Preparing for the Next Pandemic

Michael T. Osterholm


Annual influenza epidemics are like Minnesota winters — all are challenges, but some are worse than others. No matter how well we prepare, some blizzards take quite a toll. Each year, despite our efforts to increase the rates of influenza vaccination in our most vulnerable populations, unpredictable factors largely determine the burden of influenza disease and related deaths. During a typical year in the United States, 30,000 to 50,000 persons die as a result of influenzavirus infection, and the global death toll is about 20 to 30 times as high as the toll in this country. We usually accept this outcome as part of the cycle of life. Only when a vaccine shortage occurs or young children die suddenly does the public demand that someone step forward to change the course of the epidemic. Unfortunately, the fragile and limited production capacity of our 1950s egg- based technology for producing influenza vaccine and the lack of a national commitment to universal annual influenza vaccination mean that influenza epidemics will continue to present a substantial public health challenge for the foreseeable future.

An influenza pandemic has always been a great global infectious-disease threat. There have been 10 pandemics of influenza A in the past 300 years. A recent analysis showed that the pandemic of 1918 and 1919 killed 50 million to 100 million people, and although its severity is often considered anomalous, the pandemic of 1830 through 1832 was similarly severe — it simply occurred when the world’s population was smaller. Today, with a world population of 6.5 billion — more than three times that in 1918 — even a relatively “mild” pandemic could kill many millions of people.

Influenza experts recognize the inevitability of another pandemic. When will it begin? Will it be caused by H5N1, the avian influenzavirus strain currently circulating in Asia? Will its effect rival that of 1918 or be more muted, as was the case in the pan- demics of 1957 and 1968? Nobody knows.

So how can we prepare?

Copyright © 2005 Massachusetts Medical Society. All rights reserved.
The New England Journal of Medicine
N Engl J Med. 2005 May 5;352(18):1839-42.
doi: 10.1056/NEJMp058068.