Preparing for the Pandemic

Werner Lange knows what it's like when a wave of influenza causes the public apparatus to break down. The former director of the Robert Koch Institute (RKI), the central institution and coordination center for the Federal Ministry for Health and Social Security, remembers what happened in the winter of 1969 when, as a virologist in Berlin, Lange witnessed the second wave of the so-called Hong Kong influenza outbreak which killed about one million people worldwide.

"The hospitals announced that they were forced to stop providing care because a large number of the staff was out ill and there were no beds available," said Lange.

Many of the dead couldn't be buried and some of the corpses had to be stored in an unused subway tunnel. With many in the coal industry hit by the outbreak, the police stepped in to take over deliveries of the fuel and even transport systems could only function limitedly.

Risk of infection still low

In a bid to avoid a repeat of such widespread chaos, the World Health Organization (WHO) has been urging governments for years to keep their pandemic emergency plans up-to-date.

"In the last two months in particular, countries have begun to do more and more," said Maria Chang, spokesperson for the WHO. The reason for this is the looming threat of a global avian influenza pandemic.

At the moment, the threat to humans remains minimal. The spread of avian flu from birds to humans remains rare with only those who have intensive, unprotected contact with infected birds being most in danger. Until now, there have been only about 120 confirmed cases of people who have contracted bird flu. However, half of those have died from the virus.

The major concern of the experts is that this figure could explode if the deadly H5N1 strain of the bird virus connects with the human virus, making infection between people highly likely.

Different plans, same essentials

Some 20 countries have pandemic emergency plans in place. They include most of the European countries as well as the governments of Brazil, Canada, Hong Kong, South Africa, Japan and the US.

"The plans differ in each instance, it depends on national circumstances," said WHO spokesperson Chang. "If Australia wants to close its borders, this is of course easier than in countries which have borders with other lands."

Despite national differences, the core elements of the plans are said to have a similar structure.

The competence of the emergency services and authorities are checked as are their response procedures in the case of an outbreak; areas of the population to be vaccinated first with anti-vial drugs are identified, guidelines are laid out to deal with the supervision and control of the infection and public information, travel restrictions and quarantine rules are prepared.

German pandemic plan in place, doubts remain

For instance in Germany, the RKI implemented a national pandemic emergency plan in January compiled by a group of 20 experts who drew upon recommendations issued by the WHO.

But, implementation of the plan remains difficult to monitor because a large chunk of it is the responsiblity of the 16 German federal states and the 430 health authorities distributed around the country, said Susanne Glasmacher, spokeswoman for the RKI.

"The decision by the Federal Government to provide 20 million euros for the development of a prototype vaccine was very important," said Glasmacher, adding that it would speed up the development of an effective serum in case of a flu outbreak.

In addition, the federal states had decided to stock up on antiviral drugs. But the stockpile would only last for 10 percent of the population, while the emergency plan recommends securing drugs for 20 percent, Glasmacher pointed out.

"But one shouldn't play it down -- many countries haven't stockpiled any drugs at all," she added.

International cooperation critically important

While the readiness to prepare for a pandemic has increased, what is essential is a significant rise in international cooperation, said Maria Cheng of the WHO. Many of the countries in which bird flu has struck do not have the resources to combat the virus and a more concerted global effort would help, she added.

The main challenges are to find ways of identifying the illness early enough, preventing its spread and to create a drug that can combat the H5N1 virus strain. "If we were able to identify a new strain early enough, we could maybe prevent the spread of the virus," said Cheng.

For this reason, the WHO has hoarded three million boxes of antiviral drugs. If a strain that was transmitted between humans did arise in a country, the WHO would then send specialist teams within the shortest possible time there to contain the virus.

"According to models, this would happen in areas where there were 20 to 40 cases of infection reported,” said Cheng. “Nevertheless, this has yet to be applied in practice."

Keeping a cool head

The best advice at the moment seems to be for everyone to remain level-headed, said Susanne Glasmacher of the RKI.

There seems little doubt that there will be a pandemic as the aggressive increase in bird flu cases indicates. However, the risk of developing the illness is still very low.

"If you want to be infected, you must travel to a humid biotope in a Chinese nature reserve and pull out the feathers of the birds you find there," Glasmacher said.