Highly pathogenic influenza A(H5N1) is endemic in avian populations in Southeast Asia, with serious outbreaks now in Africa, Europe, and the Middle East.1 Human cases, although rare, continue to increase, with high reported case-fatality rates. Industrialized countries place great emphasis on scientific solutions. The White House strategic plan and congressional appropriation both devote more than 90% of pandemic influenza spending to vaccines and antiviral medications.2 Yet, medical countermeasures, discussed in a previous JAMA Commentary, will not impede pandemic spread: experimental H5N1 vaccines may not be effective against a novel human subtype, neuraminidase inhibitors may become resistant, and medical countermeasures will be extremely scarce.3 This Commentary focuses on traditional public health interventions, drawing lessons from past influenza pandemics and the outbreaks of severe acute respiratory syndrome (SARS)4 (Table).
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