Avian Flu Surveillance Project

Flu fear as migrating birds drop dead in Iran (AFP)

23 October 2005

TEHERAN - Scores of migrating birds are dropping dead in Iran’s northwest on a daily basis, a report said on Sunday, raising concerns the Islamic republic could soon join the list of countries with cases of bird flu.

The student news agency ISNA said some 5,000 birds have been found dead in West Azerbaijan province which borders Turkey, Iraq and Azerbaijan.

The report said tests had yet to confirm the presence of bird flu but added Iran would be sending samples to the World Organisation for Animal Health for verification.

Iran is also disinfecting cars entering the country from Turkey, ISNA said, adding that Iran’s Environment Organisation has banned hunting, trapping or trade of birds in the country’s wetlands.

“Although there has been no case of bird flu spotted in the country, the medicine to treat this disease has already been prepared just in case,” Health Minister Kamran Bagheri-Lankarani was quoted as saying.

http://www.khaleejtimes.com/DisplayArticle.asp?xfile=data/middleeast/2005/October/middleeast_October563.xml&section=middleeast&col=

Thanks for that update, Oorang.

Efficient Human to Human Transmission Via H5N1 / H9N2 Recombination

Recombinomics Commentary
October 22, 2005

In the upcoming Virology paper "Evolution of the receptor binding phenotype of influenza A (H5) viruses, Gambaryan et al screen H5 isolates for affinity for human Sia2-6Gal (human-like) receptors. Two isolates, A/Hong Kong/212/2003 and A/Hong Kong/213/2003 were identified. Both isolates had the S227N polymorphism.

These two isolates were from bird flu patients who had returned from a visit to Fujian province, The daughter had died in China with bird flu symptoms. The two isolates were from her brother and father. The father subsequently also died. Thus, the change in receptor binding was associated with a familial cluster that probably involved human to human transmission.

Although the S227N change requires a simple G/A transition, it is rare. This is similar to another polymorphism E627K in PB2. The change is also encoded by a A/G transition, but is strictly conserved. E was exclusively in avian H5N1 isolates and K was found in all human isolates. The conservation could be explained by selection which may have been further restricted by opportunities for recombination. The conservation was broken at Qinghai Lake, where all 16 avian isolates contained the human E627K polymorphism.

Similarly, the lack of S227N in H5N1 may be related to a lack of recombination opportunities. As H5N1 expands its global reach via spread by long range migratory birds, the potential for new recombination targets generating novel genetic changes increases.

A search of the Los Alamos flu database using a 10 nucleotide probe representing the S227N polymorphism identified 42 exact matches. All were in HA and all isolated after 1998 were in the Middle East in chickens, turkeys, geese, and an ostrich.

H9N2 has become endemic in Israel and millions of migratory birds will be passing through the area in the upcoming days. Thus, the potential for dual infections by H9N2 and H5N1 is high. The 10 nucleotides of identity offers an opportunity for homologous recombination that would create the S227N polymorphism and increase the efficiency of H5N1 human transmission.

Efforts to limit the exposure of H9N2 infected birds to H5N1 infected wild birds should be aggressively pursued.

Isolates with donor sequences for S227N acquisition:

