Michael Richardson: Need for speed to tackle killer virus

As a feared strain of avian influenza reaches Europe after spreading across Asia, threatening to trigger a global flu pandemic that could kill millions of people, political leaders are scrambling to galvanise a more effective international response.

The deadly H5N1 strain of the bird flu virus was confirmed on Saturday to have reached Romania, making its first appearance in Europe following an outbreak in Turkey last week. European European veterinary and public health officials held an emergency meeting to advise governments in the 25-nation bloc on measures to try to prevent the virus from infecting humans.

Visiting Southeast Asia last week, United States Health Secretary Michael Leaflet urged governments to work faster to prepare for an inevitable pandemic.

The Bush Administration has hosted a two-day meeting of officials from more than 65 nations concerned about preventing the spread of the H5N1 virus.

The World Health Organisation has confirmed at least 116 human cases of bird flu and 60 deaths in Vietnam, Thailand, Cambodia and Indonesia since late 2003.

The Washington meeting agreed on the need for quick and accurate reporting of potential bird flu outbreaks, donor support for developing countries that have been or might be affected, and a pledge to work closely on the issue with WHO.

Late last month, UN Secretary-General Kofi Annan appointed former WHO official David Nabarro as senior UN system co-ordinator for avian and human influenza.

Australia will host a regional meeting of pandemic management co-ordinators and health and quarantine officials at the end of this month to discuss an Asia-Pacific response. Just a few days earlier, Canada is to hold a conference of high-level officials on bird flu.

Meanwhile, the WHO has called a meeting in Geneva next month to muster funding. The Association of South East Asian Nations has agreed on a three-year plan to control and eradicate bird flu. China, too, issued a national preparedness plan last month, including guidelines on logistics and disease surveillance, a colour-coded alert system and injunctions to local governments to draw up their own contingency plans to cope with a possible outbreak of avian influenza among humans within its borders.

But while the battle lines are being drawn up, they still appear to be largely inadequate to the task. By the end of the first week in October, only 40 of the WHO's 192 member states had drawn up pandemic preparedness plans, according to Margaret Chan, the agency's top official in the area. She was the head of Hong Kong's health department in 1997, when bird flu first made the jump from poultry to humans.

Only about 30 countries, mainly wealthy ones, have stockpiled or ordered antiviral medicines for treating bird flu victims. Some of the drugs are being sent to epicentre countries such as Indonesia that cannot afford large stocks.

There are no effective vaccines against bird flu, although laboratories in the US and other nations are racing to try to develop them.

Preparations to counter a global flu attack are being complicated because intelligence is weak, and the shape and power of the enemy remains far from clear.

"The pandemic risk is great, the timing is unpredictable and the severity is uncertain," Ms Chan said last week. "Early warning systems, which are critical to get information and intelligence, are very weak in most countries."

If the H5N1 virus changes so that it can pass easily from person to person, no one yet knows what the infection and death rate will be.

In its recent form, the virus kills over half those it infects. Of the three global flu pandemics in the last century, by far the worst was in 1918 when so-called Spanish flu killed about 40 million people.

Preliminary findings from research in the US show that the 1918 outbreak was caused by an avian flu virus. Because the virus is coming from animals, humans have no or low immunity.

Scientists and epidemiologists have made widely varying predictions of the death toll in any new bird flu pandemic. They range from fewer than 2 million to as many as 360 million. The WHO says the most likely outcome would be somewhere between 2 million and 7.4 million deaths.

According to the New York Times, a draft plan drawn up by Mr Leavitt's health department to cope with a flu crisis says a large outbreak that began in Asia would be likely to reach the US within a few months or even weeks, carried by aircraft passengers or other travellers. Quarantine and travel restrictions would not be effective because of the contagious nature of the disease.

The final plan is expected to be released later this month. The New York Times says the draft warns that if a major pandemic occurred, hospitals would be overwhelmed, riots would engulf treatment clinics, and even power and food would be in short supply as people failed to report for work because they were ill or afraid of becoming sick.

The draft plan outlines a worst-case scenario in which more than 1.9 million Americans would die and 8.5 million would be admitted to hospital, with costs exceeding US$450 billion ($644 billion).

* Michael Richardson, a former Asia editor of the International Herald Tribune, is a visiting senior research fellow at the Institute of Southeast Asian Studies in Singapore.