The immediate costs of pandemic influenza to the NHS are easy to imagine, given increased demand across the spectrum of health care—from general practice for milder cases to intensive care for the most sick. The opportunity cost of this is to ration care away from other patients as resources are focused on the care of those with influenza, particularly those with serious complications, and to the creation and delivery of an effective vaccine. From an organisational viewpoint, meeting the needs of people with pandemic flu threatens performance, such as waiting times, in other areas of health care. It also makes clinical decisions about who will be treated when, and who will be left in avoidable pain and discomfort—or possibly to die, even more difficult.

Another consequence of a pandemic is its effect on the economy, and this is the focus of the linked study by Smith and colleagues (doi:10.1136/bmj.b4571),1 which uses a computer model to estimate the “economy-wide impact” of pandemic flu …