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An excellent interview with one of Indonesia’s top influenza researchers reveals refreshing candor and focus. A tip of the cap to multiflusite poster AlaskaDenise for the link: http://www.thejakartapost.com/detail...218.H05&irec=4

Specifically, writer Emmy Fitri of the Jakarta Post sat down with Udayana University-based virologist and microbiologist I Gusti Ngurah Mahardika for a chat after the nation of 18,000 islands experienced its 103^rd confirmed human fatality from H5N1. This, sadly, was before the nation reported, in rapid-fire succession, its 104^th and 105^th deaths over the weekend.

Two excerpts are particularly worth highlighting. The first deals with Dr. Mahardika’s take on what we worry about with H5N1 and pandemics. I found it to be succinct and maybe we can all grab some new talking points from his words, since he is at Ground Zero:

Question : H5N1 mutated from a flu initially confined to birds, but can now infect humans. Is it possible to roughly predict how long it would take for this virus to mutate into a "pandemic" strain?
Answer: H5N1 itself is a product of natural evolution; an assortment of viruses from quails, geese, teal birds and wild birds found in Hong Kong. They meet at bird markets -- the perfect place for avian viruses to meet and mingle.

What we know is that it's still not easy for the virus to be transmitted from human-to-human, although it has proven that it can.
At present, human-to-human infections remain unusual, meaning that the flu has yet to acquire the full ability to be transmitted in this way. Perhaps it is still in the "trial and error" phase.

Are you saying there have been cases of human-to-human transmission of bird flu?
Yes, there have, but only a limited number of cases, like in early cases in Hong Kong (in 1997). What has made the avian influenza able to infect humans was mainly the presence of a genetic susceptibility in the human recipient.
We never can tell how long it will take for a virus to mutate into a pandemic strain, able to be passed from human-to-human. It could take a very long time or could come sooner than we thought.
We are also in the dark on whether the current H5N1 will be able to trigger a pandemic, or if it could happen with a mixture of H5N1 and other viruses -- we just don't know.
At least we can still hope, and buy time, while we brace ourselves for a pandemic.
What I see nowadays while we're buying time, instead of preparing ourselves for a worst-case scenario, people are making much ado about a (bird flu) vaccine (for humans) and a material transfer agreement for virus sharing.
These are really not necessary and ill-timed. We are wasting time over unimportant issues.

If bird flu is to be considered a natural disaster, perhaps it will be the only natural disaster humans have had time to prepare themselves for.

A second passage should be required reading for all:

As you once said, weather plays an important role in the emergence and re-emergence of outbreaks. Do we have weather-related studies to support prevention measures enforced here?
There are no studies specifically targeting bird flu but general knowledge is applicable not only for the bird flu virus but also other zoonotic viruses which thrive in highly humid conditions.
I don't think we need to put too much emphasis on this to justify what we already know -- I also believe that officials here, both at the agriculture and health ministries, must realize this also; they have data on the increase of outbreaks around this time. But unfortunately, we are not accustomed to being prepared, before trouble hits home.
We don't need rocket science for that. We need innovations and investment. Public campaigns must be intensified with the same warnings, and let people know what will happen if they don't heed the warnings.

Agricultural lifestyles, seen in densely populated urban settings like Tangerang, have a high risk of harboring diseases transmitted by animals. What is your comment?
I believe people know about bird flu -- at least they've heard of it. But we're talking about the Kampung Tengah livelihood. Why would people dare to sell a sick chicken or eat a sick chicken?
Our poverty and backwardness get in the way of us seeing better managed poultry and a clean and healthy environment. It should be easier done than said, now, with more and more fatalities. The government must be ready, at all cost, to remove poultry from housing areas, especially in crowded cities like Tangerang and Jakarta. At all cost -- otherwise it will be too late. (bold all mine)

“Too late”, of course, can be applied to both the poultry industry in Indonesia, as well as the human population everywhere. We should feel free to apply it to both. His criticsm of the Indonesian government’s ongoing tiff with the WHO should not be dismissed. Nor should his admonishment that a vaccine is not a magic bullet. I have maintained that fact over and over and over again, and I am grateful to see someone who has stared Death in the face to confirm this. Vaccines will come too late in the game to really help anyone. Antivirals may lose their ability to prevent or limit viral replication. As Dr. C. Everett Koop has said, we are fighting today’s (tomorrow’s) pandemic with the same tools we had 100 years ago.