THERE is only one thing more disturbing than the domestic outbreak of a potentially lethal virus, and that is news that an even deadlier threat is lingering outside our borders.
The outbreak of bird flu in Suffolk last week renewed media alarm about Britain's vulnerability to a viral pandemic. But this week experts have warned that, in reality, that form of outbreak poses little threat to the population at large.
Our real concern, they say, should be with the situation abroad, where infections are being managed with less efficiency. It is that weakness the virus will exploit, and, as a result, we are at far greater risk of a viral attack walking through Heathrow than we are from our domestic poultry. Bernard Matthews is not the problem. But Indonesia could be. Indonesia has so far proved a hotbed for the H5N1 strain of bird flu. It has the highest number of human deaths from the strain - 63 out of a global 166 - and has received international criticism on its lax attitude towards virus surveillance.
Mike Davis, the author of The Monster at Our Door: The Global Threat of Avian Flu and a professor of history at the University of California, says the virus is now endemic in the Indonesian poultry population.
"The Indonesian authorities have been ineffective in their approach to managing this infection, and although there have been recent improvements [such as banning the ownership of domestic birds], these have been made only after the virus was allowed to spread. Jakarta is now surrounded by infection and without killing every bird in the country they will never eradicate avian flu there."
The criticism of the Indonesian government centres on a suspicion that if the current avian virus (transmissible only from birds to humans, not between humans) is to mutate into a human virus anywhere, it will do so in a country such as theirs.
It is a cultural norm for every Indonesian family to keep chickens in their backyard - they act as a nutritional and economic safety net when times get tough.
For the virus to jump species, it requires constant interaction between bird and human, as Dr Bob Dalziel, a microbiologist from the Centre for Infectious Diseases at the University of Edinburgh, explains.
"For any virus to infect a cell, it needs to bind with receptors on the outside of that cell," says Dr Dalziel. "Flu is very efficient at using the structures of bird cells, but not at using human ones. For the virus to become a human strain, small mutations must improve its recognition of human cells - and the genetic make-up of flu cells is prone to frequent mutation."
For that virus to become a pandemic in humans, it would have to mutate and reach a human cell. This could happen when the virus is passed out in bird droppings and released into the atmosphere briefly as the faeces dry out. A human would need to inhale the airborne virus by getting close to the bird droppings immediately after they were passed.
"If the mutation happens in a chicken living rurally in Vietnam, it is very unlikely any human would catch it, and the disease would simply die," says Dr Dalziel. "But because so many birds live so closely with humans in cities like Jakarta, the probability is far higher that both the right mutation would occur there, and that a human would catch the virus."
Given this near certainty that a fatal flu will develop in the Far East, the remaining task is one of management.
Containment of the disease within its outbreak location is unlikely, due to the alleged ineptitude of surveillance procedures on the ground. With international travel and industrial globalisation, the virus would likely have left the country before the authorities realised it had emerged, so the strategy comes down to vaccination.
The Indonesian authorities have been under pressure from the World Health Organisation (WHO) to share samples of their most recent virus, as scientists require the information to track its mutations. The more information it has, the quicker it will be to develop a vaccine when the human-to-human strain emerges.
This week, after months of refusal, the Indonesian government agreed to share recent virus samples - but not with the WHO. Instead, it has struck an exclusive deal with an American pharmaceutical company, Baxter Healthcare, by which the information is exchanged for expertise in vaccination production.
This is a major departure from the WHO's virus-sharing system, and has been condemned by some of the international community as a selfish act of nationalist protection. Professor Hugh Pennington, one of the UK's leading virologists, says without this information transfer, western scientists are working "with one hand tied behind their backs".
But given that countries such as Indonesia - most vulnerable to a human-to-human infection - will not be able to afford the commercial vaccines when the human virus emerges, their only bargaining tool in securing protection is the information required to manufacture the vaccine.
And the West's motivations are not entirely magnanimous.
"Western governments have already put their orders in to vaccine manufacturers," says Prof Pennington. "They have ensured they have enough capacity standing by to protect their own citizens, and so the second and third-world countries will come low on the list [of those to receive vaccines]."
Mike Davis agrees the system is biased. He says: "This exposes every inequality in the provision of public health care. The World Health Organisation needs to sound the alarm, and take the world vaccine off the commercial shelf."
In the end, the debate over vaccinations could be a moot point. The potency of avian flu is such that a vaccine - which will be developed at best six months after the first human infection - will not prevent people catching the disease. It will merely reduce the mortality rate, which, for the current strain, stands at 50 per cent.
"We have so many unknowns," says Prof Pennington. "We have never had a pandemic when a vaccine has been available, we have never had antiviral drugs, and never tried the lifestyle changes - such as closing schools - which could be relied on to reduce infection. Nobody knows what will be effective until it gets here."Scotsman
