Battleangel

On a wing and a prayer

This issue’s focus on avian flu highlights progress and incoherence in the world’s response to a potential human pandemic. But the threat is enormous, and some priorities are clear enough.

Millions of people killed in highly developed countries within months. Tens of millions worldwide. The global economy in tatters. A Hollywood fantasy? No — it’s now a plausible scenario. The first act, the spread of avian flu to, and probably between, humans, has already started across Asia. Unless the international community now moves decisively to mitigate this pandemic threat, we will in all probability pay heavily within a few years. Then, hard questions will be asked as to why we were not prepared.

Sceptics abound, convinced that talk of a pandemic must be scare-mongering, or scientists crying wolf. Surely with support care, drugs and vaccines, at least the rich world can easily stand up to a flu virus? After all, this is 2005, not 1918, when a flu pandemic killed up to 50 million people worldwide. But while the science and medicine of flu have advanced substantially, our ability to mount an effective public-health response has made remarkably little progress over the decades, and the potential for panic is, if anything, greater given the impact of television and the Internet.

In the 1918 pandemic, no one had immunity to a new subtype of the influenza virus. The maths of epidemiology says that pandemics are like fault lines: they inevitably give. But unlike earthquakes, pandemics tend to give warning signs, and all the alerts from Asia are now flashing red. Will it be the ‘big one’? No one can say with certainty, but the H5N1 flu strain now circulating widely in Asia, and several of its cousins, are ones to which we humans have no immunity. Accordingly, the world now needs to develop defences for the worst-case scenario. How prepared are we?

Extinguishing avian flu in poultry and pigs, the melting-pot from which a pandemic strain would probably emerge, is the job of national agriculture and veterinary departments, the United Nations’ Food and Agriculture Organization, and the World Organisation for Animal Health (OIE). The public-health aspects are the responsibility of health departments and the World Health Organization (WHO). This international coalition is shaky and far from united or sure in its purpose. Its efforts are grossly underfunded, and undermined at every turn by conflicts between global public health, sovereignty and the stakes of trade and economics.

Source and full text: Nature 435, 385-386 (26 May 2005) [index]

Very interesting reading. Nature again takes the lead and explains what has to be done if we are to stand prepared at the coming pandemic. Too doom-laden? Perhaps a bit. But the warning signs are impossible to ignore.

The entire avian flu feature of last week’s issue seems to be available freely online for anyone to read btw.