Considerable fi nancial resources have been devoted to pandemic infl uenza preparedness planning at the federal and state levels (6, 7) ; however, resources at state and local levels may be inadequate to implement a robust preparedness plan (8, 9) . Past experience with natural disasters and current socioeconomic and racial/ethnic disparities in healthcare in the United States (10, 11) raise questions about the adequacy of plans to address the needs of disadvantaged populations. For example, in responding to Hurricane Katrina, planners apparently failed to consider that many low-income persons might lack private modes of transportation and would depend on institutional help for evacuation. Although the evacuation was successful overall (12), deaths, injuries, and illness occurred disproportionately among low-income persons in New Orleans because of economic and logistic constraints on their ability to respond to government recommendations to leave the city. Low-income and disadvantaged persons often suffer disproportionately during natural disasters and epidemics, and historical evidence demonstrates that low-income persons fared considerably worse than high-income persons during the 1918 pandemic in the United States (13) .