Editorial: Conflicting messages on bird flu

Creating the right public response to the threat of an influenza pandemic involves treading the finest of lines. Constant reassurance that there is nothing much to worry about encourages complacency and, at worst, a state of denial. On the other hand, forecasts of widespread death and illness risk prompting an irrational reaction bordering on hysteria.

This week, we have had conflicting messages from those whose job is to find that line. The new Minister of Health, Pete Hodgson, cheerfully informed us that we are one of the best-prepared countries in the world for bird flu. Virtually at the same time, however, his ministry was postulating that more than 30,000 New Zealanders could die if the next pandemic was as serious as the 1918 Spanish flu.

The Ministry of Health is clearly determined to rid us of any apathy and indifference cultivated by Y2K and Sars. We should not, it suggests, count on this country's remoteness providing immunity, or on bird flu proving to be a false alarm. The manner of delivering that message was, however, surprisingly and probably unnecessarily alarmist.

Taking New Zealand's experience of the 1918-19 global outbreak and using mathematical modelling to extrapolate it to the present is an extremely crude device. So rudimentary, in fact, that the outcome could hardly be said even to qualify as a worst-case scenario.

It pays no heed, for example, to our vastly improved understanding of, and response to, influenza pandemics. Something like the presumed cause of the 1918 pandemic - the failure to quarantine a flu-stricken ship, the Niagara, because of the presence on board of the Prime Minister of the day, Bill Massey - would never happen today. Also overlooked is the way our improved knowledge severely diminished the impact of two subsequent outbreaks.

This, then, is the ministry using the bluntest of instruments to stir a response. Yet the bare figures it arrives at - 1.64 million New Zealanders becoming ill and 32,857 dying - are also the sort to invite panic. It seems somewhat over the top to state them baldly, without reference to a century of dramatic medical advance. Or to fail to place them squarely in the context of the present bird flu outbreak, and specifically the fact that there is still no evidence the disease can mutate like the Spanish flu virus and be spread from human to human.

What people need, rather than ill-formed postulation, is specific information that will enable them, individually, to arrive at a rational response. Knowledge that will allow each of them to manage during an outbreak. We need, for example, to know where we would stand in the queue for Tamiflu, the antiviral treatment. And precisely how eligibility has been determined. By the end of next month, New Zealand will have enough Tamiflu courses to treat only a fifth of the population.

Clearly, most people would have to rely on their own resources. We, therefore, need to know the best preventative strategies, and how to be prepared for, and to handle, a house-bound existence. Thus far, such information has not been distributed in anything like a methodical manner. A planning kit released by the Ministries of Health and Economic Development was designed mainly for business use. A similar guide for the individual must be made available.

The scary scenario delivered by health officials makes such a kit doubly important. It, and further advice, must be distributed as quickly, efficiently and widely as possible. If a flu pandemic is, indeed, inevitable, we are going to need all the information we can get - sooner or later.