Leading researchers have issued a series of stark warnings that the world is unprepared for an "inevitable" global bird flu epidemic, which even optimistic estimates predict could kill millions of people.
Experts expect that the bird flu virus, H5N1, which is circulating in Asia and has killed 53 people since 2003, will evolve the ability to spread rapidly between humans, sparking a global epidemic that will hit developing countries hardest.
In five articles in today's edition of Nature, scientists warn that current efforts to tackle the threat are underfunded and poorly coordinated.
To address this, say Ron Fouchier and colleagues at the National Influenza Centre in the Netherlands, the world needs a 'global task force' of top research groups, science policy specialists and agencies such as the World Heath Organization (WHO), UN Food and Agriculture Organization (FAO) and World Organization for Animal Health (OIE).
The proposed task force would generate a "global picture of the flu", identify research priorities and translate scientific findings into effective policies.
Fouchier and his co-authors say that such an integrated approach to the bird flu threat would cost US$1.5 million a year to operate, which is "dwarfed" by the economic losses a full-blown pandemic would bring. They point out that bird flu outbreaks in 2003 cost the Netherlands, Thailand and Vietnam US$1.3 billion in agricultural costs alone.
Thailand and Vietnam have been at the centre of debates over whether to respond to H5N1 outbreaks in poultry by mass vaccination or culling of birds.
There are concerns that vaccines could promote the evolution of H5N1 into a more deadly form. But Robert Webster and Diane Hulse, virologists based at the St Jude Children's Research Hospital in Memphis, United States argue in a separate article in Nature, that high quality vaccines might reduce the amount of H5N1 circulating to a manageable level.
"The technology for producing inexpensive agricultural vaccines using reverse genetics is available and should be developed," they write, adding that agencies such as the WHO, OIE and FAO should agree on an international standard for a vaccine.
China used poultry vaccines to control an H5N1 outbreak in 2004 and has not reported any outbreaks in domestic poultry since. But with memories of China's 2003 outbreak of SARS still fresh, many believe that how China — which has 13 billion chickens — faces bird flu could have a major impact on other countries.
David Ho of the Aaron Diamond AIDS Research Centre at Rockefeller University, United States says that while China's disease surveillance system looks good "on paper" many faults remain.
"The disease surveillance system is grossly underfunded, and consequently lacks sufficient human resources and technical capacity," says Ho in his contribution to Nature.
Ho calls on China to spend more money on microbiology research to better understand bird flu and other pathogens, and to create enough Chinese experts able to advise policymakers.
"China must make microbial threats to health a top priority in its national research agenda," says Ho. "It has a moral obligation to its own people, and to the world, to rectify the situation as soon as possible."
Creating a vaccine to prevent people from becoming infected with bird flu is the most important challenge, says Michael Osterholm of the Center for Infectious Disease Research and Policy at the University of Minnesota, United States.
Currently, just five per cent of the world's population living in a handful of rich nations receive flu vaccines, says Osterholm. But he warns that a vaccine against a pandemic strain of the bird flu virus would not be ready for at least six months after the pandemic begins. Even then, there would only be enough vaccines to protect 14 per cent of the global population.
Wherever the predicted pandemic begins — likely to be in one of the Asian nations where the virus is currently circulating — a vaccine would not be delivered fast enough.
Researchers agree that it is question of when, not if, a global flu epidemic occurs. By acting now, says Osterholm, we might be able to change its course. He urges the rich nations of the G8 group to recognise the threat and act decisively by investing in vaccine research and other efforts to minimise the number of people the epidemic kills.
We are in a race against time, agrees Anthony Fauci, of the US-based National Institute of Allergy and Infectious Diseases.
"Unlike the situation before previous flu pandemics, we now have the knowledge and technology to develop countermeasures for this disease," he says. "However, unless we improve our capacity to produce such countermeasures, we may experience again the devastation of past epidemics."
Three such flu epidemics struck in the 20th century. The 1918-19 outbreaks of 'Spanish' flu killed more than 20 million people.