But researchers are not simply watching and waiting. Scientists are continually developing new proto, so-called seed vaccines, to test against newly emerging strains of the flu.
And there is plenty to do on the logistics side. The H1N1 pandemic hit Europe later than it did South and North America. And even though the outbreak was milder, thanks to the arrival of the vaccine during the pandemic peak, as I.C.L.'s Openshaw pointed out, many places were still running out of respirators, hospital beds and nursing staff.
"We know that it takes at least four to six months to have a vaccine," noted Sylvie Briand, of the World Health Organization (WHO). And for countries that receive the early waves of a pandemic, a vaccine will likely not come in time to protect people against the virus. "So it's very important to improve clinical response," by having ample medication and facilities to treat those at risk and reduce overall mortality.
Advancing preparedness in one fell swoop, however—even within the comparatively well-equipped European Union—has proved difficult, as Cambridge's Smith pointed out, because countries that are less prepared are so for different reasons—making a one-size-fits-all approach to improving preparedness impractical. And when countries the world-over are thrown into the mix—many of which have far fewer scientific, medical and infrastructural resources—the task is even more of a challenge.
At the end of the day, much of the preparation lays in the hands of policymakers—within "the realpolitik of the department of health," Openshaw noted, adding that he realized that science was only part of the equation that politicians and governmental officials must consider.
In addition to battling the mercurial virus and any political roadblocks, those trying to mitigate a future pandemic face another unpredictable force: public behavior.
In the first days of a pandemic, scientists and policymakers are forced to make consequential decisions—about containment, treatment, prophylaxis—with relatively limited information, "based on a perception," Briand said. And communicating the appropriate message to the public, which might not be well versed in risk and uncertainty, is a difficult task. Cry wolf, and it is likely to cause panic as well as subsequent criticism of overreacting. But fail to instill adequate caution, and the reaction—and mortality rate—will be even worse.
In 2009, for example, the WHO eventually declared the H1N1 pandemic a level 6—the highest designation possible. But that, Briand pointed out, was not indicative of the disease's severity, but rather the extent of its spread. This distinction, which is great in the eyes of epidemiologists, was typically unaddressed in the media and thus in public perception, leading to later claims that officials had oversold the virus's danger.
So, in addition to lab work on the viruses, some scientists are hard at work "thinking about how best to communicate the uncertainty" that is undoubtedly going to arrive with the first wave of the next outbreak, I.C.L.'s Van Kerkhove said. "We learned that from the last pandemic, and we can expect that from the next one."
Unlike other human plagues, such as polio or smallpox, however, "eradication of the flu is impossible," Osterhaus said. The latest scientific and social research has pointed to three important steps to best meet the next pandemic head on, Briand said. Officials must make a variety of plans based on different scenarios; they must remain flexible to respond to rapidly changing situations; and they must keep plans up to date—refreshing stockpiles and reevaluating plans based on the latest science.