World Unprepared for "Bird Flu" Pandemic, Experts Say

Brian Handwerk
for National Geographic News

May 25, 2005

A global influenza pandemic, like the "Spanish flu" of 1918, could leave tens of millions dead. Many experts insist that the world is unprepared, and overdue, for just such a catastrophe.

Pandemics are disease outbreaks that occur over a wide area and sicken or kill very high percentages of the affected populations. These outbreaks often occur when viruses mutate into new forms that the human immune system cannot fight.

The leading contender for the next pandemic is H5N1, a strain of avian influenza, or "bird flu." The virus is found primarily in domestic and wild birds but also in mammals such as cats and pigs (see "Cats Can Catch and Spread Bird Flu, Study Says"). When H5N1 appeared in 1997 it killed six people in Hong Kong and southern China.

Since 2003 more than 50 people have died from H5N1 in Thailand, Vietnam, and Cambodia. Experts say those deaths are a drop in the bucket, compared to the predicted devastation should H5N1 mutate into an easily transmitted form.

"The situation right now with H5N1 is very similar to what we saw in 1918," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis.

The virus behind the influenza pandemic of 1918—called H1N1—killed an estimated 20 to 40 million people worldwide. (See "Disastrous 1918 Flu Linked to Birds, Study Says.")

"Not all influenza strains are created equal, and it's more than just idle speculation that an H5N1 pandemic could mirror that of 1918," Osterholm noted.

Osterholm is one of many experts who address the threat of avian flu and the next pandemic in this week's issue of the journal Nature.

Fortunately H5N1 is not yet spreading easily from person to person. But history suggests that the strain, or one that is similarly dangerous, will likely acquire that ability in the not too distant future.

Each of at least three known pandemics prior to 1918 had a global death rate equal to or higher than that of the 1918 outbreak. And in 1968 some 750,000 people died during a pandemic of the relatively mild H3N2 avian flu virus.

The human toll of a new, highly contagious avian flu could be shocking. Some experts estimate that 20 percent of the globe's population could fall ill and tens of millions could die.

The health threat would likely set in motion further calamities. Reductions in foreign trade and travel are probable, because governments would attempt to lock down their borders to prevent the spread of the virus, experts predict.

In today's increasingly mobile world such actions are unlikely to slow disease transmission but may well devastate the international economy. Institutions, from businesses to relief agencies, would likely stagnate as illness became widespread.

No Panacea

Vaccines can be effective against some influenza strains, but they currently promise little help in the event of an avian flu pandemic.

"[Medical] technology has improved, but the capacity to make vaccines is not great," said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the Bethesda, Maryland-based National Institutes of Health.

"We have to be careful we don't assume we have everything that we need—because we don't."

Common-flu vaccines are routinely produced from poultry eggs but under systems that are far too slow to cope with the rapid spread of a bird flu pandemic.

"You can't make vaccine in advance, because you don't know for sure which virus will eventually be the cause of a new pandemic," explained Albert Osterhaus, director of the Netherlands' National Influenza Centre in Rotterdam.

"Once you have data showing that a new influenza virus is spreading rapidly, you need to develop a vaccine as soon as possible on the basis of the information you have on the virus."

The vaccine-production process is likely to take six months or a year. Even with a robust vaccine stockpile, health workers would be able to vaccinate perhaps only 15 percent of the global population, the new report says. That timetable is too slow for an efficient response to a pandemic that could circle the globe in months.

Other protective tools could help the world cope with a new virus pandemic. These include respirators, which could be worn to avoid inhaling viruses, and antiviral drugs, which could slow the rate of infection. Neither of these, however, is stockpiled in sufficient quantity, according to the study.

Some countries, particularly in Europe, are beginning to increase antiviral-drug reserves against a future pandemic. Other countries are attempting to create vaccines to innoculate their citizens in advance of a pandemic.

The United States is now testing specific vaccines for the H5N1 avian flu virus. "We need to prepare by developing a vaccine against the best bet—the H5N1 strain now circulating in Vietnam," said NIH's Fauci.

A pandemic strain is unlikely to be an exact match for an H5N1 vaccine or any other premade vaccine. There is hope, though, that such vaccines would be specific enough to afford some protection.

"Naysayers ask why we'd even stockpile [the vaccine], because the virus may change itself," Fauci said. "Well, I'd rather have a partially effective vaccine than no vaccine, and this is the only thing we have in our hand right now."

Heeding Global Wake-Up Call?

Despite such national efforts, experts agree that vastly improved international coordination is essential to preparing for the next pandemic. The issue is on the agenda for this summer's G8 summit in Scotland. (The G8 are the world's major industrial democracies: Canada, France, Germany, Italy, Japan, Russia, the United Kingdom, and the United States.)

Osterhaus, of the Netherlands' National Influenza Centre, calls for an international task force that could create and coordinate the many aspects of pandemic preparation, surveillance, and response.

"Rather than creating ad hoc responses, we need to really create a task force that's coordinating surveillance data of wild birds, domestic poultry, and humans, to link them," he said.

Experts call for plans for emergency services, food distribution, and temporary hospitals. They add that governments should determine who should first receive the limited supplies of vaccines and antiviral drugs—particulary with respect to health workers, who would be at great risk of infection.

Vaccine manufacturers must be encouraged to revamp operations in a way that would allow greater and more flexible production, several of the new Nature reports say. Last flu season's widely publicized vaccine shortages may offer a hint of the drawbacks of the current vaccine-production systems.

Vaccine makers are generally for-profit businesses that have to deal with an unpredictable demand for their products. Without financial incentives—such as guaranteed product demand, tax breaks, or protection against lawsuits—the vaccine-supply situation appears unlikely to improve.

"At this moment if we were to face a pandemic outbreak of flu in the next year or so, the world would be basically unprepared," Osterhaus said. "I think WHO [the UN's World Health Organization] is doing a tremendous job, but they are completely underfunded."

Stepped-up international efforts might also supplement weak or nonexistent national programs in countries that lack resources. Such countries include several Southeast Asian nations, where an avian influenza pandemic is likely to originate—and where it might be easiest to fight, in its early stages.

"We seem to be doomed to repeat these kinds of experiences time and time again, not just as countries but as a world," said the University of Minnesota's Osterholm.

"This is really a clarion call to the entire world—not just to governments but to the business community, to university presidents, to HMO medical directors," he said. We need to understand what needs to be done to get through the next pandemic."

Free E-Mail News Updates
Sign up for our Inside National Geographic newsletter. Every two weeks we'll send you our top stories and pictures (see sample).