Subscription 790/year or 190/quarter

An international danger

In recent days, the bird flu virus has moved into Europe. At worst, the disease becomes a pandemic affecting the entire world.


The bird flu virus has reached southern Europe this week with outbreaks in Greece and Romania. The virus already proves to be resistant to the medicines we have. For Norway's part, the pandemic can at best not be more severe than a regular flu season, such as during the Russian flu in 1977. In the worst case, it can result in two million sick and 30.000 dead Norwegians in six months. To combat a type of virus like the bird flu virus, there is no doubt that collaboration is a prerequisite for success not only in the medical field.


The July / August issue of the well-known American journal "Foreign Affairs" draws a great deal of attention to the issue of bird flu virus. The headline on the front is as follows: "The new pandemic?" The front page sends a strong signal internationally about an expected crisis. How do we look at a pandemic from a Norwegian standpoint?

Health authorities fear that bird flu viruses may interfere with human influenza viruses and that the new virus will cause an influenza epidemic across much of the world that is more severe than the regular flu epidemics that affect the world annually.

A pandemic is an epidemic that is spreading throughout the world and affects a large proportion of the population. No or only very few can be expected to have immunity to the new virus. A significant proportion of the world's population can be infected already during the first season (20-40 percent) because there is no flock immunity.

In our part of the world, pandemics of infectious diseases are considered one of the most likely causes of acute crisis conditions. It can be difficult to stop a pandemic influenza virus by strengthening border controls or quarantine measures. WHO has a special contingency plan for influenza and recommends that each country prepare its own contingency plans.

The most widespread pandemic in modern times was the Spanish sickness. After some small epidemics spread in 1917, the epidemic hit full force in the spring of 1918. During the summer, it had spread throughout Europe and America. In the fall of 1918 a new wave came, in 1919 a third, and January 1920 a very innocent fourth wave. In several places half of the population became ill. In Europe, approx. 2.6 million, probably 20 million worldwide. The disease mainly attacked young people.

According to public statistics, in 1918 7308 of 374 288 reported cases died in Norway, but in total between 14 and 000 people are thought to have died as a result of the epidemic in Norway. The Ministry of Health and Care believes that if Norway were to be affected by an influenza pandemic today, it could at least be as severe as the Spanish disease and lead to two million flu cases in half a year and just under 15 deaths. At best, the pandemic cannot be more severe than a regular flu season, such as during the Russian flu in 000.

International instability

Experts believe a new flu pandemic will come sooner or later, but it's hard to predict the timing. Bird flu is just one of several options, and assumes that the virus can infect humans. It is perhaps more likely that there will be a pandemic with a variant of influenza virus that can already be infected in this way today.

Why does the bird flu virus get so much attention when there are 39 million people living with HIV, and there were 2,9 million people who died of AIDS in 2004? In addition, 2,8 million people die of tuberculosis and several million people from malaria. Foreign Affairs writes that the flu virus continues to be the king when it comes to mortality among the world's population. On average, 1 – 1,5 million people die from the flu each year. During a pandemic, which lasts on average between 12 – 36 months, mortality will increase dramatically. The big difference is that a pandemic will also be a threat to the rich countries, while HIV, AIDS, malaria and tuberculosis continue to be third country diseases, that is, far away from us in the rich part of the world. Therefore, one can unreservedly say that the great attention the bird flu virus gets is because it can affect us in the developed countries as much as the developing countries.

A pandemic will trigger a reaction that will change the world overnight. For poor countries, medicines will probably not be available for many months after an outbreak. In addition, there will probably not be enough medicine for all those affected, and it is very likely that only the rich countries will have access to vaccines and treatment.

A pandemic will have major consequences for foreign trade and travel, and it will be difficult to get into other countries because of the danger of infection. Economics at a global, regional and national level will also be affected. This has never happened because of HIV, AIDS, malaria and tuberculosis. The closest world has come to such a scenario in modern times was during the SARS epidemic in 2003. In a period of five months, 8000 people got this virus. 10 percent of them died. We can question why this little epidemic triggered such strong reactions. So what will trigger a major pandemic?

SARS had a major impact on the economy. In Asia, the region lost about $ 40 billion. A further danger is that the pandemic and economic collapse can destabilize governments in the countries that are hit hardest. What we saw during SARS was that cooperation between countries was exemplary and probably one of the reasons why the epidemic was stopped so quickly, but on the other hand, the contagion during influenza is greater than under SARS.

In connection with the spread of bird flu in Hong Kong in 1997, many countries intensified their efforts to finalize a plan against pandemic influenza. In Norway, such a plan was finalized in 2001 and last revised in July 2003. It addresses all aspects of the health service and how emergency preparedness should be as best as possible to be prepared for a new flu pandemic.

The time of fear

The mass media has changed our psychological position. It is not possible to distance oneself from the strong human expressions conveyed through the television screen or from news reporting of crises. This "nearness" creates fear in each of us. Fear can thus become a driving force that creates negative side effects. It is therefore important that health authorities in each country include this aspect in their contingency plan. How health authorities communicate in a contemplated crisis becomes crucial so as not to create further fear in the population. In this line of thinking there is also an understanding that the authorities' communication must be extroverted in the sense not crisis-maximizing.

The second question we can ask is whether this "time of fear" also affects our foreign policy. It is no longer possible to distinguish between national and international issues, because they run into each other. Foreign policy no longer means one state's relationship with another state, but the term is about to get expanded content because the world has come so close to us. Is it possible to distinguish between foreign, health and security policy in a pandemic? In practice, this means increasing cooperation between authorities and states. One can go so far as to say that states now need each other to work together in order to stop a pandemic, because world stability is for the good of all. It also means that the rich countries must be willing to contribute to the poor countries should a pandemic break out.

Although it is not possible to avoid a pandemic, the consequences can be reduced by the awareness of the problem "a world and a health". State leaders must understand that even if a country has enough vaccines to protect its own population, the economic consequences of poor countries not having vaccines will be great for the whole world.

For Norway, with the new red-green government, the commitment should be present – with a prime minister working for childhood vaccination, a development minister with experience from developing countries and a foreign minister with experience from the WHO and the Norwegian Red Cross. This means that if we were to have a new pandemic, Norway will in all probability play an important role in the international work to counter a crisis in the world.

Birgitte Bye, M.Sc., and Egil Lingaas, Department of Hospital Hygiene at Rikshospitalet – Radiumhospitalet HF

You may also like