AY575869 A/Hong Kong/212/03 2003 H5N1
AB212054 A/Hong Kong/213/03 2003 H5N1
ISDN38262 A/Hong Kong/213/2003 2003 H5N1
AY575870 A/Hong Kong/213/2003 2003 H5N1
AY738456 A/ostrich/Eshkol/1436/03 2003 H9N2
DQ104453 A/turkey/Avigdor/1209/03 2003 H9N2
DQ104454 A/turkey/Avigdor/1215/03 2003 H9N2
DQ104458 A/turkey/Brosh/1276/03 2003 H9N2
DQ104455 A/turkey/Kfar Warburg/1224/03 2003 H9N2
DQ104464 A/chicken/Kfar Monash/636/02 2002 H9N2
DQ104450 A/turkey/Avichail/1075/02 2002 H9N2
DQ104473 A/turkey/Beit HaLevi/1009/02 2002 H9N2
DQ104451 A/turkey/Ein Tzurim/1172/02 2002 H9N2
DQ104462 A/turkey/Givat Haim/622/02 2002 H9N2
DQ104471 A/turkey/Givat Haim/868/02 2002 H9N2
AY548507 A/turkey/Givat Haim/965/02 2002 H9N2
AY738452 A/turkey/Givat Haim/965/02 2002 H9
DQ104459 A/turkey/Kfar Vitkin/615/02 2002 H9
AY548510 A/turkey/Kfar Vitkin/615/02 2002 H9N2
DQ104460 A/turkey/Kfar Vitkin/616/02 2002 H9
AY548511 A/turkey/Kfar Vitkin/616/02 2002 H9N2
AY548512 A/turkey/Mishmar Hasharon/619/02 2002 H9N2
DQ104461 A/turkey/Mishmar Hasharon/619/02 2002 H9
DQ104449 A/turkey/Naharia/1013/02 2002 H9N2
DQ104452 A/turkey/Sapir/1199/02 2002 H9N2
DQ104463 A/turkey/Yedidia/625/02 2002 H9
AY548513 A/turkey/Yedidia/625/02 2002 H9N2
DQ104448 A/turkey/Yedidia/911/02 2002 H9N2
AY548514 A/chicken/Tel Adashim/786/01 2001 H9N2
AY738454 A/chicken/Tel Adashim/786/01 2001 H9
DQ104465 A/chicken/Tel Adashim/809/01 2001 H9
AY548515 A/chicken/Tel Adashim/809/01 2001 H9N2
AY548500 A/chicken/Tel Adashim/811/01 2001 H9N2
DQ104467 A/chicken/Tel Adashim/811/01 2001 H9
AY548501 A/chicken/Tel Adashim/812/01 2001 H9N2
DQ104468 A/chicken/Tel Adashim/812/01 2001 H9
DQ104469 A/goose/Tel Adashim/829/01 2001 H9N2
DQ104470 A/goose/Tel Adashim/830/01 2001 H9N2
AY548499 A/turkey/Givat Haim/810/01 2001 H9N2
DQ104466 A/turkey/Givat Haim/810/01 2001 H9
DQ104472 A/chicken/Maale HaHamisha/90658/00 2000 H9N2
AY738451 A/turkey/Neve Ilan/90710/00 2000 H9
AY548502 A/turkey/Neve Ilan/90710/00 2000 H9N2
AF218108 A/Peking Duck/Malaysia/F20/1/98 1998 H9N2
AF218105 A/Peking Duck/Singapore/F91-5/9/97 1997 H9N2
AY206675 A/quail/Hong Kong/A28945/88 1988 H9N2

http://www.recombinomics.com/News/10220501/H5N1_H9N2_Recombination.html

Britain: Bird Flu Is Deadly H5N1 Strain

By MICHAEL McDONOUGH, Associated Press Writer
1 hour, 50 minutes ago
http://news.yahoo.com/s/ap/20051024/ap_on_he_me/bird_flu

LONDON - The British government said Sunday that a strain of bird flu that killed a parrot in quarantine is the deadly H5N1 strain that has plagued Asia and recently spread to Europe.

Scientists determined that the parrot, imported from South America, died of the strain of avian flu that has devastated poultry stocks and killed 61 people in Asia the past two years, according to the Department for Environment, Food and Rural Affairs. (excerpted)

Daily Bird Flu News Updates:
http://www.thepoultrysite.com/LatestNews/?AREA=LatestNews&Display=6187

The Age - 23rd October 2005
Scientists continue bird flu tests on Britain, Sweden and Croatia cases
EU - Scientists are conducting tests to determine whether bird flu cases discovered in Britain, Sweden and Croatia are the lethal strain that has killed more than 60 people, as countries around the world scramble to halt the spread of the virus.
Congo has joined a growing list of African countries to ban imports of livestock and poultry from countries affected by bird flu, and Russia recorded a new outbreak of the disease in a region of the Ural mountains.

Reuters via ABC - 23rd October 2005
Duck in Sweden found with flu, virus type unclear
STOCKHOLM () - A duck found dead east of Stockholm has tested positive for avian flu, Sweden's National Veterinary Institute said on Saturday, but it was too early to determine which strain of virus the bird had.
"The result of the virus tests which were carried out today on samples from ducks found in Eskilstuna show that one of them was infected with influenza," the institute said in a statement.

Associated Press - 23rd October 2005
Croatia begins culling birds after swans found with flu
CROATIA — Authorities in Croatia began killing thousands of domestic birds Saturday and ordered disinfection for a large area near a national park where six swans were found dead from bird flu.
Elsewhere, Russia reported a new outbreak of a lethal strain of bird flu, Sweden confirmed a case, and Italy and Congo became the latest countries to ban imports of poultry from nations affected by the virus.

