# Presentation: 912512

## U.S. Pandemic Influenza Preparedness and Response: Update & Progress Report

- “The pandemic influenza clock is ticking.
-   We just don’t know what time it is.”
- “This is the one health threat we’re
- preparing for that we know will happen”

## When Will the Next Influenza Pandemic Occur?

- 1976 – H1N1 Swine flu

- 1986 – H1N1 Swine virus

- 1988 – H1N1 Swine virus

- 1993 –Swine/avian recombinant

- 1995 – H7N7 Duck virus

- 1997 – H5N1 Avian virus

- 1999 – H9N2 Quail virus

- 2003– H5N1 Avian virus

- 2003 – H7N7 Avian virus

- 2004 – H5N1 Avian virus

**Timeline of human infection with novel influenza viruses**
**(since the 1968 pandemic) **

- 2004 – H7N3 Avian virus

- 2004 – H7N1 Avian virus

## Current Pandemic Threats

- H5N1, Asia
- Domestic poultry infections identified in 9 countries
- 23 deaths and 34 cases documented in humans (most recent case in March 2004)
- Control efforts (culling ~100 million birds) have reduced the risk but given difficulties with surveillance it cannot be assumed that poultry is virus free and no risk to humans remains
- H7N3, British Columbia, Canada
- 2 cases of conjunctivitis in persons with contact with infected poultry (most recent case April 2004)

## U.S. Pandemic Influenza Preparedness Activities, 1

- Enhanced surveillance
- CDC request for proposals for surveillance in Asia
- HHS support for WHO surveillance activities
- Vaccine security and supply
- HHS funding to assure year-round egg availability and to promote expansion and diversification of U.S. influenza vaccine production
- NIH is obtaining and testing pilot lots of H5N1 vaccine

## U.S. Pandemic Influenza Preparedness Activities, 2

- Antiviral drugs
- Establishment of an oseltamivir stockpile
- State/local preparedness
- Continued support for State planning activities
- HHS funding for health care system preparedness
- Development of software to predict impacts and tabletop exercises to practice State/local plans

## Estimated Impact of an Influenza Pandemic on Healthcare in Atlanta

| Category | Number | % of Total |
| --- | --- | --- |
| Hospitalizations | 1915 | 26% |
| ICU beds |   401 | 45% |
| Ventilators |   201 | 29% |

- Peak-week impacts estimated using Flu-surge software.
- Assumes an 8-week period of illness in a community.

- _Note_: Hospitals usually run near full capacity; thus, addressing
-  this burden would require emptying or adding beds

- CDC, FluSurge software, 2004

## Pandemic Influenza Preparedness & Response Plan Status

- Plan has been cleared by HHS & HHS agencies and is being reviewed by other Departments
- After clearance, plan will be released for public comment
- Federal Register and on-line
- 60-day comment period
- Revise and post “final” plan

## Key Issues

- Public and private sector vaccine purchase and distribution
- Priority groups for early vaccine and antiviral chemoprophylaxis and therapy
- Approach to indemnification, liability protection, and compensation

## Pandemic Vaccine Purchase Options: Public/Private Sector Roles

| Purchase | Public sector roles & planning needs |
| --- | --- |
| All public |  Best opportunity to target priority groups
 Requires planning for mass distribution  |
| Increased public |  Public sector focus on target groups and
  underserved populations
 Requires coordination with private sector  |
| Current (mostly private) system  |  Public sector focus on limited target
  groups and children via VFC  |

## Vaccine Purchase and Distribution: Potential for Changes Over Time

**First wave**

**Second wave**

**Vaccine available**

**All public**

**Current**

**Increased public**

**Timeline and waves of pandemic disease**

- _Note_: This is presented as an illustration
- and not to endorse as a preferred option

## Priority Groups for Pandemic Vaccine

- Base definition of priority groups on pandemic response goals
- Reduce health impacts – Maintain quality healthcare system & protect those at highest risk
- Reduce social and economic impacts – Maintain essential community services
- Role of national plan in defining priority groups
- Need for national guidance vs state-by-state decisions
- Specific definition of target groups at State/local levels (e.g., who provides essential community services?)

## Potential NVAC Roles in Pandemic Plan Review Process  

- Provide input on key issues
- Highlighted “decision” issues
- Other issues where NVAC’s broad stakeholder perspective or NVPO priorities (e.g., vaccine supply, financing, safety, etc) are relevant
- Provide a forum for public discussion and input through the Public Participation Working Group
- Other?