Department of Health and Human Services

Pandemic Planning 

Update IV

A Report from Secretary Michael O. Leavitt

July 18, 2007

“Because of its unique nature, responsibility for preparedness and 

response to a pandemic extends across all levels of government 

and all segments of society. No single entity alone can prevent 

or mitigate the impact of a pandemic.”

— National Strategy for Pandemic Influenza, November 2005
Message from the Secretary

“In the past few months, the 

media buzz around ‘bird flu’ 

has died down, but the H5N1 

strain of avian influenza has 

not. It remains a serious 

danger that we must all 

face together.” 

–Secretary Mike Leavitt, HHS 

May 15, 2007 

Sisseton, South Dakota, (population 2,572) is actively preparing to survive an 

influenza pandemic, should that or any other public health emergency arise. 

Local officials, working closely with tribal leaders from the Sisseton-Wahpeton 

Oyate Native American community, have helped guide residents on how to 

set aside a two-week food supply. They’ve launched a campaign to encourage 

seasonal influenza vaccinations. They’ve even planned how to redirect 

traffic to and from the local high school, their designated site for any needed 

mass vaccinations. 

Over the past year State, local, tribal, and territorial governments along with 

people from all walks of life began to share responsibility for pandemic planning. 

Thanks to thousands of dedicated political and health care leaders, employers, 

school leaders, the media, individuals, and families, we can now mobilize a more 

effective response to a pandemic than we could a year ago. 

Our framework continues to be the President’s three strategic 

pillars—preparedness and communication, surveillance and 

detection, and response and containment. Since 2005, Congress 

has supported these efforts, supplying $5.6 billion in funding to 

the U.S. Department of Health and Human Services (HHS) to help 

mobilize the nation. 

Driving our sense of urgency is a two-part reality: (1) that six months 

are needed from the start of a pandemic before a well-matched 

vaccine can be developed and (2) that, even then, current domestic 

manufacturing capacity is insufficient to provide a pandemic 

vaccine for all Americans in advance of a possible (many experts 

would say “likely”) second pandemic wave. 

HHS confronted this reality and committed to addressing it. 

Early promising results of that commitment are beginning to 

appear on the horizon. 

For the first time in our history, we have licensed a pre-pandemic 

vaccine that, if combined successfully with dose-sparing additives 

called adjuvants and manufactured in large quantities, may help 

carry us through the early months of a pandemic. Furthermore, 

vaccine and related industries are accelerating the development of 

technologies to move vaccines more quickly through the production pipeline and 

make them more effective. 

Complementing our investments in vaccines are our investments in antiviral 

drugs. Enough antiviral drugs are now stockpiled among State and Federal 

governments for the treatment of more than 50 million Americans affected by 

pandemic influenza. Research proceeds on a third antiviral medication that can 

be injected directly into the body, so that those too ill to swallow the capsule 

form of current antiviral drugs can use this new option. 




We are tapping into the power of the mass media to help bring the pandemic 

preparedness message to every American. We held six exercises with key media 

leaders and senior government officials to test the validity of our own planning 

assumptions. We launched a series of television and radio public service 

announcements in English and Spanish to raise awareness about pandemic 

influenza planning. We convened a forum for leaders from 

all walks of life to begin a dynamic dialogue on preparing 

for a pandemic. And we launched our first “blog summit,” 

a five-week event joining leaders and the public in an 

open online conversation to help shape thinking about 

preparedness across society. 

Around the country, governments at every level are taking 

up their share of pandemic planning responsibilities. Over 

the past 18 months, States, territories, and tribes held 59 

planning summits to identify what decisions need to be 

made and who needs to make them—before, during, and 

after a pandemic. The National Governors’ Association 

has begun holding multistate, regional summits so States 

can decide how to rely on each other’s strengths in a public 

health crisis. 

We also help support local decision-making processes by 

bringing the best minds together nationally and developing 

guidelines so that communities can decide on local courses 

of action. 

