STORY
NEWS ANNOUNCER (ACTOR): "One topic dominates the news tonight — the bird flu pandemic sweeping the world has arrived ..with devastating results. Thirty-two ..died today from the deadly virus but by morning, health authorities fear that number will be in the hundreds. Thousands of people are being treated in hospital. Already, social order has broken down. There were riots .. at vaccination centres when stocks ran out.., gangs are roaming some inner-city streets as crime goes unchecked because the virus has cut police numbers by a third. The Federal Government is taking unprecedented action to try to contain the virus."
ROSS COULTHART: Every single word of this News Report is fiction. There's not one word of fact, but then it's not fantasy either. What we've done with that report is simply draw from America's pandemic influenza strategic plan. The plan envisages two million dead, eight million in hospital. But is this all wide of the mark? Is it scare-mongering?
Now some of the world’s leading experts are claiming this scenario, is not unrealistic.
After all it has happened once before …
ROSS COULTHART: In 1919, soldiers returning from the trenches of the Western Front in World War I brought a killer back home with them.
Some of those returning diggers were infected with a deadly virus, a new strain of influenza that swept across the country. By the time it was over, the pandemic had killed almost 40 million people worldwide, victims of the so-called Spanish Flu.
Scientists say it's now just a matter of time until history repeats itself.
This is how it might happen.
Just a couple of days ago he was backpacking in Asia, a holiday ending in Thailand.
On a crowded bus in Bangkok, just before returning home, he sat next to a person with bird flu. He's now infected with the same virus.
With his every breath, millions of influenza viruses are being released and infecting others.
PROF GRAEME LAVER, MOLECULAR BIOLOGIST: I mean, every person who's infected will infect another person. You could have an explosive outbreak of this completely, almost totally lethal virus. It would be terrible. People would just die like flies.
PROFESSOR PETER DOHERTY (Nobel Prize Winner Medicine- Immunologist) : We’re talking about a situation where we have a threat that we think can be a major threat but we don’t know it will ever happen. So it’s like a cold war situation if you like only it’s very hot at the moment. Think of the Cuban missile crisis. And so we’re preparing for something that we don’t know will happen but it would irresponsible not to prepare.
ROSS COULTHART: Australia is at the front line of attempts to contain the virus and deal with its deadly consequences. Figures suggest a bird flu pandemic could kill up to 42,000 people in Australia and put close to 148,000 into hospital. The concern is that their health system would be overwhelmed, with major cities and towns closing down as people avoid contact, even the possibility of a breakdown of public order as people demand access to stocks of the few medicines that can treat or prevent bird flu.
Then there is the damage to the economy, with a predicted collapse in world trade and travel. Authorities in Australia have been planning for the arrival of bird flu for years. But is it going to be enough?
TONY ABBOTT, AUSTRALIAN HEALTH MINISTER: No-one who lives through it will forget it. If it happens, ordinary life as we know it will cease, probably for about six months.
DR ANDREW CUTHBERTSON, CHIEF SCIENTIFIC OFFICER, COMMONWEALTH SERUM LABS: This is one of the major threats to our way of life.
PROF JOHN OXFORD, VIROLOGIST: There's no country in the world, as we stand at the moment, which is ready for the next influenza pandemic.
ROSS COULTHART: Here at St Mary's College, in London, Professor John Oxford dedicated this memorial window to the 1918 pandemic to remind his students of its terrible impact.
PROF JOHN OXFORD: And every day, day after day, week after week, month after month, as many people who died in the tsunami died in this outbreak. I don't want any more memorial services. What I want is people to get themselves sorted.
ROSS COULTHART: A world authority on the 1918 flu, Professor Oxford's concern is that a human variant of the bird flu virus poses a similar imminent threat. It could kill tens of millions of people. Yet only a few countries are doing anything about it.
PROF JOHN OXFORD: Of 120 governments in the world who have been asked by the WHO to prepare, and about 15 of them have. The rest of them aren't bothering. And we have to move into more and more preparedness. We have to build up our anti-viral stocks. If we don't, I think this virus could come and strike at our community, destroy our societies as we know them, create huge panic in countries.
ROSS COULTHART: Pandemic influenza happens when a flu virus changes so much that humans have no immunity to the new virus. This is what makes the so-called H5N1 flu virus so infectious. Why it is such an effective killer is still a mystery. It has killed 65 people in South-East Asia since 2003. since then among birds beyond South-East Asia to the west of the Russian Ural mountains, on the doorstep of Europe, and south, to Indonesia.
PROFESSOR PETER DOHERTY: Influenza viruses are carried in all types of species and they’re particularly carried in birds and the most dangerous birds are the aquatic birds like ducks. And it um, the the ducks grow them to a very high titre; that is they make a lot of virus and they also excrete it in their, through their, their their excretions and it survives for quite a long time in in water after being excreted in duck, in duck poo basically. And so where you’ve got people living very close to ducks you have a very big risk. And you find that in in essentially peasant agriculture societies that you might find say in South East Asia; in Vietnam and Cambodia and so forth. And you also have the double risk in those societies where people are very, living very close to these infected birds and that’s where many many people have been infected. But also you have the double risk that people could be doubly infected with a human virus and a bird virus.
ROSS COULTHART: We've all had a bout of the flu, but this time the stakes have skyrocketed. Nobody knows why this is happening now. This virus began stalking Asia seven years ago. It first jumped from birds to humans in Hong Kong and elsewhere in China and then radiated out. A good case study of how it spreads and kills is found in Thailand, where it broke out early last year. Here, three hours north of Bangkok by road, is where the current outbreak of bird flu first showed itself here in Thailand. It's thought that wild ducks migrating south from China for the warmer weather, rested here and infected chickens at a tiny local chicken farm.
Three weeks later, the proprietor's nephew was dead. The H5N1 flu strain the ducks brought with them is deadly for domestic poultry.
The day after the ducks arrived, the chickens began to suffer.
TRANSLATION: They were starting to shake and their face turned purple, almost black. The eyes were swollen and turned to red, then there were tears dropping out from the eyes. There were saliva came out from the mouth. Very sticky one, too. And then they started to die.
ROSS COULTHART: At that stage, no-one knew a virus was on the loose. The chickens were sick, but it seemed a waste not to eat them, so they gave some away. The farmer's nephew, Kaptan, got on his bike and, with his parents' blessing, he shared them around the neighbourhood.
TRANSLATION: Yes, the boy carried a chicken from in front of the house to the back yard, to an auntie to cook.
ROSS COULTHART: And that's when you think he contracted it?
ROSS COULTHART: The six-year-old was sick for three weeks and then he died. Soon after, a friend who'd helped deliver the chickens died as well. At this stage, the Thais went into near-panic, despite assurances that well-cooked chicken is quite safe. Given what we know, the virus can make the jump from chickens to humans. But the really frightening question is whether it can make the next step from one human to another.
PROFESSOR PETER DOHERTY: And so that’s that’s terrible of course that those people have died and so forth but for it to spread readily between humans we think it would have to undergo a change. Now that change could be a mutation that happened in some infected human and suddenly it starts to spread between humans the way the viruses we’re used to do. Or it could change by getting a mixture of a human virus and a bird virus, a new virus in fact, which would spread readily between humans.
PROF JOHN OXFORD: The first time, the first day, the first minute I hear of an outbreak outside a family group then I'll be much, much more worried, and we're thinking that will come sooner rather than later.
ROSS COULTHART : If the killer strain hits Australia, it will almost certainly have incubated somewhere in densely populated Asia first. Everyone's worst nightmare is that it reaches one of the super cities of Asia. Here in Thailand, the Government's probably better prepared than most for any outbreak, but even here there's still great concern they're just not ready for what may be coming.
