U.S. Department of Health and Human Services

Pandemic Planning 

Update V

A Report from Secretary Michael O. Leavitt

March 17, 2008

“Once again, nature has presented us with a daunting challenge: 

the possibility of an influenza pandemic... Together we will confront 

this emerging threat and together, as Americans, we will be prepared to 

protect our families, our communities, this great nation, and our world.”

—President George W. Bush
Message from the Secretary

“The Federal government 

cannot mount an effective 

response to the threats that 

we face as a nation without 

partners at every level 

of government and 

throughout society.”

– HHS Secretary Mike Leavitt

Forty million people died when the last major influenza pandemic swept around 

the world in 1918. We have seen two less severe pandemics since then. We 

will no doubt see another sometime in the future. We don’t know when, and we 

don’t know how bad it will be. But we know it will happen sooner or later and 

that what we do now will save lives — maybe millions of lives — in the future. 

We have come a long way since November 2005, when President Bush 

mobilized the nation to prepare for an influenza pandemic. HHS continues to 

play a prominent role in pandemic preparedness, giving highest priority to those 

tasks that it is best positioned or uniquely able to undertake. These include: 

• stockpiling pre-pandemic vaccine and antiviral drugs; 

• providing financial and technical assistance to States to help them, among 

other things, create complementary stockpiles of antiviral drugs and develop 

and test various mitigation strategies; 

• creating a domestic vaccine production capacity commensurate with the 

expected requirements of a pandemic; 

• sponsoring advanced development projects toward the next generation of 

vaccines, therapeutics, and diagnostics; and 

In our last Update, we mentioned many of the important milestones we have 

passed already. We have licensed the first H5N1 influenza vaccine for humans 

and stockpiled enough antiviral medicine to treat 40 million Americans. We have 

committed over $1 billion to diversify influenza vaccine production technology. 

And we have worked with the world’s leading vaccine companies to accelerate 

the development of cell-based influenza vaccine production to increase the 

nation’s domestic vaccine production capacity. We have also invested heavily in 

clinical research and surveillance programs here at home and around the world. 

We have held flu summits in every State of the Union, plus our first on-line “blog 

summit” last June. We have organized, equipped, and trained response teams and 

begun to modernize the U.S. Public Health Service Commissioned Corps to enhance 

its response capabilities.

Since our last Update, we have entered a new phase in our preparations. The 

milestones are farther apart but no less significant. We are now tackling some 

challenging issues that can only be resolved with the collaboration of the full 

range of stakeholders — State and local officials, public health and medical 

professionals, religious leaders and ethicists, the business community, organized 

labor, non-governmental organizations, and individuals from all walks of life. 

Each is needed to find the best answers to difficult questions such as 

“How do we decide who receives the first vaccines from our limited supplies?” 

and “Who should be responsible for stockpiling medical countermeasures such 

as facemasks, respirators, ventilators, and antiviral medications?” 




These issues will have a significant impact on how States, counties, cities, 

communities, corporations, families, and individuals prepare for and respond 

to pandemic disease. None can be addressed fairly and fully without the 

participation of the persons likely to be affected. 

We have mounted an unprecedented effort on the part of the 

Department and the Federal government to garner thoughts and 

comments on these issues from as many people as possible, using 

new communication tools such as blogs and web casts as well as 

large public forums, smaller group meetings, and conference calls. 

In December 2007, the Department held its first ever web dialogue 

to discuss the proposed vaccine allocation plan. More than 400 

people from 37 States took part in the five-day on-line conversation 

with Federal, State, and local health officials. The web dialogue 

followed two public meetings on vaccine allocation, in Henderson, 

NC, and Milwaukee, WI. We have also met with various stakeholder 

representatives to discuss the feedback from the public meetings 

and the web dialogue.

A cross-government working group was then tasked with defining a priority 

order for administering vaccine to counter an influenza pandemic. That group 

now is weighing the information received from the rounds of public consultation 

and is updating an earlier draft document to accommodate the most persuasive 

comments and critiques. The intent is to have a plan suitable for public release 

within the next several months. 

Through the fall of 2007, we also held nearly twenty meetings around the 

country to discuss the shared responsibility concept of stockpiling medical 

countermeasures and the feasibility of private-sector stockpiling of antivirals. 