Communities now have a series of interim guidelines to 

coach them through their planning. The centerpiece is 

the Centers for Disease Control and Prevention’s (CDC’s) 

Community Strategy for Pandemic Influenza Mitigation. 

It introduces the Pandemic Severity Index, which is much 

like the National Weather Service’s hurricane intensity scale. 

At a (low) level 2 pandemic, for example, a community 

can encourage people to stay home if they become ill. 

April 2005 – RFP for cell-based vaccine contract issued

November 2005 – President Bush announces the 

National Strategy for Pandemic Influenza

Summer 2005 – Preliminary results from H5N1 vaccine

clinical trials indicate immune response predictive of

protection against H5N1

September 2005 – International Partnership on Avian 

and Pandemic Influenza launched

October 2005 – Southeast Asia fact-finding

mission led by HHS Secretary and 

State Department

November 2005 – HHS releases Pandemic Influenza Plan

April – November 2005

Message from the Secretary (cont.)

0

10

20

30

40

50

60

70

80

Countries Affected with H5N1 Avian Influenza 

in Animals (Cumulative)

 *As of July 17

1

 11 16

 55

 60

 2003 2004 2005 2006 2007*

0

50

100

150

200

 *As of July 17

Confirmed H5N1 Avian Influenza

Human Deaths (Cumulative)

4

 2003 2004 2005 2006 2007*

 36

 79

 158

 192
In a more severe level 4 or 5 pandemic, a community would help slow the spread 

of the virus by quickly adding multiple actions—such as closing schools, keeping 

children at home, promoting social distancing in the workplace—that would help 

maintain the community’s social and economic stability. 

Interim advice is also now available on using surgical masks and respirators. 

Little evidence now exists about the benefits of masks and respirators in 

preventing the spread of influenza. However, while we gather evidence, this 

interim guidance can help local communities begin to consider the issue. 

In the first six months of a pandemic, access to pre-pandemic vaccines may 

be limited—depending upon the progress in the use of adjuvants and the 

enhancements of manufacturing capacity. Who would receive 

those few vaccines? This decision would involve everyone with a 

stake in the outcome—that is, the American public. Several public 

discussions of vaccine prioritization have already been held, with 

input from ethicists, elected and public health officials, and people 

in communities around the country. This dialogue will continue and 

lead to guidance in the near future. 

HHS has also made available two key test exercises for State 

and local government leaders to role-play their way through 

decisions about closing schools and carrying out mass 

vaccinations. The CDC provided communities with a “pre-game” 

structure and “post-game” analysis, so each community can practice and 

improve its ability to take care of itself in a crisis. 

As we closely watch the world’s avian influenza hotspots, we also coordinate with 

other government agencies and global partners as well as affected and at-risk 

countries to monitor developments and offer assistance. And we continue to call 

on countries everywhere to support the World Health Organization’s (WHO’s) May 

2007 resolution to allow the fair and transparent sharing of influenza specimens 

and viruses through the Global Influenza Surveillance Network. 

But much remains to be done. Each day we improve our ability to respond 

to this emerging public health challenge, so that we will be better prepared 

tomorrow than we are today.

December 2005 – Passage of the Public Readiness and 

Emergency Preparedness Act (PREP Act)

December 2005 – Enrollment completed for clinical trials 

with H5N1 vaccine in older, healthy adults

December 2005 – Convening of States Summit 

in Washington, DC

December 2005 – Release of State and Local and Business Checklist

December 2005 – Tabletop communications 

exercises with U.S. Departments and

representatives from Canada and the UK

December 2005 – First State Summit in MN

December 2005

Message from the Secretary (cont.)




