Highly pathogenic avian influenza virus (HPAIV) H5N1 was introduced in North America in late 2021 through trans-Atlantic and trans-Pacific pathways via migratory birds. These introductions have resulted in an unprecedented and widespread epizootic event for North America, heavily affecting poultry and free-living wild birds in the spring and summer of 2022. The North American incursions are occurring in the context of Europe’s largest epidemic season (2021 – 2022) where HPAIV may now be enzootic. A continued North American epizootic is expected in the fall of 2022 as migratory waterfowl return from their breeding grounds. The magnitude of the North American HPAIV spread indicates the need for effective decision framing to prioritize ongoing management needs and scientific inquiry, particularly for species at risk and interface areas for wildlife, poultry, and humans. The challenges of this global One Health disease could benefit from a decision framing which may result in improved collaboration across stakeholders, identification of management options, and prioritization of scientific needs. Here, we provide an overview of the Eurasian origin HPAIV H5N1 introduction, including a shift in the dynamics of disease, which has resulted in severe disease in wild birds. It is unclear if wild bird may have been previously not exposed or asymptomatic to disease. We seek to bring attention to the detrimental effects this One Health issue may have on wild birds, poultry, and potentially human health and to suggest that reframing ongoing disease management as decisions, rather than as scientific endeavors, could be a valuable change in focus.