Quotes of the Day

On Oct. 14, 1976, while the TV cameras rolled, U.S. President Gerald Ford pushed up his sleeve and received his influenza vaccine. It wasn't an ordinary flu jab. In February of that year, an 18-year-old U.S. Army recruit had died of a swine flu virus, which scientists at the time believed was closely related to the virus that had caused the 1918 influenza pandemic. High-level disease experts worried that the new virus signaled the return of the 1918 flu, and barely a month after the soldier's death, Ford announced an unprecedented emergency plan to inoculate the entire American population against swine flu. This decisive leadership was supposed to represent a crowning triumph for a public-health system that had been all but helpless in 1918.

But the inoculation program immediately hit snags. Worried about lawsuits, drug companies demanded that Congress assume liability for the new vaccines. Then, after two months, vaccinations were halted after reports that hundreds of people who had received the shot had developed a rare nerve disease. While it was never conclusively proven that the vaccine caused this disease, the result was a litigation nightmare for Washington. And it all turned out to be unnecessary anyway—the swine flu death proved to be an isolated case, and nothing remotely like a pandemic ever materialized.

For flu experts, 1976 is the flip side to 1918, a reminder that there is always a risk of overreacting to a pandemic threat. But the decision to crash test a vaccination program was based on the best available science at the time. (We know now that the 1918 flu was an avian virus, not a swine one.) While the 1976 program was an expensive and embarrassing mistake, it also underscored just how difficult it is to decide how to prepare for an influenza pandemic, whose schedule and severity we have virtually no way of predicting. "No one really knows what's going to happen," says Dr. Howard Markel, a medical historian at the University of Michigan and the author of When Germs Travel. "Anyone who says they do is an idiot or lying."

That's worth remembering as bird-flu panic begins to intensify around the world. In the West, individuals rattled by the news that the disease has hit poultry populations on the edges of Europe are buying up supplies of the antiviral drug Tamiflu. In Asia, where fresh outbreaks were reported in three countries last week, government officials in China and Australia have already warned of the possibility that they might close national borders in the event of a pandemic.

It seems smart to err on the side of caution after years of failing to take the very real threat of a pandemic seriously. But panic is the enemy of good preparation. Hoarding antivirals—which may not even be that effective in the event of a pandemic—reduces the availability of the drugs at a time when supplies are already limited, and could result in more people dying of normal flu this season. To combat hoarding, Roche, the company that makes Tamiflu, recently suspended shipments to private suppliers in several countries. Closing borders in the case of a pandemic would not only be ineffective—unlike SARS, flu is too contagious to be contained—but would also prove economically disastrous in a deeply interconnected world. "Panic is a bad stimulus for action," says Markel, who studies the history of epidemics. "It never results in anything good."

What's really needed is careful, detailed, long-term planning that answers to the realities of tomorrow, not the headlines of today. Building up government stockpiles of antivirals is necessary. But what's more vital is improving the surge capacity of our health-care systems, so there will be enough hospital beds. A vaccine would help us sleep easier, but what every country needs today is a program that explains how essential services—law enforcement, transportation, even food supplies—would continue operating in the first chaotic months of a pandemic.

U.S. President George W. Bush's high-profile $7.1 billion pandemic strategy, unveiled last week, is long on stockpiles and vaccines, as if the President believes he can build levee walls high enough to keep a pandemic out of the U.S. He can't—and much of that money would be better spent on the ground in countries like Indonesia, Cambodia, Thailand and Vietnam, where bird flu has hit hardest. The U.N. Food and Agriculture Organization has collected just $30 million of the $175 million it says is needed to control the disease in birds in Southeast Asia, though the World Bank's announcement last week that it will issue emergency loans to nations struggling with avian flu should help. As the World Health Organization has repeatedly stated, containing bird flu on the ground, in animals, is still the best way to prevent a flu pandemic. But paying for flu surveillance in Cambodia isn't going to calm scared American voters, or earn Bush back the political capital he lost in Hurricane Katrina.

Preparing for a pandemic is challenging because it is difficult to strike a balance between acting and overreacting. President Bush and the rest of the world's leaders need to rise above panic and politics. Like Gerald Ford in 1976, they can't be afraid to make the wrong choice for the right reasons.

• Bryan Walsh
• How to prepare for a pandemic that may or may not be on its way