January 2006 – RFI issued on increasing egg-based vaccine capacity

January 2006 – Bilateral teams sent to Turkey, Armenia,Azerbaijan,

Georgia, Romania, Ukraine, and Nigeria to assess avian flu outbreaks

January 2006 – International Pledging Conference in Beijing;

$334M in U.S. grants and technical assistance to aid global effort

January 2006 – 6 State Summits in AZ, VT, WV, RI, GA, KY

January 2006 – Release of Individuals and Families, 

Faith-based and Community Organizations, and School 

Districts (K–12) Checklists

January 2006 – RFI issued on advanced development of

promising antivirals

January 2006 February 2006

February 2006 – Enrollment completed 

for pediatric H5N1 vaccine clinical trial

February 2006 – Risk Communications 

Preparedness Workshop hosted by

CDC in Thailand

How will we know when a pandemic begins? The answer to that key question 

has driven the search for new and better ways to scan the world for clues that a 

pandemic influenza virus might be emerging. 

In April 2007, the National Institutes of Health (NIH) awarded $161 million to help 

expand surveillance programs internationally and bolster domestic influenza 

clinical research, along with research on how viruses cause disease and how 

the human immune system responds to influenza viral infections. The CDC has 

also invested $180 million to help high-risk countries strengthen their capacity 

to recognize, diagnose, and report influenza outbreaks caused by both avian 

influenza A (H5N1) and seasonal influenza. 

Diagnostic tests for a range of viruses help doctors and field epidemiologists 

assess patients for the presence of H5N1, other emerging influenza viruses, and 

the more common seasonal influenza. In November 2006, the CDC tapped four 

commercial companies to develop new viral diagnostic tests with quicker and 

more accurate results. Lab tests for use at the patient’s bedside and at ports of 

entry and tests designed for large reference and public health laboratories are 

also being improved. 

HHS has also supported State and local health departments as they increase 

the number of clinicians providing influenza viruses for testing, improve public 

health laboratory detections, add influenza coordinators in each jurisdiction, and 

encourage clinicians to test for possible influenza infections. 

In January 2007, the CDC in partnership with the Council of State and Territorial 

Epidemiologists (CSTE) recommended adding “novel influenza viruses”—those 

with the potential to cause a pandemic—to the list of diseases that States must 

report to the CDC each week. States and territories have now adopted this 

recommendation. 

Since 2003, HHS has spent $5 million each year to share information with 

counterpart organizations in Canada and Mexico about urgent infectious 

disease cases at the three countries’ shared border regions. Recently, border 

surveillance expanded to include role-playing exercises to test the countries’ 

responses if airline passengers arrived with possible pandemic influenza. 

Monitoring and Surveillance

“The threat to human health 

will persist as long as the

problem persists in animals.”

– Dr. Peter Horby 

World Health Organization

February 2005
February 2006 – 11 State Summits in CT, IA, MA, FL, OH, NV, DE, AL, MO, NE, MD

February 2006 – Laboratory assay for diagnostic testing of

avian influenza A/H5 approved

March 2006 – Release of Medical Offices and Clinics, Home Health

Care, Child Care and Preschool, and Colleges and Universities Checklists

March 2006 – Pandemic flu supplemental guidance sent to States

March 2006 – Published results demonstrate that inactivated 

H5N1 vaccine induces immune responses in healthy adults 

March 2006 – 19 State Summits in SC, SD, ND, WY, WI, PA, IL,

NC, VA, IN, PR,CO, UT, ID, TX, NM, OR, CA, and the Virgin Islands

Feb. 2006 March 2006

March 2006 – RFP issued for advanced

development of antigen sparing technologies

March 2006 – FDA approves

Relenza for the prevention of

Influenza A and B in adults 

and children

Monitoring and Surveillance (cont.)

Genome Sequencing

The HHS Influenza Genome Sequencing Project is an ambitious undertaking to 

sequence the entire genetic blueprints of 2,250 human and avian influenza viruses 

from around the world. In February 2007 scientists completed this formidable 

task and now use this public data to compare different strains of a virus, identify 

the genetic factors that determine its virulence, and look for new vaccine and 

diagnostic targets.