These meetings included senior leaders and subject matter specialists from 

throughout the Federal government, along with governors, mayors, State and 

local health officials, employers, health care providers, first responders, organized 

labor and law enforcement. Some meetings were conducted by conference call, 

but we also met in Atlanta, GA, Seattle, WA, Scottsdale, AZ, the Raleigh-Durham, 

NC, area, and Washington, DC. 

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 March 5

1

 11 16

 55

 67

 2003 2004 2005 2006 2008*

“This isn’t just about us, it’s 

about our neighborhoods and 

where we live.”

– Dr. Greg Dworkin, 

founding editor, 

Flu Wiki blog

2004 – H5N1 vaccine reference created by reverse genetics 

from H5N1 virus isolated in Vietnam

April 2005 – RFP for cell-based vaccine contract issued

November 2005 – President Bush announces the National 

Strategy for Pandemic Influenza

Summer 2005 – Preliminary results form H5N1 vaccine 

clinical trials indicate immune response predictive of 

protection against H5N1

September 2005 – International Partnership on Avian and 

Pandemic Influenza launched

November 2005 – HHS launches Pandemic Influenza Plan

2004 – November 2005
In December, we launched a public education campaign to encourage people 

to prepare now for a future pandemic. The campaign, titled Take the Lead: 

Working Together to Prepare Now, is aimed at community leaders such as clergy, 

employers, and health care providers, and is designed to provide them with the 

information they need to communicate the importance of pandemic planning by 

families and individuals. It was developed after consultation with over a hundred 

leading organizations such as the American Medical Association, Catholic Health 

Association, Red Cross, Lions Clubs, and the U.S. Chamber of Commerce. We 

also held our first-ever blog featuring ten prominent leaders blogging over a fiveweek period on the subject of individual pandemic planning. The blog attracted 

more than 35,000 individual visitors, 1,600 comments, and more than 300 in-bound 

links from other websites, blogs and message boards. 

There’s still much to be done. Preparedness is a process — 

learning, adapting, and growing. In 2008, we will continue 

these unprecedented efforts to reach out to stakeholders 

for help in shaping some of the most difficult pandemic 

planning issues. We will also be finalizing policies and 

guidance based on the input we have received thus far. 

The media buzz has died down, but the “bird flu” virus 

has not. Avian influenza is still highly pathogenic, inflicting 

a heavy toll on domestic and wild bird populations in 

Asia, Europe, and Africa and, from time to time, infecting 

humans. To date, some 370 people have contracted the 

disease, largely through exposure to sick or dead birds; 

235 of them have died. 

We don’t know if the H5N1 virus will spark the next pandemic, but we know that 

it’s just a matter of time before something does. There is simply no reason to 

believe that this century will be different than any past century. The difference now 

is that we better understand the threat, so we can increase our preparedness for a 

pandemic before it comes, in order to diminish its potential impact. 

The Federal government cannot mount an effective response to the threats that 

we face as a nation without partners at every level of government and throughout 

society. It is every American’s continued commitment that will make our country a 

safer and a healthier place.

Message from the Secretary (cont.)



0

50

100

150

200

250

 *As of March 4

Confirmed H5N1 Avian Influenza

Human Deaths (Cumulative)

4

 2003 2004 2005 2006 2007

 36

 79

 158

 192

 2008*

 235

December 2005 – January 2006

December 2005 – Passage of the Public Readiness and 

Emergency Preparedness Act (PREP Act)

December 2005 – First state summit in MN

January 2006 – RFI issued on increasing egg-based 

vaccine capacity

January 2006 – RFI issued on advanced development of 

promising antivirals

January 2006 – Release of individuals and families, 

faith-based and community organizations, and 

school districts (K-12) checklists

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


Responding to a pandemic will demand the cooperation of the entire world 

community. No nation can go it alone. 

An example of how closely we are connected to the rest of the world came 

late in 2007. For the first time in Pakistan, local officials identified a cluster of 

suspect human cases of H5N1. But delayed notification led to the international 

travel of an individual who had been exposed to H5N1 while in Pakistan. That 

person then requested medical attention after arriving in New York State and 

the exposure to H5N1 was discovered. Though the individual was quickly 

found to be negative to H5N1 and presented no risk to the community, the case 

underscored the need for close cooperation with our international partners to 

detect and contain the virus. 