Across Bangkok, poultry markets like this one provide a ready mixing pot for wild birds to spread their avian flu viruses into domestic chickens. Until the late 1990s it wasn't thought that the virus strain killing chickens across Asia, H5N1, could spread to humans. Once it did, scientists began to fear it could then be spread between people. In a worst-case scenario, they suggested the virus could combine with a human flu virus if people were simultaneously infected with both. If they exchanged genes, a new highly infectious virus could be created and then be passed from person to person.
ROSS COULTHART: Have we yet seen a human to human flu transmission, of bird flu?
DR MARK SIMMERMAN, US CENTRE FOR DISEASE CONTROL: That's a tough question, the main reason because the exposure to poultry in the region is so common that it is difficult sometimes to determine whether or not an individual arrived at an infection via an exposure to another human being or did they have an exposure to a poultry source.
ROSS COULTHART: The virus is becoming more dangerous with each outbreak. Earlier this year, Dr Mark Simmerman, from the US Centre for Disease Control, reported what is probably the world's first case of human to human transmission.
An 11-year-old girl died in Bangkok from bird flu she'd caught off chickens. Her mother also died a week later, but the mother had not come into contact with any chickens. So the scientists concluded she must have caught the flu directly from her daughter.
DR MARK SIMMERMAN: So that gave us a much more conclusive indication that there had been human to human transmission.
ROSS COULTHART: But we don't know for sure.
DR MARK SIMMERMAN: It's difficult to pinpoint that with 100% certainty, but I think the consensus is that's the most likely explanation for that case.
PROF JOHN OXFORD: But that's not quite the same as a person to person transmission outside a family, so at the moment we are still in God's grace. We are still there with the whole thing contained. ,..
ROSS COULTHART: Therein lies the possibility of a pandemic. In humans, the H5N1 virus zeroes in on lung cells and it has an astronomical kill rate. More than 100 have contracted it and more than half have died. But the greatest danger, the worst possible development, is the bird flu swapping genes with a human flu virus, creating a new virus altogether that could then be transmitted from human to human. That mutation is what scores of scientists, including Nobel prize-winner Professor Peter Doherty, are watching for.
PROFESSOR PETER DOHERTY: Now, if you get a human infected with a human virus and a bird virus simultaneously those viruses can just repackage so that you get some bits from the human virus and some bits from the bird virus in a new virus that comes out and that repackaged virus is the one we all fear.
ROSS COULTHART: This is what scientists fear most. The risk is that if these viruses swap genes, they may create a new super virus to which no-one has any immunity — a pandemic. To glimpse that future, Professor Oxford has been taking virus samples from the bodies of victims of 1918.
PROF JOHN OXFORD: I think without the First World War this virus would not have arisen.
ROSS COULTHART: It's still not known for sure how a bird flu virus mutates to become highly infectious between humans. But we do know that the First World War provided all the conditions necessary to help it make that leap. Professor Oxford has traced the 1918 pandemic's origins to the French army camp of Etaples.
PROF JOHN OXFORD: They threw pigs into the camps to try and feed these youngsters. Chickens were there, geese were there, ducks were there — all the things that we see in South-East Asia now were sitting there in northern France.
ROSS COULTHART: From Etaples, the flu spread like wildfire through the six million soldiers crammed into the front lines. And when peace came, they took the virus home with them.
Phyllis Burn, was a volunteer nurse out in the Western Front who had seen deadly spread of the Spanish Flu.
PROF JOHN OXFORD: When she came back to England on the armistice she came into London. She had the symptoms. She recognized that. The cough, the difficulty in breathing, headaches. And she made another decision, and that was not to go home to her mother. Because she was concerned, she was worried that she would spread the infection to her mother. She didn’t go home. She went to a little flat, a couple of miles away and she battled it out by herself. And she lost that battle. And she died.
ROSS COULTHART: But most battle weary survivors of the war were only too anxious to return to the relative safety of home and their families.
PROF JOHN OXFORD: What gave the 1918 virus its great impetus, its great ability to spread was the end of the War. The Armistice. Everyone came back. My own father came back. They all came back, Waterloo, Charing Cross, Kings Cross, spreading out to the Empire. There’d never been so many young people on boats, on trains, as in the Autumn of 1918. The virus was there and it took that opportunity. And suddenly there was Armageddon. It was the death time. There’s never been such a bad time to be an 18 or 19 year old as it was in 1918
ROSS COULTHART: These slices of lung tissue taken from the corpses of victims of the 1918 pandemic have revealed one especially disturbing fact.
PROF JOHN OXFORD: These viruses from all these different continents, 5,000 miles apart and 18 months apart, are remarkably the same. Which tells us that that virus, in an unprecedented way, it was so adapted to kill and spread that it didn't need to change.
PETER DOHERTY: It was a massive outbreak and killed somewhere in the range of 40 million plus human beings. In 1918 and 1919 it tended to affect the young and fit and healthy and kill very quickly. People would go home, they would feel ill, they'd be dead the next morning. Part of thinking about that is that the body's own immune response was very aggressive and of course that works better in the young and it contributed to the damage and to the death and people essentially drowned in their own body fluids.
ROSS COULTHART: 87 years on and on the other side of the world a killer flu virus has arrived on Australia's doorstep. If the virus now spreading across South-East Asia does mutate to become easily transmissible then a discovery made over 30 years ago by this Australian scientist offers perhaps the world's best defence. In 1969, Dr Graeme Laver found the flu virus in wild birds, a groundbreaking discovery that has since led to the recent development of new antiviral drugs that could prevent and treat influenza. But what has Dr Laver worried is this current virus strain's high death rate.
PROF GRAEME LAVER: The death rate in 1918 was not that high compared to the number of people infected. In Vietnam, about 60% of those people infected died. The death rate is very much higher. So that's the worst-case scenario — a virus which can kill half the people it infects and can infect millions is going to kill millions.
ROSS COULTHART: When Graeme Laver first proposed coming here to the Great Barrier Reef to look for flu in wild birds, his university supervisors ridiculed his theory.
PROF GRAEME LAVER: Firstly, we found tiny traces of antibody to influenza in the sera of the birds. This was a great surprise.
ROSS COULTHART: Until then, scientists had believed flu was a human disease, and that birds that died from it had caught the flu from humans. Since Laver had found it here in wild birds, nowhere near humans, that pointed to it being a bird disease.
Until that time, how did people think the flu virus was spread around the world?
PROF GRAEME LAVER: it was thought to be an entirely human disease and that the various bird flu epidemics, like fowl plague in chickens, was due to the human virus getting into the bird population, not the other way around.
ROSS COULTHART: Laver grew these crystals from live flu samples taken from a bird in 1975, allowing a flu virus's structure to be understood for the first time. This led to the creation of the antiviral drugs Relenza, first developed in Australia, and Tamiflu, made in Switzerland. These drugs do provide protection against flu viruses, including the H5N1 strain now killing across South-East Asia. They're also effective as a treatment if taken within one or two days of infection.
PROFESSOR PETER DOHERTY: They would be a first line of defence. The worry of course if always that even with these drugs that the virus might mutate and escape. It hasn’t been very easy for the virus to do that because it, it can’t change the particular structure that’s, that’s been targeted by the drug very easily, but it has happened, and um we’ve just got to hope that if it does happen it doesn’t produce a highly virulent virus which is spread fast.
ROSS COULTHART: The race is on to prevent another outbreak like 1918 and this BioLab in the Australian town of Geelong, is one of the front lines .. Virus samples from some outbreaks in Asia are tested here. This sample came from Vietnam.
LAB WORKER: The virus will replicate in the cells in the fertile egg and tomorrow morning when we come in they'll be, hopefully, if there's virus there, millions and millions of virus particles that we can use for further identification purposes.