International 

If there is a suspicious die-off of poultry in Egypt or any other country with current 

cases or significant risk of highly pathogenic avian influenza, it is likely that U.S. 

public health and animal health specialists 

monitoring avian influenza outbreaks will 

quickly learn about it, assess risks and, 

as needed, jointly pursue appropriate 

interventions. Considerable effort has gone 

toward building a strong level of networked 

international vigilance, which enhances and 

speeds U.S. awareness of animal disease 

situations that could lead toward the 

emergence of a pandemic influenza strain. 

HHS continues to work with partners 

throughout the world, including the 

WHO, to monitor disease spread and 

prepare for possible pandemics, investing 

some $125 million in 2006 to fill critical 

gaps in global disease surveillance and 

laboratory diagnostic networks. HHS has 

also established a fund to help local public health authorities quickly move field 

specimens to reference laboratories for further diagnostic work and confirmation. 

HHS continues to call on countries everywhere to support the WHO May 2007 

resolution on sharing influenza specimens and viruses within WHO’s Global 

Influenza Surveillance Network. 



H5N1 in wild birds 

H5N1 in poultry and wild birds

H5N1 in humans
March 2006 – States receive initial grant funding for pandemic preparedness

March 2006 – Order of 16.2 million courses of Tamiflu and 

3.9 million courses of Relenza

April 2006 – 7 State Summits in TN, AK,WA, HI, LA, MI, and 

the District of Columbia

April 2006 – Government leaders from the Freely Associated States

and Pacific Territories participate in the Hawaii and Guam Summits

April 2006 – FDA issues guidance for industry on diagnostic

devices to detect influenza A viruses

March 2006 April 2006

April 2006 – WHO issues guidelines for humanitarian agencies

April 2006 – NIH researchers model spread of influenza 

through the United States by virus type, size of

population, and commuting rates and distance

April 2006 – HHS provides

assistance to Bangladesh and 

India to enhance planning for 

a potential influenza pandemic

Vaccines and Vaccine Production Capacity 

If an influenza pandemic starts, planners know that six months will elapse before 

current technology will allow development of a well-matched vaccine. And, after 

that, rapid large-scale production of this vaccine will not be possible without a 

significant expansion in domestic manufacturing capacity. Many HHS pandemic 

preparedness activities work to address that critical six-month period. 

Human H5N1 Vaccine

In April 2007, the Food and Drug Administration (FDA) took an historic step when 

it approved the first human H5N1 vaccine. If H5N1 or a similar pandemic virus 

reached the United States, this vaccine could help protect those who would be at 

the highest risk of exposure to the virus, in the early critical months of a pandemic. 

Some 12 million doses (enough for 6 million people) have been stockpiled by the 

U.S. Government. This vaccine is not currently available commercially. 

In December 2006, NIH began human trials of another possible vaccine against 

H5N1 influenza infection. It contains only portions of the influenza virus’s genetic 

material. Once inside the body, it instructs human cells to make proteins that act 

as a vaccine. Clinical trials will continue throughout this year. 

Cell-Based Vaccine

The chicken egg has been the critical incubator for many of our influenza-related 

vaccines for the past half-century. But the high demand for a vaccine during a 

pandemic calls for a quicker and more flexible technology than the one based on 

chicken eggs. 

Using cells instead of eggs to produce vaccines is already standard practice with 

many other modern vaccines. This cell-based technology applied to influenza 

vaccines holds the promise of a reliable and flexible method of producing 

enough influenza vaccine for every American within six months, following the 

development of a product that is well-matched to the pandemic viral strain. 

HHS will soon ask commercial manufacturers to develop other promising 

technologies, such as recombinant vaccines, that could further diversify our 

arsenal. Recombinant vaccines, for example, can be manufactured more quickly 

than traditional egg-based vaccines. 




