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cials renewed their appeal for more international aid, H5N1 was claiming new victims in the country that remains of chief concern to the WHO.
The bottom line is that avian influenza is endemic and probably ineradicable among poultry in Southeast Asia, and now seems to be spreading at pandemic velocity amongst migratory birds, with the potential to reach most of the earth in the next year.
Each new outpost of H5N1 -- whether among ducks in Siberia, pigs in Indonesia, or humans in Vietnam -- is a further opportunity for the rapidly evolving virus to acquire the gene or even simply the protein mutation that it needs to become a mass-killer of humans.
This exponential multiplication of hot spots and silent reservoirs (as among infected but asymptomatic ducks) is why the chorus of warnings from scientists, public-health officials, and finally, governments has become so plangently insistent in recent months.
The new U.S. Health and Human Services Secretary Mike Leavitt told the Associated Press in early August that an influenza pandemic was now an "absolute certainty," echoing repeated warnings from the World Health Organization that it was "inevitable." Likewise Science magazine observed that expert opinion held the odds of a global outbreak as "100 percent."
In the same grim spirit, the British press revealed that officials were scouring the country for suitable sites for mass mortuaries, based on official fears that avian flu could kill as many as 700,000 Britons. The Blair government is already conducting emergency simulations of a pandemic outbreak ("Operation Arctic Sea") and is reported to have readied "Cobra" -- a cabinet-level working group that coordinates government responses to national emergencies like the recent London bombings from a secret war room in Whitehall -- to deal with an avian flu crisis.
Little of this Churchillian resolve is apparent in Washington. Although a sense of extreme urgency is evident in the National Institutes of Health where the czar for pandemic planning, Dr. Anthony Fauci, warns of "the mother of all emerging infections," the White House has seemed even less perturbed by migrating plagues than by wanton carnage in Iraq.
As the President was packing for his long holiday in Texas, the Trust for America's Health was warning that domestic preparations for a pandemic lagged far behind the energetic measures being undertaken in Britain and Canada, and that the administration had failed "to establish a cohesive, rapid and transparent U.S. pandemic strategy."
That increasingly independent operator, Senate majority leader Bill Frist (R-Tenn.), had already criticized the administration in an extraordinary (and under-reported) speech at Harvard at the beginning of June. Referring to Washington's failure to stockpile an adequate supply of the crucial anti-viral oseltamivir (or Tamiflu), Frist sarcastically noted that "to acquire more anti-viral agent, we would need to get in line behind Britain and France and Canada and others who have tens of millions of doses on order."
The New York Times on its July 17 editorial page, a May 26 special issue of Nature and the July/August issue of Foreign Affairs have also hammered away at Washington's failure to stockpile enough scarce antivirals -- current inventories cover less than 1% of the U.S. population -- and to modernize vaccine production. Even a few prominent Senate Democrats have stirred into action, although none as boldly as Frist at Harvard.
The Department of Health and Human Services, in response, has sought to calm critics with recent hikes in spending on vaccine research and antiviral stockpiles. There has also been much official and media ballyhoo about the announcement of a series of successful tests in early August of an experimental avian flu vaccine.
But there is no guarantee that the vaccine prototype, based on a "reverse-genetically-engineered" strain of H5N1, will actually be effective against a pandemic strain with different genes and proteins. Moreover, trial success was based upon the administration of two doses plus a booster. Since the government has only ordered 2 million doses of the vaccine from pharmaceutical giant Sanofi Pasteur, this
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