- 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
- 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
- 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.