Weighing the threat of a global avian flu pandemic, the World Health Organization has called on all nations to develop plans to prepare for the event. So far, it says, only 40 countries have done so.

A new study released this week in the Public Library of Science analyzes global preparedness for an avian flu outbreak and considers the challenge of delivering scarce life-saving drugs.

Lead author Lori Uscher-Pines, a graduate student at Johns Hopkins University's Bloomberg School of Public Health, says the first step in global preparedness is setting priorities: "These flu plans are very dynamic documents and they are constantly being edited. So, you see flu plans that are under 10 pages long and you see flu plans that are slightly under 500 [pages]. And, often they are not adhering to World Health Organization guidelines on certain issues."

For example, Uscher-Pines notes, while health care workers consistently ranked at the top of the priority lists to get antiviral drugs or vaccines, in almost half the plans, children were next in line to receive the medications. "And the World Health Organization actually does not think that this is an appropriate strategy based on the evidence that is available," she says. "So the World Health Organization is saying that they advise against this, but we are still seeing countries do this in a pretty large scale, and we can only guess why this is the case, perhaps socio-cultural values or different interpretation of evidence."

Uscher-Pines says this finding suggests that public health plans must consider both scientific and ethical issues. "Then when an event happens they will ask fewer questions. They will be less surprised. Maybe less panic will ensue as a result, that this is something everyone has thought about in advance."

Lori Uscher-Pines says attention to these details may help reduce deaths and also minimize political turmoil and the possibility of inequitable treatment during an epidemic.