During 2007, Laos, Myanmar, and Nigeria, along with 

Pakistan, also reported first-time human cases of avian 

flu in humans. As in similar past events, the Centers 

for Disease Control and Prevention (CDC) dispatched 

specialists to work with the World Health Organization 

(WHO) and local public health officials to determine 

the extent of the problem. Their reports, along with 

international networks of cooperation, have helped HHS 

keep close track of developments around the globe. 

Continued progress in virus and disease detection, 

enhancement of surveillance systems, and other 

aspects of pandemic preparedness are critical to our 

national security.

International Cooperation

In October 2007, senior representatives of eight allied nations plus the European 

Commission and WHO gathered in Washington for the seventh annual meeting 

of the Global Health Security Initiative (GHSI). The GHSI works to identify 

health-security needs and decides on courses of action that can be jointly taken 

to fill those needs. HHS has worked closely with other member countries to 

reach the common goals of informing other member of health emergencies 

as they arise and working together to coordinate national and international 

responses to disease threats, including pandemics. 

Monitoring and Surveillance

“If you empower with 

feasible steps, you’ll 

make social change.” 

– Pandemic Flu 

Leadership blogger

February 2006 – March 2006

February 2006 – State summits in CT, IA, MA, FL, OH, NV, 

DE, AL, MO, NE, MD

March 2006 – RFP issued for advanced development of 

antigen-sparing technologies

March 2006 – Releases 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

February 2006 – Laboratory assay for diagnostic testing of 

avian influenza A/H5 approved

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

H5N1 in wild birds 

H5N1 in poultry and wild birds

H5N1 in humans
Monitoring and Surveillance (cont.)

HHS also continues to engage actively with other countries around the world 

to help prepare for the possibility of a pandemic influenza outbreak and to help 

minimize and contain the impact of an outbreak, should one occur. Working with 

the U.S. Department of Agriculture (USDA) and the U.S. Agency for International 

Development (USAID), HHS has provided training, direct assistance, supplies, 

reagents, and technical support to the WHO, national ministries of health and 

non-governmental organizations. Further, HHS works actively with the Department 

of Defense, through its U.S. Naval Medical Research Units (NAMRUs), located in 

Egypt and Indonesia. 

A new Southeast Asia Research Network is a multi-lateral, collaborative partnership 

of hospitals and institutions; it has helped Indonesia, Thailand, and Vietnam expand 

their advanced research sites through a collaborative partnership with the United 

Kingdom and the United States. These local clinical laboratories carry out research 

on therapeutics, diagnostics, and vaccines, including contributing to protocols to 

evaluate the effective use of antiviral drugs in countering severe seasonal or avian flu. 

Virus Sample Sharing

The science agencies of HHS and other Federal government 

departments are strongly committed to unrestricted sharing of virus 

isolates and related biological materials. The U.S. is an active partner 

with the WHO and other member nations in promoting this concept 

and in seeking remedies for those countries who do not believe their 

interests are served by this practice. 

HHS continues to encourage nations around the world to share 

samples of influenza viruses. For the past 50 years, WHO’s Global 

Influenza Surveillance Network has provided the world with early 

warning of evolving flu viruses. All nations have a responsibility to 

share data and virus samples.



“Pandemics are earthshaking 

events. They reshape 

societies, they reshape 

economies, and they reshape 

geopolitics.” 

– HHS Secretary Mike Leavitt

March 2006 – FDA approves Relenza for the prevention 

of Influenza A and B in adults and children

May 2006 – Homeland Security Council releases National 

Strategy for Pandemic Influenza: Implementation Plan

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 – FDA issues guidance for industry on diagnostic 

devices to detect influenza A viruses

April 2006 – State summits in TN, AK, WA, HI, LA, MI and the 

District of Columbia

March 2006 – May 2006
Medical Countermeasures 

Since the HHS Pandemic Influenza Plan went into effect in November 2005, 

the Department has advanced the nation’s pandemic preparedness in a broad 

range of activities. HHS has worked to expand and diversify domestic vaccine 

production and surge capacity, enlarge H5N1 pre-pandemic vaccine and antiviral 

drug stockpiles, support advanced development of cell culture and antigen-sparing 

influenza vaccines and new antiviral drugs, support advanced development of 

point-of-care clinical diagnostics, and stockpile medical supplies, ventilators, and 

personal protective equipment such as facemasks and respirators. HHS is also 

building a robust and comprehensive portfolio leading to a broad array of medical 

countermeasures — vaccines, antivirals, and diagnostic tools. 