ROSS COULTHART: It's vital work and there is some cause for optimism. A vaccine for the known bird flu virus, H5N1, is close at hand, perhaps just months away. Human trials began recently, but this particular vaccine may not be the silver bullet we all want it to be.
PROFESSOR PETER DOHERTY: The virus, the influenza virus that’s in birds is so hot that it’s been killing the embryonated hens eggs that we normally grow influenza vaccines in. So we’ve had to make a new type of vaccine which is called a reverse genetics vaccine, ah which is a genetically modified organism, if you like. And that’s had to go through all sorts of testing because it is a new type of strategy, and so not the usual type of flu vaccine. But whether it will be exactly the right vaccine is another problem because by the time we’ve produced it the virus may have changed to the extent we we would reasonably susceptible to it.
PROFESSOR GRAHAM LAVER: It's impossible to tell what vaccine to make until the virus comes along because there may not be a match.
ROSS COULTHART: Professor Graham Laver, says in the time it would take to create the right vaccine for the particular human version of the bird flu, a great number could die. He says the best way to fight bird flu is with drugs that halt the infection once people start showing symptoms. One such drug, or anti-viral, is Tamiflu.
GRAHAM LAVER: .. Every chemist shop should have a stock of Tamiflu, for example, to be used by people … to be sold over the counter and to be used very quickly after people have become infected.
ROSS COULTHART: Australia health authorities have stockpiled nearly 4 million courses of these antiviral drugs at secret locations across the country, the largest quantity per capita in the world behind Finland.
TONY ABBOTT: Our current proposal, guided by the experts on the National Influenza Pandemic Action Committee, is to set aside about 10% of the stockpile for treatment and to keep about 90% for prophylaxis for essential service workers. That could be adjusted depending upon evidence as any pandemic unfolds as to how effective Tamiflu is as a treatment.
ROSS COULTHART: But flu expert Graeme Laver argues it's bad policy for so much of this vital stockpile to be used as prophylactics to protect healthy essential workers. This is because when Tamiflu is used preventatively, it takes far more of these antivirals than if it is used just as a treatment once a person is infected.
PROF GRAEME LAVER: Probably 10 times as much, yeah, because you have to take it for so long.
ROSS COULTHART: So inevitably, because of that strategy, less people can be helped?
PROF GRAEME LAVER: Exactly, yeah. I mean, you have 10 times more available for the rest of the community. In any case, if you were an essential worker, would you be likely to take 2 pills a day for 10 weeks if there was an alternative strategy available? You may adopt the alternative strategy and sell the remainder of your stockpile on the black market.
ROSS COULTHART: The Australian Chief Medical Officer, Professor John Horvath, says Tamiflu's effectiveness as a treatment still isn't proven.
Why are you allocating so much of it as a preventative rather than as a treatment?
PROF JOHN HORVATH, AUST. CHIEF MEDICAL OFFICER: At the present time, the scientific evidence is overwhelming that more than 90% of the time it prevents you getting the flu. The evidence for success in treatment — that is, reducing mortality — is not there yet. Now it might be, but it is not there yet, and very small studies have shown it reduces hospitalisation but doesn't stop you from dying.
ROSS COULTHART: That's news to Roche, the company that makes Tamiflu. It told us it was very surprised at the Chief Medical Officer's comments.
ROCHE STATEMENT (Voice of Actor): "Numerous studies involving thousands of patients worldwide have been presented and published on the efficacy and safety of Tamiflu as a treatment and prevention for influenza."
ROSS COULTHART: Australia's Therapeutic Goods Administration did approve Tamiflu as both a preventative and as a treatment in 2001, and two new studies recently showed Tamiflu significantly decreases the risk of death. There has since been a sudden rush on these antiviral drugs by people in the know who want their own supply. There's now a waiting list for Tamiflu in many pharmacies around Australia. The judgment call on how the Government's stockpile is used and who exactly will be deemed an essential worker is now a political hot potato.
PROF JOHN HORVATH: We will give the Government the best possible scientific advice as to which groups of people need to be protected. That becomes then a governmental decision on how to run the country.
PROF GRAEME LAVER: Who identifies these people? Who says, "You can have the drug, and you can't"? And who's going to stop the person who hasn't got the drug murdering the person who has got it, for his share of the drug? There's going to be a big black market — people who decide to sell their drugs to other people. There's going to be fake drugs on the Internet, all sorts of problems.
ROSS COULTHART: Most of the flu experts we have interviewed admitted they already have their own stocks of Tamiflu and they never travel without it. Alan Hampson is a director of one of the World Health Organisation's collaborating centres on flu. Labs like this one test samples from all over the region. He knows more than most about the threat posed by a human variant of bird flu.
ROSS COULTHART: Are we looking at a situation where, if you're rich enough, you'll be able to get Tamiflu, and those who are either ignorant or not rich enough will miss out?
DR ALAN HAMPSON, W.H.O. DIRECTOR: That remains to be seen. Certainly, the Government has a corner on most of the available market. Having said that, I did see a web site recently where you could actually purchase Tamiflu. It was priced in British pounds and it was really expensive.
ROSS COULTHART: As the outbreaks in wild birds and domestic poultry have moved towards Europe, Western governments have been scrambling to respond. In the Netherlands, farmers have been ordered to put their free-range birds indoors to avoid the risk of virus mixing. European states were urged to stockpile anti-viral drugs after two confirmed outbreaks of the virus among birds in Romania. Positive tests on dead birds found in North West Turkey and on a farm in Greece, have sparked fears it will soon spread across Europe. In the UK, health officials have announced plans to vaccinate its entire population of 60m people, their precautions, well justified.
PROF JOHN OXFORD: Because two years there was an outbreak in Holland. The great migratory birds come over Holland, they love Holland, the canals, the lakes. They land there, they are the silent infectors. They infect the little local ducks and geese who then infect the chickens. A vet came along to the first chicken outbreak, he caught the virus and died. 300 people working for those chickens got an infection. The infection then moved into Germany. So within the last couple of years we’ve had outbreaks here in Europe, forget South-East Asia.
ROSS COULTHART: On Australia's doorstep, Indonesia has suffered an explosion of bird flu outbreaks, so far killing 3 people and hospitalising 54. Just across the Indian Ocean, near Broome, in northern Australia, scientists are catching wild birds to check for the H5N1 virus. So far, that deadly flu has not shown up in any Australian samples.
From here, in a secure incident room in Australia’s capital, Canberra, scientists have plotted bird flu outbreaks across Asia. The fear is that the more widely the virus spreads around the world, the greater the chance it will mutate somewhere into a form much deadlier to humans. With modern air travel, a bird flu outbreak in any Asian country is a worldwide problem. But the concern is that some of those poorer nations just don't have the resources to cope.
KEVIN RUDD, AUSTRALIAN SHADOW FOREIGN MINISTER: They're deeply concerned about their ability at ground level to identify outbreaks in the field — that is, of bird flu — particularly in countries like Vietnam, Cambodia and Laos, where, frankly, there isn't much infrastructure on the ground.
ROSS COULTHART: Kevin Rudd believes Australia should be funding poorer Asian nations to encourage farmers to report bird flu by offering them compensation if their birds are culled.
KEVIN RUDD: Chicken farmers who suspect there may be a problem with bird flu in their flocks are saying to themselves, "I am not going to tell the authorities "because they'll come and destroy my flocks and not compensate me at market value." That's a pretty basic concern. So plainly you need a compensation fund which gives them a reasonable level of financial incentive, to be honest. But the money doesn't exist.
ROSS COULTHART: Asian nations agreed at this August meeting to collaborate on sharing a stockpile of antiviral drugs, which would be rushed to any country suffering an outbreak. It follows new research suggesting that if antiviral drugs are used quickly enough, an outbreak can be stopped at its source.