Bangkok Post - 23rd October 2005
New regulations on Thailand poultry farms
BANGKOK - Thailand has introduced two ministerial orders as further efforts to control avian influenza, the government-run Thai News Agency reported Sunday. Agriculture and Cooperatives Minister Khunying Sudarat Keyuraphan signed the two orders, which take effect in 21 of Thailand's 76 provinces.
The first ministerial order forbids farmers from raising poultry within 10 kilometres of where the disease has been found. The ban on poultry farming will stay in effect for 90 days after the last diseased bird is destroyed.

NineMSN - 23rd October 2005
ASIA - A summary of the bird flu situation in Asia
Governments around the world have gone on alert over the possible spread of the deadly H5N1 strain of avian flu that has killed more than 60 people and been found in 10 countries in Asia since late 2003.
Here is a summary of the avian flu situation in areas that have been affected in Asia, and government responses to the threat.

The Washington Post - 23rd October 2005
Indonesia criticized for flu coverup
JAKARTA, Indonesia -- Indonesian officials covered up and then neglected a spreading bird flu epidemic for two years until it began to sicken humans this summer, posing a grave threat to people well beyond the country's borders, according to Indonesian and international health experts.

Xinhua - 23rd October 2005
Italy announces to ban poultry imports from Croatia, Romania
Italian government announced on Saturday that it started banning imports of live poultry of any species and all related products from Croatia, Romania and other Balkan countries.
Health Minister Francesco Storace said that the latest move aimed at protecting Italy from the spread of bird flu, adding that he had also taken measures to step up health checks on wild birds and poultry farms, including putting nets over those considered at risk to prevent contamination by migratory birds.

Scotsman - 23rd October 2005
Scientists aim for clone cure to bird flu
SCOTTISH scientists are attempting to eliminate the threat of bird flu by creating a new breed of chicken that is resistant to the killer virus.
Researchers at the Roslin Institute in Edinburgh, where Dolly the Sheep was created, are using cloning technology to produce poultry that are genetically resistant to flu infection.

Detriot Free Press - 23rd October 2005
African nations act to ward off bird flu
JOHANNESBURG, South Africa -- The west coast nation of Senegal became the latest African country Friday to ban poultry imports as the continent begins to take precautions against a feared arrival of bird flu.

News From Russia - 22nd October 2005
Britain urges EU-wide ban of wild bird imports, examines what strain of bird flu killed parrot
UK - Britain on Saturday urged the European Union to ban imports of wild birds into the 25-nation bloc as British scientists tried to determine whether a parrot that died of bird flu had the strain that has killed more than 60 people around the world. Ben Bradshaw, the minister responsible for animal welfare, said Britain had asked the European Commission, the EU's executive arm, to ban wild bird imports.

Associated Press via News 11 - 22nd October 2005
Europe Moves to Slow Bird Flu
LONDON - Britain and Croatia confirmed cases of bird flu on Friday as countries around the world scrambled to put in place measures to prevent the spread of the virus.
In Croatia, the Agriculture Ministry said the country's first cases of bird flu were confirmed in six swans found dead in a national park. British officials said a parrot that had been imported from South America died of bird flu in quarantine.

Today Online - 22nd October 2005
German enforces anti-bird flu rule keeping poultry indoors
GERMAN - Hens are kept in their enclosure at a poultry farm in Schmachtenhagen. Germany began enforcing a temporary ban on outdoor poultry rearing in order to combat bird flu, confining fowl to sheds with spot checks on farms and fines of up to the equivalent of 30,000 dollars for violations.

Joplin Globe - 23rd October 2005
Farmers, processors focus on biosecurity
US - H5N1. It’s a combination of numbers and letters that could spell real trouble — global trouble. For people, H5N1 can be lethal. Of 117 human cases reported to date, more than 50 percent have died, according to the World Health Organization. Compare that to the Spanish flu epidemic of 1918 that killed 20 million to 40 million worldwide. The mortality rate for that virus was 5 percent.

CRI online - 22nd October 2005
Romania Reports New Bird Flu Case in Dead Heron
ROMANIA reported a new bird flu case on Friday when the H5 type bird flu virus was detected in a dead heron found on the Prut River in Vaslui, a county in eastern Romania near the border with Moldova.
After identifying the virus, Vaslui's department of veterinary service immediately ordered local farmers to cage their poultry and livestock and also banned the sales of live chickens and pigs, Romania's state news agency Rompres said.

