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Almost 100 years ago, an epidemic of flu claimed more lives than were killed in all of World War I. It’s stunning but true: The war took 16 million lives, but the flu pandemic, which began around the same time (1918), killed between 20 million and 50 million people.

Sources vary on the exact figure, but there’s no doubt that the 1918 flu pandemic, known as the Spanish flu, was one of the deadliest disease outbreaks in human history, killing more people in one year than the bubonic plague did in four years during the 14th century.

The flu hit most continents and countries, following soldiers on their way to war, trade routes and shipping lines from Europe and North America to Asia, Africa, South America and the South Pacific. One-quarter of the U.S. population, and one-fifth of the world, were infected with the disease.

Two years ago, scientists reconstructed the genetic code of that deadly 1918 flu and discovered that it is very similar to the H5N1 avian influenza virus that so worries infectious disease experts today. Both are bird flus, and both share several key mutations that involve adaptation to become more dangerous to humans, although the 1918 flu had many more such adaptations.

Right now, close contact with dead or infected birds seems to be the primary way humans contract this strain of flu, but if H5N1 continues to mutate and becomes easily transmittable from one human to another, it could spread much more rapidly. And it’s deadly—of the approximately 350 humans to become ill with avian flu so far, more than 250 have died.

Could a pandemic flu kill as many people today as it did in 1918? Maybe not quite that many, but it would probably be devastating. Epidemiological models from the U.S. Centers for Disease Control and Prevention estimate that today, a pandemic is likely to result in 2 million to 7.4 million deaths globally, with the hardest hit likely being low-income and less-developed countries that have fewer resources to combat flu.

And today, more than ever, with the “global village” and rapidity of international travel meaning that almost any disease can be transmitted across the globe within hours, it’s urgent that nations work together to prepare for such an outbreak.

In 1918, governments from different nations, beset by a major world war, were hardly prepared to work together on preparedness for an epidemic outbreak like the Spanish flu. Today, the atmosphere is different. In September 2005, President Bush announced the International Partnership on Avian and Pandemic Influenza, and the partnership’s first meeting followed a month later.

Since then, a series of conferences in Ottawa, Geneva, Tokyo, Beijing, Vienna and elsewhere have brought together key nations and international organizations to improve global readiness for a potential flu pandemic. At the Beijing conference, international participants pledged class=”import-text”>2007December.District of Choice.txt.9 billion to combat avian influenza worldwide.

The international partnership has three major areas of focus: surveillance and prevention; preparedness, planning and outreach; and response and containment. That means everything from creating massive surveillance and response systems (such as the World Health Organization’s Global Outbreak Alert and Response Network), to strengthening veterinary services in affected areas, to pre-positioning stockpiles of medical and logistical supplies.

Pilot projects are testing the world’s preparedness. For example, the U.S. Agency for International Development and the U.N. Food and Agriculture Organization are developing disease surveillance and response teams with the government of Indonesia. From 12 pilot districts on the island of Java, the project will eventually expand to 159 districts on Java, Bali and Lampung to improve rapid response to flu outbreaks in poultry. Indonesia has been particularly hard hit by avian flu—of the 113 human cases confirmed to date by the World Health Organization, 91 have been fatal.

In addition, the World Health Organization and the Secretariat of the Pacific Community are sponsoring educational workshops to raise awareness of avian flu in Pacific Island communities such as Fiji, Samoa and the Solomon Islands. Recent UNICEF studies in the region have shown that approximately half of some population groups in these countries had never even heard of avian flu.

There are also regional projects between neighboring nations. The governments of Mexico, Canada and the United States are working collaboratively to create an avian and pandemic influenza plan focused on emergency coordination, borders and transportation, and critical infrastructure protection.

It’s an uphill battle. Avian influenza in poultry spread from 14 countries to 55 between 2005 and 2006; the number is now thought to be more than 60.

“Unfortunately, only a relatively small proportion [of countries] are adequately prepared to keep going in the event that the pandemic has massive absenteeism associated with it. And we need hard work for at least two or three years more to make sure that the whole world is properly pandemic ready,” Dr. David Nabarro, the U.N. senior coordinator for avian and human influenza, said at a meeting in Geneva in October.

And of course, the next global pandemic may not be H5N1, or a bird flu virus—or even the flu at all. But the worldwide partnerships and resources that are being developed to help plan and prevent for an avian flu outbreak should also help prepare for other infectious disease outbreaks as well. And if it takes a village to raise a child, it definitely takes a (global) village to keep children and adults safe from pandemic disease.

About the Author

Carolyn Cosmos is a contributing writer for The Washington Diplomat.