DR ALAN HAMPSON: There are some indications that if the world all pulled together, if we shared our resources, if the surveillance was good enough — and that's a very big if at the moment — that it would be possible to stamp out a pandemic at its source.
ROSS COULTHART: The Thai health ministry concedes that is a very big 'if'.
What is your worst nightmare?
DR KUMNUAN UNGCHUSAK, THAILAND HEALTH MINISTRY: I think that when we cannot detect the outbreak at the beginning and we find it when it blow up on a very big scale. And we are not prepared for that.
ROSS COULTHART: Are we ready?
DR MARK SIMMERMAN: I don't think anyone could say that's 100% sure.
ROSS COULTHART: What makes H5N1 all the more frightening is that so much is unknown, and it's not the only virus in this class. About three-quarters of emerging diseases in humans come from animals and wildlife. Flying foxes, bats and birds — we've got a bit to worry about. But throw pigs into the equation and then it's getting quite serious.
DR HUME FIELD: There would be this symptom associated with the disease in pigs, a barking cough, and it became known as a one-mile barking cough because you could hear it a mile away. People would know that the disease had arrived in their area and they'd hear the cough and they'd hear it coming closer and closer and then to their neighbours and then they'd know that they were going to be next.
ROSS COULTHART: Dr Hume Field, a specialist on emerging diseases, is talking about an outbreak of Nipah virus he investigated in Malaysia. This virus broke out in pigs and infected hundreds of people living near pig farms but no-one knew why the animals were getting sick.
DR HUME FIELD: And that's the fundamental question. Where did the virus come from into the pigs?
RESEARCH WORKER: Here we go.
ROSS COULTHART: Working on a hunch, they found the same virus in the saliva of flying foxes. It turned out the flying foxes ate mangoes in trees above the pig pens and their droppings infected the pigs. The Malaysians bulldozed countless farms, destroyed all the pigs, but not before the virus had spread to humans, killing half of those who caught it.
DR HUME FIELD: Temperature, fever, headaches, but fairly quickly it went into a coma and unconsciousness. Within 48 hours or so they could be in a coma and certainly within a couple more days they could be dead.
ROSS COULTHART: One hundred people died in that Nipah virus outbreak, but if bird flu strikes .., would 100 deaths be realistic?
PROFESSOR GRAHAM LAVER: 100?
ROSS COULTHART: Yes.
GRAHAM LAVER: More like two million.
ROSS COULTHART: Australia’s only other defence against a flu pandemic is a vaccine, which makes this factory in Melbourne, owned by pharmaceutical company CSL, such a prize. It's the only flu vaccine factory in the southern hemisphere. To fast track production of a pandemic influenza vaccine, taxpayers have given CSL $5 million. But, as CSL's Dr Andrew Cuthbertson concedes, until that pandemic killer strain of flu strikes, it's difficult to make an effective vaccine.
DR ANDREW CUTHBERTSON: We've never seen this virus before. None of us have seen it before. So we are — the term would be, our immune systems are naive to this infection. And therefore we don't know yet how much of a dose and how many doses to ensure that each of us has an immune response capable of protecting us from this previously unseen viral infection.
DR ALAN HAMPSON: There will be a delay. The virus will spread very quickly. History says that pandemic viruses may spread in more than one wave. There may be a first smaller wave, a second major wave and even a third major wave.
PROFESSOR PETER DOHERTY: I think the best strategy we can possibly follow is to get a vaccine out there and into people as soon as possible, and to try and vaccinate the whole population as soon as possible. It’s a defence me-measure though, it’s like ah, it’s like buying military aircraft or a B1 Bomber. It’s a defence measure against something that may happen. There’s no certainty to it and of course if we duck the bullet, we’re lucky. I mean I hope we don’t have to bring this into effect.
ROSS COULTHART: Australia is probably as ready as it could ever be for any flu pandemic. Already about $160 million has been spent on preparations.
TONY ABBOTT: One of the scenarios contained in an early US document dealing with a possible flu pandemic ended with mass chaos, New Orleans on a massive scale, New Orleans writ large. Now that is a very scary prospect.
ROSS COULTHART: Science has come a long way since the pandemic of 1918. But despite all the technological advances since then, when facing bird flu, we're vulnerable, and little can change that.
UPSOT NEWSREADER: this morning, federal health authorities have confirmed the first suspected case of bird flu…
ROSS COULTHART: The Australian Government's other strategy is containment — keeping the virus out. In recent months, Australia's Quarantine Inspection Service, AQIS, has collected tonnes of undeclared poultry products, like these, found in passenger baggage.
AQIS OFFICER: Do you know whether they contain any egg yoke or not?
TRAVELLER: I have no idea.
AQIS OFFICER: I will just cut one open.
TRAVELLER: Yeah, OK, no worries.
ROSS COULTHART: In China, it's just been Moon Festival time, an autumn festival for family reunion, and these moon cakes are a common gift. They're also loaded with eggs, which can carry the avian flu virus. But looking for suspect food alone won't keep killer flu out.
PROF GRAEME LAVER: The only defence we have against this at the moment are these drugs. Quarantine won't work. You can imagine a guy in Bangkok catching the bird flu, getting on a plane to Sydney. There's no symptoms at all. He's streaming out virus all over the plane. Nobody knows he's sick. He doesn't know he's sick. Everyone gets infected. They get off the plane in Sydney and spread the virus throughout Australia. You can't quarantine against this thing.
DR ALAN HAMPSON: We won't necessarily detect them coming into the country because in the early stages, while you can be shedding influenza virus, you may not at that stage be febrile or feeling ill or feeling that you need to go and lie down.
ROSS COULTHART: Australia's pandemic flu disaster planning is well advanced. The portable beds and other equipment are ready to turn hangars here at Sydney airport into hospital wards. If and when pandemic flu hits Australian shores, the disruption could be huge.
TONY ABBOTT: Well, if it is necessary to halt flights between Australia and affected countries, we would do so. But we would not do it lightly and we would only do it on the receipt of clear expert advice that a pandemic had broken out or was imminent. We would take whatever steps we thought were reasonably necessary to safeguard the population to try to minimise the spread of the disease.
PROFESSOR GRAHAM LAVER: If it really comes and kills people as it's killing people now and it's highly transmissible, I think the statement of 'the world as we know it won't exist' is true, and there's very little to be done about it.
ROSS COULTHART: How do you know when you've got it?
PROFESSOR PETER DOHERTY: If we suddenly start to feel those typical fluey symptoms that we're all so familiar with, I think, the fever, the head sort of dullness and start to cough and so forth, then you know you've got flu. If at that stage you're lucky enough to have some Relenza or Tamiflu, you'd take it.
ROSS COULTHART: The whole world is on alert for the first verified case of human-to-human transmission. The last time, 1918, there was a minimum of 40 million dead. But that was before the age of air travel. If a human-to-human outbreak does occur, what should you do?
PETER DOHERTY: The advice that would tend to go out, I would think, would be to tend to isolate yourself if you can, stay away from public places. That's what happened in 1918, 1919. People were wearing masks, they were told to stay out of public places where they were likely to catch it. I mean it's a respiratory infection, after all, so the less that you're exposed to other people and it doesn't just spread by respiratory, it's also spreads by hand contamination and so forth. So whether people would want to put themselves at risk by accumulating into large crowds I would doubt. I think they'd be more likely to try to isolate themselves.
ROSS COULTHART: We don't know if or when it will emerge, or what shape it will take. But most experts are now sure another pandemic is looming and that the loss of life may be enormous. What we do then, how well we're going to cope, we really have no clear idea. For answers to those questions, we'll just have to wait until the day the super flu arrives.