CBS - 22nd October 2005
Bird Flu Found In Croatia
WASHINGTON The European Union said Friday it was preparing a ban on poultry imports from Croatia after it became the latest European nation to register cases of bird flu. Croatia had already given assurances that no live poultry and poultry products will be exported to the EU, the European Commission said in a statement.

BBC - 22rd October 2005
Avian flu found in parrot in UK
UK - Birds across Europe are being kept indoors as a precaution A parrot that died in quarantine in the UK has tested positive for avian flu, the government has said. A highly pathogenic H5 strain of the disease has been found, but it is not known if it is the H5N1 variant which has killed at least 60 people in Asia. Because the bird - imported from south America - was in quarantine, the UK's disease-free status is not affected.

Thanks for the pings and posts EBH. The spread seems to be picking up speed, unfortunately.

pinging the original list and the mother abigail list to the above posts: nice work, you all!

on or off, FR-mail me or doggone or judith anne ...

Thanks for the ping.

Do we have human to human transmission yet?

from #1923, it looks like it:

'These two isolates were from bird flu patients who had returned from a visit to Fujian province, The daughter had died in China with bird flu symptoms. The two isolates were from her brother and father. The father subsequently also died. Thus, the change in receptor binding was associated with a familial cluster that probably involved human to human transmission.'

"from #1923, it looks like it: "

Thanks. I thought that was what it said, lol.

http://www.gulf-times.com/site/topics/article.asp?cu_no=2&item_no=57736&version=1&template_id=45&parent_id=25

Thais deny that flu virus mutatedPublished: Sunday, 23 October, 2005, 12:40 PM Doha Time

BANGKOK: Thai health officials have confirmed that the son of a man who died from bird flu Wednesday is also infected with the virus, but have denied reports of human-to-human transmission, local media reported yesterday.
Doctors said Ronarit Benpad, 7, was responding well to treatment at a Bangkok hospital after being infected with the H5N1 virus about the same time as his father, Bang-on, who died from the disease.
The Nation newspaper reported yesterday that relatives alleged the government was concealing information that the boy caught the virus from his father. A Thai senator also called for independent laboratory tests on the cells of the two newest victims.
But Paichit Warachit, director of the Medical Science Department, said the virus gene sequence taken from Bang-on had not mutated from the specimens found in victims who died in 2004.
He said that led doctors to conclude that the virus could not have been transmitted from one human to another.
Warachit said the boy had likely been infected by poultry along with his father in western Kanchanaburi province, where the virus is common among fowl.
Some doubts were raised after initial tests on both the father and son were negative for H5N1, but later analyses proved positive.
Warachit said multiple testing was normal and necessary procedure, as the virus can be difficult to detect.
Kulkanya Chokephaibulkit, a paediatrician and infectious-disease specialist treating the boy, called it the first mild case of avian flu to be found in the country, the Bangkok Post reported.
“His condition is different from the other bird flu victims, Kulkanya said. “His body responded very quickly to Oseltamivir, the anti-viral drug.”
First appearing in Southeast Asia in 2003, the H5N1 virus has caused 63 human deaths in the region, but no cases of human-to-human transmission have been confirmed. Bang-on Benpad, 48, was Thailand’s 13th human fatality, and the first since October 2004.
Many international health experts warn that the virus will eventually mutate into a strain that can be passed among humans, causing a pandemic that could kill millions of people.
China will close its borders if it finds a single case of human-to-human transmission of bird flu there, a Hong Kong newspaper reported yesterday.
Saving lives would be Beijing’s top priority in efforts to contain a possible outbreak of bird flu, even if it meant slowing the economy, Huang Jiefu, a vice-minister of health, was quoted as saying by the South China Morning Post.
In Finland, the head of the World Bank said that while prevention measures would cost a lot, the economic damage from a pandemic would be far worse.
Speaking to health officials from China, Hong Kong and Macau in Yunnan province on Friday, Huang said any suspected human case would be quarantined.
The World Health Organisation (WHO) has said that the strain is endemic in poultry in China and across much of Asia, and it may only be a matter of time before it develops the ability to pass easily from human to human.
China’s sheer size and its attempts to conceal the Sars epidemic in 2003 have prompted fears among some experts that it has had more bird flu cases than officially recorded.
Since breaking out in late 2003 in South Korea, the deadly H5N1 strain of influenza has killed more than 60 people in four Asian countries and reached as far west as European Russia, Turkey and Romania, tracking the paths of migratory birds.
Amid growing fears about the spread of the disease, Swiss pharmaceutical giant Roche AG has come under pressure to pump up output of its antiviral avian flu drug Tamiflu.
The company agreed on Thursday to meet four generic drug makers with a view to possible tie-ups.
The World Health Organisation’s director of epidemic and pandemic alert, Mike Ryan, told the Financial Times yesterday it would cost billions of dollars to prepare the world fully for a potential pandemic with large-scale production of vaccines and other measures.
World Bank president Paul Wolfowitz told world parliamentarians in Finland that prevention would still be far cheaper than cure.
He said Sars, despite being contained relatively early, had cost east Asian countries two or three per cent of their gross domestic product for a quarter.
“Stop and think what a larger epidemic that spreads death and disease around the world would do in damage to commerce and the international economy,” he said.
“The cost of prevention, while it may be expensive, would be much cheaper than the cost of dealing with an outbreak.”
The Asian Development Bank said it hoped to provide $58mn to help fight the spread of bird flu — half of it to combat the virus in Cambodia, Laos and Vietnam and the rest to help international technical agencies.–Agencies

