“We have as much chance of stopping a pandemic as we would of putting a curtain around Minnesota and keeping out winter.”

-Michael Osterholm²²⁰⁵

Michael Osterholm on the Oprah Winfrey Show

Even assuming that countries had the resources for proper surveillance and reported outbreaks promptly, no antiviral stockpile currently exists to carry out the ring-fencing strategy. The WHO only has 120,000 courses of antivirals, whereas millions may be necessary.²²⁰⁶ The WHO sent 2,500 treatments to Vietnam, 500 to Cambodia,²²⁰⁷ and a few hundred courses divided among 44 hospitals in Indonesia; many received no more than a handful.²²⁰⁸ Countries at risk, like Sri Lanka, report they don’t have a single dose.²²⁰⁹ “I think the take-home message,” said an epidemiologist at Harvard, “is that the current stockpile is very unlikely to be adequate to stop anything.”²²¹⁰

Meanwhile, the Western world is continuing in its “narcissistic planning,”²²¹¹ as described in a medical journal editorial, ignoring pleas from the World Health Organization to pour resources into Southeast Asia.²²¹² The United States may spend $1 billion to domestically stockpile antiviral drugs.²²¹³ That’s more than ten times the entire health budget for Vietnam. In Cambodia, the total annual budget for a campaign to encourage citizens to report suspected cases of bird flu is about $3,000.²²¹⁴ In a New Yorker interview, a senior public health official pondered the question of whether countries in the West might send their resources to combat the flu in Southeast Asia. He told the reporter, “Who are you kidding?”²²¹⁵

In the end, mathematical models remain just that—mathematical models. Even assuming that the models are valid, they are so qualified with conditional assumptions as to potentially render them useless under real world conditions. Public health experts point out that the odds are vanishingly slim of early detection of a small cluster in a rural area with little public health infrastructure followed by the distribution of an antiviral stockpile that doesn’t yet exist—all within a three-week period.²²¹⁶ Michael Osterholm, who was responsible for leading the single-largest containment campaign in U.S. history to control a meningitis outbreak,²²¹⁷ is skeptical that influenza can be stopped: “To believe that you can contain this locally is to believe in fairy tales.”²²¹⁸

Poorly executed, the strategy could even make things worse by creating Tamiflu resistance in the virus that escapes. This class of drugs represents our last remaining hedge against the pandemic.²²¹⁹ “We have to be very careful right now,” warns one University of Hong Kong microbiologist. “We don’t want a lot of drug resistance for Tamiflu because if the pandemic comes, it may become useless…[and] we will then be completely disarmed. We will be finished, this is the concern.”²²²⁰

Even if the human pandemic could be successfully quashed, we might still face a “reloading” problem. Experts speculate that H5N1 could be so endemically entrenched within multiple, globe-trotting migratory species of birds that its eradication must be regarded as impossible, presenting a constant pool of mutant virus ready to pop up somewhere else. In bird populations, we are dealing with a moving target.²²²¹ The genie cannot be put back in its bottle.

Given these considerations, a microbiologist at Chinese University sums up the bottom line: “[O]nce H5N1 becomes easily transmissible in humans, it will be the end,” he said. “We can do nothing to control this spreading.”²²²²