Three times during the 20th century the human population suffered pandemic influenza disease caused by particularly virulent strains. The most famous—and the most deadly—of these was the 1918 pandemic known as the “Spanish flu,” which caused an estimated 50 million deaths worldwide, including nearly half amillion in the United States. It has been nearly 40 years since the last major pandemic, the “Hong Kong flu” of 1968, but the threat of a new pandemic remains quite real. The influenza strain known as H5N1 is especially worrisome, for instance, as more than half the human cases that have occurred have been fatal. Although H5N1 is persisting in causing disease among chickens and other poultry in parts of China and Southeast Asia, the virus does not (as yet) pass easily from one human to another.Most of the human cases have resulted from close handling of infected birds.

One of the first lines of detection of a possible influenza pandemic is the Department of Defense Global Emerging Infections Surveillance and Response Program (DoD-GEIS), which maintains a global influenza surveillance network. In 2006, spurred in part by concerns about the H5N1 virus, Congress allocated $39 million in supplemental funding for DoD-GEIS to improve this surveillance network by upgrading the capabilities of its domestic and overseas laboratories. Afterward, DoD-GEIS management asked the Institute of Medicine to form a committee that would evaluate how well DoD-GEIS had spent the supplemental funds. In addition, IOM was asked to assess more generally the effectiveness of the entire program.

The report of that committee, Review of the DoD-GEIS Influenza Programs: Strengthening Global Surveillance and Response, offers a mainly favorable assessment of DoD-GEIS efforts to date and offers some suggestions for future improvements.