workshop presenters—is the political will to support such efforts before the next pandemic renders them futile. However, developments during the writing of this report might suggest that the tide is changing. The World Health Organization has called for an unprecedented summit of national public health leaders, vaccine manufacturers, and leading researchers to expand the plans and possibilities for responding to a pandemic influenza threat—now a growing concern among many nations and leaders (see, http://www.who.int/en/) (Marchione, 2004).

To expand on some of the key messages described above, the following text summarizes workshop presentations and discussions concerning preparedness for influenza outbreaks at every level of government and society and the prospects for preventing or mitigating the next pandemic.

Although historical evidence of probable encounters with virulent influenza date back to the 16th century, chronicles of the disease often begin with the 1918 pandemic (see Barry in Chapter 1). By that time, science was sufficiently sophisticated to characterize the most lethal infectious outbreak in recorded history, and even to anticipate that such an event would occur. As a result of its staggering mortality, the brunt of which was borne by young adults, the 1918 influenza pandemic remains a focus of scientific inquiry; the origin of the virus remains to be determined. Most recently, the “source” of its exceptional virulence has been discovered, and these findings suggest it is due to the hemagglutinin (HA) gene (Kobasa et al., 2004). Workshop participants discussed progress to date in addressing these critical issues. They also considered the consequences of deeply flawed public and official responses to the 1918 flu and their implications for the management of future pandemics and other public health crises.

Current estimates place the death toll from the approximately year-long 1918 pandemic at 50 to 100 million.¹³ A “herald wave” of influenza in the spring of that year produced a relatively mild disease, as described in Western medical journals (Taubenberger, 2004). The second pandemic wave struck violently in early autumn, spreading and killing with astounding rapidity. The unusually severe symptoms of this so-called Spanish flu included cyanosis, internal and external hemorrhage, and intense pain (see Barry in Chapter 1). Limited reliable mortality statistics from the United States show that the highest number of flu deaths occurred in people aged 25 to 29 years and that more than twice as many people aged 20 to 34 died