ENDS
NEWS ANNOUNCER (ACTOR): "One topic dominates the news tonight — the bird flu pandemic sweeping the world has arrived ..with devastating results. Thirty-two ..died today from the deadly virus but by morning, health authorities fear that number will be in the hundreds. Thousands of people are being treated in hospital. Already, social order has broken down. There were riots .. at vaccination centres when stocks ran out.., gangs are roaming some inner-city streets as crime goes unchecked because the virus has cut police numbers by a third. The Federal Government is taking unprecedented action to try to contain the virus."
ROSS COULTHART: Every single word of this News Report is fiction. There's not one word of fact, but then it's not fantasy either. What we've done with that report is simply draw from America's pandemic influenza strategic plan. The plan envisages two million dead, eight million in hospital. But is this all wide of the mark? Is it scare-mongering?
Now some of the world’s leading experts are claiming this scenario, is not unrealistic.
After all it has happened once before …
ROSS COULTHART: In 1919, soldiers returning from the trenches of the Western Front in World War I brought a killer back home with them.
Some of those returning diggers were infected with a deadly virus, a new strain of influenza that swept across the country. By the time it was over, the pandemic had killed almost 40 million people worldwide, victims of the so-called Spanish Flu.
Scientists say it's now just a matter of time until history repeats itself.
This is how it might happen.
Just a couple of days ago he was backpacking in Asia, a holiday ending in Thailand.
On a crowded bus in Bangkok, just before returning home, he sat next to a person with bird flu. He's now infected with the same virus.
With his every breath, millions of influenza viruses are being released and infecting others.
PROF GRAEME LAVER, MOLECULAR BIOLOGIST: I mean, every person who's infected will infect another person. You could have an explosive outbreak of this completely, almost totally lethal virus. It would be terrible. People would just die like flies.
PROFESSOR PETER DOHERTY (Nobel Prize Winner Medicine- Immunologist) : We’re talking about a situation where we have a threat that we think can be a major threat but we don’t know it will ever happen. So it’s like a cold war situation if you like only it’s very hot at the moment. Think of the Cuban missile crisis. And so we’re preparing for something that we don’t know will happen but it would irresponsible not to prepare.
ROSS COULTHART: Australia is at the front line of attempts to contain the virus and deal with its deadly consequences. Figures suggest a bird flu pandemic could kill up to 42,000 people in Australia and put close to 148,000 into hospital. The concern is that their health system would be overwhelmed, with major cities and towns closing down as people avoid contact, even the possibility of a breakdown of public order as people demand access to stocks of the few medicines that can treat or prevent bird flu.
Then there is the damage to the economy, with a predicted collapse in world trade and travel. Authorities in Australia have been planning for the arrival of bird flu for years. But is it going to be enough?
TONY ABBOTT, AUSTRALIAN HEALTH MINISTER: No-one who lives through it will forget it. If it happens, ordinary life as we know it will cease, probably for about six months.
DR ANDREW CUTHBERTSON, CHIEF SCIENTIFIC OFFICER, COMMONWEALTH SERUM LABS: This is one of the major threats to our way of life.
PROF JOHN OXFORD, VIROLOGIST: There's no country in the world, as we stand at the moment, which is ready for the next influenza pandemic.
ROSS COULTHART: Here at St Mary's College, in London, Professor John Oxford dedicated this memorial window to the 1918 pandemic to remind his students of its terrible impact.
PROF JOHN OXFORD: And every day, day after day, week after week, month after month, as many people who died in the tsunami died in this outbreak. I don't want any more memorial services. What I want is people to get themselves sorted.
ROSS COULTHART: A world authority on the 1918 flu, Professor Oxford's concern is that a human variant of the bird flu virus poses a similar imminent threat. It could kill tens of millions of people. Yet only a few countries are doing anything about it.
PROF JOHN OXFORD: Of 120 governments in the world who have been asked by the WHO to prepare, and about 15 of them have. The rest of them aren't bothering. And we have to move into more and more preparedness. We have to build up our anti-viral stocks. If we don't, I think this virus could come and strike at our community, destroy our societies as we know them, create huge panic in countries.
ROSS COULTHART: Pandemic influenza happens when a flu virus changes so much that humans have no immunity to the new virus. This is what makes the so-called H5N1 flu virus so infectious. Why it is such an effective killer is still a mystery. It has killed 65 people in South-East Asia since 2003. since then among birds beyond South-East Asia to the west of the Russian Ural mountains, on the doorstep of Europe, and south, to Indonesia.
PROFESSOR PETER DOHERTY: Influenza viruses are carried in all types of species and they’re particularly carried in birds and the most dangerous birds are the aquatic birds like ducks. And it um, the the ducks grow them to a very high titre; that is they make a lot of virus and they also excrete it in their, through their, their their excretions and it survives for quite a long time in in water after being excreted in duck, in duck poo basically. And so where you’ve got people living very close to ducks you have a very big risk. And you find that in in essentially peasant agriculture societies that you might find say in South East Asia; in Vietnam and Cambodia and so forth. And you also have the double risk in those societies where people are very, living very close to these infected birds and that’s where many many people have been infected. But also you have the double risk that people could be doubly infected with a human virus and a bird virus.
ROSS COULTHART: We've all had a bout of the flu, but this time the stakes have skyrocketed. Nobody knows why this is happening now. This virus began stalking Asia seven years ago. It first jumped from birds to humans in Hong Kong and elsewhere in China and then radiated out. A good case study of how it spreads and kills is found in Thailand, where it broke out early last year. Here, three hours north of Bangkok by road, is where the current outbreak of bird flu first showed itself here in Thailand. It's thought that wild ducks migrating south from China for the warmer weather, rested here and infected chickens at a tiny local chicken farm.
Three weeks later, the proprietor's nephew was dead. The H5N1 flu strain the ducks brought with them is deadly for domestic poultry.
The day after the ducks arrived, the chickens began to suffer.
TRANSLATION: They were starting to shake and their face turned purple, almost black. The eyes were swollen and turned to red, then there were tears dropping out from the eyes. There were saliva came out from the mouth. Very sticky one, too. And then they started to die.
ROSS COULTHART: At that stage, no-one knew a virus was on the loose. The chickens were sick, but it seemed a waste not to eat them, so they gave some away. The farmer's nephew, Kaptan, got on his bike and, with his parents' blessing, he shared them around the neighbourhood.
TRANSLATION: Yes, the boy carried a chicken from in front of the house to the back yard, to an auntie to cook.
ROSS COULTHART: And that's when you think he contracted it?
ROSS COULTHART: The six-year-old was sick for three weeks and then he died. Soon after, a friend who'd helped deliver the chickens died as well. At this stage, the Thais went into near-panic, despite assurances that well-cooked chicken is quite safe. Given what we know, the virus can make the jump from chickens to humans. But the really frightening question is whether it can make the next step from one human to another.
PROFESSOR PETER DOHERTY: And so that’s that’s terrible of course that those people have died and so forth but for it to spread readily between humans we think it would have to undergo a change. Now that change could be a mutation that happened in some infected human and suddenly it starts to spread between humans the way the viruses we’re used to do. Or it could change by getting a mixture of a human virus and a bird virus, a new virus in fact, which would spread readily between humans.
PROF JOHN OXFORD: The first time, the first day, the first minute I hear of an outbreak outside a family group then I'll be much, much more worried, and we're thinking that will come sooner rather than later.
ROSS COULTHART : If the killer strain hits Australia, it will almost certainly have incubated somewhere in densely populated Asia first. Everyone's worst nightmare is that it reaches one of the super cities of Asia. Here in Thailand, the Government's probably better prepared than most for any outbreak, but even here there's still great concern they're just not ready for what may be coming.
