New approaches to confronting an imminent influenza pandemic.

Scientists and health officials are concerned that an H5N1 influenza pandemic could be both imminent and catastrophic. Managing it will be difficult. Supplies of antiviral agents will be limited and expensive. Clinical development of adjuvant-combined, antigen-sparing, inactivated vaccines has been slow; the vaccines will take several months to produce and the global capacity to produce them will remain limited for several years. People who live in countries without vaccine companies - more than 85% of humankind - will have little prospect for being immunized. Thus, new approaches are needed to confront an imminent pandemic. The interventions must be scientifically promising and already licensed or near licensure. Moreover, the global industrial capacity to produce them must be large and already in place. Three interventions meet these criteria. Within a few months, several billion doses of live-attenuated H5N1 vaccines could be produced in existing egg-based or cell culture production facilities and several billion doses of an H5 recombinant hemagglutinin (rHA) vaccine could be produced in existing pharmaceutical bioreactors. In addition, generic medications such as statins might be able to moderate the aberrant innate immune response that characterizes human cases of H5N1 influenza. Statins would be affordable and available worldwide on the first day of the pandemic. Given the limitations of current efforts to develop and produce antivirals and conventional vaccines, urgent attention must be given these promising new approaches to pandemic control.