There's hardly a better spawning ground for a bird-flu pandemic. If the virus makes the leap to human-to-human transmission, the odds are strong that it will happen in China. The place is home to 1.3 billion humans--three quarters of them still living on the farm--and more than 10 times that number of chickens, ducks and other domestic poultry. Those farmers keep 70 percent of the world's pigs, which can be walking petri dishes for mutating strains of flu. To top it all off, the public-health system is in ruins.
Doctors in China could head off a pandemic--in theory, that is. Epidemiologists say the secret would be to spot the mutated disease before it infects more than 20 people, within three weeks of exposure. If those patients are quickly isolated and treated with antiviral drugs, "there's more than a 90 percent chance of stamping out that strain of the virus," says Dr. Julie Hall of the World Health Organization in Beijing. If things get past that point, the contagion has probably spread too far. "The problem is, even with the best health care it's hard to detect individual cases," says Hall.
It's that much tougher in China. Hospitals are pretty much the only medical early-warning system the country has, yet surveys show that a third of the population refuses to use them. The reason is cost: even if a sick Chinese goes to a hospital, the best way to get proper attention from a doctor is often by offering "red envelopes" bribes. Medical expenses can eat up a tenth or more of a typical family's income, mostly in inflated fees and under-the-table payoffs to physicians. Few people outside the cities have health insurance. With countless people suffering sickness in the obscurity of their homes, a pandemic could get a flying start before doctors ever noticed.
At present, the Health Ministry isn't even in charge of tracking the disease. The Agriculture Ministry is doing it instead because the virus is killing poultry. (Health officials will take over only when humans get sick.) Neither ministry has responsibility for spotting cases of bird-to-human transmission. Lack of coordination is a chronic problem in China's bureaucracy, says Prof. Mao Shoulong of the School of Public Administration at People's University. Eventually, he predicts, a newly formed interagency body will get going--but only if people start dying.
The government announced a new outbreak of the virus's bird-killing strain last week. After 2,600 chickens died in 24 hours on a farm in Inner Mongolia province, authorities pre-emptively destroyed more than 90,000 birds within a seven-mile radius. Since then local reporters have been barred from making any mention of bird flu in their stories. More than a handful of local residents, contacted by phone, asked not to be quoted by name. "You won't be reading anything about this in the press in Inner Mongolia," said one. After the public dressing-down China got from the rest of the world for trying to cover up the country's 2003 SARS (severe acute respiratory syndrome) epidemic, the Health Ministry proclaimed a new policy of transparency. But by reverting to its secretive old habits, Beijing may be endangering millions of lives.