Alarmed by the spread of avian flu, the Bush administration has released its pandemic influenza response and preparedness plan. This is a first draft that will be open for public comment until October. In late 1997 a new and virulent strain of flu, A(H5N1), was detected in Hong Kong through the World Health Organization's global influenza surveillance network. This strain normally infected birds and had never before been known to infect humans. However, bird flu killed 27 people in Asia this year (BMJ 2004;328:368). Administration health officials are worried that another flu pandemic is inevitable and fear that the recurring bird flu in Asia could trigger it, if the genes of A(H5N1) combine with the genes of a human influenza strain to create a new virus. “We've never seen so many birds infected with the virus at one point in time,” said Dr Julie Geberding, director of the Centers for Disease Control and Prevention (CDC). The worst influenza pandemic occurred in 1918, when 20 million people worldwide, including 500 000 Americans, died. The federal government plans to create “seed viruses” in the hope of speeding production of potential vaccine candidates. The drug industry produces tens of millions of standard influenza vaccines on a seasonal basis but lacks the capacity to produce a pandemic vaccine at the same time. Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, said the government is helping manufacturers produce vaccine throughout the year. Two manufacturers, Aventis and Chiron, are expected to deliver enough vaccine against the A(H5N1) strain to the institute in November, he said. Under the federal plan the CDC is increasing surveillance to identify flu strains as soon as they appear. Four drugs can be used to treat flu, if given immediately when symptoms begin, and the CDC says the neuraminidase inhibitor oseltamivir phosphate (Tamiflu) is best. The government has stockpiled enough to treat a million people, but this will be inadequate in a pandemic. The CDC says that the government must decide who has priority: first responders or vulnerable elderly people. The Department of Health and Human Services is increasing pressure on states to create their own plans for dealing with a flu pandemic this year, including providing enough hospital beds for the sickest patients. Travel restrictions such as those imposed during the severe acute respiratory syndrome crisis, closing of schools, restricting public gatherings, and quarantine may be necessary. “Good, old fashioned isolation and quarantine have a special role to play in any pandemic,” said Dr Geberding.