May 2006 – Release of Homeland Security Council National Strategy

for Pandemic Influenza: Implementation Plan

May 2006 – HHS awards contracts totaling more than $1billion

to develop cell-based influenza vaccine

May 2006 – Department of State establishes Avian Influenza

Action Group to coordinate U.S. international effort

May 2006 – Release of Long-Term Care and Other Residential 

Facilities Checklist

May 2006 – 7 State Summits in MS, OK, NJ, KS, NH, MT, and tribal leaders

May 2006 June 2006

May 2006 – HHS Secretary addresses the World Health

Assembly on pandemic flu preparedness

June 2006 – Secretaries Leavitt of HHS, Norton of DOI, 

and Johanns of USDA hold national briefing on U.S.

preparations for avian influenza

June 2006 – HHS Secretary 

addresses health ministers

of Central America on

pandemic preparedness

Vaccines and Vaccine Production Capacity (cont.)

Vaccine Adjuvant

Adjuvants form another promising technology. Adjuvants are substances added 

to a vaccine that boost its ability to protect the body from a virus. Added to a 

vaccine, these adjuvants can help stretch a limited supply by decreasing the 

amount of vaccine per person while still providing the same level of protection. 

In January 2007, HHS awarded $132.5 million to three vaccine makers to develop 

adjuvanted vaccines against the H5N1 influenza virus. In addition to allowing 

immunization with lower doses of vaccine, preliminary results indicate that these 

adjuvanted vaccines may have the potential to protect against a wider array 

of influenza viruses. Should further research prove this true, a safe and more 

effective pre-pandemic vaccine could be developed without having to wait for 

the emergence of a pandemic virus. 

Expanding Capacity

Over the next five years, vaccine manufacturers, spurred by a $1 billion HHS 

investment, will develop the capacity to produce and deliver enough pandemic 

vaccine for every man, woman, and child in the United States within six months 

of the appearance of a pandemic virus. More funding will follow in the near future 

to help build U.S. factories that will produce cell-based influenza vaccine. 

International

In many countries, national vaccine production capacity cannot meet the needs 

of its citizens. To help extend protections to our global neighbors, HHS provided 

$10 million to the WHO, which then awarded that sum to six key developing 

countries in April 2007 to expand their local infrastructure and produce safe, 

effective seasonal influenza vaccines. This expanded capacity would also help 

fill their own (and possibly regional) needs in the event of a pandemic.


June 2006 – CDC issues updated Interim Guidance for 

Laboratory Testing of Persons with Suspected Infection 

with avian influenza A (H5N1) virus in the United States

June 2006 – Indonesia holds H5N1 influenza expert consultation

June 2006 – Congress passes $2.3 billion funding for 

pandemic preparedness

July 2006 – 2 Summits in AK and New York City

July 2006 – HHS allocates $170 million to subsidize State 

purchases of antiviral drugs

June 2006 July 2006 August 2006

August 2006 – Quick diagnosis of flu strains possible

with new microchip test

August 2006 – State Summit in NY

September 2006

September 2006 – FDA issues

guidance to industry for 

development of cell-based

viral vaccines

Antiviral Drugs

In January 2007, scientists around the world held their collective breath as early 

news from Egypt indicated that the avian influenza virus that had killed two 

human victims there seemed to have developed resistance to the antiviral drug 

oseltamivir, one of only two antiviral drugs that combat most current influenza 

viruses. Further testing showed that the resistance was similar to what 

had already been noted two years earlier in Thailand and that resistant 

viruses were not spreading. But the experience underscored the critical 

role played by antiviral medications in helping reduce pandemic influenza 

symptoms and shorten the length of illness. 

HHS antiviral drug strategy includes supporting the development of new 

drugs that can broaden our ability to treat and even prevent influenza as 

well as stockpiling existing antiviral drugs. 

New Antiviral Drugs

In January 2007, HHS awarded some $103 million to develop a new 

influenza antiviral drug, peramivir, which has proven effective in laboratory 

tests against a number of influenza strains. Further studies will test whether this 

drug can treat seasonal and other life-threatening influenza viruses such as H5N1. 

Stockpiling Antiviral Drugs 

HHS, working closely with State governments, is striving toward the goal of having 

81 million antiviral treatment courses on hand: 50 million by HHS for distribution 

to States through the Strategic National Stockpile when an influenza pandemic 

is judged imminent and 31 million by the States for their respective stockpiles. 

