The Threat of Pandemic Influenza: Are We Ready?

world stands on the verge of an influenza pandemic. 1–3 Yet, despite the legacy of the 1918 “Spanish flu, ” which was estimated to have killed at least 20 million people, and the additional deaths, social disruption, and economic losses that resulted from pandemics in 1957 and 1968, the general public and their elected representatives appear relatively unconcerned about the next “killer flu.” Considerably more attention has been focused on protecting the public from terrorist attacks than from the greater threat of pandemic influenza—an event conservatively expected to cause between 2 and 8 million deaths. 2 Meanwhile, the danger mounts as the world’s capacity to produce vaccines shrinks and avian H5N1 influenza, which has infected many people and killed at least 44 to date, continues to circulate in Southeast Asia. 4 With the H5N1 virus showing progressive genetic changes as it has adapted to new avian hosts in recent years and is now circulating at or near endemic levels in poultry in many parts of Asia, the pervasive threat of a pandemic outbreak in humans grows larger and more imminent. A summary was recently prepared for the Forum on