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MICHELE NORRIS, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.

MELISSA BLOCK, host:

And I'm Melissa Block.

Our series on global health continues today with a look at pandemic flu and a high-stakes experiment being planned in Vietnam. Public health officials hope to extinguish a pandemic flu strain almost as soon as it appears. In 1918, a pandemic that started from a bird flu virus killed as many as 50 million people. But there is one big difference today: This time public health officials have the luxury, and perhaps the curse, of foresight. That means they can plan and prepare if they can figure out what to do. NPR's Richard Knox reports now on Vietnam's effort to prevent the next pandemic from starting or, if that fails, to stop it early on.

RICHARD KNOX reporting:

Experts in human and animal health say Vietnam is the perfect incubator for the next pandemic.

(Soundbite of traffic; fowl)

KNOX: That's mainly because the Vietnamese have intense daily contact with poultry in traffic-clogged cities and in remote villages.

Dr. MARIE SWEENEY (Health Attache, US Embassy, Hanoi): This is the poultry market here.

KNOX: Dr. Marie Sweeney is taking us on a tour of one of Hanoi's many open-air markets. She's the health attache at the US Embassy here.

Dr. SWEENEY: And not only do you have live poultry; you have freshly killed, dressed poultry. People can buy the whole bird. You could buy the gizzards and the livers. You can buy chicken feed.

(Soundbite of fowl)

KNOX: When Sweeney looks out over the hundreds of birds for sale here, she sees things most people don't, billions of viruses, or at least she sees the perfect opportunity for flu viruses to mutate and spread.

Dr. SWEENEY: Now this lady has a fresh bird. So now what she's doing is she's going to cut the throat and take the blood out. Watch. And now it's--that blood goes into a bowl. But she's doing this without any gloves on her hands, no--nothing on her face, no mask.

KNOX: The lady is Nguyen Thi Nguyen(ph). She's 24 and she's been slaughtering and plucking birds since she was 14, so she knows about chicken flu, or (Vietnamese spoken) as the Vietnamese call it.

Ms. NGUYEN THI NGUYEN: (Through Translator) I have heard of the bird flu, but there haven't been any cases here. There were chicken deaths, but not because of the bird flu.

KNOX: You have not seen any sick chickens, sick ducks?

Ms. NGUYEN: (Through Translator) I do worry about the bird flu, but I work on the chickens that are still alive. But if they're already dead, I won't work on them. I'll take them to the market. I won't work on dead chickens.

KNOX: But that won't necessarily protect her. Vietnamese ducks are often infected with the bird flu virus without showing symptoms, and new studies show chickens can be silently infected, too. That means Vietnam can't stamp out bird flu by just killing sick birds. So it's trying to give flu shots to every last chicken and duck. The idea is to reduce the chance that the bird flu virus will jump from birds to humans.

(Soundbite of music)

KNOX: It's only a short drive out of Hanoi before you're in a densely populated countryside of serene rice paddies dotted with bustling towns and tightly clustered hamlets.

(Soundbite of music)

Mr. LOONG VAN TINH(ph): (Vietnamese spoken)

KNOX: This is where you can see the crash campaign to vaccinate poultry in full swing. Loong Van Tinh stands in a vast parking lot in front of the People's Committee headquarters of Ha Tien province, southwest of Hanoi. He's a surreal figure wearing a blue plastic gown, goggles and a triangle of plaid cloth tied over his mouth. As he lifts a big syringe, vaccine bubbles out in milky drops.

(Soundbite of fowl)

Mr. TINH: (Through Translator) So we've vaccinated the chicks from 20 days to two months. So this is like part of the national program here to provide the vaccination for all chickens, with international support.

KNOX: Tinh pinches the skin on the bird's naked belly and pumps in vaccine. He does this again and again and again for hundreds of chickens.

(Soundbite of horn honking; child's voice in background)

KNOX: Next in line, farmer Dong Van Tah(ph) patiently waits his turn. He carries a bamboo basket full of chickens.

Mr. DONG VAN TAH (Farmer): (Through Translator) Well, I heard from radio and also from TV, newspaper. They say H5N1 is very dangerous, and, therefore, we have to bring all chickens here to be vaccinated. I'm worried about getting the infection myself and also the members of family.

KNOX: But vaccinating chickens is only part of Vietnam's crash program to head off a pandemic. Wi Quon Ang(ph) is in charge of animal health in Vietnam's Ministry of Agriculture. When Ang talks about the live poultry markets, urgency is written all over his face.

Mr. WI QUON ANG (Vietnamese Ministry of Agriculture): (Through Translator) We cannot contain this kind of reckless slaughtering and buying and selling of potentially infected poultry.

KNOX: Ang says Vietnam is imposing some revolutionary changes: a national moratorium on duck production; banning poultry raising in cities; prohibiting the sale of duck blood soup--human cases of bird flu have been traced to this delicacy. And most startling for a society that insists on fresh-killed meat, Vietnam plans to centralize the slaughter of poultry in factories and sell it in plastic-wrapped packages.

Mr. ANG: (Through Translator) I think that by 2006 the Vietnamese people will be going to the grocery store to buy their poultry. We can get it done.

KNOX: But Ang is frustrated. Local governments aren't eager to destroy the livelihood of farmers and butchers, and the virus isn't going to wait around for all these things to work. It's out there busily mutating.

