One million heart attacks, 700,000 strokes and 900,000 miscarriages — U.S. public health officials want Americans to know these will happen every single year with or without a swine flu vaccine campaign.
Yet this year, they know a significant number will be blamed on the H1N1 vaccine, which will roll out within weeks, and they are struggling to be ready.
They expect an avalanche of so-called adverse event reports, which are reports of death, illness or other health trauma that occur within two weeks after receiving treatment — in this case, the swine flu vaccine.
"We are going to be overwhelmed with potential events," said Mike Osterholm, a public health expert at the University of Minnesota.
"Anything that happens to anybody in the period of 7 to 14 days after vaccination will be reported."
And not just to U.S. officials. The World Health Organization is trying to reassure a global audience that vaccines being made by 25 different companies, with various formulations, are all safe.
"If we have a safety signal in one country it could stop vaccination efforts in others," WHO's top flu expert Dr Keiji Fukuda told a meeting of infectious disease specialists organized by the U.S. Institute of Medicine this week.
Flu experts themselves have little doubt the vaccine being made against H1N1 is safe. It is made using precisely the same technology as the annual seasonal flu vaccine, which is given to hundreds of millions of people every year.
But because H1N1 is new, vaccine makers have been testing it to learn what the right dose is.
SPIRIT OF '76
Memories linger of the 1976 swine flu debacle, when 43 million Americans were vaccinated against a virus that never spread, and newspapers filled with reports of a rare and crippling neurological disease called Guillain-Barre syndrome.
Guillain-Barre was never definitively linked with the vaccine, but many Americans have viewed immunizations with suspicion ever since.
"We have anticipated that there will be a need for enhanced surveillance for Guillain-Barre as well as other adverse events," Dr Nancy Cox of the U.S. Centers for Disease Control and Prevention told the meeting.
And there will be more to contend with than critical newspaper and television reports. The Internet did not exist in 1976. Nor did blogs, Facebook, Twitter or dozens of other ways for people to communicate globally and instantly.
"Information is the most globalized product of all," Fukuda said. "The ability of blog sites to influence countries' decision-makers and so on — coming to grips with how we deal with this is going to be a priority."
To address this, CDC and the U.S. Food and Drug Administration are gearing up for one of the biggest surveillance efforts ever. "We know how absolutely essential clear, transparent communications are to the public in order to have a successful vaccination campaign," Cox said.
CDC's weapons of choice — Facebook, Twitter, Internet RSS feeds, humorous "viral" videos posted on YouTube, iPhone apps such as the CDC News Reader. Children's Hospital Boston has an app (short for application) called Outbreaks Near Me that allows people to track the pandemic locally.