Mr Dare is a microbiologist in the Division of Viral and Rickettsial Diseases at the Centers for Disease Control and Prevention. His research focuses on developing molecular diagnostic assays for respiratory viruses.  Resource Allocation during an Influenza Pandemic Resource Allocation during an Influenza Pandemic To the Editor: Planning for pandemic infl uenza is accepted as an essential healthcare service and has included creation of national and international antiviral drug stockpiles and novel approaches to emergency vaccine development (1) . The effectiveness of these strategies in a pandemic may be substantial but is unknown. More certain is that effective management of severe and complicated infl uenza will reduce deaths and that demand will exceed available treatment resources (2) . Appropriate allocation of treatment resources is therefore essential, perhaps more important than any specifi c treatment such as administering antiviral medication to symptomatic patients. Re- (4) . Even more important for most severely ill patients, however, will be deciding whether to admit them to the hospital at all. The UK pandemic-planning criteria currently recommend a scoring system for hospital admission based on an assessment of poor outcome rather than on capacity to benefi t (2). Indeed, age >85 years and severe underlying cognitive impairment, which would rule out admission to critical care in Canada, would strongly favor admission to hospital care in the United Kingdom, the opposite of the situation for a younger cognitively intact person with similar disease severity. If tools are to be developed to support triage at all stages of the patient pathway in a pandemic, societies must consider the ethical issues raised (4,5), debate them, and take a position on the values that should underpin decision making in a pandemic. Even when clear societal goals are established, much work remains to ensure that the healthcare community is equipped to steer healthcare resources to deliver these effectively (6) . Community-acquired pneumonia has been used as a surrogate for infl uenza to test predictive scoring systems for assessing severity and assisting triage decisions (7) . Seasonal infl uenza epidemics would provide the most realistic setting available, in particular, if protocols were in place to test criteria when a relatively severe infl uenza season occurs. In addition to identifying criteria for setting priorities within infl uenza management, such testing will need to consider the balance of resources between infl uenza treatment and treatment of other usual noninfl uenza conditions that will require emergency care during the pandemic. Decisions that must be made during a pandemic are complex, varying from when to stop major elective surgery so critical care capacity can be opened up, to how to triage those who have experienced major trauma and those with infl uenza. These decisions could differ from those same decisions made outside a pandemic, and an adequate evidence base is needed if they are to be of good quality.