(Soundbite of horns)

KNOX: Whether it happens back here in Hanoi or in a rural area, a pandemic strain will emerge if the bird virus acquires the changes it needs to spread freely among humans. Vaccinating poultry might slow that process but not prevent it. So Vietnam will soon release another plan, this one aimed at stopping the spread of the H5N1 virus after it becomes a human virus. This is called pandemic containment, stopping the pandemic at its source. Nobody has ever tried that before. Dr. Peter Horby is with the World Health Organization's office in Hanoi. He says everything depends on spotting the very first cases fast.

Dr. PETER HORBY (World Health Organization): The thought has been sort of around the area of 20 to 50 cases occurring over a period of several weeks would be the kind of alarm bell.

KNOX: Earlier this year WHO officials thought it actually was happening in Thai Binh province a couple of hours southeast of Hanoi. It started with a 21-year-old man named Nguyen Sy Tuan. He helped his parents slaughter chickens, then he fell ill. His 14-year-old sister got sick, too. Tuan's mother and aunt took him to the Thai Thuy district hospital. A nurse named Nguyen Duc Tinh helped him to his bed and took care of him through the night.

Mr. NGUYEN DUC TINH (Nurse): (Through Translator) Well, first, because we didn't have an X-ray, so I'm just thinking that maybe he's fever--high fever. We're thinking of pneumonia.

KNOX: But it wasn't pneumonia. It was bird flu. Then a few days later something alarming happened. Nurse Tinh fell ill himself with high fever and difficulty breathing.

Mr. TINH: (Through Translator) I thought I may die. I was in crisis, so I was frightened about that. Spiritually, yes, I'm afraid.

KNOX: Experts feared the virus had learned to spread from person to person. But no more cases occurred in Thai Thuy, and investigators say the nurse might have been exposed to sick poultry. Still, the possibility of human-to-human transmission galvanized officials here. Now they know they have to watch for signs of flu not just in birds but in people.

Mr. DAO CHUNG BING(ph) (Administrator, Thai Thuy): (Through Translator) We need to have medical workers at the grassroot level...

KNOX: Dao Chung Bing is an administrator at Thai Thuy district hospital.

Mr. BING: (Through Translator) ...so that when there's cases of this, they were able to detect at the very beginning, you know?

KNOX: Bing has been standing at Nurse Tinh's shoulder nodding and listening. He says he needs more than grassroots workers. He needs a drug called Tamiflu. It can save lives if given early and sometimes prevent the spread of flu. Bing says his hospital has enough Tamiflu to treat only two patients. The hospital did get a respirator recently to treat patients with failing lungs.

Mr. BING: (Through Translator) But it doesn't work yet because we need oxygen before it works.

KNOX: The hospital administrator, who doesn't even have oxygen, is skeptical that a pandemic could be stopped.

Mr. BING: (Through Translator) If the scientists prove that H5N1 transmitted between human to human, then it would be the disaster, and once it is a disaster, it's really out of our control.

(Soundbite of suitcases being unlocked)

KNOX: Dr. Nguyen Van Tong(ph) unlocks two ordinary looking suitcases sitting in his office.

Dr. NGUYEN VAN TONG (Provincial Health Official): (Through Translator) So these are, you know, cases of medicine ready for when the epidemics occurs here.

KNOX: Tong works for the provincial health department a few miles from Thai Thuy hospital. Inside the suitcases are precious boxes of Tamiflu. Tong thinks the pandemic can be stopped, and he says he's ready to try.

Dr. TONG: (Through Translator) This is like for quick reaction, so, you know, even the most distant places we are go to bring these medicines there in 45 minutes time. So we have Tamiflu here, a thousand tablets, and also have antibiotics and some other medicine needed in case.

KNOX: But if H5N1 breaks out, it's going to take a lot more than a thousand doses of Tamiflu to stop it. That's because experts think everybody within a few kilometers of the first cases will have to get the drug to stop the spread of the new virus, and they'll have to keep taking it until no more new cases appear. Studies say that could take several million doses of Tamiflu. Right now Vietnam has a tiny fraction of that, and it's scattered around the country. The WHO has enough for three million people. It's sitting in a warehouse a few hours away by jet. Once experts decide a pandemic strain is really circulating, the WHO would rush its Tamiflu stockpile to the outbreak. But Dr. Peter Horby of the WHO says that assumes the killer virus pops up in a single place.

Dr. HORBY: And it may not be like that at all. We may start to see multiple small fires bursting out over a wider area.

KNOX: In that case, the supply of Tamiflu could run out fast. And besides blanketing the area with antiviral medicine, authorities will have to do other things: isolate flu patients; protect health care workers; seal off the affected area so people don't flee, spreading the virus as they go; close schools; ban public gatherings. In short, a lot has to go very right in a very short span of time. And flu planners hope the first outbreak doesn't happen in or near a city. In that case the virus would spread too fast to contain it. It's a tall order, but Horby says it's necessary to give containment a try or forever regret it.

Dr. HORBY: I think everyone realizes that it's, you know, probably a long shot, but it could be one of the most sort of important public health shots ever. It may be unsuccessful, but if it was successful, you'd have a huge impact.

(Soundbite of horn)

KNOX: Back in Ha Tien province, technicians on motorbikes go house to house making sure every chicken is vaccinated.

(Soundbite of announcement)

Unidentified Man: (Foreign language spoken)

KNOX: And a set of loudspeakers broadcast messages about chicken flu to the residents of Hong Song Commune(ph). `Make sure your poultry gets vaccinated,' says the voice. `Report all suspicious cases of bird flu.' Richard Knox, NPR News.

(Soundbite of announcement)

Unidentified Man: (Foreign language spoken)

NORRIS: You can hear other stories in this series and find answers to questions about pandemic flu at npr.org. And global health coverage continues tonight with "Rx for Survival," a television special on PBS.

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