Many of the advanced development contracts to carry out these activities have 

made commitments pending successful completion of milestones. One example 

is the advanced development of cell-based seasonal and pandemic influenza 

vaccines, in which contractors must demonstrate that they have met milestone 

biosecurity measures in their domestic manufacturing facilities. Another example 

is the advanced development of an antigen-sparing pandemic influenza vaccine, 

in which successful completion of phase I trials of the candidate vaccine 

must be obtained for confirmatory testing. This is a major step forward in the 

development of pandemic influenza detection and response in priority countries. 

New cooperative efforts are leveraging resources from throughout HHS, along 

with other Federal departments, States and industry. Since 2005, HHS has 

awarded 27 contracts totaling $3.5 billion to develop plans and begin projects 

within the medical countermeasures program. 

No one can say with certainty when new technologies such as recombinant DNA 

vaccines will take center stage for influenza vaccine manufacturing. But HHS is 

committed to accelerating the maturation of DNA vaccines and other emerging 

technologies, funding important research on DNA vaccines against influenza 

viruses and soliciting contract proposals for advanced development of a DNA 

vaccine. This latter initiative is a critical milestone on the path from the laboratory 

bench to the manufacturing floor. 



May 2006 – HHS awards contracts totaling more than $1 

billion to develop cell-based influenza vaccine

June 2006 – Congress passes $2.3 billion funding 

for pandemic preparedness

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 checklist

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

May 2006 – 7 State summits in MS, OK, NJ, KS, NH, MT and 

tribal leaders

May 2006 – June 2006


Medical Countermeasures (cont.)

Vaccines and Vaccine Production Capacity

A flu pandemic poses unique public health challenges. A novel influenza virus 

means that everyone in the world is susceptible, and the entire population should 

be vaccinated for optimal protection. Our investments in science and vaccine 

research will help bring about a new generation of influenza vaccines that could 

take the threat of a pandemic off the table. But our current approach requires that 

production of a pandemic vaccine can only start once that virus appears — after 

the flu pandemic begins — and we will be challenged to allocate a limited supply of 

vaccine early in a pandemic. We are taking steps now to address these challenges. 

Vaccine Production

One of HHS’ highest priorities, in concert with an array of leading pharmaceutical 

companies, is to enhance and expand U.S.-based production capacity to the 

point that it can generate 600 million doses of a pandemic influenza vaccine (two 

doses for every American) within six months of the time that a reference strain 

of the actual pandemic virus is developed. When this initiative began just over 

two years ago, the U.S. had only a small fraction of this target capacity. Only two 

domestic manufacturers of approved influenza vaccine existed, and only one of 

those had a product that was licensed for use in all appropriate age groups. 

Today, with HHS funding, six companies are in various stages of implementing 

commercial-scale production cell culture methods and/or expanding their 

capacity for conventional manufacturing using chicken eggs. The target date for 

achieving the 600 million dose target is 2011. The work is on schedule. 

The driving motivation to build this target production capacity within the U.S. is 

to ensure that we can provide pandemic influenza vaccine for every American 

without having to purchase and import it from foreign-based manufacturing 

facilities. A condition of HHS’ funding for the participating companies is that their 

manufacturing facilities be located within the United States. 

“Many people want good 

information and good advice, 

and now there is an answer 

to the question, ‘What can 

I do?’” 

– Dr. Greg Dworkin, 

founding editor, 

Flu Wiki blog

July 2006 – Summits in AK and New York City

November 2006 – HHS awards $199 million to 

manufacturers for 5.3 million doses of H5N1 vaccine

July 2006 – HHS allocates $170 million to subsidize State 

purchase of antiviral drugs

August 2006 – State summit in NY

September 2006 – FDA issues guidance to industry for 

development of cell-based viral vaccines

October 2006 – Guidance on use of surgical masks and 

respirators in health care settings released

July 2006 – November 2006


At the same time, HHS expects that these manufacturers, once they have met the 

needs of the U.S. market, will have opportunities to sell their life-saving products 

to others around the world. Our current collaborations with WHO and other 

international partners are an important step toward creating the mechanisms 

that will be needed to combat pandemic influenza in a coordinated manner 

around the globe. 

