Wide Angle. H5N1 · Killer Flu

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H5N1 influenza -- the powerful virus that is raging through the bird flocks of Asia -- has successfully made the leap to humans, infecting hundreds of people and killing 58 as of September 2005. It has not yet become easily transmissible from person to person, but the medical community is preparing for the possibility. Clinical trials of a human vaccine against H5N1 are continuing with promising initial results, and experiments with a number of new vaccine production methods and alternative drug treatments are underway. Similarly, the antiviral drug Tamiflu (oseltamivir) has shown promise against H5N1 in laboratory testing. Whether the vaccine or drug treatments will prove effective in the event of an actual pandemic, and whether the pharmaceutical industry will be able to ramp up production levels in order to provide enough doses to protect the entire human population remain open questions.

Read this week's briefing (below) and learn about the dangers posed by H5N1 avian influenza, as well as the political, public health, and medical challenges the world's nations must overcome in order to fight the flu.

The Next Pandemic?
by Laurie Garrett
Excerpted from the July/August 2005 issue of FOREIGN AFFAIRS

PROBABLE CAUSE

Scientists have long forecast the appearance of an influenza virus capable of infecting 40 percent of the world's human population and killing unimaginable numbers. Recently, a new strain, H5N1 avian influenza, has shown all the earmarks of becoming that disease. Until now, it has largely been confined to certain bird species, but that may be changing.


1889-1890	The first known influenza pandemic kills an estimated one million people across Europe and Asia. Doctors at the time were unable to identify or treat the disease.
1918-1919	An estimated 25-40 million people die worldwide of the "Spanish Flu," though contemporary experts believe as many as 100 million -- almost 5 percent of the world's population at the time -- may actually have perished. Recent research has identified the culprit as a flu virus subtype known as H1N1, believed to have originated in birds.
1933	Identification of a virus as the cause of influenza.
1946-1947	A killed-virus flu vaccine is developed by Thomas Francis and Jonas Salk (who would later go on to collaborate on the polio vaccine).
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The havoc such a disease could wreak is commonly compared to the devastation of the 1918-19 Spanish flu, which killed 50 million people in 18 months. But avian flu is far more dangerous. It kills 100 percent of the domesticated chickens it infects, and among humans the disease is also lethal: as of May 1, about 109 people were known to have contracted it, and it killed 54 percent (although this statistic does not include any milder cases that may have gone unreported). Since it first appeared in southern China in 1997, the virus has mutated, becoming heartier and deadlier and killing a wider range of species....

In short, doom may loom. But note the "may." If the relentlessly evolving virus becomes capable of human-to-human transmission, develops a power of contagion typical of human influenzas, and maintains its extraordinary virulence, humanity could well face a pandemic unlike any ever witnessed. Or nothing at all could happen. Scientists cannot predict with certainty what this H5N1 influenza will do. Evolution does not function on a knowable timetable, and influenza is one of the sloppiest, most mutation-prone pathogens in nature's storehouse.

Such absolute uncertainty, coupled with the profound potential danger, is disturbing for those whose job it is to ensure the health of their community, their nation, and broader humanity. According to the Centers for Disease Control and Prevention (CDC), in a normal flu season about 200,000 Americans are hospitalized, 38,000 of whom die from the disease, with an overall mortality rate of .008 percent for those infected. Most of those deaths occur among people older than 65; on average, 98 of every 100,000 seniors with the flu die. Influenza costs the U.S. economy about $12 billion annually in direct medical costs and loss of productivity.

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Get Avian Flu Updates

To learn more about the avian flu, visit the Web site of the Centers for Disease Control and Prevention at http://www.cdc.gov.

Inside This Episode

Explore how avian flu is spreading across Asia in the Interactive Map.

Learn more about influenza and science's struggle against it in the Photo Essay.

Go behind the scenes with producer Micah Fink in the Filmmaker Notes.

Photo of a young Vietnamese boy being tested for influenza.

A young Vietnamese boy is tested for influenza

Photo Credit: Thirteen/WNET/Blue Ice Pictures, Inc.

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