A Wing And A Prayer

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Getting accurate intelligence about h5n1 in southern China — where it was concentrated until bird flu exploded throughout Southeast Asia at the end of 2003 — is vital to understanding the virus. But Beijing has traditionally been reluctant to share information about infectious diseases with the rest of the world. Nevertheless, with his mainland connections and his base in Shantou, Guan has been able to keep H.K.U. supplied with a steady stream of bird-flu viruses. That has enabled his lab to monitor how h5n1 is changing and how close it may be to mutating into more virulent and communicable strains. Using technicians who roam markets and poultry farms, Guan's team has taken more than 100,000 samples from birds throughout the country, from which it has sequenced over 250 different strains of h5n1. "Guan is our connection to China," says Yuen Kwok-yung, the head of the microbiology department at H.K.U. "By tracing the virus in surveillance, we can know what the best vaccine would be, if it did trigger a pandemic."

Acting outside Beijing's regimented official disease-response system, Guan and his team occasionally clash with China's Ministry of Agriculture, which maintains the country has been able to control avian flu through mass poultry vaccinations and strict government surveillance. When Guan's paper in Nature concluded that the genetic markers of the viruses found in the Qinghai outbreak pointed to southern China as the likely source, the Ministry's chief veterinary officer, Jia Youling, criticized Guan's conclusions and the quality of his research in an interview with the Asian Wall Street Journal. A spokesperson for the Ministry told Time that the Shantou lab had failed safety standards under new rules established for mainland labs, a charge Guan denies. "This fighting has hurt me a lot, and damaged my progress in China," he says. "But in my mind I feel comfortable, because I do nothing wrong."

Ministry officials briefly investigated the Shantou lab, although H.K.U.'s Yuen says the Center is clarifying its status with Beijing, and bird-flu work there is continuing. But the minor spat underscores how flawed disease surveillance remains in China, where local officials treat epidemic data as state secrets unless Beijing orders disclosure. While who officials are quick to praise Beijing for its overall improvement in dealing with epidemics since the sars outbreak more than two years ago, there continue to be frustrations. In Qinghai, for example, Beijing was slow to share samples taken from the outbreak site and turned down offers by international experts to help coordinate research — especially surveillance work that would have looked for the virus in healthy birds, the prime candidates to spread flu via migration. (Birds sensitive to h5n1 would likely be too sick to migrate.) Yet when a much smaller outbreak of avian flu in wild birds was detected in Mongolia in August, the government welcomed a surveillance team from the Wildlife Conservation Society and the U.N.'s Food and Agriculture Organization (fao). The team's preliminary results showed little evidence that large numbers of healthy birds were carrying the virus.

That's good news, but researchers still need a full account of what happened at Qinghai Lake. Some of those answers may come soon when China's National Avian Influenza Reference Laboratory, which did manage to conduct some research at the site, publishes its work. Dr. Juan Lubroth of the fao, who has seen some of the data, says Beijing's slow reaction was due to bureaucratic red tape and concern over scientific credit rather than deliberate deception, and believes the government will respond more comprehensively to the next outbreak. That might make Guan Yi's brand of maverick virology a little less necessary, but he insists he won't stop hunting the virus. "If we face this disease, and help each other, we have a chance to control it," he says. "But if we avoid it, and miss the chance to control it, we'll end up far worse than [we were] with sars."

In a small room adjoining his office in Hanoi, Dr. Nguyen Hong Ha takes a chest X-ray image from a female bird-flu patient and displays it on a light board. Her lungs are covered with scattered clouds that indicate infection. "And this is the next day," he says, slapping another X-ray photo on the board; by now, her lungs are utterly obscured. "This patient died last year," says Ha.

As the director of the National Institute for Tropical Medicine in Hanoi's Bach Mai Hospital, Ha likely has more experience treating human cases of bird flu than anyone else. While the rest of the world worries about a future h5n1 pandemic, the Vietnamese are suffering right now: 41 of the 60 people confirmed to have been killed by bird flu since the end of 2003 have died in Vietnam. "During the last eight months, it's been a steady trickle," says Ha. "There's no season for this disease anymore."