Vaccine Adjuvants

HHS has a strong interest in vaccine adjuvants. These are chemical or biological 

substances that are added to vaccines to increase the magnitude and, sometimes, 

the scope of the immune response. The addition of an adjuvant can have a 

dose-sparing effect — meaning that protective immunity is achieved with smaller 

quantities of vaccine than if the adjuvant were absent. 

Further, addition of an adjuvant may increase cross-protection — the adjuvanted 

vaccine elicits an immune response against more strains of influenza virus than if 

the vaccine were used alone. HHS is funding a variety of advanced development 

projects involving adjuvanted influenza vaccines, and several manufacturers are 

pursuing independent efforts. 

To date, HHS has invested more than $130 million working with vaccine 

manufacturers and the biotechnology community to study adjuvants. 

Pre-Pandemic Vaccine

To meet the first wave of a pandemic, work has been ongoing for the past two 

years to build a “pre-pandemic” vaccine, one that would use likely viruses already 

in circulation to provide early protection against the pandemic virus for those 

with the most critical needs within a community. By the end of 2007, HHS had 

purchased and stockpiled 13 million courses of pre-pandemic vaccine. 

Medical Countermeasures (cont.)

December 2006 – NIH begins human clinical trials of DNAbased H5N1 vaccine

February 2007 – CDC releases community 

mitigation guidance

January 2007 – HHS awards $132.5 million to develop H5N1 

adjuvanted influenza vaccines

January 2007 – HHS awards $102.6 million for advanced 

development of new influenza antiviral drug, peramivir

February 2007 – HHS launches pandemic flu public 

service announcements

January 2007 – U.S. businesses with overseas operations 

checklist released

December 2006 – February 2007

“In public health, we believe 

that the community-level 

direction is the best in dealing 

with public health and 

medical issues...who knows 

the behavior, the culture, the 

desire, the priorities of the 

community better than the 

people who actually live in 

that community?” 

– Rear Admiral Craig 

Vanderwagen, Assistant 

Secretary for Preparedness 

and Response
10

Antiviral Drugs

Experience with seasonal flu has shown that antiviral drugs are a proven tool in 

the arsenal of weapons that could be used to help contain a flu pandemic. They 

can play a critical role in the earliest pandemic stages, by helping contain an early 

outbreak wherever it occurs, slowing the spread of the disease, and treating those 

who are ill during later community outbreaks. 

In November 2005, the Federal government determined that pre-pandemic 

stockpiling of antiviral drugs was essential and proposed a national target of 81 

million treatment courses — assuming that, during an influenza pandemic, about 

25 percent of the U.S. population would seek treatment. The 81 million antiviral 

treatment courses include 6 million treatment courses set aside for the early 

stages of an emerging pandemic. 

Viewing such stockpiling as appropriate for shared responsibility, the 

Federal government proposed to acquire and stockpile about 60 percent 

of the national requirement directly and to look to the States to acquire 

and stockpile the other 40 percent. HHS then assisted States both 

administratively and financially to meet that stockpiling goal. Most States 

have availed themselves of this opportunity, with many of them purchasing 

the full subsidized amount or more. HHS is hopeful that States will make 

additional purchases through this mechanism this year. 

Each State is responsible for allocating its respective share of the HHS 

stockpile and its own stockpile, if any. As part of their preparedness 

planning, States need to identify the hospital entities and other healthcareassociated places where the drugs are to be pre-positioned when an 

influenza pandemic is judged to be imminent. 

States are not responsible for allocation of antiviral drugs that are held outside 

the national and State stockpiles — e.g., drugs acquired by businesses or 

not-for-profit entities for their employees and, possibly, the employees’ families. 

In these instances, allocation is the responsibility of the purchaser. HHS will 

continue to encourage States, local governments, and private sector entities to 

share the responsibility for stockpiling antiviral drugs. 

Antiviral Stockpile

Goal Progress

81 Million

Courses

(Dec. 2008)

50 Million 

Courses

Medical Countermeasures (cont.)

