Preparing for avian influenza: lessons from the "swine flu affair".

As a low-likelihood, high-consequence event, the possibility of an influenza pandemic poses a difficult challenge to policymakers. Drawing from the ill-fated swine influenza immunization program of 1976, this article outlines 7 lessons that apply to preparations for avian influenza: (1) beware of overconfidence in models drawn from meager evidence, (2) invest in a balanced portfolio of research and contemporary preparedness, (3) clarify operational responsibilities in the federal government, (4) refrain from overstatement of objectives and misrepresentation of risk, (5) strengthen local capacity for implementation, (6) communicate strategically, and (7) lay the basis for program review.