http://msnbc.msn.com/id/9787479/site/newsweek/

Newsweek

'The Fight Against the Flu The lethal H5N1 virus was found last week in birds in Europe. So far it has spread between humans in only a few suspected cases, but with no cure in sight, global health officials are nervously watching their borders and preparing for the worst.'

snip...

'One man, Bangorn Benpad, 48, a sometime driver and gardener in the Thai province of Kanchanaburi, who had helped himself on a couple of occasions to chickens from a neighbor's flock. The flock had been dying off, and the chickens he took were close to death anyway. Days after he killed, plucked, grilled and ate the birds, he developed a cough and a fever and visited a local clinic, where they took an X-ray of his lungs and suggested he check himself into a hospital. Instead, he went home, but last Monday his condition worsened, and a new X-ray showed a rapid deterioration in his lungs. By Wednesday he was dead.'

Here's the latest from TCS:

The Andromeda Strategy
James Pinkerton
http://www.techcentralstation.com/102005C.html

How much of a threat is the avian flu? We don't really know. The future is like that: it's unpredictable in its specifics. But the future is completely predictable at a more general level. Bad things happen. The good times no longer roll. Night must fall. That's a truth as old as Aesop; nothing will ever repeal the need to be vigilant and to be prepared. And right now, we are not prepared, for the current epidemic, or for the epidemic next time.

When the prospect of disaster looms small on the horizon, when it is no bigger than a fist on the periphery of our sightlines, it's easy to be overconfident, even smug. After all, our recent history is full of doomy media sensations that never amounted to much. Remember global cooling? Or swine flu? Or Y2K? Even the recent SARS breakout proved to be dangerous but not devastating.

Or conversely, and perhaps even more dangerously, the prospect of dread can make us cynical and fatalistic; we're all going to die anyway, so what's the big deal -- why not just ride it out? If our number is up, so goes such thinking, our number is up. Indeed, such nihilism is a pathogen that can't be contained by science, because it burrows into the human soul; there such nothingness rests, throwing its lulling nightshade over action, turning it into inaction. And thus the glory of humanity -- our capacity to change our circumstance through hard work and hard thought -- is extinguished.

So once again, it could be that the bird flu is the Next Big Nothing. But since we know that history has a way of repeating itself, it's a cinch that we have calamitous epidemics in our future, as we did in our past. From the Black Death of the 14th century to the Spanish Flu of the 20th century, we can see a long and dolorous epidemiological chain. And in the future, we can see more such epidemics. Perhaps it will be like The Andromeda Strain, in some future century as yet undetermined. Or perhaps it will be the bird flu, after all -- which means that disaster draws near.

With those historically informed thoughts in mind, let's consider a strategy for dealing with the next big danger, whenever it comes. That strategy might be summed up in four M's: Monitor, Manage, Manufacture, and Mobilize.

As we shall see, bits and pieces of this strategy are in place. That's the good news. The bad news is that the missing pieces -- most obviously, a comprehensive and long-term plan for producing more life-saving drugs -- stare at us like the hollow eyes of a skull.

