Confronting the global threat of avian flu.

George B. Abercrombie, president and CEO of Hoffmann-La Roche in Nutley, N.J., speaks out about his concern over the strong possibility of a worldwide avian flu pandemic and our seeming inability to thwart it.

Why is this a major issue with you?

I've spent the past four years living with it. I met with the President's domestic policy adviser and Tommy Thompson and Mike Leavitt, Secretary of the Department of Health and Human Services [HHS], and with the Centers for Disease Control and the National Institutes of Health. I'm convinced, as they are, that the single biggest catastrophic global health threat is an avian flu pandemic.

The H5N1 virus currently circulating is deadly. About 60 percent of people who are infected die. There's little to no human immunity to it, and history says we are due for a global pandemic. The 1918 viral pandemic, like this H5N1, originated in birds. It progressed from birds to mammals to humans, and H5N1 has already moved from birds to mammals. The virus is spreading and is constantly mutating. However, it's not yet easily transmissible.

If you know all this about avian flu, then you must know how it went from birds to mammals. Isn't there a way to stop that from happening?

I'm not sure any scientists have figured out how to stop it. When the virus does inhabit a human, it resides deep in the lungs, which fill up and cause the victim to suffocate. However, if the virus should mutate so that it latches onto the nose and upper respiratory tract, that's when it may become easily transmissible.

At that point, would the virus be very contagious?

Absolutely. We're at Stage III, where some humans have been infected. Although there's no easy human-to-human transmission, it is spreading. If we go to Stage IV, that could be the beginning of a pandemic.

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Viral experts fear it is inevitable. The World Health Organization [WHO] says countries need to put pandemic plans together. Part of that is to stockpile Tamiflu, an antiviral used to treat and prevent influenza. Its mode of action also works in H5N1, so countries around the world are stockpiling.

Tamiflu can only be used to treat a known case. Is there nothing you can take to prevent infection?

Well, there are two things. Researchers are working to produce a vaccine. One was approved by the FDA, but it has only a 45 percent efficacy rate, which is very low. Also, to make a vaccine that's effective you have to know the precise strain of virus, and once you know that, the pandemic has already started. Then there are antivirals like Tamiflu, which treat an existing infection. A victim would have to start taking Tamiflu within 48 hours of symptom onset, before the virus spreads throughout the body.

How do you differentiate this from some other virus?

If a pandemic occurs, the symptoms will be well publicized. The antiviral can also be used to prevent infection if you are exposed to it. You have to keep taking it for it to be prophylactic. The dilemma is if you have a supply of Tamiflu, when should you start taking it, either prophylactically or for treatment, so you don't blow it? No one has answered that question.

Meanwhile, our government has recommended that corporations put pandemic plans together. Every company needs to say, 'What will my workforce, my suppliers, my vendors, my trucking lines look like if a pandemic occurs?' (See Roche's Web site, PandemicToolkit.com.)

Are you suggesting stockpiling?

Stockpiling is necessary because it takes six to nine months to make Tamiflu. If you wait until Stage IV to buy it, you've waited too long. There will be a panic. We cannot stockpile for the world, so that's why you have to stockpile.

Roche is the only company that makes Tamiflu, right?

Before the pandemic threat, our annual production capacity was about 10 million courses of therapy. We've increased that capacity to 400 million courses of therapy by partnering with companies. We've sublicensed the patents to companies in China, India and South Africa. We've donated to WHO.

We have not let patents get in the way of patients. But the cumulative number of orders we've received is 200 million to 250 million, far below our capacity. Mike Leavitt of HHS has told communities and companies not to expect the federal government to come swooping in and save the day. You have more control over helping your employees than we do. If you're the CEO of a company, now is the time to put a pandemic plan together.

Give me the highlights of your plan.

We've simulated when we would tell people to go home. When do we invoke the essential employee come-to-work rule? We had every employee certify their knowledge of when to use Tamiflu with an online training program and have a personal examination with a physician.

And you want every CEO of every major company to do that?

CEOs have to think about the unthinkable. What do you need to do to keep your company going and to protect your employees? Something like this can only be successful if it's sponsored and driven by the CEO.

A cynic might say urging stockpiling is a great way to push sales.

WHO recommended that countries stockpile Tamiflu for 25 percent of their populations. HHS warned communities and businesses to get prepared.

Yes, we will benefit, but my biggest nightmare as a CEO is that we will be in a no-win situation. No matter how much we try to get companies to prepare, if a pandemic happens, there will not be enough Tamiflu to go around. Then we'll be blamed for not warning, for not lighting a fire.