Medical countermeasures for pandemic influenza: ethics and the law.

SERIOUS OUTBREAKS OF AVIAN INFLUENZA A (H5N1) have occurred among birds in Asia, with cases now reported in Europe. Although H5N1 is highly contagious among birds, it is rare in humans due to a significant species barrier. As of January 7, 2006, 146 cases were reported with 76 deaths. Human-to-human transmission has occurred, but transmission to date has not continued beyond one person. The prevalence of H5N1 is currently very low and pales in comparisonwithpandemicsofhumanimmunodeficiencyvirus, malaria, and tuberculosis. However, recent evidence that the 1918“Spanish” fluwascausedbyanavian influenzavirus lends credence to the theory that current outbreaks could have pandemic potential. Extrapolating from the 1918 pandemic, which killed an estimated 20 million to 50 million people in a less-populatedplanet, modelingstudies indicate that500 000 to1millionAmericanscoulddie,with tensofmillionsofdeaths globally. In response, the US government and the World Health Organization recently issued strategic plans. Therapeutic countermeasures (eg, vaccines and antiviral medications) and nonpharmaceutical interventions (eg, infection control, social separation, and quarantine) form the 2 principal strategies for prevention and response. This Commentary focuses on the medical countermeasures.