H5N1, Part I
Brian Trumbore
President/Editor, StocksandNews.com

I was in Morocco a few weeks ago and one day hired out a driver to take me from my base in Casablanca to Marrakech, the famous marketplace. It's a long, 3 ?-hour, boring journey, I must say, but along the way I was observing the peasants hawking vegetables (holding clumps of asparagus, for example) as well as live chickens. When I saw the chickens I remarked to the driver, Ali, that this was how bird flu spreads. He was a sophisticated man, 52, who spoke good English but he didn't seem to understand where I was coming from.

Each one of us is in tune to various issues in life. For my part I try my best to keep up on as much as possible, and as a result perhaps I'm too much of an alarmist, as best expressed in my "Week in Review" commentaries.

Over the past year, however, I haven't written much on the bird flu front because it seemed fairly well contained. But we have to constantly be on guard for growing evidence that today's virus, the H5N1 strain, is mutating. If a story ever broke that two died in Hong Kong as a result of human to human transmission, I can guarantee that would shock Asian markets and these days the contagion would immediately spread, much as we saw on Feb. 27 and the rough day on Wall Street following Shanghai's mini- debacle.

Back in 2005, a series of articles in Foreign Affairs spurred action on the part of public officials, but the sense of urgency has largely died down. In the current March/April 2007 edition of the periodical, however, Michael T. Osterholm, an expert on infectious diseases, particularly H5N1, provides an update. Following are some excerpts.

"Like earthquakes, hurricanes, and tsunamis, influenza pandemics are recurring natural disasters. The natural reservoir of influenza virus is wild aquatic birds."

The impact on humans of the H5N1 strain thus far may be limited, "but a human influenza pandemic could occur - and be devastating - if a current strain underwent the right genetic changes."

Much study has been taking place concerning the famous 1918- 19 influenza, including the study of tissue samples, and the conclusion is the virus back then evolved through a process known as adaptation, "a series of critical mutations that rendered it capable of being transmitted between humans."

Michael Osterholm notes that many of the genetic changes documented in the 1918-19 influenza now appear to be taking place today in the H5N1 strain, while the virus is affecting more avian species.

"No one can predict when the next pandemic will occur or how severe it will be. But it will occur for sure, and because of the interdependence of the global economy today, its implications will reach far beyond its toll on human health. A recent study by the Lowy Institute for International Policy, which provides the most comprehensive estimate yet, found that a mild pandemic similar to that of 1968 would kill 1.4 million people and cost approximately $330 billion (or 0.8% of global GDP) in lost economic output. Were a pandemic as severe as that of 1918-19 to occur, over 142.2 million people would die, and the world's GDP would suffer a loss of $4.4 trillion."

Osterholm details the spread of H5N1.

In the fall of 2003, the avian influenza first appeared in Asia. It died off as an issue then, only to reemerge in the summer of 2004 in Cambodia, China, Laos, Thailand, and Vietnam, where it persists today despite a widespread vaccination effort.

In 2005, H5N1 expanded beyond Asia into Kazakhstan, Mongolia and Russia in July, and then Turkey and western Europe by October. By February 2006, it had reached Nigeria and has since been documented in other African nations, including Egypt.

Osterholm writes: "In Africa, it most likely spread through the trade of poultry for human consumption, although migratory birds may have contributed to the problem there as well." [My concerns in Morocco were warranted.]

As yet, though, there are still no documented cases of the spread of H5N1 to the Americas but it only seems a matter of time since the Arctic regions of North America are used as flyways for migratory birds or poultry.

The march of the virus into the human population has been a steady one. As of January 15, 2007, it had infected 265 people, 159 of whom died, or exactly a 60% mortality rate. Deaths have occurred in ten countries; Azerbaijan, Cambodia, China, Djibouti, Egypt, Indonesia, Iraq, Thailand, Turkey, and Vietnam. 79 fatalities were recorded in 2006, a steady increase each year from just 4 in 2003.

As for the lethality, the World Health Organization in a November 2006 report concluded, "Should the virus improve its transmissibility by acquiring, through a reassortment event*, internal human genes, then lethality of the virus would likely be reduced. However, should the virus improve its transmissibility through adaptation as a wholly avian virus (as what occurred with the 1918 pandemic strain), then the present high lethality could be maintained during a pandemic."

[*Reassortment "occurs when an avian virus and a human virus both infect the same cells of an animal (a pig, for example) or a person and swap genes, creating a new virus adapted to humans."]

Following the Foreign Affairs pieces in 2005, the Bush administration and Congress worked on emergency funding to prepare for a pandemic and in the end legislation was approved providing $3.8 billion. In fiscal 2007, a further $2.3 billion was allocated for implementing the preparedness strategy. Other nations, including Australia, Canada, France, Singapore and the U.K. have accelerated similar plans.

Michael Osterholm:

"As positive as these steps may seem, there are critical problems with the preparedness plans worldwide. Many crucial questions remain unanswered and even unaddressed. What are the technological challenges and barriers to achieving a higher state of preparedness? What steps should be taken to significantly reduce the impact of a global pandemic? How does one measure preparedness? Who should pay for it? What are the economic costs of being more prepared compared to the costs of being less prepared? In some ways, a fog of confusion has settled over these issues. Like soldiers in battle, policymakers and planners in the private sector are overwhelmed by the many uncertainties and complexities surrounding the threat and by the question of how to anticipate and respond to such a catastrophe."

Next week we'll delve into some of Osterholm's specific recommendations for business.

Brian Trumbore