Pandemic Influenza—Confronting a Reemergent Threat

denced by the updating of⁄1 of the viruses in the vaccine. It is not surprising that the greatest change in the influenza virus, plans are briefly described in this supplement. antigenic shift associated with production of a pandemic, has The US plan has been designed to be updated regularly on been scrutinized on a number of levels, from the most scientific the basis of scientific and societal developments. It was also to the most literary. This concern seems more commensurate realized that answers to many scientific questions would be with the magnitude of the threat than with the sometimes irra- required to optimize the proposals and that in many cases, tional sensationalism preceding annual influenza outbreaks, im- the state of current knowledge was inadequate to provide the portant as they are in terms of morbidity, mortality, and local- appropriate information. The National Institutes of Health ized disruption of normal activities. (NIH) is the medical research arm of the federal government. Past experiences indicate that pandemics have the potential A decision was made within the NIH’s Division of Microbiolto be true public health emergencies, even when they resemble ogy and Infectious Diseases, National Institute of Allergy and the 1957 and 1968 episodes more than the infamous 1918 Infectious Diseases (NIAID), to convene an international meetexperience. In addition, the periods between influenza recur- ing to examine available data, identify critical scientific issues, rences have been relatively long and unpredictable. Thus, it is and frame the research questions relative to scientific issues not surprising that in the current examination of emerging and and gaps in knowledge vital to controlling pandemic influenza. reemerging infections, influenza pandemics have served as an The meeting was held in Bethesda in December 1995, when example of an event that has resulted in a complacent attitude the first draft of the Pandemic Plan had been formulated and toward the enormous threat to health and economic life. For the kinds of additional information that would be needed had example, until now, the US government plan for handling a begun to be identified from that standpoint. The organizing future pandemic had not been updated since 1983. committee designed the meeting to examine these questions The current change in approach has much to do with the and to explore other, more long-term scientific issues that recognition of the global danger of emerging and reemerging would affect the pandemic preparedness of the country. These microbial pathogens. In the report of the Institute of Medicine, involved a review of the events of past pandemics and new influenza, especially in its pandemic manifestation, was promi- scientific developments, all of which could help in developing nently used as a case requiring much more attention than it recommendations for increasing pandemic preparedness. Also has received in the past. In the Centers for Disease Control and considered was the issue of interpandemic influenza: Annual Prevention’s response to that report, preparedness for potential outbreaks cause major health and economic consequences, and influenza pandemics and for the more predictable interpan- studying them is the best strategy for gaining important knowldemic outbreaks was prominently discussed. As a result, it was edge relative to the pandemic situation. decided to give high priority to updating and expanding the The first 2 days of the 3-day meeting were devoted to plenary ability of the United States for managing an influenza pan- papers in the morning, discussing current knowledge, followed demic. each afternoon by three simultaneous workshops on specific As described in this supplement, the plan was developed by topics. These workshops addressed specific questions that dea US Public Health Service interagency panel with a group of fined the research agenda in light of gaps in scientific understanding. The texts of the plenary papers are given here along with summaries of each of the workshops. Participants in the workshops were asked to review their areas of research and to