The following is an edited excerpt from and interview with Dr. Frank Plummer, conducted in late 2005...

Why is avian flu, or H5N1, why is that a concern right now?

There is a concern about the H5N1 virus because it has been on a few occasions, spreading from birds to humans. This had been happening since 1997. And the human infections have a very high fatality rate. Initially, about 75 per cent of people infected with Avian flu died.

The flu, it doesn’t seem like something we should be nervous about.

Influenza is a very important health problem on an annual basis. We have periodic epidemics that kill up to 5,000 or 6,000 Canadians and may more people globally. Periodically, the virus changes and causes what we refer to as a pandemic, which can result in much greater numbers of people infected and very severe illness with a lot of mortality.

What does the flu virus do when it attacks a cell?

A virus is a molecularly simple parasite. It is one of the simplest life forms known. But it can take over the replication machinery of a host cell and can ultimately kill people fairly rapidly.

All viruses replicate much more rapidly than humans do, and mutations occur in viruses pretty regularly. If one of those mutations make the virus less likely to be susceptible to the host immune system, that variant could be selected out by the immune system, and that’s one of the mechanisms that the flu virus uses to change and why it continues to be a problem annually.

Why did the virus of 1918 mutate to the form that it did?

Nobody really knows why the 1918 flu virus was so highly pathogenic. We do know that if you take the hemoglutin gene out of that 1918 flu virus and put it into a lower pathogenic virus, that it becomes lethal for mice, so a part of that reason for its higher lethality is properties of the hemoglutin gene.

Why have we not seen another one since 1918?

I think its largely about the properties of the virus but it may also be about the conditions of the human population at the time. It was post World War I. People in Europe in particular were malnourished. Soldiers coming back from the war had nutritional problems; weakened hosts may have played a role as well.

What is the dialogue about the pandemic in the infectious disease community?

There is a lot of concern about pandemic influenza. It is the single most known threat that we face from infectious diseases currently, so the attention that its been getting over the last couple of years is certainly warranted.

Why is it the single greatest known threat?

Influenza is highly contagious compared to any other infectious diseases, and it can be lethal in some instances due to the properties of the virus or to the condition of the host.

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If human-to-human transmission is documented in Asia, what do you do when you get the call; what does your job become?

We would initially find out about human-to-human transmission from newspaper reports that we monitor using a system called GPHIN – Global Public Health Intelligence Network. Those reports would lead to counties investigating the problem and reporting to the WHO, who would then officially report to all its member nations that the phase of pandemic preparedness had changed – that there was sustained human-to-human transmission.

What we would do depends a bit on what the global response is. There may be efforts to try to contain a newly emerged pandemic virus within the country that it has emerged. There might be calls for teams to go to whatever country the problem has been recognized in. We would offer assistance there in the laboratory equipment in the field, so testing could be done.

In Canada, we would be trying to obtain samples of the virus so that we could work on characterizing it, making sure that our diagnostic tests were able to detect it, preparing diagnostic tests to equip laboratories on a provincial level to be able to test the virus, and then we would start developing a vaccine.

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Do you work 24 or 36 hours straight, when every hour counts?

I think we’d manage it quite a bit like we managed to squash the SARS epidemic. Essentially, you squash the hierarchy of the lab; form a number of different teams to look at different aspects of the science that is needed to produce a vaccine strain.

We would pull the people who don’t normally work on influenza onto the work we are doing to prepare a vaccine seed; most of the energies of the lab would be put into that project.

If everything goes very well it would take two to three months to produce a vaccine seed strain. If there are problems for whatever uncontrollable reasons, it could take a bit longer than that - but it is critical that we are able to do that as quickly as possible.

Does two or three months seem like a long time to wait for a vaccine?

I think any delay in having vaccines is a problem and we have to shorten the time as much as we can. That is why it is important for countries to work with the WHO to identify this problem as quickly as we can.

What are we not doing now in countries in like Vietnam and Thailand that we could be doing?

I think one of the problems with countries like Vietnam and others in the region is that surveillance systems and their border capacity are not very robust. We need to work with them to make sure they can detect a pandemic of influenza as quickly as possible.

We also need to make sure that the environment that we are in, in terms of trust, the emergence of a pandemic are minimized so that the situation that happened with SARS, where the government of China was slow to admit it had a problem, doesn’t occur again.

What kind of psychological pressure is there on the scientist who has to be as rational and scientific as possible when a society is in a fair bit of fear of the unknown?

There is tremendous pressure to produce results, to get diagnostics tests made, to get them validated, to produce vaccine seed strains as quickly as possible. There is tremendous pressure for information from the media and from the public.

Usually scientific results are subjected to peer review and validation by other scientists before they become widely known. That probably would not happen during a pandemic of influenza.

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If the virus were to be of 1918 proportions, some of the estimates say 60, 70 per cent of the population got it, what would that be like?

This isn’t 1918 and we are a lot better equipped to deal with a pandemic now than we were than in 1918, when we didn’t even know that influenza was caused by a virus. It didn’t have any kind of vaccine technology.

However, a virus that had the lethality of the 1918 pandemic would cause severe social disruption. That’s why the influenza plans have been put in place to try to figure out how we would deal with these things if there were huge numbers of people requiring hospitalization and medical care. And that's why we need to make a vaccine as quickly as we can.

It’s very important that we have contingency plans in place to ensure that critical systems, including laboratories, are functioning. You won’t be able to make an influenza vaccine if all your scientists are sick.

I would think that scientists would be among those as considered as priority for anti-viral use, and would be among the first to be vaccinated once vaccines are available.

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You’ve worked with some of the worst viruses in the world, how do you personally rate the risk of pandemic influenza?

I’m certain that pandemic influenza is the greatest infectious disease threat that we know of right now. It’s much more likely to happen than small pox or anthrax, its much more likely to become a global problem, like a virus like Ebola or Marburg. It’s something we need to be concerned about and work hard at for preparing for.

What are you doing personally with your family, what do you tell your friends to prepare for this?

I haven’t touched it very much with my family. I think that we would not do anything other than what was recommended by the public health officials in Manitoba. Certainly I need to be here to make sure that the work that this lab needs to do gets done.

I don’t have a personal stockpile of Tamiflu, and I don’t have evacuation plans. I don’t think that I would be in a position to evacuate. And I don’t think you can escape this by barricading yourself at the cottage or something like that. You have to deal with it head on.

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How well is Canada prepared compared to other countries in the world?

Canada is in a better position than many other countries. Many countries have not even started to think about pandemic influenza, and have very limited capacities for surveillance or detection by their laboratories. That doesn’t mean that we have done everything that we need to do, you can never be fully prepared.

What’s your nightmare scenario?

I think a 1918 pandemic would be a nightmare, from my reading of the accounts. The rapidity with which it is spread, the fact that young people were affected, that people died very quickly, is very chilling when you read it.

The likelihood that we will have another influenza pandemic at some point in the near future is considered to be basically 100 per cent. How severe that would be, we don’t know. The 1918 flu seems to be an exception as to its severity, but most other pandemics have been considerable less severe than that. But it is a possibility that we could experience a problem of a similar nature in a future pandemic. It’s something that we need to be concerned about as a risk and be prepared for so we can deal with it when it emerges.

Although the 1918 flu was a very, very severe problem, a lot of people survived the pandemic as well. It’s not as if everyone in the world is going to die from this.

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