According to an official announcement last month by the World Health Organization, the Asian bird (or avian) flu now poses "the gravest possible threat of a global pandemic." The disease has a 72% mortality rate among humans. So far, only a few dozen victims have died, but if it becomes more easily transmittable between people, the influenza could result in millions of fatalities worldwide.

Meanwhile, Interpol last month warned it is highly likely that sometime in the next few years one or more terrorist groups will launch a spectacular attack with weapons of mass destruction (WMD): nuclear; dirty bomb; chemical; or biological. They suggest that among the ways for such a group to stealthily move and use WMD would be as a biological agent such as smallpox or anthrax.

Just as is true for avian flu, the world's population is unprepared for the new introduction of a virulent, contagious disease like smallpox. Depending on how quickly outbreaks were discovered and triage efforts to halt its spread were successful, the death toll could be as few as tens of thousands or as many as several hundred million.

In the 16^th through the 19^th Centuries, our European ancestors and later American traders, missionaries, colonists, military units, and westward venturing homesteaders were often initially confronted with powerful native tribes of Indians, resistant to the white man's takeover of lands they considered theirs. The Native Americans sometimes employed insurgent or terrorist methods to good effect against those they regarded as invaders and occupiers.

The Plague, Arnold Böcklin, 1898

But once native peoples had caught smallpox from our forebears, or occasionally from infected blankets knowingly and deliberately traded or given to them (perhaps the first genocidal use of WMD), Indian populations were decimated. They had no immunity and sometimes lost 80-90% of their numbers to the disease.

Resistance continued here and there but essentially collapsed. We perhaps wrongly attribute the relative ease of victory over most Indian tribes to our superior technology and numbers. These were factors, to be sure, but had our adversaries not lost so many and in fairly short order, the contest would likely have been more equal and the outcome in places rather different.

It would be ironic if modern insurgents or terrorists should use smallpox against us, now that it is we who have virtually no immunity to the disease.

Nations are quite conservative in their planning for a potential biological catastrophe. To date, for example, avian flu vaccine is being acquired in Britain sufficient to inoculate only about one-third of its residents. The equivalent figure for the US is just 2%.

If avian flu should become as highly infectious as the World Health Organization (WHO) anticipates, the volume and speed of modern transportation will virtually assure its rapid and global transmission.

At the current rate of lethality, within a few days thousands of people would begin dying, quarantines would be established too late to halt the influenza's spread, and millions could die before the flu is finally brought under control. It is already assumed the toll would be far worse than with the South Asian Respiratory Syndrome (SARS), for which the rate of death was only 10%.

If the proportion of the world's population infected would be similar to that for the Spanish flu of 1918, over half a billion people could die of this virus strain (based on our population being about three times what it was in the early 20^th Century and the mortality rate for this flu being so much higher).

"Forbes" reports that, per epidemiologist Michael Osterholm, "Even with moderate transmission and fatality rates, this could do in less than a year what HIV took 30 years to do."

The periodical points out that if only a mild flu epidemic should occur, such as strikes here roughly every thirty years but which is now "overdue," the Centers for Disease Control (CDC) estimates 207,000 Americans could be killed, while another half-million would need hospitalization. According to "Forbes" again, "The influenza tsunami is coming. It is hard to say that the probability of it occurring is anything other than 100%," as the magazine quotes the CDC's Martin Meltzer.

Were either avian flu or smallpox to become pandemic, some countries, perhaps many, would likely be so affected that, as with nations of sub-Saharan Africa whose populations had been overwhelmingly affected by AIDS, the basic institutions of stability (health care, social services, defense, commerce, agriculture, education, etc.) would be unable to cope, leading to "failed states."

Despite advances associated with modern civilization and, in one sense, the microscopic (each virus so small that it would take about 1000 together to match the width of a human hair) aspect of the threats, ones that, arguably, have been integral to the natural setting in which we have thrived for millennia, the economies of such countries could be so disrupted as not to be restored for several generations.

Detail from The Triumph of Death, Pieter Bruegel the Elder, 1562

Are we prepared for either the next major flu outbreak or a smallpox infection racing around the globe? In a word, no. As indicated above, we are told, by Interpol, the World Health Organization, and the Centers for Disease Control, that it is but a question of time before such a pandemic sweeps through our populations. Yet we have insufficient vaccines at hand or being manufactured to deal with even a fraction of the potential infection problem. A modest program of vaccination for smallpox in this country had been offered, but it has hardly begun. To date, probably far less than 1% of our population has received new smallpox vaccinations. There is not even the possibility in the near-term for most of us of getting shots to protect against the avian flu threat.

"Forbes," once more, writes that 20 of our state health departments still have no plan of response to a widespread infection problem. Nor, in at least half of US states, is there any modern means of reporting cases of smallpox or a spreading influenza.

Our hospitals are not now equipped to handle even an above average flu outbreak. A rather common multiple vehicle traffic mishap or an industrial accident can quickly exhaust locally available patient beds and medical personnel.

Thus, we do not appear to be ready today. Let us hope reasonably responsible preparations are commenced and carried out soon. The consequences of inaction, while we as a nation debate comparatively unimportant issues, could be almost unthinkable.

Watching for the Next Pandemic series. J. Hamilton on NPR broadcasts; December 7, 2004, December 8, 2004, and February 23, 2005.

Responding to the Threat of Smallpox Bioterrorism: An Ounce of Prevention is Best Approach. V. de Rugy and C. V. Pena in Cato Institute, Cato Policy Analysis No. 434; April 18, 2002.

Silent Weapon: Smallpox and Biological Warfare. C. Flight in BBC; January 2, 2002.