Quotes of the Day

Tony Abbott had been health minister for only a few months when his home fax machine discharged the fateful report one February morning last year. Outlining the possible impact on Australia of an avian-flu pandemic, the departmental brief stunned Abbott, whose gaze kept returning to the key forecasts: 13,000 deaths, 58,000 hospitalizations and 2.6 million people seeking medical help in just the first three months of an outbreak. Abbott attended a funeral that day, but on his way to and from the service he spoke by phone to the report's author, Chief Medical Officer John Horvath. While Horvath's calm manner was reassuring, their conversations left the Minister in no doubt that this was a threat Australia could not afford to ignore.

Moves to shield the country from a human strain of avian flu have been in full swing ever since. And should they fail, how prepared is Australia to cope with an outbreak? More prepared than most countries, and about as ready as it's possible to be for a virus that could be up to 25 times more deadly than a standard flu (thus killing 2.5% of those it infects), to which no one is yet immune, and for which there's no effective treatment. The gloomiest scenario for Australia, Abbott says, is an outbreak "that would bring life as we know it to a standstill for about six months." Societies like Australia's, he adds, "are not used to contemplating death on this scale."

Quite a bit would have to go wrong before it came to that. Even if the virus, H5N1, mutates into a strain that can jump from person to person, it's not inevitable that it will make it into Australia from Southeast Asia, says CMO Horvath, chairman of the National Influenza Pandemic Action Committee (NIPAC). It's likely the first cases of person-to-person transmission in Asia would occur in clusters, where local authorities, working alongside the World Health Organization and AusAID, would try to contain the virus by quarantining the sick and giving them - and those who've had recent contact with them - the antiviral drug oseltamivir (Tamiflu), which would probably offer some protection against the virus. "We would do everything in our power to contain the virus within the country of origin," says Horvath, "while at the same time upgrading our border responsiveness" to intercept infected travelers at Australian airports and docks. If containment measures failed and a virulent, highly infectious flu began spreading through Asia, the government could ban incoming flights from affected countries.

By then, however, a carrier might have slipped into the country, at which point the challenge for Australian authorities would start in earnest. Theoretically, Horvath could assume extraordinary powers by invoking the Quarantine Act. But the CMO says he would advise government leaders on closing schools and canceling sporting events in an attempt to control the virus' spread, and on distributing antivirals from the country's stockpile of 4 million doses. That sounds like a lot of antivirals - and per capita only Finland has more - but it would be "woefully inadequate" if the bug were rampant, says Peter Curson, director of health studies at Sydney's Macquarie University. NIPAC says the supply is sufficient to protect up to a million of the country's essential service workers for about six weeks. The grim conclusion is that for the duration of a pandemic beginning any time soon, the vast majority of Australians won't see an antiviral tablet.

A better prospect is a vaccine, which the government has commissioned the Melbourne-based biopharmaceutical company CSL to fast-track. CSL will soon begin clinical trials on a prototype vaccine based on H5N1. With this head start, the company would be capable of producing enough vaccine to inoculate every Australian in a minimum of three months from the time a pandemic started and the exact strain was identified. If a pandemic does break out, authorities would hope that H5N1 was the culprit, since CSL's project is to some extent based on that premise. "This is a good scientific gamble," says Horvath, "but if it's (a different strain) . . . well, it's a bit like buying a battleship that you don't ever fire a gun from. If the eventual pandemic is H5NI and the virus hasn't drifted significantly, then we've hit the jackpot. If it drifts somewhat, then there's a lot of evidence that the vaccine will still be effective to some extent."

Macquarie's Curson envisages delays in the vaccine project that could mean a pandemic was over before anyone had received a shot. Officials have tended to sugarcoat the prospect of an outbreak, he says, and there's nothing in NIPAC's plan about managing public hysteria. "There's a feeling in Australian society that the government will protect us, that we don't need to do anything," he says. "But people are going to be thrust back on their own resources."

If H5N1 does make it to Australia - about a 10% chance, according to government assessments - then it's more likely to happen within months than weeks, Horvath says. As to when the threat will be deemed over and people can get back to worrying about more mundane crises, "I have no idea," the CMO says. "But my colleagues in the (veterinary) world don't think this threat is going to abate in the foreseeable future." In the case of an avian-flu pandemic, it's unlikely that the waiting would be the worst part.

• Daniel Williams
• A few hours from Asia, Australia is stepping up border checks and readying its health system for the worst