Ward off a pandemic
By Paula Dobriansky
Published November 16, 2005

If avian flu, caused by the virulent influenza strain known as H5N1,
sparks a pandemic among humans, no country will be safe. Indeed, if the
virus mutates to pass easily between humans and is allowed to spread
rapidly, the ensuing pandemic could cripple economies, bring
international trade and travel to a standstill, and devastate entire
societies. To respond to this threat, the Bush administration has
launched an unprecedented international effort.
   Why is avian flu so worrying? First, it is uncommonly deadly in
animals. In birds, the virus is highly contagious and has led to the
deaths of more than 150 million of them in Cambodia, China, Indonesia,
Japan, Kazakhstan, Laos, Malaysia, Mongolia, Russia, Thailand, Vietnam
and, most recently, Romania, Turkey and Greece. Infected migratory
birds threaten flocks and, therefore, people in Europe, the Middle East
and Africa. Second, since H5N1 has infected humans only since 1997,
people have not developed immunity. In known cases of human infection,
more than half die. Victims, mostly in Southeast Asia, now number more
than 60. Third, there is potential evidence of limited human-to-human
transmission. If the virus mutates to facilitate easier human-to-human
transmission, the end result could be a pandemic.
   The 1918 Spanish Flu pandemic killed more than 40 million people,
and scientists consider another flu pandemic of that scale a worrying
possibility. What we do not know is whether a pandemic will come next
week, next year or next decade.
   Since no country can successfully combat avian flu alone, all
countries must join in the fight. The costs of inaction vastly exceed
the cost of enhanced preparedness, surveillance, response and
containment. The 2003 SARS outbreak cost more than 700 lives and some
$80 billion worldwide.
   To avoid the much higher toll of a flu pandemic, all countries must
elevate the need to address avian flu on their national policy agendas
and commit appropriate resources. They must educate their publics,
especially in rural communities, and improve surveillance and reporting
procedures. Flu viruses first spread slowly and locally, then
exponentially and widely, so a flu pandemic can be stopped only if
outbreaks are detected early, reported to the World Health Organization
and international community, and treated quickly through containment
and the administration of antiviral drugs.
   An enhanced capacity for rapid response and coordination should be
put in place now. With the lives of millions at stake, doing anything
else is both dangerous and immoral.
   Recognizing the need for an effective global response, the
president announced the International Partnership on Avian and Pandemic
Influenza at the September meeting of the U.N. General Assembly. The
president is personally engaged and has raised this issue directly
with, among others, the presidents of China, Indonesia and Russia, as
well as the prime minister of Thailand.
   This week, during the Asia Pacific Economic Cooperation Leaders'
Meeting in Pusan, Korea, he will also highlight the urgent need to take
action. He has met with representatives of the major pharmaceutical
companies, whom he encouraged to develop and produce vaccines and
anti-flu medicines faster. Our country is working closely with the
private sector and more than 90 partner countries and organizations,
such as the United Nations, World Health Organization, Food and
Agriculture Organization, World Animal Health Organization (OIE), the
World Bank, Asia Pacific Economic Cooperation forum and Association of
Southeast Asian Nations.
   Within the United States, agencies across the federal government
are working jointly to implement a $7.1 billion national strategy for
combating pandemic influenza. Recently, Secretary of Health and Human
Services Secretary Mike Leavitt and I met with key partners in
Southeast Asia to engage senior government leaders in the anti-flu
effort. The United States has sent two additional multi-agency missions
led by USAID to work with health and agriculture experts abroad and
offer assistance.
   The State Department hosted a major international meeting to
develop and implement a comprehensive global strategy to combat avian
flu. We have already committed $38 million to prevent the spread of
avian influenza in Southeast Asia and the President has just requested
an additional $251 million to detect and contain outbreaks around the
world. These monies fund such vital measures as preparedness plans,
expanded surveillance and testing activities, training of first
responders and purchase of protective gear.
   Avian flu has not yet mutated in a way that threatens to become a
pandemic. If we are lucky and proactive, it never will. But even if
H5N1 does not spark a pandemic, another strain could. To prepare, we
must work globally and we must work together. When nature strikes, we
must be ready.

   Paula Dobriansky is undersecretary of state for democracy and
global affairs.