Only influenza holds the potential of both severe contagion and, in the case of H5N1, astounding mortality rates, ranging from about 35 percent in Egypt (where the virus circulates widely) to more than 80 percent in parts of Indonesia (where 178 confirmed cases have resulted in 146 deaths). The virulence of H5N1 is far higher than that seen with any other influenza, including the notorious 1918 flu that killed an estimated 62 million people in less than two years. (Some reckonings of 1918 death tolls in poor countries that lacked epidemic reporting systems, such as China, India, and all of Africa, put the final mortality at 100 million, when the world population was just 1.8 billion and commercial air travel did not exist.) Six years ago, the spread of H5N1 sparked concern in the Executive Office of the Secretary-General of the United Nations, the White House, and many of its counterpart centers of government worldwide. Tremendous efforts ensued to kill infected domestic poultry, rapidly identify outbreaks, and pool scientific resources to track and scrutinize various H5N1 strains as they emerged. Some 400 million domestic birds were killed between 2004 and 2010, at an estimated global cost of $20 billion. It all seemed to work: By the end of 2008 the annual number of poultry outbreaks of H5N1 had shrunk from 4,000 down to 300.
In fearful anticipation, health and virus experts also watched for signs that the virus was spreading from one person to another. Although there were clusters of victims, infected families, and isolated person-to-person possible infections, the dreaded emergence of a form of humanly contagious H5N1 never occurred. By 2010, many leading virologists concluded that H5N1 was a terrifying germ -- for birds. The confident consensus, however, was that the mutations that avian flu would have to undergo to be able to spread easily from one human lung to another's were so complex as to approach evolutionary impossibility.
By mid-2011 the global response to avian flu had grown lethargic and complacent. Predictably, in the absence of vigilant bird-culling and vaccination efforts, trouble emerged as outbreaks mounted across Asia. Between January 2010 and the spring of 2011 more than 800 outbreaks were dutifully logged by government officials worldwide. In late July, a 4-year-old girl died of H5N1 in Cambodia, making her the seventh avian flu mortality in a country that had been free of the microbe for a long time.
On Aug. 29, the Food and Agriculture Organization sounded a mutation alarm, noting a new strain of the virus, dubbed H5N1-2.3.2.1, had surfaced in wild and domestic bird populations in Vietnam. Vietnam was one of six countries (including Bangladesh, Egypt, Indonesia, China, and India) in which avian flu had become endemic, meaning it permanently circulated among local and migratory birds. A week later, a Boston biotech company called Replikins announced the discovery of a mutant combination of the avian H5N1 flu and the so-called "swine flu" that spread swiftly among people during the 2009 global pandemic. Replikins's claim implied that the highly virulent bird flu could gain the capacity to spread rapidly between people by absorbing infection genes from the contagious-but-wimpy H1N1 swine influenza.
Although these announcements sparked a minor panic in Asia, further scrutiny of both the 2.3.2.1 and Replikins's claim left the WHO convinced that no new human threat loomed. In early September, a collective sigh of public-health relief was expelled.
Three days later, the conference of the European Scientists Fighting Influenza (ESWI, the Romance-language acronym) convened in Malta, opening with scientific evidence of current pandemic potentials. The stage was set by renowned University of Hong Kong flu scientist Malik Peiris, who described with exquisite precision which genetic factors made the "swine flu," H1N1, highly contagious between pigs, ferrets, humans, and other mammals. Peiris offered evidence that the 2009 H1N1 pandemic started among American pigs but had been circulating in swine populations throughout North America and China for decades before making the mutational steps that sparked global spread.
Fouchier, the Dutch scientist, who has tracked H5N1 avian flu outbreaks in Indonesia for years, then suggested that vaccines used for years on chicken farms are now failing. Perhaps under selective evolutionary pressure, forms of vaccine-resistant H5N1 have appeared, Fouchier told the Malta meeting, adding, "We discovered that only one to three substitutions are sufficient to cause large changes in antigenic drift." In other words, naturally occurring, infinitesimal changes in the flu's genetic material are sufficient to render vaccines useless.
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