Be prepared, or procrastinate and panic

An influenza virus may emerge against which most people in the world have no immunity. This will be the next influenza pandemic, with high attack rates in all ages, a risk of high death rates, and a heavy burden on health services. It is prudent to prepare for such a pandemic, particularly if there are actions that could prevent or reduce severe morbidity. At an international meeting in Washington in 1995, countries from around the world met to discuss their plans of attack.

Britain's health departments have now published their plans,1 revealing as much about the convoluted organisation of health services as about the epidemiology of influenza. The plans concentrate on the actions of central agencies, as a framework on which health authorities and trusts should make local plans. When most people working at the local level in the NHS are struggling with the existing workload and budgetary constraints, it is tempting to shy away from preparing for an influenza pandemic.

Previous pandemics have been due to influenza A viruses and have occurred at irregular intervals: 1889, 1918, 1957, and …