Fears of a global human influenza epidemic have grown in recent months as the H5N1 bird flu virus spread for the first time to Europe. But experts say the response to the disease in Asia, where the strain first appeared, remains the key to preventing a pandemic.
Asia remained the epicenter of bird flu outbreaks during 2005, with the World Health Organization warning that any human influenza pandemic is likely to begin here.
The H5N1 bird flu strain has infected more than 130 people in Asia in the past two years, killing more than half of them.
So far, almost all of the human victims caught the flu from poultry. But the WHO says it is only a matter of time before the virus mutates into a form that can be transmitted by humans, possible killing millions of people.
Experts say the ability of Asian countries to halt the spread of the virus in poultry and their preparedness to battle any bird-flu outbreak among humans are critical in preventing a pandemic.
But Peter Cordingley, Asian spokesman for the World Health Organization, says few countries in the region are ready. "Across Asia there is probably not more than a handful of countries that have a full operational working plan," he said. "Some are very good, some are approaching being very good but more countries than that don't have any working plan at all, for the obvious reason that they don't have the funds to put one together at that stage."
Singapore, South Korea and Hong Kong have put in place comprehensive bird flu preparedness plans and stockpiled antiviral drugs. Indonesia and Laos are among those poorer Asian countries that lack the resources to implement adequate anti-bird flu measures.
Surveillance of outbreaks among poultry remains a major problem in Asia, especially in remote rural areas. Poor farmers are often either ignorant about the danger bird flu poses or are reluctant to report outbreaks because culling their poultry affects their livelihood. Many countries lack the funds to compensate farmers for the loss of income.
Mr. Cordingley says poverty is also the reason human infections may not be detected. "The further you go into the countryside, the lower the chances are of picking these human cases up - particularly when you get into rural areas that are very poor," he added. "People just don't check into hospital when they have influenza-type symptoms for the simple reason that it will cost them money and it will have an impact on the family budget. Quite clearly, surveillance has a lot of inherent weaknesses in this part of the world."
The WHO and the U.N. Food and Agricultural Organization say they need around $260 million to help Asian countries improve detection and reporting of outbreaks.
The World Bank estimates affected countries will need a further $1 billion over the next three years to finance animal and human vaccinations, buy antiviral drugs and compensate farmers.
A major donor conference will be held in Beijing later in January to raise the money.
Australia, the United States and the European Union have already promised financial aid to help Asia combat the disease. The U.S. health secretary visited the countries most affected by bird flu last year, as did the EU health commissioner, Markos Kyprianou.
"We have not only offered solidarity, but also we are investing in our own protection when we help the affected countries," he said.
Asian nations have also recognized they cannot combat bird flu alone and have stepped up regional cooperation.
At the meeting of the Asia-Pacific Economic Cooperation grouping in South Korea in November, member nations pledged to improve surveillance, share technical expertise and improve transparency in reporting outbreaks.
Avian flu was also high on the agenda at last year's meetings of the Association of South East Asian Nations. ASEAN's Secretary-General Ong Keng Yong says cooperation among members is improving.
"We have organized ourselves in terms of health care, communication, agriculture, finance, all has come together," he said. "I believe that it will take some time to perfect the system but at least in terms of catching the outbreak, immediately informing all the other countries concerned that an outbreak has happened, I think we will become quite effective with that."
Health experts believe China is a key player in preventing a bird-flu epidemic among humans. It is not only the world's most populous nation, but also the world's biggest poultry producer.
There have been concerns about China's openness in reporting bird flu outbreaks because of its attempts to cover up the SARS epidemic three years ago, until the disease spread around the world killing more than eight hundred people.
International health organizations complained last year that Chinese officials were restricting bird flu investigations. But China has had more than 20 outbreaks of the virus in poultry since mid-October and experts say this has prompted Beijing to become more transparent about its avian flu management.
Joseph Domenech, chief veterinary officer of the United Nation's Food and Agriculture Organization in Rome, says China now responds quickly when a new outbreak occurs.
"They react immediately," he said. "They apply immediately strict quarantine measures, stamping out and vaccination surrounding the outbreaks in risk areas."
However, the WHO still says that China has been slow about sharing tissue samples from infected birds.
The Asian Development Bank says a human flu pandemic would have a serious impact on the region's economy. The Manila-based non-profit lender says a pandemic could slow Asia's growth rate to virtually zero and reduce the global trade in goods and services by up to 14 percent.