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From Medscape General Medicine™

Webcast Video Editorials
Pandemic Flu: We Are Not Prepared

Posted 4/15/2005
Marc Lipsitch, D. Phil

The world faces a new influenza pandemic about 3 times each century.[1] The 1918 pandemic killed at least 20 million people.[2] We don't know when the next one will hit, but flu experts agree that we are now at high risk for a serious pandemic.[3] H5N1 flu has become endemic in Asian birds, and at least 74 human cases, including 49 deaths and probable human-to-human transmission, have occurred since the beginning of 2004.[1,4,5]

We are unprepared for a new pandemic. International health officials lack the resources to monitor avian flu in a human population of hundreds of millions in affected parts of Asia, including some countries with almost no public health systems.[1,6] Asia needs a significant stockpile of the anti-influenza drug oseltamavir, on-site, to treat and stop transmission of the early cases that could give rise to a pandemic.

If a pandemic reached the United States today, we could manufacture only enough vaccine for perhaps a quarter of our population.[7] Our planned domestic stockpile of oseltamavir would leave over 99% of the country unprotected.[8] Proportionally, Great Britain's stockpile will be 25 times greater,[9] and some authorities suggest that even that isn't enough.[10] To make a dent in a pandemic, vaccines and antivirals will be needed in much greater quantities than current plans allow.[11]

Pandemic flu is an enemy that we know will return. Indeed, of the 12 disaster scenarios recently assessed by the US Department of Homeland Security, it is the most likely and perhaps the most deadly.[12] Our surveillance and countermeasures abroad are inadequate, and current response plans won't do much to slow a pandemic once it is under way. The United States, and the world, must meet this enemy with the seriousness, the investment, and the urgency that it demands.

That's my opinion. I'm Dr. Marc Lipsitch of the Harvard School of Public Health. To contact the author:

Readers are encouraged to respond to George Lundberg, MD, Editor of MedGenMed for the editor's eye only or for possible publication via email: .

  1. World Health Organization. Avian influenza: assessing the pandemic threat. January 2005. Available at: Accessed April 11, 2005.
  2. Patterson KD, Pyle GF. The geography and mortality of the 1918 influenza pandemic. Bull Hist Med. 1991;65:4-21. Abstract
  3. Li KS, Guan Y, Wang J, et al. Genesis of a highly pathogenic and potentially pandemic H5N1 influenza virus in eastern Asia. Nature. 2004;430:209-213. Abstract
  4. Ungchusak K, Auewarakul P, Dowell SF, et al. Probable person-to-person transmission of avian influenza A (H5N1). N Engl J Med. 2005;352:333-340. Abstract
  5. World Health Organization. Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) since 28 January 2004. Available at: Accessed April 11, 2005.
  6. Aldhous P. Vietnam's war on flu [news feature]. Nature. 2005;433:102-104. Abstract
  7. Fedson D. Pandemic influenza vaccines: obstacles and opportunities. In: Knobler SL, Mack A, Mahmoud A, Lemon SL, eds. The Threat of Pandemic Influenza: Are We Ready? Workshop Summary Prepared for the Forum on Microbial Threats, Board on Global Health, Washington, DC: National Academies Press; 2005:184-196.
  8. United States Department of Health and Human Services. Testimony of Dr. Julie L. Gerberding before the Committee on Energy and Commerce United States House of Representatives, Nov. 18, 2004. Available at: Accessed April 11, 2005.
  9. Naughton P. UK to stockpile drugs against bird flu pandemic. Times (London). March 1, 2005. Available at:,,2-1506055,00.html Accessed April 11, 2005.
  10. Infectious Diseases Society of America (IDSA). Flu pandemic coming, U.S. not prepared [press release]. March 22, 2005. Available at: Accessed April 11, 2005.
  11. Longini IM Jr, Halloran ME, Nizam A, Yang Y. Containing pandemic influenza with antiviral agents. Am J Epidemiol. 2004;159:623-633. Abstract
  12. Lipton E. U.S. lists possible terror attacks and likely toll. New York Times. March 16, 2005:A1.

Marc Lipsitch, D. Phil , Associate Professor of Epidemiology, Department of Epidemiology and Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts.

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