Managing and Reducing Uncertainty in an Emerging Influenza Pandemic

In a recent Perspective article in the New England Journal of Medicine, Dr. Marc Lipsitch et al. addressed several relevant issues related to decision-making in an environment of uncertainty in their article entitled Managing and Reducing Uncertainty in an Emerging Influenza Pandemic.

While the article touches on several important considerations, the authors' last statement about disproportionate implications for developing countries resonated with me:

"As we adjust our mitigation policies, there will be a continuing need to make decisions without definitive estimates of severity. For example, the decision to move from production of vaccine for seasonal influenza to that for pandemic influenza will need to be made in the next month or two. Similarly, the United States will need to decide soon whether to use adjuvanted vaccines to protect more people with a given amount of antigen, although such vaccines are not currently licensed in the United States. As always, however, the main losers from delays in such decisions are likely to be developing countries, which will have less access to vaccine while probably suffering the greatest clinical impact from this new pandemic virus. "

While the article is a bit domestic in focus, I think many of the key points can be translated into the international setting. The entire article is worth reading, and can be viewed at: http://content.nejm.org/cgi/content/full/NEJMp0904380