Table of Contents:



I. Storm Gathering

1. 1918

2. Master of Metamorphosis

3. H5N1

4. Playing Chicken

5. Worse Than 1918?

6. When, Not If

II. When Animal Viruses Attack

1. The Third Age

2. Man Made

3. Livestock Revolution

4. Tracing the Flight Path

5. One Flu Over the Chicken's Nest

6. Coming Home to Roost

7. Guarding the Henhouse

III. Pandemic Preparedness

1. Cooping Up Bird Flu

2. Race Against Time

3. Tamiflu

IV. Surviving the Pandemic

1. Don't Wing It

2. Our Health in Our Hands

3. Be Prepared

V. Preventing Future Pandemics

1. Tinderbox

2. Reining in the Pale Horse


References 1-3,199

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—NIH director Anthony Fauci580
Senate Majority Leader Frist

In a talk at his alma mater, Harvard Medical School, Senate Majority Leader Frist described the horrors of 1918—at least 50 million dead from an “avianlike” virus.581 Frist asked:
How would a nation so greatly moved and touched by the 3,000 dead of September 11th react to half a million dead? In 1918–1919 the mortality rate was between 2.5% and 5%, which seems merciful in comparison to the 55% mortality rate of the current avian flu. In just 18 months, this avian flu has killed or forced the culling of more than 100 million animals. And now that it has jumped from birds to infect humans in 10 Asian nations, how many human lives will it or another virus like it take? How, then, would a nation greatly moved and touched by 3,000 dead, react to 5 or 50 million dead?582
Other public health authorities have expressed similar sentiments on a global scale. World Health Organization executive director David Nabarro was recently appointed the bird flu czar of the United Nations. At a press conference at UN headquarters in New York, Nabarro tried to impress upon journalists that “we’re dealing here with world survival issues—or the survival of the world as we know it.”583 “The reality is that if a pandemic hits,” explained the executive director of Trust for America’s Health, a public health policy group, “it’s not just a health emergency. It’s the big one.”584

Similar fears reportedly keep U.S. Secretary of Health and Human Services Mike Leavitt awake at night. “It’s a world-changing event when it occurs,” Leavitt said in an interview. “It reaches beyond health. It affects economies, cultures, politics and prosperity—not to mention human life, counted by the millions.”585 Yes, but what are the odds of it actually happening?

What are the odds that a killer flu virus will spread across the world like a tidal wave, killing millions? “The burning question is, will there be a human influenza pandemic,” Secretary Leavitt told reporters. “On behalf of the WHO, I can tell you that there will be. The only question is the virulence and rapidity of transmission from human to human.”586 The Director-General of the World Health Organization concurred: “[T]here is no disagreement that this is just a matter of time.”587 “The world just has no idea what it’s going to see if this thing comes,” the head of the CDC’s International Emerging Infections Program in Thailand said, but then stopped. “When, really. It’s when. I don’t think we can afford the luxury of the word ‘if’ anymore. We are past ‘if’s.’”588

The Chief Medical Officer of Great Britain,589 the Director-General of Health of Germany,590 the director of the U.S. Centers for Disease Control,591 the Senior United Nations Coordinator for Avian and Human Influenza,592 and the director of the U.S. National Security Health Policy Center593 all agree that another influenza pandemic is only a matter of time. As the director of Trust for America’s Health put it, “This is not a drill. This is not a planning exercise. This is for real.”594