Across Bangkok, poultry markets like this one provide a ready mixing pot for wild birds to spread their avian flu viruses into domestic chickens. Until the late 1990s it wasn't thought that the virus strain killing chickens across Asia, H5N1, could spread to humans. Once it did, scientists began to fear it could then be spread between people. In a worst-case scenario, they suggested the virus could combine with a human flu virus if people were simultaneously infected with both. If they exchanged genes, a new highly infectious virus could be created and then be passed from person to person.
ROSS COULTHART: Have we yet seen a human to human flu transmission, of bird flu?
DR MARK SIMMERMAN, US CENTRE FOR DISEASE CONTROL: That's a tough question, the main reason because the exposure to poultry in the region is so common that it is difficult sometimes to determine whether or not an individual arrived at an infection via an exposure to another human being or did they have an exposure to a poultry source.
ROSS COULTHART: The virus is becoming more dangerous with each outbreak. Earlier this year, Dr Mark Simmerman, from the US Centre for Disease Control, reported what is probably the world's first case of human to human transmission.
An 11-year-old girl died in Bangkok from bird flu she'd caught off chickens. Her mother also died a week later, but the mother had not come into contact with any chickens. So the scientists concluded she must have caught the flu directly from her daughter.
DR MARK SIMMERMAN: So that gave us a much more conclusive indication that there had been human to human transmission.
ROSS COULTHART: But we don't know for sure.
DR MARK SIMMERMAN: It's difficult to pinpoint that with 100% certainty, but I think the consensus is that's the most likely explanation for that case.
PROF JOHN OXFORD: But that's not quite the same as a person to person transmission outside a family, so at the moment we are still in God's grace. We are still there with the whole thing contained. ,..
ROSS COULTHART: Therein lies the possibility of a pandemic. In humans, the H5N1 virus zeroes in on lung cells and it has an astronomical kill rate. More than 100 have contracted it and more than half have died. But the greatest danger, the worst possible development, is the bird flu swapping genes with a human flu virus, creating a new virus altogether that could then be transmitted from human to human. That mutation is what scores of scientists, including Nobel prize-winner Professor Peter Doherty, are watching for.
PROFESSOR PETER DOHERTY: Now, if you get a human infected with a human virus and a bird virus simultaneously those viruses can just repackage so that you get some bits from the human virus and some bits from the bird virus in a new virus that comes out and that repackaged virus is the one we all fear.
ROSS COULTHART: This is what scientists fear most. The risk is that if these viruses swap genes, they may create a new super virus to which no-one has any immunity — a pandemic. To glimpse that future, Professor Oxford has been taking virus samples from the bodies of victims of 1918.
PROF JOHN OXFORD: I think without the First World War this virus would not have arisen.
ROSS COULTHART: It's still not known for sure how a bird flu virus mutates to become highly infectious between humans. But we do know that the First World War provided all the conditions necessary to help it make that leap. Professor Oxford has traced the 1918 pandemic's origins to the French army camp of Etaples.
PROF JOHN OXFORD: They threw pigs into the camps to try and feed these youngsters. Chickens were there, geese were there, ducks were there — all the things that we see in South-East Asia now were sitting there in northern France.
ROSS COULTHART: From Etaples, the flu spread like wildfire through the six million soldiers crammed into the front lines. And when peace came, they took the virus home with them.
Phyllis Burn, was a volunteer nurse out in the Western Front who had seen deadly spread of the Spanish Flu.
PROF JOHN OXFORD: When she came back to England on the armistice she came into London. She had the symptoms. She recognized that. The cough, the difficulty in breathing, headaches. And she made another decision, and that was not to go home to her mother. Because she was concerned, she was worried that she would spread the infection to her mother. She didn’t go home. She went to a little flat, a couple of miles away and she battled it out by herself. And she lost that battle. And she died.
ROSS COULTHART: But most battle weary survivors of the war were only too anxious to return to the relative safety of home and their families.
PROF JOHN OXFORD: What gave the 1918 virus its great impetus, its great ability to spread was the end of the War. The Armistice. Everyone came back. My own father came back. They all came back, Waterloo, Charing Cross, Kings Cross, spreading out to the Empire. There’d never been so many young people on boats, on trains, as in the Autumn of 1918. The virus was there and it took that opportunity. And suddenly there was Armageddon. It was the death time. There’s never been such a bad time to be an 18 or 19 year old as it was in 1918
ROSS COULTHART: These slices of lung tissue taken from the corpses of victims of the 1918 pandemic have revealed one especially disturbing fact.
PROF JOHN OXFORD: These viruses from all these different continents, 5,000 miles apart and 18 months apart, are remarkably the same. Which tells us that that virus, in an unprecedented way, it was so adapted to kill and spread that it didn't need to change.
PETER DOHERTY: It was a massive outbreak and killed somewhere in the range of 40 million plus human beings. In 1918 and 1919 it tended to affect the young and fit and healthy and kill very quickly. People would go home, they would feel ill, they'd be dead the next morning. Part of thinking about that is that the body's own immune response was very aggressive and of course that works better in the young and it contributed to the damage and to the death and people essentially drowned in their own body fluids.
ROSS COULTHART: 87 years on and on the other side of the world a killer flu virus has arrived on Australia's doorstep. If the virus now spreading across South-East Asia does mutate to become easily transmissible then a discovery made over 30 years ago by this Australian scientist offers perhaps the world's best defence. In 1969, Dr Graeme Laver found the flu virus in wild birds, a groundbreaking discovery that has since led to the recent development of new antiviral drugs that could prevent and treat influenza. But what has Dr Laver worried is this current virus strain's high death rate.
PROF GRAEME LAVER: The death rate in 1918 was not that high compared to the number of people infected. In Vietnam, about 60% of those people infected died. The death rate is very much higher. So that's the worst-case scenario — a virus which can kill half the people it infects and can infect millions is going to kill millions.
ROSS COULTHART: When Graeme Laver first proposed coming here to the Great Barrier Reef to look for flu in wild birds, his university supervisors ridiculed his theory.
PROF GRAEME LAVER: Firstly, we found tiny traces of antibody to influenza in the sera of the birds. This was a great surprise.
ROSS COULTHART: Until then, scientists had believed flu was a human disease, and that birds that died from it had caught the flu from humans. Since Laver had found it here in wild birds, nowhere near humans, that pointed to it being a bird disease.
Until that time, how did people think the flu virus was spread around the world?
PROF GRAEME LAVER: it was thought to be an entirely human disease and that the various bird flu epidemics, like fowl plague in chickens, was due to the human virus getting into the bird population, not the other way around.
ROSS COULTHART: Laver grew these crystals from live flu samples taken from a bird in 1975, allowing a flu virus's structure to be understood for the first time. This led to the creation of the antiviral drugs Relenza, first developed in Australia, and Tamiflu, made in Switzerland. These drugs do provide protection against flu viruses, including the H5N1 strain now killing across South-East Asia. They're also effective as a treatment if taken within one or two days of infection.
PROFESSOR PETER DOHERTY: They would be a first line of defence. The worry of course if always that even with these drugs that the virus might mutate and escape. It hasn’t been very easy for the virus to do that because it, it can’t change the particular structure that’s, that’s been targeted by the drug very easily, but it has happened, and um we’ve just got to hope that if it does happen it doesn’t produce a highly virulent virus which is spread fast.
ROSS COULTHART: The race is on to prevent another outbreak like 1918 and this BioLab in the Australian town of Geelong, is one of the front lines .. Virus samples from some outbreaks in Asia are tested here. This sample came from Vietnam.
LAB WORKER: The virus will replicate in the cells in the fertile egg and tomorrow morning when we come in they'll be, hopefully, if there's virus there, millions and millions of virus particles that we can use for further identification purposes.
