THE BURNED OVER DISTRICT

From the front page of the WaPo comes this story on the frightening lack of defenses against the possible H5N1 bird flu pandemic.

Public health officials preparing to battle what they view as an inevitable influenza pandemic say the world lacks the medical weapons to fight the disease effectively, and will not have them anytime soon.

Public health specialists and manufacturers are working frantically to develop vaccines, drugs, strategies for quarantining and treating the ill, and plans for international cooperation, but these efforts will take years. Meanwhile, the most dangerous strain of influenza to appear in decades -- the H5N1 "bird flu" in Asia -- is showing up in new populations of birds, and occasionally people, almost by the month, global health officials say.

If the virus were to start spreading in the next year, the world would have only a relative handful of doses of an experimental vaccine to defend against a disease that, history shows, could potentially kill millions. If the vaccine proved effective and every flu vaccine factory in the world started making it, the first doses would not be ready for four months. By then, the pathogen would probably be on every continent.

Theoretically, antiviral drugs could slow an outbreak and buy time. The problem is only one licensed drug, oseltamivir, appears to work against bird flu. At the moment, there is not enough stockpiled for widespread use. Nor is there a plan to deploy the small amount that exists in ways that would have the best chance of slowing the disease.

The public, conditioned to believe in the power of modern medicine, has heard little of how poorly prepared the world is to confront a flu pandemic, which is an epidemic that strikes several continents simultaneously and infects a substantial portion of the population.

Some folks may ask why this is a problem, don't we have flu outbreaks each year?

Pandemic influenza is not an unusually bad version of the flu that appears each winter. Those outbreaks are caused by flu viruses that have been circulating for decades and change slightly year to year.

Pandemics are caused by strains of virus that are highly contagious and to which people have no immunity. Such strains are rare. They arise from the chance scrambling and recombination of an animal flu virus and a human one, resulting in a strain whose molecular identity is wholly new.

In the 20th century, pandemics occurred in 1918, 1957 and 1968. Although the 19th-century record is less certain, there appear to have been four flu pandemics -- in 1833, 1836, 1847 and 1889. On a purely statistical basis, the nearly 40 years since the last one suggests the time may be ripe.

My father, who was born in 1910, lived through the Spanish flu pandemic and combat in WWII. Of the two, he said that the flu scared him the most. In combat you had the means to fight back. There was no way to fight the flu, you just waited to see who would get it next.