do with the outcry over the Bush Administration's lack of preparedness for Hurricane Katrina?
The trip was scheduled before [Katrina].
When was the first time you spoke to President Bush about H5N1?
This spring. He was conscious of it then, but as he learned more about it, the level of his attention began to increase. It was the kind of subject that, when I would be in the Oval Office on another subject and I'd be walking out the door, he would bring me back and sit down and ask questions about our progress.
Would the U.S. ban travel from certain countries if a pandemic did occur?
It's unlikely, frankly, that it would be effective. But there is a step short of that: screen people who come from a specific region; if they have been exposed, but are not symptomatic, then they are quarantined.
Should the world focus on preventing avian flu or on responding to it once an outbreak occurs?
[We do] not need to eliminate it; sometimes delaying it is a success. An example of that is the first manifestation of the H5N1 virus in 1997 in Hong Kong. They responded with a vigorous culling of their flocks, and isolation of anyone who had been exposed—and they successfully stopped the virus for a time. It began to manifest itself again a couple of years later, but we now have the makings of a vaccine that we'll need to refine. My point is that Hong Kong's containment activities produced a delay that really helped.
You've called for an increase in U.S.-based vaccine production, which right now doesn't meet the need for even regular flus. Should this be a government or private initiative?
For the last 25 years the United States has allowed the vaccine-manufacturing industry to diminish to the point that we are dependent on foreign manufacturers. That's a dangerous situation and it needs to change even without a pandemic potential. In situations like that, there's a compelling national interest for government's involvement.
Will countries be able to stockpile antivirals like Tamiflu now that patent-holder Roche has decided to license others to manufacture it?
[This] has to be done carefully, because the demand for Tamiflu makes it attractive for counterfeiters.
How much Tamiflu do you have in your medicine cabinet at home?
I have a blister pack of 10 with me. It was provided by those who arrange my travel. And that's it.
Realistically, how long will it take for the world to be ready for a pandemic? A year? Five years? 10?
We're better prepared today than we were yesterday. We'll be better prepared tomorrow than we are today. It's a continuum. I don't think a nation is ever perfectly prepared.