Bracing for a Plague; The physician charged with preparing the world for a flu pandemic reflects on the threat.(Dr. David Nabarro )(Interview)(Excerpt)

Byline: Geoffrey Cowley

Dr. David Nabarro was going about his business on Sept. 12 when the head of the World Health Organization hit him with a three-Rolaid question. Would he mind moving from Geneva to New York--right away--to oversee global preparations for a catastrophic flu pandemic? Nabarro reported for work in Manhattan two weeks later (his family plans to join him next year).

As the United Nations' senior coordinator for avian and human influenza, Nabarro is up against one of the worst health threats imaginable: a human outbreak of avian flu. So far, doctors have recorded just 133 cases and 68 deaths, mainly among people exposed to infected birds in Asia. But if an infection that deadly started spreading from person to person, it could quickly claim tens of millions of lives. Nabarro's job is to prepare a half-dozen U.N. agencies--and 191 member states--for a seamless international response.

It's the kind of challenge this intense 56-year-old physician relishes. Nabarro spent his early career running medical-relief efforts for the British government in South Asia and sub-Saharan Africa. More recently, as director of the WHO's Health Action in Crisis program, he has helped mobilize medical responses to the Iraq war, the Niger famine and the 2004 tsunami. He spoke with NEWSWEEK's Geoffrey Cowley about the prospects for meeting this new threat. Excerpts:

COWLEY: You've been given a daunting job. Have you figured out where to start?

NABARRO: We've got three big challenges--a technical one, a political one and an institutional one--and I think the first two are moving well at the moment. The U.N.'s specialized agencies have some of the world's best doctors and agriculturalists working on the threat of a flu pandemic, and heads of state are very eager to do something about it. We don't have to go around and convince presidents and politicians that this could have absolutely massive consequences for their people. They know, and they're worried. But I'm still concerned about the institutional part. How do you get public-health systems and veterinary agencies going after years of inadequate investment? How do you minimize human contact with birds in places where backyard farming is a matter of subsistence? How do you get disease surveillance up to speed in remote ...