"The Monster at Our Door" provides an excellent summary of key flu characteristics, assessment of the current serious avian flu threat, and the shocking failure of our government to take appropriate action.
Davis reports that RNA viruses evolve up to millions-fold faster than their our antibody sources. One key point is that the co-infection of a host by two different subtypes can result in reassortment of constituent genes, and a new, more virulent strain.
A second key point is that starvation, malaria, and coo-infections act as flu impact multipliers - thus, Asia, Africa, and Latin America are particularly vulnerable.
Davis also summarizes the failure of recent "market-solutions" to the flu problem. Vaccine producers waited until demand strengthened in '57, resulting in availability that was generally too late and a total of about 80,000 U.S. deaths. This happened again in '68, and about 34,000 deaths followed. Another serious problem with past market-based solutions is that they failed to focus on those most vulnerable - elderly, asthmatics, and pregnant women - often corporations bought up the supply to give to their relatively healthy workers.
Still another key point brought out by Davis is the likely success of isolation and quarantine in a slow-moving virus (eg. SARS), vs. H5N1 flu. SARS has a five-day incubation period and only becomes contagious well after the onset of obvious fever and dry coughing. Infectiousness and sickness with other viruses (eg. HIV), however, do not coincide - HIV can be contagious for years without symptoms being present. Further, pandemic flu spreads much more easily than SARS. Thus, while SARS was controlled largely by authoritarian China's ability to quickly isolate and quarantine, this would not be possible with a faster-moving flu - especially in a democratic nation with advanced travel systems such as the U.S.
Another problem with the new flu is that it benefits through traveling and mutating via swine and poultry. These food sources represent 76% of the developing world's increased meat consumption; further the problem is acerbated by the increased tendency for their being concentrated in large-scale production centered around processing facilities. Destroying the affected livestock has proven effective, but this is increasingly difficult in areas with limited diagnoses capability and where the local population relies so heavily on the affected sources.
H5N1 has broken out in a number of Asian countries, and recently has been found in Russia, Africa, and Eastern Europe. Experts increasingly are concerned that eventually it will mutate into a form that is easily transmitted between humans. At that point, it's anyone's guess how strong the flu will be (the mutation may make it weaker, or it may retain its current strength; further, mutations may or may not render current vaccines and treatments being developed inpotent) - thus, estimates of world-wide fatalities range up to ONE BILLION!
As for defenses, in '76 the U.S. had 37 vaccine producers - now there are only two, and production for one of them is located in England and was shut down last year for quality problems. Japan has acquired enough Tamiflu medication for 20% of its population, while as of '04 the Bush Administration had only arranged for less than 1% of U.S. coverage. Davis also points out that in '04 the U.S. spent more on abstinance education than avian flu vaccine, and until very recently there has been greater focus on bio-terror defense (anthrax, smallpox, etc.) than influenza.
"The Monster at Our Door" is a great educational and wake-up contribution; I recommend it to EVERYONE!