As for Monitoring, there's a lot of that going on now. We can all watch the grim progression of the avian flu, as it advances from Asia into the edges of Europe, toppling dominoes of complacency as it edges closer.

Sir Liam Donaldson, chief medical officer of the United Kingdom, warned recently that if a new flu strain hit his country, 50,000 would die. He added that a death toll 15 times that great was "not impossible."

And Klaus Stoehr, director of the World Health Organization's influenza program, observed, "The virus has the potential to change and mutate and thus spark a terrible pandemic." Once again, uncertainty; as Stoehr continued, "We don't know whether a pandemic will break out in the coming weeks, months or only in years. But there's no question that if such a pandemic occurs we'll be looking at hundreds of thousands or even millions of deaths worldwide."

In the meantime, as we wait for perspective on what might come, we can monitor the past, too; we can look back, most urgently, to the killer Spanish Flu. Here's a letter dated September 29, 1918, written from the US Army's Camp Devens, Mass. World War One was raging in Europe, but American doughboys faced greater danger at home, far from the Kaiser's bullets:

"These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the Hosp. they very rapidly develop the most viscous [sic] type of Pneumonia that has ever been seen. Two hours after admission they have the Mahogany spots over the cheek bones, and a few hours later you can begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the coloured men from the white. It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate. It is horrible. One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies sort of gets on your nerves. We have been averaging about 100 deaths per day, and still keeping it up."

But monitoring is mostly passive -- not good enough by itself. If all we do is watch and wait, and then do nothing, we might as well just have a party, like the one Edgar Allen Poe described in "The Masque of the Red Death". Here's a spoiler for the time-pressed: Poe's macabre tale does not have a happy ending.

So next we turn to that most American of virtues: Managing. In the wake of the management snafus of Katrina, President Bush was asked about the avian flu threat at his October 4 press conference; he offered a thoughtful answer which shows, at least, that no hapless Michael Browns will be in charge of a Viral Big One. Yet once again, we don't know the future; we don't know whether the US government's response will be equal to the challenge. But some distant early warning indicators are not so promising; one of Uncle Sam's scenarios envisions shortages of food, medicine and electricity, followed by mass riots and the ultimate death of 1.9 million Americans.

In other words, as we stare into the tiny grains of the flu virus, we could be looking at Katrina multiplied by a thousand. This is the best we can do? The richest country in the world? Clearly, what we have seen over the past few decades hasn't been management, but rather malpractice.

But even before we get to the management blame game, we should be looking toward the manufacture of a cure. Unfortunately a cure doesn't exist -- a future action item if there ever was one, which we will come back to later. For now, we do have an anti-viral medicine, called Tamiflu, but we don't have enough. Indeed, at present, so parlous is our condition that even if we wanted to start manufacturing more right away, it would still take years to build up an adequate stockpile.

What's more, as Waldemar Ingdahl has noted here at TCS, since 1970, the number of companies producing vaccines has fallen by 80 percent. Which is to say, while the need has been going north, the supply has been going south.

What explains this wrong-way trend? One reason is that the government has practiced a kind of malign neglect toward vaccines and toward the innovative side of the pharmaceutical industry. Consider the fate of Merck. The New Jersey-based company is currently being clobbered by costly Vioxx lawsuits, based on junk science, as the federal government watches passively. Yet even so, Merck has persevered on a vaccine for the human papilloma virus, which accounts for perhaps 70 percent of the world's cervical cancers. It would be a tragic shame if Merck were knocked out of the innovation box by big lawsuits, before its vaccine, Gardasil, ever reaches the women who need it. What national interest would that serve? We need to rethink our approach to manufacturing, because at present, US government mismanagement -- tolerance for predatory lawsuits -- is undercutting the productive and lifesaving fundaments of the pharmaceutical industry.

Indeed, motivated by a strange mix of desperation and calculation, many governments around the world are considering compounding past mismanagement with still more mismanagement. Here's how: Hans Hogerzeil, acting director of the department of essential drugs and medicines policy at the World Health Organization, demanded recently that Roche, the maker of Tamiflu, cut its price and waive its patent rights, so that anybody, anywhere, could make the drug. Hogerzeil's comments stand in sharp contrast to those of his boss, Lee Jong-wook, who, mindful of the enormous investment needed to make medicines, has said that it is bad policy to weaken drug patents, since they are the cornerstone of production. But of course, it's Hogerzeil's flamboyantly anti-corporate populism that grabs the attention of the controversy-crazed world media.

