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Editorial
Nature 459, 9 (7 May 2009) | doi:10.1038/459009a; Published online 6 May 2009

Between a virus and a hard place

Abstract
Complacency, not overreaction, is the greatest danger posed by the 
flu pandemic.  That's a message scientists would do well to help get 
across.

	[but is there any need to go off to the other extreme, e.g. 
saying 'the flu pandemic' when there is none? -  RM]

	Damned if you do, damned if you don't.  The emergence of a 
new, swine-flu-related H1N1 strain of influenza in people in North 
America, with sporadic cases elsewhere in the world, has left the US 
Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, 
and the World Health Organization (WHO) in Geneva in an unenviable 
position.
	For more than a week now, these two agencies have been 
holding daily media briefings to keep the world informed about the 
rapidly unfolding story.  There is ample reason for concern: a new 
flu virus has emerged to which humans have no immunity, and it is 
spreading from person to person. That has happened only three times 
in the past century. The pandemics of 1957 and 1968 were mild in most 
people but still killed many, and that of 1918 - which also seemed 
mild in its early phases - killed at least 70 million people 
worldwide. As Nature went to press, the WHO had already upped its 
pandemic threat level from 3 to 5, and a final step to its highest 
level of 6 - a global pandemic - seemed only a matter of time.
	Yet at this early stage, the consequences of the pandemic are 
so uncertain that communicating the risks is a delicate matter. 
Influenza viruses evolve rapidly, making it extremely difficult to 
predict what this strain might look like a few months from now. If 
the agencies alert people and the pandemic fizzles out, they will be 
accused of hyping the threat and causing unnecessary disruption and 
angst. Indeed, just such a media backlash is already beginning, 
because most cases so far have been mild. But if the agencies 
downplay the threat and an unprepared world is hit by a catastrophe 
on the scale of 1918, the recriminations will come as fast as you can 
say 'Hurricane Katrina'.

The risk is not hyping the pandemic threat, but underplaying it
	To their credit, the WHO and the CDC have avoided the kind of 
falsely reassuring officialese that has too often accompanied past 
crises. As Peter Sandman, a risk-communication consultant based in 
Princeton, New Jersey, aptly puts it: "Anyone who's paying attention 
gets it that we just don't know if this thing is going to fizzle, 
hang in abeyance for months, disappear and then reappear, spread but 
stay mild, replicate or exceed the 1918 catastrophe, or what. The 
reiteration of uncertainty and the insistence on what that means - 
e.g., advice may change; local strategies may differ; inconsistencies 
may be common - has been almost unprecedentedly good."
	Also encouraging is that many governments now have at least 
some kind of pandemic plan in place, thanks to the scare over the 
H5N1 avian flu virus earlier this decade. Five years ago very few of 
them did. But many of those plans contain an important element that 
has been conspicuously absent in the current communication by 
governments and public-health authorities: during a severe pandemic, 
there is only so much they can do. Much of the response will depend 
on local communities taking action for themselves.
Scientists can help, by serving as credible voices to inform their 
communities of the risks and uncertainties, and by pointing people to 
the pandemic-planning resources on the CDC and WHO websites, the 
PandemicFlu.gov site, and many others. For the moment, the risk is 
not hyping the pandemic threat, but underplaying it. We know a 
tsunami is coming. No one can say whether it will be just a large 
wave, or a monstrous one, but it is time to start thinking about at 
least being ready to move to higher ground.