THE ARRIVAL OF avian flu in Africa means that the bird epidemic is officially out of control. None of the methods used against it so far -- mass vaccination of poultry flocks in China, mass bird slaughter across Southeast Asia -- has prevented wild birds from spreading the H5N1 virus across the globe, to Italy, Greece, Bulgaria and Azerbaijan, as well as Siberia and Indonesia. The flu has probably been killing birds in Africa for many months and will probably not be stopped: In poor countries with weak or nonexistent veterinary controls, where chickens are the only source of protein and no compensation for farmers for loss of their livestock is likely, it will be impossible to enforce either mass vaccinations or mass slaughter.
Knowing the flight path of migratory birds, many predicted the disease would arrive in Africa. But predicting a disaster and being prepared for a disaster -- as this country learned during Hurricane Katrina -- are not the same thing. Despite high-level attention paid to this issue, by President Bush as well as the United Nations, neither Africa nor the international community is even remotely prepared for an epidemic of avian flu or for a human disease that could develop if the virus mutates.
Congress has allocated $280 million for flu surveillance and preparedness abroad, but none of that money has been spent yet. The United Nations has appointed David Nabarro, a senior flu expert, to coordinate international efforts -- but many donors' projects still duplicate one another. The international health system, such as it is, remains totally inadequate. The World Health Organization cannot send more than a handful of officials to any one country. The Food and Agriculture Organization, which theoretically deals with the animal side of the problem, employs fewer veterinarians than the U.S. Centers for Disease Control and Prevention. So strapped is the world for health personnel that after conducting a flu pandemic simulation exercise at the recent World Economic Forum in Davos, Switzerland, Mr. Nabarro stated that the maintenance of water and power systems in a real pandemic might prove key, since it may become "more important to concentrate on the essentials of life for those who are living than it is to focus on the treatment of those who are sick."
Progress has been made in the realm of antivirals, drugs such as Tamiflu and Relenza that can relieve flu symptoms. Roche, the maker of Tamiflu, is negotiating licensing agreements with companies in China, India and Vietnam so that they can produce generic versions. The WHO has a stockpile of Tamiflu, enough to be used in a concentrated manner should one or two outbreaks begin in a country with no stockpile of its own (as is the case in most of Africa). But it is no closer to mass capability than the United States, which has a stockpile of 4.3 million courses of Tamiflu. The administration's goal is 81 million courses, but no one knows when it will be reached. Of course, there is
no guarantee that antivirals work: The virus may mutate and become resistant to Tamiflu anyway.
Given the overwhelming challenges of preparation as well as the uncertainties surrounding antivirals, it would make the most sense to focus on a vaccine. And vaccine research is being carried out, in Vietnam, China, Russia and Hungary, as well as the United States. But although meetings among international scientists will be held this summer, in the hopes that they will exchange information and speed up research, officials at the Department of Health and Human Services agree that they still "don't have visibility" about what everyone is doing. Furthermore, some U.S. companies say that they remain confused about this country's vaccine development program, which lacks a timeline, leadership and clear incentives for the private sector.
In other words, cross your fingers. Maybe the pandemic will never come.