If any of this legal-medical jousting sounds familiar, it should. Because the same Hogerzeil and the same WHO had the same bright idea about AIDS drugs. Working closely with NGO activists, the world's public health-ocracy cooked up a scheme to "pre-qualify" copycat AIDS drugs, manufactured in India, onto the market. But "pre-qualification" proved to be a synonym of "non-quality." So great was the danger of these pseudo-drugs that they had to be withdrawn from the marketplace. It was a humiliating for the neo-Naderite "H Team" of genericists, but evidently not so humiliating that the H-ers aren't up to the same trick again.

So what to do? Roche made mistakes. It obviously underestimated the demand for Tamiflu and/or failed to sound the epidemiological alarm bell. But at the same time that Roche was falling down on the manufacturing side, the governments of the world were failing to monitor and manage.

Now there's only one thing to do: manufacture more. Roche is frantically trying to expand capacity for Tamiflu. Is that a good enough plan? It's hard to know, but Tyler Cowen of George Mason University has an idea: why not offer a prize to Roche if it successfully ramps up production? Why not? After all, incentives work; prizes work.

Moreover, Roche has even indicated that it is willing to contract out its patent to qualified drug manufacturers, but not to the Indian generic-makers, such as Ranbaxy and Cipla. Yet if the flu flaps its deadly wings closer to humans, the pressure to override Roche and turn the whole flu-vaccine project over to the Indians will only intensify.

If that happens, not only will Tamiflu production be jeopardized, but the entire future of the pharmaceutical industry will be undercut. If it costs close to a billion dollars to make a drug, and if future profits are non-existent -- well, it doesn't take much management expertise to see that future discovering and manufacturing will be non-existent, too.

Obviously these sorts of concerns will keep coming to the fore. We can continue to think of the problem as a matter for monitoring, managing, and manufacturing, but something is missing -- the sense of urgency that should come from a truly grave threat. And so to the fourth M: Mobilization. If we now understand that this is an urgent priority for America, we should act accordingly. We've mobilized in the past, and it's time to do so again.

I have written elsewhere that we need to think of natural disasters as a kind of war, and that we need to call out the military when needed -- because if it's a matter of life and death, we should use all our resources.

But our greatest resource is our collective will to solve problems -- to apply the lessons of the past to the threats of the future. We have been caught unawares many times before -- the Great Mississippi River Flood of 1927, Pearl Harbor, 9-11, and now Katrina. In each instance, our system failed us. But our past record suggests that we have the capacity to institute new mechanisms and safeguards to prevent repeat disasters. And while the great chronicler Edward Gibbon might have been right when he wrote that history is "little more than the register of the crimes, follies and misfortunes of mankind," we should continue to act as if America is different -- can be made different. So when we see a headline in The Indianapolis Star -- "Flu pandemic will happen eventually, experts say/Some form of the virus will sweep the world and take a high toll, but it may not be avian" -- we should view those words as an injunction to action, not as a death sentence.

We don't know what we face in the future. But we can be reasonably sure that the sorry saga of natural diseases will soon enough be supplemented by new chapters of unnatural epidemics, inked inadvertently in industrial accidents, or written purposefully by malevolent scientist-terrorists. The specter of new "superbugs" -- imagined by science-fiction writers today, created in laboratories tomorrow -- haunts our normal revelry, like Poe's Red Death.

Thus the absolute necessity of the Four M's -- the need for constant monitoring, managing, manufacturing, and mobilizing. If we implement these Ms, we will be as equipped as we can be for the Andromeda-level threats that are sure to come. And if we don't, well, then we will suffer and die as we have in the Gibbonesque past.

I can't remember if I gave you all the link to the TCS Special Report. Here it is: http://www.techcentralstation.com/birdflu/.

Turn up your volume to hear some great audio clips.

Here is an interesting link.

CHRONOLOGY-Spread of bird flu from Asia

The problem will most definitely be production.

I already got my supply of Tamiflu. ID doc I know recommended it.

Thanks for the ping.

the chickens he took were close to death anyway

I don't care how poor you are or what culture you come from, what that fellow did is just plain dumb.

And so it spreads.

Thanks to you both for the excellent links.

Here is another - pass it on :)

US Stockpiling Antiviral Drugs Against Possible Bird Flu Pandemic (October 24th, 2005)