demic. However, strategic actions recommended against influenza that could also inform efforts to better prepare for other viral disease outbreaks have yet to be implemented. These strategies include:1

  • stockpiling of broad-spectrum antiviral drugs,

  • advanced development of pandemic strain vaccines,

  • the establishment of surge capacity for rapid vaccine production, and

  • the development of models to determine the most effective means of delivering therapies during an outbreak.

It is evident from the experience of the late 2003 influenza season that our supply and effectiveness of antiviral drugs, capabilities to accurately predict the best viral strain for annual vaccine production, and mechanisms for surge capacity production remain inadequate (Treanor, 2004). Recognition of these vulnerabilities led numerous workshop participants to call for greater scientific and financial investments to strengthen our defenses against these certain future threats.

However, most emerging infections other than influenza will represent a truly novel threat for which the world is inadequately prepared. In these cases, models based on detailed observations from previous epidemics can be used to predict demands on hospital capacity during a hypothetical epidemic and to guide the timing and nature of quarantine measures. Two papers in this chapter (Amirfar et al. and Kimball et al.) examine the modeling strategies that have been used for analyzing public health responses to epidemics as well as the particular challenges that SARS presented for international disease surveillance and alert networks. As with other public health measures, these strategies are potentially applicable not just to SARS but to any future outbreaks in which appropriate actions to protect the public’s health must be taken swiftly (and possibly even before the complete clinical profile of the new disease and the etiological agent behind it are fully understood).

When containment measures such as quarantines must be put in place, establishing the trust of the public is crucial to their effectiveness. Social cohesion and compliance with SARS quarantine in Toronto, for example, have been attributed in part to a combination of clear communication and practical guidance by public health authorities. In the extreme case of mandatory quarantine, enforcement requires careful planning and a clear understanding of public health law. This is particularly true in the United States, where quarantine is likely to necessitate the coordination of federal, state, and local jurisdictions and legal authorities. As Gene Matthews’ paper elaborates, additional legal considerations include: due process, which requires proper notice; legal representation; court-reviewed decisions; and remote communications to permit a quarantined person to be heard in


Workshop presentation, Robert Webster, St. Jude Children’s Research Hospital, October 1, 2003.

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