ROSS COULTHART: It's vital work and there is some cause for optimism. A vaccine for the known bird flu virus, H5N1, is close at hand, perhaps just months away. Human trials began recently, but this particular vaccine may not be the silver bullet we all want it to be.
PROFESSOR PETER DOHERTY: The virus, the influenza virus that’s in birds is so hot that it’s been killing the embryonated hens eggs that we normally grow influenza vaccines in. So we’ve had to make a new type of vaccine which is called a reverse genetics vaccine, ah which is a genetically modified organism, if you like. And that’s had to go through all sorts of testing because it is a new type of strategy, and so not the usual type of flu vaccine. But whether it will be exactly the right vaccine is another problem because by the time we’ve produced it the virus may have changed to the extent we we would reasonably susceptible to it.
PROFESSOR GRAHAM LAVER: It's impossible to tell what vaccine to make until the virus comes along because there may not be a match.
ROSS COULTHART: Professor Graham Laver, says in the time it would take to create the right vaccine for the particular human version of the bird flu, a great number could die. He says the best way to fight bird flu is with drugs that halt the infection once people start showing symptoms. One such drug, or anti-viral, is Tamiflu.
GRAHAM LAVER: .. Every chemist shop should have a stock of Tamiflu, for example, to be used by people … to be sold over the counter and to be used very quickly after people have become infected.
ROSS COULTHART: Australia health authorities have stockpiled nearly 4 million courses of these antiviral drugs at secret locations across the country, the largest quantity per capita in the world behind Finland.
TONY ABBOTT: Our current proposal, guided by the experts on the National Influenza Pandemic Action Committee, is to set aside about 10% of the stockpile for treatment and to keep about 90% for prophylaxis for essential service workers. That could be adjusted depending upon evidence as any pandemic unfolds as to how effective Tamiflu is as a treatment.
ROSS COULTHART: But flu expert Graeme Laver argues it's bad policy for so much of this vital stockpile to be used as prophylactics to protect healthy essential workers. This is because when Tamiflu is used preventatively, it takes far more of these antivirals than if it is used just as a treatment once a person is infected.
PROF GRAEME LAVER: Probably 10 times as much, yeah, because you have to take it for so long.
ROSS COULTHART: So inevitably, because of that strategy, less people can be helped?
PROF GRAEME LAVER: Exactly, yeah. I mean, you have 10 times more available for the rest of the community. In any case, if you were an essential worker, would you be likely to take 2 pills a day for 10 weeks if there was an alternative strategy available? You may adopt the alternative strategy and sell the remainder of your stockpile on the black market.
ROSS COULTHART: The Australian Chief Medical Officer, Professor John Horvath, says Tamiflu's effectiveness as a treatment still isn't proven.
Why are you allocating so much of it as a preventative rather than as a treatment?
PROF JOHN HORVATH, AUST. CHIEF MEDICAL OFFICER: At the present time, the scientific evidence is overwhelming that more than 90% of the time it prevents you getting the flu. The evidence for success in treatment — that is, reducing mortality — is not there yet. Now it might be, but it is not there yet, and very small studies have shown it reduces hospitalisation but doesn't stop you from dying.
ROSS COULTHART: That's news to Roche, the company that makes Tamiflu. It told us it was very surprised at the Chief Medical Officer's comments.
ROCHE STATEMENT (Voice of Actor): "Numerous studies involving thousands of patients worldwide have been presented and published on the efficacy and safety of Tamiflu as a treatment and prevention for influenza."
ROSS COULTHART: Australia's Therapeutic Goods Administration did approve Tamiflu as both a preventative and as a treatment in 2001, and two new studies recently showed Tamiflu significantly decreases the risk of death. There has since been a sudden rush on these antiviral drugs by people in the know who want their own supply. There's now a waiting list for Tamiflu in many pharmacies around Australia. The judgment call on how the Government's stockpile is used and who exactly will be deemed an essential worker is now a political hot potato.
PROF JOHN HORVATH: We will give the Government the best possible scientific advice as to which groups of people need to be protected. That becomes then a governmental decision on how to run the country.
PROF GRAEME LAVER: Who identifies these people? Who says, "You can have the drug, and you can't"? And who's going to stop the person who hasn't got the drug murdering the person who has got it, for his share of the drug? There's going to be a big black market — people who decide to sell their drugs to other people. There's going to be fake drugs on the Internet, all sorts of problems.
ROSS COULTHART: Most of the flu experts we have interviewed admitted they already have their own stocks of Tamiflu and they never travel without it. Alan Hampson is a director of one of the World Health Organisation's collaborating centres on flu. Labs like this one test samples from all over the region. He knows more than most about the threat posed by a human variant of bird flu.
ROSS COULTHART: Are we looking at a situation where, if you're rich enough, you'll be able to get Tamiflu, and those who are either ignorant or not rich enough will miss out?
DR ALAN HAMPSON, W.H.O. DIRECTOR: That remains to be seen. Certainly, the Government has a corner on most of the available market. Having said that, I did see a web site recently where you could actually purchase Tamiflu. It was priced in British pounds and it was really expensive.
ROSS COULTHART: As the outbreaks in wild birds and domestic poultry have moved towards Europe, Western governments have been scrambling to respond. In the Netherlands, farmers have been ordered to put their free-range birds indoors to avoid the risk of virus mixing. European states were urged to stockpile anti-viral drugs after two confirmed outbreaks of the virus among birds in Romania. Positive tests on dead birds found in North West Turkey and on a farm in Greece, have sparked fears it will soon spread across Europe. In the UK, health officials have announced plans to vaccinate its entire population of 60m people, their precautions, well justified.
PROF JOHN OXFORD: Because two years there was an outbreak in Holland. The great migratory birds come over Holland, they love Holland, the canals, the lakes. They land there, they are the silent infectors. They infect the little local ducks and geese who then infect the chickens. A vet came along to the first chicken outbreak, he caught the virus and died. 300 people working for those chickens got an infection. The infection then moved into Germany. So within the last couple of years we’ve had outbreaks here in Europe, forget South-East Asia.
ROSS COULTHART: On Australia's doorstep, Indonesia has suffered an explosion of bird flu outbreaks, so far killing 3 people and hospitalising 54. Just across the Indian Ocean, near Broome, in northern Australia, scientists are catching wild birds to check for the H5N1 virus. So far, that deadly flu has not shown up in any Australian samples.
From here, in a secure incident room in Australia’s capital, Canberra, scientists have plotted bird flu outbreaks across Asia. The fear is that the more widely the virus spreads around the world, the greater the chance it will mutate somewhere into a form much deadlier to humans. With modern air travel, a bird flu outbreak in any Asian country is a worldwide problem. But the concern is that some of those poorer nations just don't have the resources to cope.
KEVIN RUDD, AUSTRALIAN SHADOW FOREIGN MINISTER: They're deeply concerned about their ability at ground level to identify outbreaks in the field — that is, of bird flu — particularly in countries like Vietnam, Cambodia and Laos, where, frankly, there isn't much infrastructure on the ground.
ROSS COULTHART: Kevin Rudd believes Australia should be funding poorer Asian nations to encourage farmers to report bird flu by offering them compensation if their birds are culled.
KEVIN RUDD: Chicken farmers who suspect there may be a problem with bird flu in their flocks are saying to themselves, "I am not going to tell the authorities "because they'll come and destroy my flocks and not compensate me at market value." That's a pretty basic concern. So plainly you need a compensation fund which gives them a reasonable level of financial incentive, to be honest. But the money doesn't exist.
ROSS COULTHART: Asian nations agreed at this August meeting to collaborate on sharing a stockpile of antiviral drugs, which would be rushed to any country suffering an outbreak. It follows new research suggesting that if antiviral drugs are used quickly enough, an outbreak can be stopped at its source.
