What kind of response does a 10 per cent probability of disaster warrant?

That’s the figure calculated by Australian experts in assessing the likelihood of the H5N1 avian flu virus triggering a worldwide pandemic. For Dr. Peter Curson, Health Studies Program director at Macquarie University in Sydney, Australia, the threat is significant enough to insist upon greater preparedness: “Most government messages about the pandemic have largely been reassurances rather than warnings, and one must question whether the latter would have more impact. An important way of raising public consciousness is to get people involved whether locally, regionally, or nationally. It’s a good way of confronting denial and disinterest, and if you involve people you are likely to get better results and better understanding of the issues.”

Dr. Curson anticipates fear and panic as a response to a pandemic.

“Stressing this might allow people to cope better,” he comments, “and build up personal preventive strategies. Fear of contagion and infection is probably one of the most deep-seated of human fears. Past epidemics reveal just how much expressions of fear and panic can paralyze the normal functions of society. What is needed is better communication of the threat, particularly to address the first human reaction of denial and apathy. Not stressing how frightening or threatening a pandemic would be, and telling people not to be frightened about something which in essence is exceedingly threatening, is as good as encouraging disinterest and denial.”

Acquiring that all-important understanding begins with a look at the virus itself, which is transmitted from bird to bird, and in some cases to humans. The spread is insidious, moving primarily from poultry stocks to wild birds, and occasionally to people, who are usually infected while handling a carcass. Asia, Europe and Africa are now at peril from migratory birds, intensifying fears of a major pandemic. The danger persists that H5N1 will mutate, and become easily transmissible between people, a worst-case scenario that has experts like Dr. Curson urging more action.

Since there is currently no vaccine for H5N1, antiviral medication represents the only means of combating a pandemic. The most promising of these is Tamiflu, which is being stockpiled in numerous countries, including Australia.

“In my opinion there is a legitimate role for Tamiflu in providing short-term protection against the flu,” says Dr. Rachael David, director of public affairs for CSL Limited, a global biopharmaceutical company based in Melbourne, Australia (www.csl.com.au).

“The government here has a stockpile of doses for use in pandemic. This is insufficient to protect the whole population, but is sufficient to protect health, emergency and other critical workers for several weeks. Its limitations are that there are insufficient supplies to use for entire populations, it is relatively expensive, duration of protection is short, and it is possible that pandemic flu viruses may ultimately develop resistance to it. For these reasons, a vaccine solution is the only comprehensive solution to the pandemic problem.”

On a positive note CSL is progressing in its attempts to create a flu vaccine for the H5N1 virus. “We have developed some test doses of a vaccine against the current strain of H5N1 associated with avian flu in Asia,” reports Dr. David. “Two different doses will be tested in healthy adult volunteers, with and without adjuvants. The results should be available by December this year.”

The sooner a vaccine is available the greater the chance of averting a pandemic, at least from this strain. In the meantime, there’s little people can do except wait and hope.

“In a globalized world where people travel around a lot and where most places are interconnected, avoiding something like influenza becomes difficult,” notes Dr.Curson. “Personal masks, hygiene, avoidance strategies might help—flu shots might lessen the effects, simple things like sneezing, coughing into tissues and then destroying them. But many people are infected by touching a surface that some one has coughed/sneezed over sometime before and then say rubbing their nose. How do you know that the mail you collect hasn't just been sneezed over by the delivery person?”

The threat of infectious disease is magnified by air travel, which played such a dramatic role in the spread of SARS. A serious outbreak of this deadly respiratory ailment occurred in Canada following the return of a single infected person from Asia.

“The globalization of infectious disease is a critical issue for the next few years,” comments Dr.Curson. “Given the interconnected nature of the world, and the fact that more people (not to mention goods), now travel more than ever before, and in most cases their journeys are far less than the incubation time of most infections, plus the rise of eco-tourism to exotic, remote locations—all means that in health terms the ‘national’ has become irrelevant and been replaced by the ‘international.’ Infectious disease is now literally just a plane flight away. Add all this to our continued ignorance of the interconnections between animals (wild and domesticated), and our own health, and the fact that we continue to intrude on or modify pristine environments where zoonotic infections are entrenched, then we are looking at an interesting infectious future.”

During the Spanish flu pandemic of 1919, a number of small communities in North America isolated themselves from all outside contact; some placing armed guards along roads to prevent entry or exit. They succeeded in preventing the spread of disease, but Dr. Curson doubts the effectiveness of such a strategy today: “In Australia during 1919 people did flee from Sydney up to the Blue Mountains (in some cases carrying the flu with them!). I guess that isolated rural communities might be slightly safer than elsewhere—but is it possible to be isolated in our modern world?”



With a stockpile of four million doses of antivirals such as Tamiflu, Australia is better prepared to face a pandemic than most countries. Yet Dr.Curson finds many flaws in the nation’s Influenza Pandemic Management Plan. Here is a list of government objectives, followed by his comments:

• Identify the disease agent and its location ASAP. Limit geographical spread: “It is unlikely the spread of influenza could be halted.”
• Increased surveillance at airports: “Presumes that symptoms are readily identifiable—SARS demonstrates how hard this is. Perhaps we will see scanning of temperature at airports again.”
• Reduce opportunities for infection by quarantine: “Home quarantine raises other issues. Would people go home and stay there? How easy would it be to maintain essential supplies to them, be enthusiastic about delivering to a suburb designated as infected? What about loss of income and compensation? And the home quarantine during SARS in Canada raised many psychological issues of isolation, depression etc.”
• Ensure that key health/emergency personnel are protected: “In Australia we are told that the healthcare sector could cope, but I doubt it very much. I cannot see the present system coping with say 2,000 severely ill people being admitted to hospital every day for two or three months. And presumably, key healthcare workers would also be ill. Would we see schools etc., being converted into temporary influenza hospitals staffed by volunteers—probably? Would local GPs be able to cope with a 10/20-fold increase in patients each day?”