Table of Contents:

Foreword

Introduction

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

Topics

References 1-3,199

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When is the pandemic going to strike? The experts are vague on this point: “probably sooner rather than later,”618 “any time now,”619 “this year or next”620 are common refrains. Some wonder why it hasn’t happened already.621 “It’s tough to make predictions,” said Yogi Berra, “especially about the future.”

Some have attempted to take comfort in the fact that the virus has been in existence for almost ten years and hasn’t sparked a pandemic yet.622 Evidence suggests, though, that the 1918 virus was “smouldering” for at least 11 years before it went pandemic.623 A WHO and USDA research team agree: “It is probably dangerous to rely on the ‘if it were going to happen it already would have’ argument….”624

Even if greater numbers of people start falling ill, the virus may still need to fine-tune its human appetite. Historians have found evidence of suspicious outbreaks of severe respiratory illness in the year preceding the pandemic of 1918. “We think these outbreaks in these army camps started in 1917,” concluded one expert, “then it took another year of an extra few mutations before it really exploded into the great wide world.”625 Gerberding told a meeting of the American Association for the Advancement of Science that H5N1 represented the “most important threat” the world is currently facing. She said, “I think we can all recognize a similar pattern probably occurred prior to 1918.”626

Unlike annual seasonal influenza, which tends to strike the northern hemisphere in winter,627 pandemics have been known to occur at any time of the year.628 Although there does not seem to be a concrete seasonal pattern, based on an analysis of past pandemics, appearance in the summer was more common than the winter,629 which may coincide with the placing of ducks onto China’s flooded rice fields.630 The increased poultry sales and mass travel in the days leading up to the Tet Lunar New Year festival (which starts February 9) may also be a high-risk time.631 Experts admit that they really don’t know.

“It would be irresponsible to say we are absolutely going to get there this year or next year because we just don’t understand virus evolution enough,” says one Harvard epidemiologist. “It is, I think, correct to say that we are in a period where the risk is growing and where it’s higher than we’ve ever known it to be.”632 What most scientists do agree on is that each day brings us one day closer to the pandemic, though they admit it is unknown which virus will ultimately trigger the pandemic or how severe the next one will be.

“With the advent of AIDS, avian flu, Ebola and SARS,” a Tulane researcher notes, “the question of what launches new epidemics and pandemics is extremely important. The somewhat shocking answer is that we actually know nothing about the factors that launch animal viruses into epidemics or pandemics.”633 A few scientists have toyed with the idea of trying to find out.

By mixing H5N1 and human influenza viruses together in a lab, one might be able to estimate how much time we might have left by identifying how many mutations H5N1 may be away from creating a pandemic strain. The World Heath Organization is cautious about this approach and has called for a formal scientific consensus, believing that global decisions that entail global risks require global review. For any one country to undertake the project on its own, WHO’s principal flu scientist Klaus Stöhr said, “is like a decision to start testing nuclear weapons unilaterally.”634 Proponents argue that any pandemic H5N1 virus they create would be sequenced, but then promptly be destroyed. With a genetic description of the virus, though, and the easy availability of its progenitors, it could be recreated. “You can destroy this virus,” one critic remarked, “but it will never really be gone.”635 The Dutch scientist who proposed the original idea admitted, “You could create a monster. But it’s a monster that nature could produce as well.”636