One of the nation's leading flu pandemic experts and the state Department of Health say it's not a question of whether bird flu will hit Hawai'i, but when.

Both the Health Department and Dr. Duane Gubler, director of the Asia-Pacific Institute of Tropical Medicine and Infectious Diseases, point to Hawai'i's high volume of international visitors and concerns over controlling the global poultry industry as key reasons a pandemic flu strain would arrive.

"The key to reducing the public health threat of a global pandemic is to deal with it in the animal population," Gubler said. "There's no magic bullet. There's a fine line between getting people prepared without causing them to panic."

Hawai'i's role in fighting a flu pandemic will be highlighted next week when Gov. Linda Lingle and state Adjutant Maj. Gen. Robert G.F. Lee join governors from four other states in a pandemic war-game scenario at the Pentagon. The scenario will be played out Feb. 28 during the National Governors Association meeting.

Lee said the purpose of the war game is to see how the board of governors would respond if a pandemic comes from the Pacific, and that the governors will be playing the role of an advisory panel to the president.

"Gov. Lingle will be a key player because of our key role in the Pacific for this war game, which has the pandemic starting in the Pacific," Lee said.

Bird flu has killed at least 92 people worldwide, mostly in Asia, since 2003, according to the World Health Organization.

In Hawai'i, state epidemiologist Dr. Paul Effler said Gubler's assessment of the situation is accurate.

"No one can predict the future, but recent developments with unprecedented flu in the avian species indicate a cause for concern," Effler said. "In Hawai'i with 7.5 million visitors last year, many of whom are from Asia, there is a higher chance for early introduction of avian flu here."

Bird flu is spread by wild waterfowl that infect poultry. People can become ill if they come in contact with sick poultry, Gubler said, and the concern is that the strain spreading now is highly pathogenic and persistent.

If the bird flu does make it to Hawai'i, its effect on tourism could be similar to what was seen during the 2003 SARS (Severe Acute Respiratory Syndrome) epidemic, said Gubler, who has spent 35 years conducting international field research.

At its peak, SARS cost Hawai'i about 47,000 international visitors in May 2003, or slightly less than one-third of the international visitors market. There was a slight improvement in June, however a total recovery didn't occur until March 2004, according to the Department of Business, Economic Development and Tourism. Domestic visitor arrivals weren't noticeably affected.

Health officials have estimated that the state could face more than 2,400 deaths if a moderately severe strain of a pandemic flu virus were to hit the Islands. State health officials are already screening international visitors for respiratory illness, Gubler said.

Hawai'i might consider stepping up its efforts and use a technology used in Taiwan and other Asian countries involving an infrared scan of every arrival. The scan seeks out elevated temperatures, usually an indication of a fever and a sign of infection, said Gubler, who spoke about the topic last week at the Pacific Asian Affairs Council.

The first wave of the deadly H5N1 bird flu virus affecting humans occurred in Southeast Asia, Gubler said. Cases of people contracting the avian flu have been reported in China, Vietnam, Thailand, Cambodia, Indonesia, Hong Kong, Turkey and Iraq. And recent reports indicated there were people infected in Germany, Iran, Austria, Denmark and throughout Africa.

India has been slaughtering hundreds of thousands of chickens this week, trying to stop the spread of the disease.

Just how hard an arrival of avian flu hits Hawai'i's economy depends on a variety of factors, including how the world perceives the problem, said Bank of Hawaii economist Paul Brewbaker. Certainly there is a potential that avian flu could have a similar or possibly worse effect on Hawai'i than SARS.

"If we have it and everybody else has it, that's huge," Brewbaker said. "If we have it and nobody else has it, that's also going to be huge."

Throughout history, influenza epidemics have caused the deaths of millions of people worldwide, Gubler said. In 1918, influenza killed more than 50 million people around the planet. In 1957-58, the Asian flu killed 4 million people worldwide, including 70,000 in the United States. And in 1968-69, the Hong Kong flu killed 1 million to 4 million worldwide, including 34,000 in the United States.

Reach Suzanne Roig at sroig@honoluluadvertiser.com.