By Adam Blenford
Plans for a global response to a mass outbreak of bird flu in humans are taking shape, but are far from complete.
The last global flu pandemic, in 1918, killed at least 20m people
Public health experts and epidemiologists are issuing shrill warnings about the dangers a pandemic would pose to human health around the world.
Any confirmation that the H5N1 bird flu virus has become capable of human-to-human transmission will send the World Health Organisation's pandemic alert level, currently at Level 3, soaring towards the highest state of danger, Level 6.
Air travel could be among the first casualties of a global panic as governments try to prevent the disease spreading.
"There may be some small restrictions imposed in the early days of a pandemic," Dick Thompson of the WHO told the BBC News website.
"But they will fail, because infected people will not yet be showing symptoms."
While emergency services in many countries train regularly to cope with major terror attacks, convincing national governments to draw up and implement expensive plans for disease containment is proving hard work.
Just 40 governments around the world have submitted plans for dealing with a pandemic to the WHO.
The majority of those are wealthy western nations - not the Asian countries where the H5N1 avian influenza virus has taken hold and killed 57 people.
The detection of bird flu in Russia has jolted European nations towards action, fearful that migration patterns could spread the virus westwards.
Tamsin Rose, secretary general of the European Public Health Alliance, which represents 115 European NGOs in Brussels, fears that a lack of planning could undermine efforts to contain the virus.
"There needs to be clear guidance on what civil society needs to do," she told the BBC News website.
Bird flu spread in Thailand: computer model map of new cases (red) and where the epidemic has finished (green) 60-90 days after an uncontrolled outbreak
"Which key workers are needed to help out? Will schools be closed and turned into triage centres? How ready are we for this effort? We can't see our members getting ready for this."
Indeed, experts trying to forecast the outbreak of a human pandemic are still focusing on south-east Asia, not Europe or north America.
In a recent simulation designed to assess the likelihood of containing an outbreak in that region, scientists concluded that the bird flu virus could be contained by rapid identification of the source of infection, combined with quick and intensive distribution of anti-viral drugs.
An international stockpile of anti-viral drugs should be established to enable rapid distribution in the event of an outbreak, the study said.
The findings, published in the journal Nature at the start of August, were broadly welcomed by the WHO.
In response, pharmaceutical giant Roche has pledged to make three million courses of its anti-viral drug Tamiflu available to the organisation.
Distributing them effectively is another matter. Thus far, agreement extends to a "promise" from Roche to ship the drugs to an international airport near the outbreak.
On the ground, mankind's fight against a potentially deadly virus will fall into the hands of highly skilled volunteers.
With little manpower of its own, the WHO operates a worldwide volunteer known as the Global Outbreak Alert and Response Network.
Small teams of epidemiologists, database managers, intensive care staff and other experts can quickly be deployed to try to control an outbreak.
After the initial "firefighting", though, responsibility must rest with national governments. If a pandemic develops, the WHO warns, relying on volunteers will be pointless.
Secondary clusters of infection are unlikely to receive anti-viral drugs from any international stockpile, and governments will have to rely on their own supplies.
In any case, those drugs already developed are unlikely to be entirely equipped to quell an outbreak of a mutated form of H5N1. An effective vaccine could take six months to develop once any new strain is identified.
"We keep encouraging countries to develop a plan because a pandemic is inevitable," Dick Thompson said, warning that between two million and seven million people around the world could die.
Tamsin Rose of EPHA is less circumspect.
"Millions and millions would die, and a pandemic would change society as we know it," she said. "And no-one seems prepared."