By Jenny Cuffe
BBC File On 4
Scientists in Egypt are examining the possibility that the deadly H5N1 Avian flu virus could be changing into a deadlier strain.
Egypt is on a migration path between Africa, Asia and Europe
Dr Zuhir Hallaj, director of the World Health Organization's communicable disease programme says there is particular concern that previous victims in Egypt have suffered from respiratory problems.
Nadia Hafez, who died in Egypt's Fayoum region last month, experienced multi-organ failure which failed to respond to anti-viral drugs.
So far the Egyptians who have died had direct contact with birds, but there is a fear the virus will cross the species barrier causing a pandemic which will disrupt world economies and claim lives on an unprecedented scale.
Egypt, which is a high risk area for avian flu and a gateway to Africa, is under growing pressure from the international community to control the spread of bird flu among poultry.
A UN-commissioned report accused the Egyptian government of lacking commitment and failing to develop a national strategy.
Partner agencies within the UN were also criticised for a lack of co-ordination.
The report questioned Egypt's ability to plan and execute a credible response to the threat of pandemic.
Health Minister Hatem el-Gabaly, who chairs Egypt's Supreme Committee on avian influenza, admitted it would take three to four months to develop a national plan but said Egypt could not afford to do it alone.
Egypt's bird feeding culture dates back to the Pharaohs
The country needs $66m to meet its targets for tackling bird flu, but none of the money pledged at a donors' meeting in Bamako, Mali, in December has arrived.
"The world's not taking Africa seriously", said Mr Gabaly. "Even though it is the backyard of Europe and close to the US."
"With mutations and an increase in mortality, things shouldn't be taken lightly."
Five million Egyptians keep chicken and ducks in their homes and backyards, providing an essential source of food and income.
Women feed their birds by chewing corn and blowing it into their mouths, a tradition that dates back to the days of the Pharaohs.
These households will be difficult to regulate.
When Nadia Hafez was diagnosed with bird flu in February, Fayoum governrate sent in a veterinary team and police to cull poultry within two kilometres (1.2 miles) of her home.
Health chief, Hussein Abu Talib, said in the village of Itsa they were only able to find about 20 birds out of a total of thousands.
Scientists fear the deadly H5N1 strain of avian flu could be mutating
"When they hear the police car's horn they start hiding the birds."
A compensation scheme for the commercial sector was stopped when some farmers were discovered passing sick birds to each other so that they could all claim.
Domestic poultry keepers have never received a penny for birds that have been culled and they are sometimes reluctant to report cases of disease.
Only half of the last year's 110 outbreaks of avian flu were reported.
The rest were discovered by spot checks and officials worry this may be only a fraction of the total.
Commercial poultry farmers now vaccinate all their birds and believe this has helped bring the disease under control.
And the government wants to do the same in people's backyards.
It is setting up a pilot scheme in three governorates to offer a vaccinated chick for every bird that is culled.
In Fayoum, veterinary officials have been offering free vaccination since May 2006.
But the under-secretary of the veterinary service in Fayoum, Mustapha Awis, said it is difficult to keep up with the work because the birds are quickly eaten or sold.
"As soon as we get out of one street, the next day they have new poultry. It's a big challenge for us."
The Egyptian government is asking donors to contribute $450m to its vaccination programme, but one of the world's leading experts on avian flu questioned whether this is the right use of limited resources.
Dr Michael Osterholm, director of the Center for Infectious Disease Research and Control in the US, pointed to the poor record of poultry vaccines in China and Vietnam.
He said vaccines may do more harm than good, by keeping birds from dying but allowing them to continue transmitting the virus.
"We are pressuring countries into launching these extensive vaccine campaigns as a way of saying that we're doing something. It would be better to spend those same funds on preparing countries for flu instead of trying to prevent it."
Dr Osterholm said the world should put more money into developing a generic vaccine to protect humans from the disease.
"It will become irrelevant which country is the original site of a pandemic strain. The virus will spread so quickly that we will all be in the soup at the same time."
Hear the full story on Radio 4: File on 4 Tue 13 March 2007 at 2000 GMT