Influenza pandemics are associated with high morbidity, excess mortality, and social and economic disruption. There were three such pandemics in the twentieth century: in 1918, 1957, and 1968. During 2004, the world moved closer to a further pandemic than it has been at any time since 1968. In the past, pandemics have announced themselves with a sudden explosion of cases which took the world by surprise. This time, we have been given a clear warning. During 2004, large parts of Asia experienced unprecedented outbreaks of highly pathogenic avian influenza, caused by the H5N1 virus, in poultry. The virus crossed the species barrier to infect humans, with a high rate of mortality. Monitoring of the evolving situation, coordinated by WHO, has produced many signs that a pandemic may be imminent. This time, the world has an opportunity to defend itself against a virus with pandemic potential before it strikes.
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