South East Asia is under attack by deadly disease. With growing industrial development and market economies, the region was looking at a rosy future in 2004, when bird flu first made its appearance. A variant of avian influenza deadly to humans surfaced in poultry. But when the virus combined with influenza contagious in humans, the epidemic started. Now Vietnam’s economy is in tatters, its workforce decimated, the public health service unable to cope, and its government at the mercy of foreign aid donors.

Thailand is also under pressure, with deaths mounting daily. In scenes reminiscent of the great plague of London, people huddle indoors, afraid to go to work or mingle in public. The mood is one of despair and decline.

But the greatest threat from Bird Flu is to the economic miracle of China. Hong Kong is already shattered, and the death toll mounts. Authorities scramble to contain the pandemic by increasing limits on travel and trade, economists predict the impact will be “somewhere between halving economic growth and eradicating it entirely.”

Now observers are wondering what will get to the western world first, the virus or the economic fallout?

ANALYSIS >> SYNTHESIS: How this scenario came to be

Scenario

On 13 December 2004, health leaders from around the world met in Geneva to discuss the potential threat posed by the predicted future mutation of avian influenza into a highly contagious and virulent form that could quickly pass from person to person. The World Health Organization (WHO) has warned that avian flu variant H5N1 could combine with an influenza strain already contagious in humans to cause a pandemic that might kill millions of people. Bird flu has been found in poultry in 11 Asian countries. Attempts to eradicate the disease have not succeeded, despite the destruction of over 100 million birds. To date, 54 human cases of avian influenza have been reported, all in Thailand and Vietnam. Most of the victims had direct contact with birds; 36 of the victims died.

The impact on business of a pandemic which is more virulent and contagious that SARS would include travel restrictions and quarantines or problems with markets, suppliers and employees because of illness and fear.

1918: The Spanish Flu
A global influenza pandemic after the First World War kills more than 40 million people.

2002: Severe Acute Respiratory Syndrome (SARS)
Severe Acute Respiratory Syndrome (SARS) catches public health officials unprepared when it infects more than 8000 people, killing 774. While the outbreak started in Hong Kong, the source of the virus is traced to mainland China, where people living in close proximity to livestock in semi-urban conditions provided the breeding ground for a virus that migrated from animals to humans.

2004: Bird Flu
A variant of avian influenza infects humans in Thailand, Vietnam and Japan. A total of 32 people – 20 in Vietnam and 12 in Thailand – die of bird flu this year. All but one of the known human victims caught it from direct exposure to infected fowl. The other was a Thai woman thought to have got it from cradling her dying daughter all night.

But experts fear the H5N1 virus could get into an animal, most probably a pig, also capable of hosting a human flu virus. The two could then breed a mutant strain to which the planet’s human population has no immunity.

Vietnam records GDP growth of 7.5%. Almost 30 years after the end of the war, the country is following China’s example and encouraging business and trade. China, on the other hand, is the world’s second most important economy, and fast becoming the biggest participant in global trade. In December, Thailand suffers the Tsunami disaster which kills thousands and decimates the fishing industry. However, the effect on the economy is marginal, with only 0.5% decline in growth.

2005: The SARS – Bird Flu link
Links are discovered between SARS and Bird Flu. It seems that SARS was an early precursor to Bird Flu; a human-contagious mutation of a virus commonly found in poultry and pigs. Once the mutation could travel between humans, it quickly spread to several continents. To date, all Bird Flu victims have been in direct contact with the animals, which has limited the spread of the disease geographically. It is also thought that ducks, including wildfowl, can carry the disease without suffering symptoms.

“The potential transmission of bird flu between humans is the World Health Organization’s worst fear,” says Francois Xavier Meslin, the group’s chief of animal diseases. The ease of human-to-human transmission would make any bird flu pandemic much worse than 2002’s outbreak of severe acute respiratory syndrome. The group previously warned that bird flu may mutate into a form that could pass easily from human to human. “If it happens, it’s going to be worse than SARS,” says Meslin. “SARS was mildly transmissible between humans. It was mild compared with a flu virus.”

Scientists develop Bird Flu vaccines for poultry, but no vaccine can be developed for a yet-to-evolve human contagious strain of the disease.

2007: Complacency sets in
There have been no further outbreaks of either SARS or Bird Flu among humans in over two years. Health authorities relax, feeling that they have beaten the threat, despite warnings from doomsayers that a pandemic is just beyond the horizon. Health officials warn that severe flu epidemics can be expected every 20 years – the last one was in 1968.

Scientists claim to have an antidote for SARS, but no human testing is undertaken, for fear of sparking an outbreak.

2008: A fresh outbreak
At the end of a particularly wet and hot summer in South East Asia, a new variant of Bird Flu kills 50 poultry workers in Vietnam. Authorities order an immediate quarantine and the destruction of most of the country’s poultry, but the measures are too late. The disease strikes down traders in Hong Kong, Bangkok and Shanghai.

Bird Flu is now a human contagious disease, and surfaces in Korea, Toronto and Singapore. A worldwide alert is issued, and travel restrictions and quarantine measures announced in all the developed countries. These measures, combined with high tech screening and detection equipment, prevent the epidemic spreading in San Francisco.

The pandemic spreads to the general population, and 70% of infected people die from the disease. Health workers desert their jobs in fear. The only solution lies in the prevention of infection, and draconian quarantine measures are introduced. These, together with the logistical problems of dealing with the large numbers of dead, turn Vietnam into a ‘war zone’, increasingly isolated from the rest of the world.

Global attention turns to China, where birds are culled and inoculated at an amazing rate. But now that the disease is “in the wild” among humans, panic spreads. Workers not already struck down with illness stay home for fear of being exposed. Trade slows to a trickle.

2009: Counting the cost
Millions die in South East Asia. The WHO declares Bird Flu a greater threat to human welfare than AIDS. There is no vaccine yet, and no antidote. Avoidance of infection is the only prevention, though early diagnosis and supportive treatment helps patients recover in many cases. A strong immune system is the best defence. High-risk populations include the elderly, infirm and those already infected with HIV.

Besides the cost in human life, the greatest effect is on economic growth. Vietnam’s burgeoning economy has been destroyed. Thailand is expected to have negative economic growth for the first time in years. The world watches apprehensively to see what the effect will be on China. Will it survive this pandemic? How great will the impact be? US exports start to slide as the epidemic bites. What will the final death toll be? 10 million, 50 million or 100 million? Will this pandemic trigger an economic meltdown of global proportions?