Bird flu

More (well-justified) doom and gloom:

World Is Unprepared For an Avian-Flu Pandemic

World experts in influenza, writing in the journal Nature, warn that despite stepped-up disease monitoring and research, the world is far from prepared to cope with a possible pandemic of avian flu that is mutating in Southeast Asia.

Experts worry that avian flu, which is highly lethal to humans but usually requires contact with sick birds, could mutate to a form easily transmitted from person to person.

Pandemic flu could trigger an economic crisis, according to Michael Osterholm, head of the University of Minnesota's Center for Infectious Disease Research and Policy. Dr. Osterholm noted that the 2003 outbreak of SARS, or severe acute respiratory syndrome, snarled air traffic, paralyzed cities and cost billions -- even though its toll, 8,000 sick and 800 dead, was relatively light.

Pandemic flu could "change the world overnight...reducing or even ending foreign travel and trade," he said.

Frozen trade and travel could worsen shortages of vaccines, antiviral drugs, antibiotics for secondary bacterial infections, ventilators, and vital basics like food and water. Temporary hospitals, contingency staffing and allocation plans for scarce supplies are needed to survive 12 to 36 months of a pandemic.

Writers in Nature tried to estimate how many people would be sickened or killed by a powerful, pandemic avian virus. Albert Osterhaus at the National Influenza Centre in Rotterdam, the Netherlands, warned that it could make 20% of the world's 6.5 billion people ill, putting 30 million in the hospital and killing 7.5 million.

Dr. Osterholm put the potential toll even higher, arguing that a pandemic could rival the 1918 flu, which he says killed at least 50 million people. A boom in people and poultry living in together in Asia has given the virus room to grow, he said. When a milder pandemic struck in 1968, China had 790 million people and 12.3 million poultry. Today, it has 1.3 billion and 13 billion respectively.

In a normal year, garden-variety flu and complications such as pneumonia kill an estimated 1.5 million people world-wide.

Dr. Osterholm said a vaccine against a pandemic strain won't be available for six months after its outbreak because flu vaccines use an old production technology based on incubation in eggs. And once a vaccine was ready, it would still reach only 14% of the world, due to inadequate manufacturing capacity. He urged acceleration of new cell-based technology that can lead to quicker production of vaccines.

Although an experimental avian flu vaccine by Sanofi-Aventis Group is now in safety tests, Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, warned, "Unless we improve our capacity to produce such countermeasures, we may experience again the devastation of past pandemics."

The World Health Organization last week reported that avian flu strains circulating in Vietnam show signs of evolving toward greater transmissibility from human to human. More human clusters are growing in northern Vietnam and lasting longer, suggesting possible human spread. The virus is also attacking people ranging more widely in age, and is showing signs of resistance to the best available antiviral drug against it, Roche Group PLC's Tamiflu (oseltamivir).

Robert Webster of St. Jude Children's Research Hospital in Memphis blasted failures to control avian flu at its source in poultry and wild birds -- failures that some fear have let the virus become entrenched.

Dr. Osterhaus said a lack of international harmony in detection and control programs has concealed the true death rate. So far, calculating from hospitalized cases, scientists estimate a mortality rate of roughly 60%. But since the total number cases -- including milder ones -- isn't known, the real death rate remains uncertain.

Dr. Osterhaus also called for a global task force to set research, policy and control strategies. He puts the cost at $1.5 million a year -- a sum dwarfed by the $1.35 billion cost so far of the animal outbreaks alone in the Netherlands, Thailand, and Vietnam, and even more so by the potential toll of a human pandemic.