National Strategy for Pandemic Influenza Implementation Plan One Year Summary

July 17, 2007

Table of Contents

• Executive Summary
• Introduction
• Limiting the International Spread of a Pandemic
• Limiting the Domestic Spread of a Pandemic and Mitigating Disease, Suffering, and Death
• Sustaining Infrastructure and Mitigating Impact to the Economy and the Functioning of Society During a Pandemic
• Looking Ahead: What Have We Learned Through These Efforts and What Gaps Still Need to Be Addressed?
• Acknowledgements

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Executive Summary

Since the release of the National Strategy for Pandemic Influenza Implementation Plan one year ago, much has been accomplished to realize the U.S. Government's pandemic preparedness and response goals of: (1) stopping, slowing, or otherwise limiting the spread of a pandemic to the United States; (2) limiting the domestic spread of a pandemic and mitigating disease, suffering, and death; and (3) sustaining infrastructure and mitigating impact to the economy and the functioning of society.

Although the visibility of avian influenza and pandemic preparedness has waned in the media, the threat of avian influenza and the potential for an influenza pandemic has not. A pandemic occurs when a novel strain of influenza virus emerges that has the ability to infect humans and to cause severe disease, and where efficient and sustained transmission between humans occurs. Though we cannot be certain that highly pathogenic avian influenza A H5N1 (H5N1) will spark a pandemic, we can be sure that a pandemic will occur at some point in the future. It is everyone's responsibility to remain vigilant. We cannot become complacent and must continue to take the threat of a pandemic very seriously.

Over the past year, through the International Partnership on Avian and Pandemic Influenza, the United States and the international community have mobilized to confront the threat of an influenza pandemic at its source, by containing H5N1 poultry outbreaks and rapidly identifying associated cases of human disease. The United States is supporting efforts to improve laboratory diagnosis and early warning networks in more than 75 countries and is working with its partners to expand on-the-ground surveillance capacity, enhance national and regional laboratories, and improve knowledge about the movement and changes in H5N1 on a global scale to ensure that countries are able to quickly confirm outbreaks in animals or people. In cooperation with the World Health Organization (WHO) and the United Nations Food and Agriculture Organization (FAO), U.S. experts have investigated outbreaks of H5N1 in countries on three continents and provided technical assistance, commodities, and logistical or financial support to 39 of the 60 countries and jurisdictions affected by H5N1. As a result of the efforts of the United States and the support of our international partners, the international community becomes aware of outbreaks sooner and is able to launch more effective and timely responses.

Although a pandemic virus has not yet emerged, the appearance of limited human clusters of H5N1 cases has tested our international surveillance and response capabilities. Should a pandemic emerge, whether from the current H5N1 subtype of concern or from another influenza virus with pandemic potential, the United States is better positioned today to detect an outbreak earlier, to support an international effort to contain the pandemic in its earliest stages, to limit the spread of the pandemic, and to save lives.

The United States has developed protocols and trained personnel to support an international effort to contain the pandemic in its earliest stages. The U.S. Government procured and pre-positioned overseas stockpiles of personal protective equipment, decontamination kits, and antiviral medications to complement global efforts to contain pandemic outbreaks. Today, our Federal and State stockpiles contain enough antiviral medications to treat nearly 50 million people, with up to 6 million courses now reserved for containment efforts. If a pandemic begins outside the United States, and our international containment efforts fail, the U.S. Government is planning to implement border measures during a severe pandemic to slow the entry of a pandemic virus into the United States while allowing the flow of goods and people.

Once an influenza pandemic reaches the United States, the primary focus is safeguarding the health of Americans. The U.S. Government is working to enhance the Nation's ability to detect and respond early and effectively to a pandemic. To better identify the first cases of pandemic influenza in a community, the U.S. Government has provided resources to State and local health departments to increase the number of sentinel providers and improve laboratory detection at public health laboratories. The U.S. Laboratory Response Network (LRN), which includes State public health laboratories, is prepared to conduct initial testing of suspected human infection with H5N1 within 24 hours of receipt. To ensure that suspected cases can be promptly confirmed and treated, the Federal Government is working with industry partners to develop rapid diagnostic tests to quickly discriminate pandemic influenza from seasonal influenza or other illnesses.

The Federal Government is investing in the expansion of vaccine manufacturing capacity, the advanced development of new cell-based vaccines, antigen-sparing technologies to stretch our vaccine supply, and the establishment and maintenance of pre-pandemic vaccine stockpiles. In April 2007, the Federal Government approved the first pre-pandemic vaccine for humans against the H5N1 virus. We currently have enough of this pre-pandemic H5N1 vaccine for approximately 6 million people, with plans to stockpile enough pre-pandemic vaccine for 20 million people. In addition, antiviral medications are an important element of pandemic influenza preparedness. As of June 2007, the Strategic National Stockpile contains more than 35 million regimens of antiviral drugs with an additional 2 million regimens on order. So far, individual States have stockpiled more than 13 million regimens of antiviral drugs.  The Government's antiviral strategy includes not only stockpiling existing antiviral drugs, but also developing new antiviral medications to further broaden our capabilities to treat and prevent influenza.

