Simple printed public health messages and cooperative media helped to positively influence social behavior, even when dealing with a heterogeneous population and uneven literacy rates. Interviewees noted widespread compliance throughout the country with little pushback, and a temporary suspension of partisan politics. And finally, health officials reacted nimbly to support and encourage the population's spontaneous use of face masks.

Still, the authors say, authorities had problems, especially in terms of technical and scientific infrastructure. For example, there were difficulties with accurate, timely surveillance and reporting because some areas still rely on pen and paper, or do not generate any public health data at all. And without its own viral library, Mexican scientists were unable to conduct rapid genomic identification of patient specimens. And one problem was beyond the realm of control: the pandemic's impact on Mexico's economy.

Even with these difficulties, Mexico's authorities and its people have set a high bar for establishing and executing effective community mitigation strategies.

"If anything can be called fortunate about the spring 2009 outbreak of A(H1N1), it is that the global community is eager to extract lessons from Mexico's experience with influenza in order to replicate its successes and avoid similar problems during future public health emergencies," said Markel, who is the George E. Wantz Distinguished Professor of the History of Medicine.

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