A treatment course is enough medication to treat one person. This antiviral drug 

supply will allow public health officials to help contain or suppress a pandemic 

outbreak. The 81 million antiviral treatment courses include 6 million treatment 

courses set aside for the early stages of an emerging pandemic. 

HHS has purchased or has at hand approximately 36 million antiviral treatment 

courses. Almost all States have taken advantage of a Federal discount plan and, 

to date, have purchased more than 12 million treatment courses. 

Antiviral Stockpile

Goal Progress

81 Million

Courses

(Dec. 2008)

50 Million 

Courses
October 2006 – Guidance on use of surgical masks and 

respirators in health care settings released

October 2006 – WHO issues global influenza action plan

to increase vaccine supply 

November 2006 – United States and Mexico pledge increased 

cooperation in pandemic influenza preparedness along border

November 2006 – HHS awards $199 million to manufacturers 

for 5.3 million doses of H5N1 vaccine

October 2006 November 2006

November 2006 – WHO issues guidelines for investigating 

human cases of avian flu 

November 2006 – HHS taps four commercial companies

to develop new H5N1 diagnostic tests 

December 2006

December 2006 – CDC awards 

$11.4 million for rapid bird flu

diagnostic tests 

Stockpiling Other Supplies

Along with the antiviral drugs, other types of equipment and material help reinforce 

the HHS and State stockpiles. These will help prevent people’s direct contact with 

the pandemic virus, when it emerges, and reduce the spread of the disease. HHS 

has purchased over 155 million surgical masks and respirators; this 

total includes 104 million N95 respirators and 52 million surgical 

masks. HHS has also committed $100 million to buy ventilators, 

syringes, and intravenous antibiotics and to store and secure these 

supplies for pandemic-affected areas. 

International 

As a supplement to the national stockpile, HHS has prepositioned 

overseas stockpiles of personal protective equipment, 

decontamination kits, and antiviral medications to complement 

global efforts to help contain pandemic influenza overseas.

State and Local Preparedness

Five thousand communities across the nation have actively joined forces with 

State and Federal government officials to practice and improve ways they can 

work together to manage a pandemic influenza. 

Planning 

By December 2006, with $325 million in funding from HHS, States, territories, 

and tribes had held 59 pandemic influenza planning summits, where Federal, 

State, and local leaders; health professionals; schools; and the private 

sector could begin to work together toward resolving State and community 

preparedness issues. 

Antiviral Drugs (cont.)

10

“The more informed we are, 

the more empowered we are.”

–Participant at Pandemic 

Preparedness Forum, 

June 13, 2007
December 2006 – NIH begins human clinical trials of

DNA-based H5N1 vaccine

December 2006 – Template for tabletop planning exercises released

January 2007 – CDC adds “pandemic flu-like viruses” to list of

reportable diseases

January 2007 – HHS awards $132.5 million to develop H5N1

adjuvanted influenza vaccines

Dec. 2006 January 2007

January 2007 – HHS awards $102.6 million for advanced

development of new influenza antiviral drug, peramivir 

January 2007 – U.S. Businesses with Overseas Operations

Checklist released 

February 2007

January 2007 – Vaccine for H5N1 influenza enters

human clinical trials

February 2007 – WHO and OIE

revise Influenza Vaccine 

Development Guidance

HHS provided another $250 million to intensify ongoing pandemic preparedness 

exercises. These include incorporating community mitigation measures, 

containment plans, the medical surge capacity to treat influenza victims, and 

seasonal influenza vaccinations to test mass inoculation capabilities. 

As a follow-up, HHS asked the National Governors Association 

(NGA) to hold 10 regional pandemic influenza workshops this year 

to test intergovernmental and interstate coordination. 

Internationally, HHS has provided onsite technical assistance to 

help more than 20 countries develop their own national pandemic 

preparedness plans. These reflect the best science on preparing 

for and responding to a potential pandemic. 

