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A pandemic is the worldwide spread of a new disease, such as a new form of influenza or coronavirus.

With increasing globalization and the ability for people to travel to any country in the world in the span of a single day, there is always the potential for a new infectious disease to be introduced to Hawaii.

Notable historical pandemics have included the 1918 Spanish flu and Severe Acute Respiratory Syndrome (SARS) in 2003, or the 2019 Novel Coronavirus (COVID-19) pandemic we are experiencing now. While natural barriers effectively prevent many diseases from reaching Hawaii, thousands of visitors arrive each day from all around the world, so continued vigilance is essential.

During public health emergencies, the Hawaii Department of Health (DOH)works with many partners at the federal, state, and local levels to protect the public’s health. In the event of a pandemic, the Medical Reserve Corps may be called upon to provide volunteers and assist with emergency operations. As DOH and the State of Hawaii have made preparing for an influenza pandemic a top priority, DOCD regularly updates Hawaii’s pandemic preparedness plans for when the next global epidemic occurs.

In recent years, DOH’s Office of Public Health Preparedness (OPHP) and Disease Outbreak Control Division (DOCD) have coordinated with the Centers for Disease Control and Prevention (CDC) in scaling up prevention efforts during the 2009 H1N1 flu pandemic and by conducting educational efforts during the Ebola and Zika epidemics, which ended in 2016.

Why are health officials concerned about this?

Health officials are concerned because public health emergencies have happened before and will happen again. In an emergency many people could get sick and die and few people are prepared. According to a 2013 survey by the Federal Emergency Management Agency (FEMA) and the Ad Council, only 19 percent of Americans say they are well prepared for emergencies. Nearly two-thirds of American households do not have adequate plans and supplies for a disaster.

Many families mistakenly believe that policemen, firemen, hospitals, and doctors will be available at all times. But in a severe public health emergency, like a natural disaster or pandemic flu, those services may be limited or unavailable. Pandemic flu is not like any other kind of flu: no one has immunity and everyone is affected when large numbers of people get sick.

Health officials worldwide believe we may be due for a flu pandemic (a worldwide outbreak of a new influenza A virus).  Although the United States may not be currently experiencing an influenza pandemic, concern is focused on avian (bird) flu viruses strain such as H5N1, H7N9, and H1N1 (the kind that created a pandemic in 2009).

Avian (or bird) flu viruses occur naturally in wild birds and can spread to domestic birds, such as poultry. Health officials are particularly watching for cases of the H5N1 bird flu. In rare cases it can be transmitted from birds to humans. There is no human immunity to this virus and no vaccine is available.

H5N1 and H7N9 are considered to be of particular concern. Almost all H5N1 cases occur in birds, but since 2003 more than 700 people have gotten the disease. Approximately 60 percent of the H5N1 cases have died, with mortality highest among people aged 10 to 19 and young adults. The fifth outbreak of H7N9 in China infected 764 people (as of September 2017), killing up to 40 percent. Officials believe close or direct exposure to infected birds caused most of the cases of both of these viruses. Some clusters of infection within families have been investigated, but there are no reports of sustained human-to-human transfer. However, both H5N1 and H7N9 could evolve to spread easily among people and cause a flu pandemic.

Although no one knows when the next flu pandemic will strike or whether H5N1, H7N9, or another influenza A virus will be the cause, the Hawaii State Department of Health is actively planning for a flu pandemic and so should you. For more information, visit

The State of Hawaii has been preparing for a possible influenza pandemic for some time now. While these preparations served us well during the 2009 H1N1 pandemic and we have a strong framework in place, we can always be more prepared. The Hawaii Pandemic Flu Preparedness & Response Plan is being updated and will be available for public comment soon.

DOH continues to lead efforts in Hawaii to educate the public about the differences between seasonal flu and pandemic flu, and to provide local governments and decision makers with tools and tips they can use to prepare for any future pandemic.

Pandemic flu: A flu pandemic is a global outbreak that occurs when a new influenza A virus causes serious human illness and spreads easily from person to person.

Avian flu: Avian, or bird, flu occurs naturally among birds. All bird flu subtypes are influenza type A. There are many strains of avian flu viruses, some are more common than others.

Seasonal flu: These are the influenza viruses that circulate and infect people throughout the year. In many people, its symptoms are mild and last no more than a week. However, about 36,000 Americans die of seasonal influenza each year.

Influenza A: Influenza A viruses are found is many different animals, including ducks, chickens, whales, horses, seals, and dogs. Influenza A is primarily a respiratory disease, causing cough, congestion, sore throat, muscle aches, fatigue, and fever in most species it infects.

Influenza B: This virus circulates widely only among humans. It generally does not make people as sick as influenza A does.


Last reviewed March 2020