By Marc Lipsitch

mlipsitc@hsph.harvard.edu

Phone: +1 617 432 4559

Q.  Why does the US influenza pandemic plan include stockpiling enough antiviral flu medication for less than 1 percent of the population, when the World Health Organization recommends enough for 25 percent, a recommendation followed by Great Britain, and the Infectious Diseases Society of America recommends twice that?

Q.  Of the 12 scenarios in the Department of Homeland Security "National Planning Scenarios," pandemic flu is the one experts say is virtually certain to happen in the next decades, maybe in the next few years. It is also the most severe in terms of lives lost, according to the scenarios, apart from a nuclear bomb exploding in a major city. Are we apportioning our spending on prevention to reflect this probability and this impact?

Q.  Why do US pandemic planning scenarios, which estimate between 89,000 and 207,000 deaths from a flu pandemic, rely on "best-case" assumptions about the likely outcome, when the 1918 pandemic killed about 500,000 in a much smaller population, and the bird flu virus appears (so far) to be more deadly than even the 1918 strain?

Q.  Is the current US investment of $5 million per year in surveillance in Asia for bird flu adequate to aid local officials in China, Vietnam, Indonesia, Cambodia, Laos, Thailand, and other countries where bird flu threatens to spread more widely in humans? Are we doing all we can, in particular, in Cambodia and Laos, where public health systems are nearly nonexistent?

Q.  If bird flu breaks out in humans in Asia, as many experts predict it will, what will the response of the world community be? Are there adequate stockpiles of antivirals in Asia to contain such an outbreak, and if not, will we be likely to send our limited antiviral supplies to Asia when news of a pandemic hits?

(Editor's note: In mid-March, the New York Times, Newsday and several other newspapers ran a story about a Department of Homeland Security report that outlined 12 disaster scenarios. Apart from a nuclear explosion in a major city, pandemic influenza was the most deadly of this group and is one of the few virtually guaranteed to happen. The most recent pandemic flu was in 1968. Experts see the human cases of H5N1 avian influenza in Asia as the harbinger of an eventual mutated form that would transmit efficiently enough to cause a pandemic. The UK has taken much more serious steps than the US to prepare.)

Marc Lipsitch is Associate Professor of Epidemiology at the Harvard School of Public Health. E-mail: mlipsitc@hsph.harvard.edu

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