DR ALAN HAMPSON: There are some indications that if the world all pulled together, if we shared our resources, if the surveillance was good enough — and that's a very big if at the moment — that it would be possible to stamp out a pandemic at its source.
ROSS COULTHART: The Thai health ministry concedes that is a very big 'if'.
What is your worst nightmare?
DR KUMNUAN UNGCHUSAK, THAILAND HEALTH MINISTRY: I think that when we cannot detect the outbreak at the beginning and we find it when it blow up on a very big scale. And we are not prepared for that.
ROSS COULTHART: Are we ready?
DR MARK SIMMERMAN: I don't think anyone could say that's 100% sure.
ROSS COULTHART: What makes H5N1 all the more frightening is that so much is unknown, and it's not the only virus in this class. About three-quarters of emerging diseases in humans come from animals and wildlife. Flying foxes, bats and birds — we've got a bit to worry about. But throw pigs into the equation and then it's getting quite serious.
DR HUME FIELD: There would be this symptom associated with the disease in pigs, a barking cough, and it became known as a one-mile barking cough because you could hear it a mile away. People would know that the disease had arrived in their area and they'd hear the cough and they'd hear it coming closer and closer and then to their neighbours and then they'd know that they were going to be next.
ROSS COULTHART: Dr Hume Field, a specialist on emerging diseases, is talking about an outbreak of Nipah virus he investigated in Malaysia. This virus broke out in pigs and infected hundreds of people living near pig farms but no-one knew why the animals were getting sick.
DR HUME FIELD: And that's the fundamental question. Where did the virus come from into the pigs?
RESEARCH WORKER: Here we go.
ROSS COULTHART: Working on a hunch, they found the same virus in the saliva of flying foxes. It turned out the flying foxes ate mangoes in trees above the pig pens and their droppings infected the pigs. The Malaysians bulldozed countless farms, destroyed all the pigs, but not before the virus had spread to humans, killing half of those who caught it.
DR HUME FIELD: Temperature, fever, headaches, but fairly quickly it went into a coma and unconsciousness. Within 48 hours or so they could be in a coma and certainly within a couple more days they could be dead.
ROSS COULTHART: One hundred people died in that Nipah virus outbreak, but if bird flu strikes .., would 100 deaths be realistic?
PROFESSOR GRAHAM LAVER: 100?
ROSS COULTHART: Yes.
GRAHAM LAVER: More like two million.
ROSS COULTHART: Australia’s only other defence against a flu pandemic is a vaccine, which makes this factory in Melbourne, owned by pharmaceutical company CSL, such a prize. It's the only flu vaccine factory in the southern hemisphere. To fast track production of a pandemic influenza vaccine, taxpayers have given CSL $5 million. But, as CSL's Dr Andrew Cuthbertson concedes, until that pandemic killer strain of flu strikes, it's difficult to make an effective vaccine.
DR ANDREW CUTHBERTSON: We've never seen this virus before. None of us have seen it before. So we are — the term would be, our immune systems are naive to this infection. And therefore we don't know yet how much of a dose and how many doses to ensure that each of us has an immune response capable of protecting us from this previously unseen viral infection.
DR ALAN HAMPSON: There will be a delay. The virus will spread very quickly. History says that pandemic viruses may spread in more than one wave. There may be a first smaller wave, a second major wave and even a third major wave.
PROFESSOR PETER DOHERTY: I think the best strategy we can possibly follow is to get a vaccine out there and into people as soon as possible, and to try and vaccinate the whole population as soon as possible. It’s a defence me-measure though, it’s like ah, it’s like buying military aircraft or a B1 Bomber. It’s a defence measure against something that may happen. There’s no certainty to it and of course if we duck the bullet, we’re lucky. I mean I hope we don’t have to bring this into effect.
ROSS COULTHART: Australia is probably as ready as it could ever be for any flu pandemic. Already about $160 million has been spent on preparations.
TONY ABBOTT: One of the scenarios contained in an early US document dealing with a possible flu pandemic ended with mass chaos, New Orleans on a massive scale, New Orleans writ large. Now that is a very scary prospect.
ROSS COULTHART: Science has come a long way since the pandemic of 1918. But despite all the technological advances since then, when facing bird flu, we're vulnerable, and little can change that.
UPSOT NEWSREADER: this morning, federal health authorities have confirmed the first suspected case of bird flu…
ROSS COULTHART: The Australian Government's other strategy is containment — keeping the virus out. In recent months, Australia's Quarantine Inspection Service, AQIS, has collected tonnes of undeclared poultry products, like these, found in passenger baggage.
AQIS OFFICER: Do you know whether they contain any egg yoke or not?
TRAVELLER: I have no idea.
AQIS OFFICER: I will just cut one open.
TRAVELLER: Yeah, OK, no worries.
ROSS COULTHART: In China, it's just been Moon Festival time, an autumn festival for family reunion, and these moon cakes are a common gift. They're also loaded with eggs, which can carry the avian flu virus. But looking for suspect food alone won't keep killer flu out.
PROF GRAEME LAVER: The only defence we have against this at the moment are these drugs. Quarantine won't work. You can imagine a guy in Bangkok catching the bird flu, getting on a plane to Sydney. There's no symptoms at all. He's streaming out virus all over the plane. Nobody knows he's sick. He doesn't know he's sick. Everyone gets infected. They get off the plane in Sydney and spread the virus throughout Australia. You can't quarantine against this thing.
DR ALAN HAMPSON: We won't necessarily detect them coming into the country because in the early stages, while you can be shedding influenza virus, you may not at that stage be febrile or feeling ill or feeling that you need to go and lie down.
ROSS COULTHART: Australia's pandemic flu disaster planning is well advanced. The portable beds and other equipment are ready to turn hangars here at Sydney airport into hospital wards. If and when pandemic flu hits Australian shores, the disruption could be huge.
TONY ABBOTT: Well, if it is necessary to halt flights between Australia and affected countries, we would do so. But we would not do it lightly and we would only do it on the receipt of clear expert advice that a pandemic had broken out or was imminent. We would take whatever steps we thought were reasonably necessary to safeguard the population to try to minimise the spread of the disease.
PROFESSOR GRAHAM LAVER: If it really comes and kills people as it's killing people now and it's highly transmissible, I think the statement of 'the world as we know it won't exist' is true, and there's very little to be done about it.
ROSS COULTHART: How do you know when you've got it?
PROFESSOR PETER DOHERTY: If we suddenly start to feel those typical fluey symptoms that we're all so familiar with, I think, the fever, the head sort of dullness and start to cough and so forth, then you know you've got flu. If at that stage you're lucky enough to have some Relenza or Tamiflu, you'd take it.
ROSS COULTHART: The whole world is on alert for the first verified case of human-to-human transmission. The last time, 1918, there was a minimum of 40 million dead. But that was before the age of air travel. If a human-to-human outbreak does occur, what should you do?
PETER DOHERTY: The advice that would tend to go out, I would think, would be to tend to isolate yourself if you can, stay away from public places. That's what happened in 1918, 1919. People were wearing masks, they were told to stay out of public places where they were likely to catch it. I mean it's a respiratory infection, after all, so the less that you're exposed to other people and it doesn't just spread by respiratory, it's also spreads by hand contamination and so forth. So whether people would want to put themselves at risk by accumulating into large crowds I would doubt. I think they'd be more likely to try to isolate themselves.
ROSS COULTHART: We don't know if or when it will emerge, or what shape it will take. But most experts are now sure another pandemic is looming and that the loss of life may be enormous. What we do then, how well we're going to cope, we really have no clear idea. For answers to those questions, we'll just have to wait until the day the super flu arrives.
ENDS