Medical Surge

If a pandemic strikes a community, its hospitals, clinics, and other health care 

delivery sites could quickly reach their capacity to provide critical care to 

influenza victims. Having a plan to draw on other local resources is one way 

to help gain control of that situation. HHS has given both funding and guidance 

to community health officials throughout the country so they can strengthen 

their local medical surge capabilities. 

Local groups have worked through such critical issues as the purchase and 

storage of pharmaceutical caches (including antiviral drugs for health care 

personnel and their families), isolation capacity, plans to provide care at alternate 

sites, stockpiling personal protective equipment (PPE) and ventilators, developing 

bed-tracking systems, buying and testing interoperable communications, and 

conducting pandemic influenza exercises and training. 

Facemasks and Respirators

One important question was whether to use or not use a facemask or respirator. 

An answer came in May 2007 when the CDC presented preliminary advice to the 

public about using facemasks and respirators in certain public (nonwork) settings 

during an influenza pandemic. 

State and Local Preparedness (cont.)

11
This interim guidance stresses that in a pandemic situation surgical masks and 

respirators may help prevent or slow the spread of the pandemic when they are 

used along with hand washing, avoiding people who have influenza, treating 

those infected with antiviral medications, having people who care for ill family 

members voluntarily stay home, and encouraging people to avoid crowded 

places and large gatherings. 

Very little research now exists about the usefulness of surgical masks or 

respirators, so studies are under way to learn more about whether surgical masks 

and/or respirators can provide protection from influenza and how people should 

consider using them. 

FDA has approved two N95 respirators that people can use in a public health 

emergency to help reduce their exposure to airborne germs. 

Community Mitigation 

In February 2007, the CDC released a community mitigation interim 

guidance to help local communities make appropriate decisions about 

what actions to take to help delay or mitigate the spread of a pandemic, 

and when to take those actions. These community mitigation actions 

would be especially critical in the first six months of a pandemic. The 

interim guidance introduced a Pandemic Severity Index (PSI), akin to 

the National Weather Service’s hurricane intensity scale. Both scales 

move up from 1 to 5 as the severity of the situation increases. 

The Pandemic Severity Index links information about the severity of 

disease spread (number of fatalities) to specific measures that could be 

implemented. These measures range from encouraging individuals to 

stay home voluntarily when they become ill, to more stringent “social 

distancing” measures such as closing schools and canceling public 

gatherings. By quickly adding these multiple actions, communities 

could help balance the need to protect the public’s health and the 

need to minimize a pandemic’s social and economic disruptions. 

State and Local Preparedness (cont.)

12

“To be truly prepared, 

all leaders and individuals 

across communities must 

be involved.” 

–Assistant Secretary 

John Agwunobi, HHS, 

June 13, 2007

February 2007 – HHS launches pandemic flu public service announcements

February 2007 – CDC releases community mitigation guidance 

February 2007 – 2,250 human and avian influenza virus genomes

completed and publicly accessible

March 2007 – Health Insurers Planning Checklist released

February 2007 March 2007

April 2007 – FDA approves first U.S. H5N1 human influenza vaccine 

April 2007– 12 million doses of human H5N1 vaccine added 

to Strategic National Stockpile 

April 2007

April 2007– Travel Industry Planning Checklist

released April 2007– NIH awards $161

million to expand surveillance 

and bolster research

April 2007 – HHS provides $10 million to WHO to expand

vaccine infrastructure in six developing countries
Many Federal, State, and local governments are incorporating this community 

mitigation guidance into their pandemic planning processes, and they are 

distributing the guidance throughout their systems. The Community Strategy 

for Pandemic Influenza Mitigation is available at http://www.pandemicflu.

gov/plan/community/commitigation.html. 

Vaccine Allocation

In a pandemic, until there is enough vaccine for everyone, determining 

which individuals and groups should have early access to available 

vaccines is one of the thorniest problems that Federal, State, local, 

tribal, and territorial pandemic planners face. 

