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All influenza A viruses, including the avian flu and the common flu, have evolved the frightening ability to elude host defenses. During human DNA replication, a “proofreading” mechanism ensures that our DNA is transcribed with fidelity, saving our genetic code from harmful misreadings and mutations. Yet influenza viruses do not have this ability to “proofread” their DNA, and so with every successive generation, the viruses can acquire new mutations and traits. As a result, the number of influenza variants is constantly increasing. Even more alarming is the influenza virus’s ability to “re-assort,” or to integrate the genetic material of a different species of virus, a process that can result in novel progeny to which no animal population has immunity. The emergence of these “reassorted” viruses is thought to occur most often when humans live in close proximity to domestic poultry and pigs. Because the latter are susceptible to both avian and mammalian influenza, they are perfect hosts for the recombination of these two forms of flu. The resultant “re-assorted” virus may be then transmitted to humans via poultry farming or consumption. One region of the world that is especially conducive to this genetic mixing is southern China, where hundreds of millions of fowl roam freely alongside humans on farms and at markets.

Over the past few years, the relationship between the avian influenza virus and its natural reservoir, wild birds, has changed. Now the virus seems to be migrating along flyways that take the birds not only westward, into Europe, but potentially all over the world. The virus has already spread to places far west of Asia, including Romania, Turkey, and most recently, Croatia. If scientists’ worst fears are correct, then the world may be witnessing the unfolding of a global pandemic reminiscent of the notorious Spanish Flu of 1918.

In the fall of that year, World War I was winding down in Europe, and peace was drawing near. Suddenly, however, a new contagion erupted, and by the fall of 1919, a new influenza virus had swept across the globe, infecting one-fifth of the world’s population and leaving 50 million corpses in its wake. Rather than preying on the young and the elderly, the Spanish Flu was most deadly to people aged twenty to forty. Ultimately, the virus infected 28% of all Americans, approximately 675,000 of whom died during the pandemic, a death toll ten times as high as America suffered during World War I. In fact, the 1918 epidemic was so severe that the average lifespan in the US fell by ten years, and of the 170,000 US troops who perished in Europe, more died from the virus than from enemy fire. Decades later, a similarly grim scenario is conceivable. One of the only reasons that H5N1 has not become a global disaster like the 1918 flu is that the virus cannot yet be spread by human-to-human contact. It may only be a matter of time, however, before the virus evolves this frightening ability.

Although the United States has announced an ambitious plan to protect the country against avian flu, our real preparedness level, as corroborated by recent remarks from Health and Human Services Secretary Mike Leavitt, falls alarmingly short of paper promises: “What we all learned from [Hurricane] Katrina is that sometimes we have to think very clearly about the unthinkable,” Leavitt said. “We’re not as prepared as we need to be [for the bird flu] … We will not have enough [antiviral drugs] for everyone.” As of a few weeks ago, according to Leavitt, the US had stockpiled 2.3 million courses of bird flu treatment but would not be able to manufacture enough drugs for the entire US population until 2007. Continued
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