Bird Flu: How Concerned Should We Be?

Fears of bird flu dominated last week’s headlines. First, scientists announced their discovery October 5 that the 1918 outbreak of influenza, which killed 50 million people, was caused by bird flu that jumped to humans. The same day, Senate Democrats proposed a bill calling for a “bird flu czar.” Then, October 6-7, world health leaders from more than eighty countries gathered in Washington, DC, to discuss the possibility of a bird-flu pandemic and devise a response to this threat. Eben Kaplan, research associate at cfr.org, asks four experts how concerned people should be about bird flu and what the most important preventative step policymakers should be taking.

The experts:

Laurie Garrett is a senior fellow for global health at the Council on Foreign Relations.

Rita Colwell is a professor at the University of Maryland and Johns Hopkins University.

Anthony Fauci is director of the National Institute of Allergy and Infectious Diseases at the National Institute of Health.

William Karesh is director of the Field Veterinary Program at the Wildlife Conservation Society and co-chair of the World Conservation Union’s Veterinary Specialist Group.

How concerned should we be about bird flu?

GARRETT: There are many reasons to be anxious, from a scientific point of view, about what is going on with the H5N1 virus [the avian influenza strain] in nature right now. It is appropriate and prudent for government leadership to take the threat extremely seriously. But for the average person, at this moment, the odds that you will become infected with this super-lethal flu are probably quite low. So, the answer is that if you are a policy leader you should be deeply concerned and should be moving to improve flu preparedness posthaste. But the average person should not be in conniption fits of paranoia.

COLWELL: We should be very concerned. Bird flu has the potential of being a severe economic, social, and security disaster for this country, but also for other countries. It’s a situation that [may never] occur, but the evidence that is accumulating—with the number of deaths since May [2005] more than doubling [bringing the number of reported deaths to sixty-two] and the statistics not completely available from all countries—as a microbiologist leads me to conclude that we need to be extremely concerned and worried about our ability to respond.

FAUCI: You cannot quantify concern when you have an unknown probability. I am concerned enough that I believe we should prepare for the worst-case scenario, even though it is unlikely to occur. It’s almost certain that within a reasonable period of time we will experience an influenza pandemic. It may be this year or a few years from now. The total uncertainty is how severe the pandemic will be. In the twentieth century, we had three pandemics: The 1918 pandemic was a public-health catastrophe, while the 1968 pandemic was relatively mild. It’s impossible to predict.

KARESH: I think serious concern is warranted, and steps need to be taken immediately to reduce the likelihood of the avian influenza becoming established in humans as well as prepare for the possibility that it may. [Taking these steps] will put the world in a better position for the future, regardless of the current H5N1 strain becoming a pandemic or not.

What is the most important preventative step that can be taken by policymakers to avoid a disaster?

KARESH: Every human case provides the opportunity for the current strain of H5N1 avian influenza to change its ability to infect people. Rather than waiting to treat hundreds of thousands of people once the virus becomes established, the most effective—and far less expensive—approach is to focus upstream at the source. Right now, the major risk factor for avian influenza infecting humans is the direct contact of humans with infected domestic poultry. Like buying lottery tickets, every contact with an infected chicken or domestic duck provides an additional opportunity for human infection. Any investment to reduce the incidence of the disease in poultry will automatically reduce the human contact numbers, and teaching people in affected countries about how the disease is spread and controlled, as well as the simple basics of hygiene, will further reduce the odds of human infection. Further upstream, understanding the dynamics of the virus in wild birds could provide us with early-warning systems as well as some clues about inherent disease resistance. Ben Franklin said, “An ounce of prevention is worth a pound of cure.” I would venture to even reduce that by a factor of ten and say, $100 million in controlling the disease in poultry is worth $16 billion in Tamiflu [a flu vaccine].

FAUCI: We desperately need to strengthen the vaccine production capacity in this country, such that we can have available within a reasonable period of time, from the onset of a pandemic, a vaccine dose for every American.

GARRETT: The list of things that need doing is so long, I would have a hard time saying that there is just one [step]. There is no single thing that government or the United Nations could do at this time if the virus manages to mutate into a human-to-human transmissible form that would fundamentally eliminate the probability of a pandemic. There are a number of things that can be done that would limit the probability of a devastating pandemic if we’re lucky, and the virus mutates slowly, and we have a few years to get ready.

COLWELL: There’s no single magic bullet. We need to fix the capacity to produce vaccine. We have a candidate vaccine, but we wouldn’t be able to put it into production for months, maybe years. We need to address the public-health infrastructure as soon as possible, and that includes communication between the lay public, organizations, citizen groups, and first responders. [We need] education that doesn’t frighten everybody to death but gives them an empowerment; we need to increase our communication with other countries, which allows us to be able to coordinate our responses to the pandemic threat. In addition, we need to continue and expand our technical capability to be able to determine genetically, that is to sequence and use that information to monitor the changes that are taking place as the virus evolves in its interaction between its animal and human hosts. That is particularly important, especially considering the flyways of the involved population of birds that seem to be carrying it to other countries. So there are many other things that we should be doing, and we should be doing them simultaneously, not sequentially. As I’ve said many times, the environment doesn’t respond linearly to impingements upon it. It’s a complex problem; we need a complex, but coordinated response.