Mathematical modeling of pandemic scenarios added another dimension to a recurring topic of discussion: how to manage likely shortages of vaccines and antiviral medications (see Medema et al. in Chapter 5). Although models are not evidence of effectiveness, it was suggested by several presenters that they could be helpful decision-making tools during the crisis of a pandemic outbreak. One presentation described the use of a stochastic model that simulates daily contacts by a cross-section of Americans to examine the effects of epidemic influenza under various regimens of antiviral prophylaxis and/or vaccination (Longini, 2004; Longini et al., 2004; Monto, 2003). A strategy known as targeted antiviral prophylaxis (TAP), in which antiviral medications are given to people believed to be in close contact with index cases, was found to temporarily contain influenza transmission when 80 percent of all identifiable contacts were treated prophylactically for 4 weeks; similar results were obtained in simulations when 50 percent of the population in the model was immunized (Longini et al., 2004). The epidemic was extinguished when the TAP treatment was extended to 8 weeks, much as it was when 80 percent of the children in the model population were vaccinated. Vaccinating children, as opposed to adults, was found to increase the effectiveness of vaccination in this model (Longini et al., 2004).

A comprehensive response to pandemic influenza should address far more than the disease itself. As several of the previously discussed pandemic plans have anticipated, a pandemic will introduce a plethora of legal and ethical dilemmas and political and economic consequences. It will also take place in a social context in which public perception of and reaction to an emergency strongly influences its impact. In light of these profound influences, workshop participants considered a variety of social perspectives on the coming pandemic: economic, legal, and ethical implications of various response options; opportunities for collaboration between public and private sectors; and public communication strategies to address both interpandemic and pandemic influenza.

Pandemic preparations can be viewed as an insurance policy: an investment, accumulated over time, in anticipation of an eventual crisis (see Chapter 6) (Meltzer, 2004). The annual rate of investment in pandemic preparedness, the “premium” on the insurance policy, depends on the potential impact of pandemic influenza and its probability of occurrence in

Front Matter (R1-R18)

Summary and Assessment (1-56)

1 The Story of Influenza (57-114)

2 Today (115-140)

3 Toward Preparedness: Opportunities and Obstacles (141-221)

4 Strategies for Controlling Avian Influenza Birds and Mammals (222-253)

5 Emerging Technical Tools (254-314)

6 Beyond Biomedical Response (315-372)

Appendix A: Pandemic Influenza: Assessing Capabilities for Prevention and Response (373-380)

Appendix B: Selected Bibliography (381-387)

Appendix C: The Critical Path to New Medical Products (388-389)

Appendix D: Forum Members, Speakers, and Staff Biographies (390-412)