h5n1 at the pandemic threshold: military-grade preparedness for an avian influenza crisis

Background and aims: the rapid evolution of highly pathogenic avian influenza h5n1, with recent spillover to mammals and sporadic human cases, may pose a serious pandemic risk. this study focused on examining how integrating cbrne principles can address critical gaps in traditional preparedness frameworks. methods: this narrative review comprehensively synthesized evidence from virological research (2003-2025), who outbreak reports, and military-civilian biosecurity collaborations. results: h5n1's pandemic potential is escalating through key mutations, such as ha-t160a and pb2-e627k, which enhance mammalian airway replication. current surveillance systems remain inadequate, particularly at animal-human interfaces. crucially, cbrne adaptations demonstrated superior containment in simulations. nato's 2023 global biolock exercise achieved a 63% reduction in cross-border transmission through spectral biosensor checkpoints and coordinated alert protocols. moreover, military-civilian partnerships proved effective in the rapid deployment of field hospitals, as observed in spain's establishment of a 72-hour biocontainment unit. conclusion: in general, the convergence of h5n1's virological risk factors and cbrne's operational capabilities suggests the necessity of a paradigm shift. thus, it is proposed that an international task force be established to standardize cbrne protocols for avian influenza, prioritizing environmental biosurveillance and dual-use training for health workers. this strategic integration offers a tangible solution to mitigate the most probable pandemic threat, as the who considers it to be.