For nearly nine years, infectious disease specialists at Rochester University Medical Center in Rochester, N.Y., have been conducting tests as part of a broad national effort to develop a bird flu vaccine.
Beginning in late 1997, the human trials have tested 30 different vaccines, all pegged to the H5N1 virus. The testing is funded by National Institute of Allergy and Infectious Diseases at Rochester and six other centers around the country.
Volunteers like Jamal Khal are acutely aware of the growing talk that avian flu may be the next pandemic. As he received an injection at Strong Memorial Hospital, Khal said, "I just wanted to be prepared in case it comes to this country."
As infected birds are found closer and closer to the United States, moving from Asia through the Middle East to Europe, scientists also are feeling a sense of urgency.
"When you are trying to be ready for a disaster, you have to be prepared for the worst-case scenario," said Dr. John Treanor who heads the Rochester program.
So far, there has been limited success. The latest vaccines have been effective when given in large doses -- four to 12 times normal. And two shots would be required, straining the ability of pharmaceutical companies to produce enough to protect the U.S. population.
Since the bird flu virus has yet to mutate so that the illness can be transmitted from person to person, instead of bird to person, Treanor and other specialists do not believe that a pandemic is inevitable. But they are preparing, nevertheless.
"The goal would be to have a vaccine that's safe, first of all -- that would be effective, at least preventing the most severe manifestations of bird flu," Treanor said, "and that could be made widely available."
He also sees part of the scientist's job to gather enough information to guide those in Washington who would decide whether to stockpile a vaccine and when to order inoculations.
What's happening in Rochester and elsewhere is a reminder of another pandemic scare 30 years ago.
The pandemic never occurred, but the vaccine produced to protect Americans had tragic consequences.
In 1976, three American soldiers at Ft. Dix, N.J., died from swine flu, raising fears of a pandemic. Unlike bird flu, the swine flu virus was transmitted person to person.
The administration of President Ford mounted a national campaign urging Americans to get swine flu shots. In a famous photo opportunity that year, Ford himself rolled up his sleeve and was inoculated.
But the vaccine was unsafe. Thirty-two people died and hundreds of other developed paralysis from Guillain-Barre syndrome.
Patty Tipton was 32 in 1976, when she was inoculated.
"I didn't know anything about the side effects," she says today at her home in Owensboro, Ky. "It has been such a life-changing event."
After being inoculated with the swine flu vaccine, she developed Guillain-Barre and is confined to a wheelchair. She has lost her fine motor skills and can no longer sew or embroider, things that once gave her pleasure -- let alone play softball or ride a horse, her main outdoor pursuits in 1976.
Her constant thought is what might have been had she not had the vaccine.
"I could have survived the swine flu," she says. "I was young, I was healthy."
What would she recommend about the bird flu vaccine? Find out first if there are side effects.
The decision to inoculate is still defended by Dr. David Sencer, director of the Centers for Disease Control in 1976.
"If there was a pandemic and we hadn't done anything," he says today, "there would have been a lot more deaths than we saw."
Sencer says the big mistake in 1976 was ceding the decision making to politicians, a mistake he hopes is not repeated.
"The more it's recognized as a health problem and decisions are made by health personnel," he adds, "the better off we'll be."
Today in Rochester and at the other centers, there is confidence the mistakes of 1976 won't be repeated with bird flu.
"We have demonstrated that the vaccine is safe," says Treanor. "The name of the game now is finding a vaccine that is equally effective."
Treanor says scientists have had time they did not have in 1976 to follow the development of the bird flu. But underscoring the difficulty is the notorious ability of a flu virus to change its characteristics rapidly.
"If a pandemic were to arise," he says, "it's very possible that the pandemic strain would not be exactly the strain as the one in the vaccine we're testing."
In that case, Treanor says it might take four to six months to develop the proper vaccine.
But unlike 1976, he says, nothing in 2006 will be done in panic.
"I think the commitment right now is not to immunize until there is clear evidence of person to person to person transmission," he says. "And that, I think, would be a signal suggesting that pandemic is inevitable. And would probably be a good time to start vaccinating people."