The possibility of an avian flu pandemic has not diminished, and there is a new and dire prediction about what the death toll could be. Meanwhile, public health experts fear that public and the media have let their guard down because there has not been an outbreak yet.

"This could still be that we're talking about the possibility of the levees breaking, and it's the year before Katrina strikes," said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

The lethality rate of an avian flu pandemic could be many times higher than the rate during the flu epidemic of 1918 that killed around 50 million people.

In 1918, the lethality rate was 2.5 percent. Today, there is a possibility that the lethality rate of an avian flu epidemic could be as high as 60 percent to 65 percent if the virus adapts and becomes more transmissible between humans. Over 150 people have died worldwide from avian influenza. Current evidence suggest that close contact to sick or dead birds is the principal source of infection, but researchers worry that a mutation could make the virus more transmissible between humans.

In a recent report by the avian flu working group at the World Health Organization, the panel wrote, "Should the virus improve its transmissibility through adaptation as a wholly avian virus, then the present high lethality could be maintained during a pandemic."

"I have never seen a more scary horrible statement than that," Osterholm said.

In their recent report, the WHO working group also wrote that the virus continues to mutate and that there continues to be a risk of a pandemic.

"Evidence presented indicates that the H5N1 virus is still evolving in animals and humans; much about the disease it causes remains poorly understood," the reports says. "It was further acknowledged that the seriousness of the present situation, including the risk that a pandemic virus might emerge, is not likely to diminish in the near future."

A pandemic, according to Osterholm, is much more than a public health issue, rather it could have a domino effect to topple many world industries.

"From a world perspective, this has to be a top priority," said Osterholm. "What this could do to the world is huge in every other way."

There is much work to be done, according to Osterholm, mainly in the area of vaccine distribution. While governments have been busy stockpiling vaccines, Osterholm says that the focus should be on building assembly lines and plants to manufacture large quantities of a vaccine.

"We've done absolutely nothing to enhance actual production and distribution," he said. Given that the virus that could emerge as the pandemic one will likely be a mutated version of H5N1, the stockpiled vaccines may or may not be effective. The manufacturing plants, however, can be up and ready to go before an outbreak, according to Osterholm, and the exact formula of the vaccine can be determined post-outbreak.