The Federal government is soliciting advice from influenza experts, State 

and local public health officials, homeland security experts, ethicists, 

private-sector stakeholders, and the public. They identified the most important 

vaccination goals as protecting those who will first respond to the pandemic and 

care for the sick, those who keep vital community services working, those who 

have increased exposure due to their jobs, and children. 

State and Local Preparedness (cont.)

13

Communications

Reporters, government officials, and local airport quarantine officers gather 

around a table to role-play a scenario that imagines the arrival of a passenger 

in the early stages of pandemic influenza. What does the quarantine officer say 

to the passenger? What if the passenger refuses to cooperate? How does the 

officer explain the situation to local reporters? What does the reporter report? 

What do the government officials say to national reporters? 

These and other challenging questions arose during six recent tabletop exercises 

that brought together both key media leaders and senior government officials in 

New York; Chicago; Los Angeles; Miami; Washington, D.C.; and Atlanta. In their 

dialogues, the two groups considered the challenges they would face and what 

could be done to address them in a public health crisis. 

May 2007 – HHS issues interim guidance on community 

(nonwork) use of facemasks 

May 2007 – FDA clears first respirators for public 

health emergencies

May 2007 – New online training course released for State 

and local public health responders

May 2007 – Pandemic Flu Leadership Blog begins

May 2007

May 2007 – FDA finalizes guidances for manufacturers

of pandemic and seasonal flu vaccines

June 2007

June 2007 – HHS convenes 

Pandemic Influenza Leadership 

Forum for faith-based, civic, 

and health care leaders to

encourage preparedness 

June 2007 – WHO moves ahead with plans for 

global stockpile of H5N1 vaccine

May 2007 – World Health Assembly agreement reached 

on influenza virus sharing
14

Communications (cont.)

HHS pandemic communications planning is built on the principle that every 

person in the country needs—and should get—immediate and accurate 

information about the rapidly changing pandemic situation. And HHS is building 

networks of communicators, within and outside the Federal government and 

within and outside our country, to help make sure that needed information is 

available to all. 

In February 2007, HHS launched a series of television and radio public 

service announcements (PSAs) in English and Spanish to raise awareness 

of pandemic influenza and to educate the public about the steps people 

can take now to prepare. The PSAs, released under the title Know What to 

Do about Pandemic Flu, were distributed to 300 television and 1,000 radio 

stations across the country. 

In June 2007, HHS convened an interactive Leadership Forum for influential 

leaders from the business, faith, civic, and health care sectors to participate 

in dynamic discussions aimed at helping Americans become more prepared 

for a possible pandemic. In conjunction with the Forum, HHS launched 

a five-week-long “blog summit”—an online event—that allowed leaders and 

members of the public to join an open conversation and begin to shape thinking 

about how to communicate the critical need for preparedness at home and within 

workplaces and communities. 

HHS has worked closely with Federal, State, tribal, and territorial 

communications specialists to develop plans that will help guide the 

public, the news media, health care providers, and other groups to 

respond appropriately in outbreak situations and to encourage people to 

follow the necessary public health measures. A government-wide public 

health emergency communications plan is now ready to activate in the 

event of a pandemic. 

The website www.pandemicflu.gov, managed by HHS on behalf of the entire 

Federal government, continues to provide one-stop access to all Federal avian 

and pandemic influenza information. The entire site has been translated into 

Spanish, and key documents are also available in Chinese and Vietnamese. 

To help know what planning questions to ask, HHS has 

developed and distributed 19 checklists and guidances. 

State and local governments, businesses, school systems, 

colleges and universities, health care organizations, and 

individuals and families can draw on these checklists and 

guidances as they lay their own plans. Many of the actions are specific to 

pandemic influenza, but some are useful for any public health emergency. 

All are available at www.pandemicflu.gov. 

Internationally, HHS has provided expertise and funding to the WHO for 

training and exercises for local communications officials and journalists. 

“An influenza pandemic 

knows no political or 

geographic boundaries.”

–Assistant Secretary 

Craig Vanderwagen, HHS, 

November 14, 2006