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Institute of Medicine (US) Forum on Microbial Threats; Knobler SL, Mack A, Mahmoud A, et al., editors. The Threat of Pandemic Influenza: Are We Ready? Workshop Summary. Washington (DC): National Academies Press (US); 2005.

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The Threat of Pandemic Influenza: Are We Ready? Workshop Summary.

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The Forum on Microbial Threats (previously named the Forum on Emerging Infections) was created in 1996 in response to a request from the Centers for Disease Control and Prevention and the National Institutes of Health. The goal of the Forum is to provide structured opportunities for representatives from academia, industry, professional and interest groups, and government to examine and discuss scientific and policy issues that are of shared interest and that are specifically related to research and prevention, detection, and management of emerging infectious diseases. In accomplishing this task, the Forum provides the opportunity to foster the exchange of information and ideas, identify areas in need of greater attention, clarify policy issues by enhancing knowledge and identifying points of agreement, and inform decision makers about science and policy issues. The Forum seeks to illuminate issues rather than resolve them directly; hence, it does not provide advice or recommendations on any specific policy initiative pending before any agency or organization. Its strengths are the diversity of its membership and the contributions of individual members expressed throughout the activities of the Forum.


Most infectious disease experts believe that a future influenza pandemic is inevitable. Yet despite the legacy of the 1918 “Spanish flu,” which killed an estimated 20 million people,1 and the additional deaths, social disruption, and economic losses that resulted from pandemics in 1957 and 1968, the general public appears relatively unconcerned about the next “killer flu,” which is conservatively expected to cause between 2 and 8 million deaths. Considerably more attention has been focused on protecting the public from terrorist attacks than from the far more likely and pervasive threat of pandemic influenza. Meanwhile, the danger mounts as the world's capacity to produce vaccines shrinks and pandemic avian H5N1 influenza—which has infected many people and killed at least 32 to date—takes hold in southeast Asia.

Research has identified three essential prerequisites for the start of a pandemic: transmission of a novel viral subtype to humans; viral replication causing disease in humans; and efficient human-to-human transmission of the virus. Since 1997, the first two prerequisites have been met on four occasions; the most recent occurred early this year in Vietnam and Thailand. With H5N1 at or near endemic levels in poultry in many parts of Asia, the world stands at the verge of pandemic and is likely to remain there for years. A recent expert consultation convened by the World Health Organization concluded that “the unpredictability of influenza viruses and the speed with which transmissibility can improve mean that the time for preparedness planning is right now.”

To address these urgent concerns, the Institute of Medicine's Forum on Microbial Threats hosted a public workshop on June 16 and 17, 2004. Through invited presentations and discussions among participants, the workshop informed the Forum, the public, and policy makers of the likelihood of an influenza pandemic and explored issues critical to the preparation and protection of the global community. Topics and questions considered during the workshop's presentations and discussions included the following:

  • Learning from the past: pandemics and other threats to public health
  • Global preparations against pandemic influenza
  • Preparing the United States for pandemic influenza
  • State and local preparation measures
  • Strategies to prevent and control transmission in birds and other animals
  • Biomedical approaches to preventing or controlling a pandemic
  • Legal issues in pandemic prevention and control
  • Improving preparedness: surveillance, prediction, and communication



For more detailed estimates of the numbers of deaths caused by the 1918 influenza outbreak, see Barry's section in Chapter 1.

Copyright © 2005, National Academy of Sciences.
Bookshelf ID: NBK22162
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