People first contracted the current strain of bird flu in Hong Kong in 1997. Since then, Mainland China has also confirmed human cases of bird flu. VOA's Carol Pearson looks at how Hong Kong, Mainland China and Taiwan are preparing for a bird flu pandemic that has the potential to take the lives of tens of millions of people, not only in this region but around the world.

Experts say it is not a matter of "if" but "when" and "how" a bird flu pandemic among humans will unfold. They say when the virus mutates and can be passed along by human-to-human contact, it would be irresponsible not to have a worst case scenario plan in place.

In Mainland China, 18 cases of bird flu in humans have been confirmed. China's population is estimated at more than one-point-three billion. Its territory is so vast that China could qualify as a separate continent according to the World Health Organization's representative to China, Dr. Henk Bekedam.

He says containing bird flu is a daunting challenge for China with its estimated 14 billion domestic farm birds. "What we see now is a political commitment in dealing with it [bird flu]. But it needs to be translated into appropriate action also in the provinces."

Dr. Bekedam says it is very important to monitor farm birds where the virus is endemic and that China needs to strengthen animal surveillance.

China's Ministry of Health has tightened regulations for live chicken markets and has banned live chicken sales in densely populated areas. Rural China is the centerpiece of the country's economic development. It is also the front line of China's battle against bird flu.

Yet information about the virus there seems sketchy.

One woman we spoke with says the government has given "shots" to chickens in the area. She did not say what kind of shots. A truck driver says farmers now slaughter ducks not sold at live poultry markets.

The government acknowledges there is room for improvement. Qunan Mao is spokesman for China's Ministry of Health. "Eliminating interactions between infected birds and humans remains the most important part of our efforts to prevent the spread of the virus in China's urban regions."

Hong Kong is the most densely populated city in the world. Nearly seven million people live on 1,000 square kilometers. Hong Kong's Center for Disease Control strictly monitors markets, ventilation systems and makes sure the markets are cleaned weekly.

The city is also testing the idea of separating poultry buyers and sellers by glass partitions to reduce contact. The Hong Kong government is gradually phasing out the sale of live chickens to protect the health of its people.

Taiwan has its own bird flu prevention program. It is one of a handful of regions in Asia that has yet to have a single case of the flu. The government has initiated a long list of measures intended to curb the virus, including the inspection of foreign animals and enforcement of strict health standards for every farm on the island.

The government has formed a new board specifically designed to coordinate bird flu prevention efforts according to animal inspector Ying Ye. "Last year, we conducted a reality simulation to evaluate readiness of every related department in the event of a bird flu outbreak."

Roche Pharmaceuticals has given Taiwan permission to mass-produce Tamiflu, an antiviral drug, in case of an outbreak.

Dr. Yan Je Jea, director of Taiwan's Center for Disease Control, says Taiwan and Mainland China are now sharing information on the virus. "We now have non-governmental officials regularly heading to Mainland China to obtain the latest information. It just takes a little time to build a foundation of mutual trust."

Taiwan has its own vaccine research and development program. It hopes to be able to produce 200,000 units of vaccine by the end of 2006.

The U.S. Department of Agriculture categorizes the current strain of bird flu as a bird-to-bird communicable disease, bhat could change at any moment.