The example given here of an ancient Chinese medicine formula used to treat influenza containing nine (out of 11) herbs with anti-inflammatory properties provides compelling evidence that the way forward for the treatment of influenza in a pandemic should be immunomodulation. The host response is targeted, rather than the virus itself. Our observation that treatment of influenza virus-infected mice with a pharmaceutical used in humans, the lipid-lowering and immunomodulatory PPAR alpha agonist gemfibrozil, resulted in significantly decreased influenza-induced mortality, further shows that targeting the host response is a valid possibility. The natural immunomodulatory agent biochanin A from Red Clover, which is both a PPAR alpha and PPAR gamma agonist, could have similar effects to gemfibrozil on the course of influenza disease in vivo. Chinese herbs such as A. sinensis and S. miltiorrhiza which independently reduce secretion of the novel inflammatory cytokine HMGB1, and glycyrrhizin from liquorice root, which binds to HMGB1 and inactivates its activity, provide another avenue for investigation, as does the establishment of the role of HMGB1 in severe influenza. The wide availability and low economic price of these agents could make such agents an inexpensive alternative treatment, particularly in countries with large populations who will have no access to pandemic vaccines or antivirals. Pandemic (H1N1) 2009 Influenza Community Transmission Was Established in One Australian State When the Virus Was First Identified in North America BACKGROUND: In mid-June 2009 the State of Victoria in Australia appeared to have the highest notification rate of pandemic (H1N1) 2009 influenza in the world. We hypothesise that this was because community transmission of pandemic influenza was already well established in Victoria at the time testing for the novel virus commenced. In contrast, this was not true for the pandemic in other parts of Australia, including Western Australia (WA). METHODS: We used data from detailed case follow-up of patients with confirmed infection in Victoria and WA to demonstrate the difference in the pandemic curve in two Australian states on opposite sides of the continent. We modelled the pandemic in both states, using a susceptible-infected-removed model with Bayesian inference accounting for imported cases. RESULTS: Epidemic transmission occurred earlier in Victoria and later in WA. Only 5% of the first 100 Victorian cases were not locally acquired and three of these were brothers in one family. By contrast, 53% of the first 102 cases in WA were associated with importation from Victoria. Using plausible model input data, estimation of the effective reproductive number for the Victorian epidemic required us to invoke an earlier date for commencement of transmission to explain the observed data. This was not required in modelling the epidemic in WA. CONCLUSION: Strong circumstantial evidence, supported by modelling, suggests community transmission of pandemic influenza was well established in Victoria, but not in WA, at the time testing for the novel virus commenced in Australia. The virus is likely to have entered Victoria and already become established around the time it was first identified in the US and Mexico. The first confirmed case in Australia of pandemic (H1N1) 2009 influenza (pH1N1) was recorded in Queensland in a returned traveller from the United States (US) on 9 May 2009 [1] , almost four weeks after the first cases were confirmed in the US on 15 and 17 April 2009 [2] . Victoria confirmed its first case in a traveller from the US on 20 May [3] and the first case in Western Australia (WA) was notified on 24 May in a traveller returned from Canada via the US [4] .