BMJ  2006;332:913 (15 April), doi:10.1136/bmj.332.7546.913

Letter

Bird flu

Pandemic flu preparation: an unheeded lesson from SARS

EDITOR—Current global battle plans against pandemic flu discussed by Pickles seem to ignore one clear lesson of the severe acute respiratory syndrome (SARS): that international air travel is the one feature that most differentiates current transmission scenarios from those in 1918.¹ The new coronavirus arrived in Hong Kong from China on a jet plane and, from that efficient air hub, quickly spread to Vietnam, Singapore, and Canada, eventually engulfing 27 countries around the globe.

One thing is certain: if and when sustained human to human transmission of H5N1 becomes reality, the world will no longer be dealing with sporadic avian flu, borne along migratory flight paths of birds,² but aviation flu—winged at subsonic speed along commercial air conduits to every corner of planet Earth.

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I hope that appropriate preventive measures are being put into place by the airlines and airports of the world, but that may be just the problem. What is the evidential base for effective interventions, and how rigorously have the aviation policy options been evaluated? Three years after the SARS episode, we still do not understand the dynamics of microbial transmission in aircraft cabins, toilets, and airport transit lounges; neither are we clearer regarding the complex spatial interactions of travellers converging on busy air terminals, nor how best such human traffic may be channelled to minimise the risk of viral transmission.

Against an estimated $800bn (£460bn; 650bn) a year that a human pandemic of avian influenza could cost the global economy,³ not to mention the incalculable cost in terms of human lives, it seems incredible that the SARS scare did not spur serious scientific activity to strengthen public health on the air transportation front. Should not the technology for picking out passengers capable of transmitting deadly pathogens and setting off epidemics be pursued as energetically as the technology for stopping terrorists from boarding a plane?

Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597 coflimmk{at}nus.edu.sg

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Competing interests: None declared.

References

1. Pickles H. Using lessons from the past to plan for pandemic flu. BMJ 2006;332: 783-6. (1 April.)[Free Full Text]
2. Liu J, Xiao H, Lei F, Zhu Q, Qin K, Zhang XW, et al. Highly pathogenic H5N1 influenza virus infection in migratory birds. Science 2005;309: 1206.[Abstract/Free Full Text]
3. World Bank. Avian flu: economic losses could top US$800 billion. World Bank News and Broadcast. 8 November 2005. http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:20715408~pagePK:64257043~piPK:437376~theSitePK:4607,00.html (accessed 6 Apr 2006).

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