1) How to improve containment in birds? Early detection of new clusters of disease among birds is crucial. Poultry farming can be targeted by mass culling but such farming is an economic necessity in many low-to-middle income countries.
2) How to improve surveillance and reporting? There is currently no reliable early warning system in place across large parts of the world. This vacuum in surveillance poses the most serious risk to human health.
3) How to tackle the intellectual property rights for antiviral drugs? Ramping up production of the antivirals, oseltamivir and zanamavir, is an urgent priority.
4) How to administer antivirals? The efficacy of antivirals in pandemic human influenza remains unknown. The summit should address ways to avoid resistance to antivirals.
5) How to deal with a pandemic? Current preparedness plans in many developed countries are well advanced. However, in low-income and middle-income settings, plans for massive international support are urgently needed.
The Lancet states: "The Geneva summit will be a make-or-break time for the human threat of H5N1 influenza. Existing knowledge of avian and human influenza--in epidemiology and molecular characterisation, infectivity and pathogenicity, containment and treatment, and preparedness--is the only hope for reducing the mortality from a human H5N1 pandemic... After the summit, country responses must show the seriousness with which they are taking the threat of a possible pandemic. They must be willing not only to cooperate but also to cede a certain amount of sovereignty to limit that threat. After the summit, the World Health Organization, the Food and Agricultural Organization, and the World Organization for Animal Health, will need to seize the initiative in influenza preparedness. They must do so even at the discomfort of their member states. Bold and visible leadership is essential."
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