Dr. Osterholm says there are a few troubling aspects to bird flu.
Regular flu shots do not work to prevent transmission of bird flu. "Influenza viruses are unique," he says. "We talk about this H5N1, the bird virus. 'H' and 'N' just stand for parts of the virus. Every year, we tell people to get a flu shot because of the mutation problem. This indiscreet, sloppy reproduction changes enough from year to year that we actually need to get a new flu shot every year, unlike other viruses like measles that do not mutate nearly as much."
One year of working to create a bird flu vaccine would only yield enough for about 300 million people—less than 5 percent of the world's population.
Another major concern is the period in which influenza is at its most contagious—a day before symptoms become known. "So right now, if I have an influenza infection, and I'm going to be sick tonight, at midnight when I wake up in the middle of the night with muscle aches, fever and chills, I've already exposed [others to the virus]," Dr. Osterholm tells Oprah. This makes quarantining those infected with the virus incredibly difficult, if not impossible.
To see what a worst-case scenario flu pandemic looks like, Dr. Osterholm points to historical precedent. Though there were other smaller scale pandemics in 1957–58 and 1968–69, the plague of 1918 was clearly the worst. As recounted in historian John M. Berry's The Great Influenza, the 1918 pandemic killed an estimated 50 million people worldwide.
We may not get such a deadly strain of bird flu, but as for completely escaping another pandemic, Dr. Osterholm says, "This is not a probability issue, it's going to happen. What we don't know is which strain it's going to be or when it's going to happen. It could be tonight. It could be 10 years from now. The bottom line is, we have a lot to do to get better prepared."
Dr. Osterholm points to the lack of sufficient drugs, hospital beds and ventilators as key problems if a pandemic were to break out. However, it's not too late to start planning, he says.