Avian flu strain H5N1 represents a potentially devastating threat to public health in the United States, and preparation for its arrival on our shores is one of our nation's utmost priorities.

Responding to a potential public health threat from a virus is nothing new for NCI. Twenty-five years ago with the emergence of HIV/AIDS, the viral oncology expertise within NCI was mobilized, resulting in the successful development of therapies that have had global health impact on people living with HIV/AIDS.

As with HIV/AIDS, an avian flu pandemic could be particularly catastrophic for some of the most vulnerable populations, including cancer patients, who constitute the largest segment of immunocompromised patients in the country and would be most susceptible to this deadly strain. In addition, the impact of a pandemic would be felt for decades to come, as it could compromise many clinical trials and render useless the resources devoted to those trials.

At my urging, NCI's Center for Cancer Research (CCR) has recognized this threat and developed an excellent preparedness and response plan. The plan draws on the impressive breadth of knowledge and know-how of CCR scientists, outlining the role CCR could play, in general, in responding to an avian flu pandemic, but more specifically in aiding cancer patients and oncology care professionals.

Among the vital activities CCR scientists would perform in the case of a pandemic is the development of high-throughput molecular assays for diagnosing flu strains and detecting genotypes of the flu that are resistant to antiviral agents.

Advanced testing technologies already available in CCR laboratories for use in HIV-related research can be quickly adapted to highly sensitive tests for the H5N1 strain. Accurate testing will be extremely important in the case of an avian flu pandemic. The availability of effective antiviral agents would likely be limited, thus accurate tests that can ensure that such drugs are not used in people with nonvirulent influenza strains or strains that are resistant to those agents are imperative.

In view of their expertise in conducting phase I and II trials, CCR researchers also are well positioned to rapidly perform trials of newer antiviral agents, such as oseltamivir (Tamiflu) in pediatric and adult patients.

Also, because we cannot predict the exact strain of an avian flu pandemic, vaccines that elicit broad immunity will be critical. The specialized skills of CCR researchers in developing vaccines designed to work in immunocompromised individuals will be of paramount importance in these efforts.

Beyond research, CCR would have an important role in training oncologists and oncology nurses to diagnose, prevent, and treat avian flu infections in their patients. Under this plan, the more than 125 physicians and clinical associates in CCR could be trained in activities such as vaccine administration, managing vaccine and antiviral stockpiles, and using and interpreting rapid diagnostic tests; they could then become part of rapid response teams sent around the country to combat the pandemic.

I'd like to offer my sincere congratulations to CCR Director Dr. Bob Wiltrout and all of the CCR staff who helped to develop this plan. I'm hopeful that it will be one that we'll never need to act on, but, if we do, I'm confident in NCI's ability to help soften the impact of an avian flu pandemic.

Dr. John E. Niederhuber
Acting Director
National Cancer Institute