Not if, but when

October 06, 2005

Official Washington is finally in a public tizzy over the possibility that a particularly deadly strain of avian flu could explode into a worldwide pandemic that could quickly take millions of lives here and around the globe -- just like the lethal 1918 flu outbreak.

The heightened sense of alert is very much needed and long overdue -- but it should prompt aggressive and thorough preparations, not a wholesale invitation for deploying the U.S. military for civilian law enforcement, as President Bush suggested Tuesday. If quarantines might be needed, the focus instead ought to be on preparing for local and state enforcement.

Many experts believe it's only a matter of time before a form of bird flu mutates sufficiently to start passing among humans -- with the real potential for terrible consequences. In the 20th century, such pandemics arose three times: the post-World War I "Spanish flu" that took 500,000 lives in the United States and as many as 50 million worldwide, the 1957-1958 "Asian flu" that caused 70,000 U.S. deaths, and the 1968-1969 "Hong Kong flu" that killed 34,000 Americans. (These days, about 200,000 Americans annually are hospitalized with ordinary seasonal influenza, with about 36,000 dying each year.)

This century's first candidate for the source of the next pandemic is an Avian flu known as H5N1, which has infected millions of birds in 11 Asian countries and more than 100 people, most of whom have died, going back to 2003. In only one case has H5N1 been suspected of having been transmitted between humans, but scientists announced yesterday they now fear that the virus could easily mutate to allow human-to-human transmission -- much like the 1918 flu.

Health and Human Services Secretary Michael O. Leavitt held private, frightening briefings on Capitol Hill last week on this threat that included the warning that as many as 2 million Americans could die. Part of the reason for that is the United States is dangerously short of the antiviral drugs used in treating the H5N1 virus; the Senate wasted little time approving $3.9 billion for preparedness, including funds for developing vaccine for 20 million Americans and producing antiviral doses to help another 20 million.

Even as his department is putting the final touches on its first comprehensive plan to combat a flu pandemic, Mr. Leavitt also is going to Asia next week to talk about greater virus surveillance and prevention there. And Australia announced yesterday that it will host the first Asia-Pacific summit to coordinate a regional response to the avian flu threat. Again, it's about time.

Meanwhile, the president said yesterday that he's reading a new book about the 1918 pandemic, an outbreak made worse by government inaction. After 9/11 and Hurricane Katrina, Mr. Bush appears rightly concerned about getting blindsided again. But focusing on breaching the long-standing prohibition against using the armed forces for domestic law enforcement is a counterproductive distraction from the big public health tasks of preparedness and prevention. The military is not the answer to this problem.

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