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Preparing for the real terror: Flu pandemic remains a threat

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Is avian flu another false alarm, flaring up mainly in headlines? We don't think so, and that's why this issue includes a series of articles on tribal preparedness for a global outbreak of a possible killer strain of this disease. Although the conditions for a pandemic still haven't come about, and one hopes they never will, the world has already seen it happen three times within the century. The mass deaths from the 1918 influenza outbreak were particularly unexpected and devastating - by most recent estimates 50 million to 100 million perished worldwide and 500,000 in the United States, many of whom were healthy and in the prime of life just weeks earlier. Even if the threat remains a speck on the horizon, its potential severity justifies our attention and foresight.

Public health officials keep calling for readiness because those specks won't go away. The most worrisome strain of the flu virus, called H5N1 after its antigen composition, is found throughout the bird population. Even though millions of domestic poultry have been culled in Asia, outbreaks are spreading geographically. Migrating wild birds provide a reservoir for the virus. It has turned up in wild swans in Romania and, most lately, ducks in southern Sudan. So far human infections have been rare and mostly traceable to close contact with infected birds.

But of the slightly more than 200 confirmed cases, 113 have died, and the rate has been highest in the supposedly most healthy age; 10 - 39 years of age.

The real nightmare is that the virus might mutate to a form that can spread easily from human to human. The concern was heightened in the last year by research concluding that the deadly 1918 strain originated as avian flu. Up until this spring, there was little sign such a mutation had occurred. But in May the disease swept through a family in North Sumatra, apparently spreading directly from a young mother to her sons and a brother. In the latest count from Indonesia, 70 people contracted the flu and 49 died. The outbreak revived world concern and vindicated the U.S. government's decision to allot $250 million for state, tribal and local preparedness.

It's to the credit of the U.S. Health and Human Services Department that it has included tribal officials in its training and to the credit of those tribes that have stepped up. American Indians and Alaska Natives are on the front line. Subsistence hunters in Alaska are providing first warning of the appearance of avian flu in the migratory flyways from Asia. They have helped provide 13,000 carcasses from 26 species for testing by the Interior and Agriculture departments, in a program now being expanded to include the lower 48 states. (So far none have shown the highly pathogenic form of H5N1, although a mild strain has turned up in Michigan swans and Maryland and Pennsylvania mallards.)

Emergency planning officers in tribes from the St. Regis Mohawk in upstate New York to the Lakota nations in the northern Plains to the Navajo in the Southwest have been preparing to cope with an outbreak. They face the added factor of rural isolation and realize they might have to rely on their own resources for much of the response. Other tribes in more densely populated regions are coordinating planning closely with state and local governments.

Casino-owning tribes could find themselves at the nodes of an epidemic, especially those with heavy international traffic. They could also bear the economic brunt of a quarantine.

By leading in the preparedness planning, tribal governments are not only tending to their own safety and the safety of their members, but vindicating their claims to sovereignty and self-determination as well. Performance is the best proof for self-government. In the American system of federalism, the governments that show they can do the job tend to gain a more respectful hearing for their claims to authority. This isn't invariably true, of course, but ''states' rights'' began to gain more favor in federal courts in the 1970s when state governments could show their programs were more innovative and effective than their federal counterparts. The more tribes lead in providing services like pandemic preparedness, the more respect they will command.

The St. Regis Mohawk Tribe, for instance, deserves commendation for its efforts to share its expertise with other tribes. Although its first attempt to host a conference on pandemic planning did not attract sufficient interest, it intends to try again in October or November when other tribes should be more focused on the threat.

Indian country, more than most other peoples of the world, should be sensitive to the impact of disease. The historic case can be made that the continent was conquered not by European arms but by European microbes. Because Europe itself suffered devastating plagues in the Middle Ages, the surviving population showed, and still shows, an elevated level of immunities. The relatively disease-free Native population in North America, however, had no resistance to common European maladies like measles, let alone the scourge of smallpox.

Diseases which spread at first contact, even before organized settlement, caused such depopulation that European colonists met a fraction of the resistance they might have encountered. One doesn't have to argue that disease was spread deliberately to show that it altered the course of history.

Even today, isolated outbreaks like hantavirus and plague in the Southwest are a cause of dread.

After centuries of global contact and survival in substandard conditions, the Native population today is probably on an equal biological footing when it comes to disease resistance. The difference in facing any future outbreak will lie in the level of planning and preparation. It's heartening that tribal governments are showing the foresight to be ready.