We lucked out on the last flu pandemic, but don't count on doing so on the next!

John Barry, the author of The Great Influenza: The story of the deadliest pandemic in history, has an article in the current Foreign Policy magazine with some good common sense on flu as a public health problem. The World Health Organization data on the number of cases and number of fatalities is based on laboratory confirmed cases of H1N1 flu, and thus massively undercounts the real burden of the disease. Still, we are lucky that the impact of that flu was much less than that of previous pandemics.

We don't know when a new strain of flu will emerge capable of causing a major pandemic, but the world is still not ready for it despite progress made in recent decades. Early case finding, perhaps the most critical capacity, has improved but is still not at the level one desires. Vaccine production technology has improved, but in February 95 countries told WHO that they had no flu vaccine at all. New approaches to applying the vaccine are in the works, but the ability to get the vaccine into huge numbers of vulnerable people, as is required to limit a pandemic, is just not there.

On the other hand, a number of public health officials overreacted to the H1N1 (swine flu) epidemic:

Egypt, for example, slaughtered its entire pig population; Singapore warned citizens that violating a quarantine order would result in jail time. Mexico, where the 2009 outbreak began, was punished harshly for its transparency: France demanded that the European Union cancel flights to the country, and some U.S. commentators wanted the border shut. In total, the Mexican economy lost nearly $3 billion. This kind of overreaction only encourages governments to keep quiet the next time a virulent flu strain hits.