In February 2007, the U.S. Government released groundbreaking Federal guidance for non-pharmaceutical interventions for mitigating the impact of a pandemic. This community mitigation strategy is important because the best protection against pandemic influenza, a matched pandemic vaccine, is not likely to be available at the outset of a pandemic. Recent scientific modeling and historical reviews of the 1918 pandemic suggest that non-pharmaceutical interventions (such as school closures, social distancing, and cancellation of large public gatherings) could be very effective at slowing the spread of disease and mitigating the outbreak, but only if they are implemented early and maintained consistently across communities affected by a pandemic. These interventions, coupled with the use of antiviral medications, could dramatically reduce the number of people who become infected, potentially preventing illness and death in millions of Americans.

The U.S. Government has invested in health system preparedness of hospitals and medical facilities across the country, has produced tools to assist in planning for expansion in hospital capacity during a pandemic, and is stockpiling medical supplies for distribution to individual States in the event of a pandemic.

Each Federal department and agency is developing its own department- or agency-specific pandemic preparedness plan to ensure the continuation of Federal Government essential functions. Over the past year, the Federal Government has produced tools for businesses and other employers to assist them in pandemic planning and has conducted an extensive outreach effort to the private sector. Through these efforts, businesses operating at home and abroad have been provided practical action-oriented information to identify essential functions and critical planning elements, to protect the health of employees, to maintain continuity of business operations, and to sustain community function during a pandemic.

Preparing the Nation for the threat of an influenza pandemic has provided a platform to address issues and concerns common to all types of mass casualty disasters. Promoting a culture of individual, family, and community preparedness is the foundation for all emergency planning efforts.

Though we have made significant progress over the past year to prepare the Nation and the international community for the threat of an influenza pandemic, much important work lies ahead. One of the most tangible benefits of planning and preparing at a Federal level has been the forging of close working relationships and unity of effort among Federal departments and agencies. It is important that we enhance connectivity and collaboration between all levels of government and all segments of society. Now is the time, before a pandemic emerges, to establish and test these relationships and partnerships. The Federal Government must continue playing a leadership role in fostering an environment of collaboration and public engagement.

Although we have realized progress in enhancing disease surveillance, critical gaps remain with respect to "real-time" disease detection and clinical surveillance in the United States. The Federal Government must redouble its efforts for developing "real-time" surveillance to ensure that we are not "blind" during the next pandemic. Real-time surveillance is needed to provide broad situational awareness, including the ability to detect, integrate, analyze, and operationally respond to pandemic influenza. The Federal Government must accelerate the development of rapid diagnostic tests and screening tests to ensure that our efforts to detect disease, treat ill people, and limit disease transmission can be appropriately and effectively implemented.

Many hospitals and emergency departments nationwide are already operating at or near capacity and may not have the capability to treat the large numbers of patients who may need care during a severe pandemic. Healthcare workers and first responders will be on the front lines during an influenza pandemic. Ensuring the availability of protective measures for these critical workers will be essential to our efforts to protect the health and safety of the public.  Community planning efforts will require the coordination of many providers and organizations and must address how healthcare facilities can best share medical response assets of personnel, materiel, and infrastructure in order to assure the greatest benefit for the largest number of people in the most ethical manner with the highest standard of medical care. The Federal Government has incorporated both funding and guidance to assist in planning for the strengthening of mass casualty care capacity.  The stockpiling of critical medical materiel, including a reassessment of antiviral medication stockpile goals, is one area the Federal Government needs to address in the coming year. However, medical countermeasures, such as antiviral medications, have little utility if they cannot be delivered quickly to those in need. The Federal Government is working with State and local public health officials to strengthen plans to swiftly distribute needed medical countermeasures.

Although the community mitigation strategy may significantly reduce illness and death, implementing this strategy will not be easy. To enhance individual and community adherence to these community mitigation measures, the Federal Government must continue to work with non-Federal stakeholders to address practical implementation considerations, including legal and feasibility concerns, at the State, local, and tribal levels and minimize any adverse consequences associated with implementation.

Our Nation's investment in pandemic preparedness could translate to a reduction in the number of deaths each year related to seasonal influenza. Improving disease detection and surveillance, utilizing antiviral medications, and promoting healthy behaviors such as hand washing and cough etiquette could help reduce the spread of seasonal influenza and other respiratory diseases.

The unprecedented efforts to prepare for and respond to the threat of a pandemic underscore our resolve to protect human life and safeguard our Nation. No prior generation has ever anticipated and prepared for a pandemic. We have the opportunity to be the first generation to use our collective knowledge, determination, and resources to take on this task. The stakes are high, and our greatest enemy is complacency. We remain committed to this effort, not only for generations of Americans alive today, but also for the sake of generations to come.