Quotes of the Day

International donors at a conference in Beijing last month pledged $1.9 billion for global efforts to control bird flu. The latest news on the spread of the disease suggests this would be money well spent. Over the past two weeks, H5N1 avian flu has breached the heart of Europe, cropping up in Germany, Italy, Austria and France, among other countries. On Saturday, India confirmed its first outbreak of H5N1 in poultry, and began culling 500,000 birds in the western state of Maharashtra. Yet in a world where millions die every year because of diseases that could be prevented with a bit more funding, $1.9 billion is a lot of money for a virus that has so far killed fewer than 100 people. A real risk exists that a single-minded battle against a pandemic that may or may not occur soon could drain needed health resources from clear and present dangers.

Nowhere is that choice more stark than in Africa. Earlier this month, authorities uncovered a large bird-flu outbreak on several poultry farms in northern Nigeria, the first time H5N1 has been found on the continent; more than 140,000 chickens have so far died from the virus or been culled. Though no human cases have been discovered yet, the news that the outbreak had gone undetected for up to a month raises concerns that the virus may already be spreading under the radar to other parts of the continent. Africa has an estimated poultry population of 1.1 billion birds, many of them sharing living space with people—the same epidemiological powder keg that enabled bird flu to cause so much damage in much of Southeast Asia. Avian-flu experts see impoverished Africa, with its inefficient governments and millions of immuno-compromised HIV infectees, as a perfect breeding ground for a pandemic.

Yet the sheer number and severity of Africa's ills puts bird flu in perspective. Medical resources in Africa are cruelly finite—death tolls rise and fall according to how well those resources are allocated. Africa has no shortage of candidates to compete for triage: an estimated 6,600 Africans die of AIDS every day, 3,000 die of malaria, 24,000 of hunger and poverty. As long as bird flu primarily remains a threat to birds, it just doesn't compare with these everyday scourges. Even South Africa, the nation best equipped to respond to bird flu, faces "a lot of other health issues" competing for resources, says Dr. Lucille Blumberg, head of the epidemiology and outbreak unit at the National Institute for Communicable Diseases. Referring to AIDS, she notes: "We already have an epidemic here that's killing hundreds of people a day." A spokesperson for the World Health Organization's Roll Back Malaria program points out that while the need for malaria funding tops $3 billion every year, only $600 million was available in 2005. International donors need to be very sure that they aren't robbing from other health programs to pay for bird-flu measures.

This does not mean the world should neglect to take prudent steps to fight bird flu—a pandemic could become the greatest health catastrophe the modern world has ever faced. Avian flu is already beginning to cause real economic pain. When infected wild birds were detected last week in European countries, poultry sales across the continent plummeted. But a handful of dead swans on the Danube and a bad quarter for chicken sellers in Rome isn't why we're spending billions to fight bird flu. We want to stop the big one. A report released last week by an Australian think tank reminded us just how big that might be. The Lowy Institute estimated that a worst-case pandemic, one even deadlier than the 1918 Spanish Flu, could kill up to 142 million people and cost the global economy $4.4 trillion—the equivalent of eliminating Japan's annual economic output.

Those are scary numbers, but they're hardly the only frightening pandemic predictions circulating these days. Last month, two doctors in Minnesota published a modest paper in the journal Academic Emergency Medicine. The authors point out that even in a weak pandemic there would be far fewer mechanical ventilators than the number of desperately ill flu patients who would need them to survive. "In this situation," they write, "triage of resources would be needed to offer 'the greatest good for the greatest number.'" That means that the very sick or the very old would probably be denied ventilator support—even removed from the machines—in favor of those more likely to survive. The assumption that most people in the developed world have about medical care—that everything possible will be done to help the sick—would be shattered. Doctors would be left to allocate scarce resources, deciding who should live and who should die. If that happens, Africa will no longer seem so far away.

• Bryan Walsh
• Fixated on fighting bird flu, we risk shortchanging other prevention programs