February 2007 – 2,250 human and avian influenza virus 

genomes completed and publicly accessible

April 2007 – NIH awards $161 million to expand 

March 2007 – Health insurers planning checklist released

surveillance and bolster research

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

influenza vaccine

April 2007 – Travel industry planning checklist released

April 2007 – 12 million doses of human H5N1 vaccine added 

to Strategic National Stockpile

February 2007 – April 2007
Diagnostics

Early warning about a possible pandemic can come through quick and accurate 

diagnostic tools. By shortening the time between a suspected diagnosis and one 

that is confirmed, targeted treatment can begin earlier and fewer people run the 

risk of being exposed to the pandemic virus. 

HHS began the search for such rapid diagnostic tests by funding the development 

and evaluation of new point-of-care tests and laboratory-based tests, reagents, 

and devices that can be used for screening and surveillance. These diagnostic 

tests and devices will help distinguish between seasonal flu strains and novel flu 

strains, such as H5N1. 

In December 2007, the first of two prototype point-of-care influenza rapid test 

devices underwent independent evaluation; the second such test device is 

expected in March 2008. Both new devices will allow doctors and other health 

professionals to diagnose avian influenza rapidly and easily in a clinic office or 

other outpatient setting. 

Medical Countermeasures (cont.)

11

May 2007 – HHS issues interim guidance on community 

(nonwork) use of facemasks

July 2007 – HHS announces $896.7 million in 

funding to states for public health preparedness 

and emergency response

May 2007 – FDA clears first respirators for public health 

emergencies

May 2007 – New online training course released for State and 

local public health responders

June 2007 – Pandemic Flu Leadership Forum

June 2007 – Two contracts awarded to expand domestic 

vaccine manufacturing capacity

May 2007 – July 2007
HHS has stressed repeatedly in State pandemic influenza summits with 

governors and in numerous other meetings that preparedness for pandemic 

influenza must be a shared responsibility among governments at all levels, the 

private sector, and individuals. To the extent that potential partners refuse to 

apply their talents and assets unless the Federal government foots 

the bill, they are abdicating their responsibility and thereby placing 

their communities at higher risk than need be. 

Since 1999, HHS has provided funding to State and local public 

health departments to enhance their preparedness for naturally 

occurring, accidental, or terrorist-induced emergencies. This 

has included strengthening relationships with public safety 

and emergency management agencies. Since 2002, HHS has 

provided all States and territories as well as four major urban areas 

with some $2 billion to enhance surge capacity in hospitals and 

other healthcare entities. 

HHS is also leading an effort involving eight cabinet departments of the Federal 

government to help States refine their plans for countering pandemic influenza. 

The primary focus of the planning guidance, technical assistance, and readiness 

assessments is to help all agencies of State governments — not just health 

departments — understand what they can do to help mitigate and otherwise 

counter an influenza pandemic. 

This involves State public health departments looking inward to do what is 

necessary to continue their respective operations. But it also involves looking 

outward to establish and test partnerships with other agencies of State 

governments, local governments and the private sector — including both 

for-profit and not-for-profit entities. State-based partnerships are one of the 

most promising ways to prepare for pandemic influenza. 

In 2007, HHS made available $75 million to States, territories, and four 

metropolitan areas to help strengthen their capacity to respond to a pandemic 

influenza outbreak. This funding came in addition to the $325 million provided 

over the past two years. 

State and Local Preparedness

12

“We need to remember 

that we are our brothers’ 

and sisters’ keepers, that we 

are responsible not just for 

ourselves and our families but 

for the common good.” 

– Sister Patricia Talone, 

Catholic Health Association

July 2007 – Homeland Security issues one-year summary on 

the National Strategy Implementation Plan 

August 2007 – North American plan for avian and pandemic 

influenza released

August 2007 – $75 million released to states to strengthen 

pandemic response capacity

December 2007 – 8 suspected human cases of 

H5N1 in Pakistan

September 2007 – Planning checklists released for law 

enforcement and correctional facilities

December 2007 – Myanmar confirms first 

human H5N1 infection

July 2007 – December 2007
Strong, sustained communication about the threat of pandemic influenza and 

recommended countermeasures is central to preparedness. The challenge is 

more difficult now than two years ago because, for many laypersons, the novelty 

of the topic has worn off and anxiety seems to have diminished. Nevertheless, 

the threat remains; and the nation must not let down its guard. H5N1 avian 

influenza may not become the trigger for the next human influenza pandemic. 

All of us should hope it isn’t. But, if not, history says that, sooner or later, a 

pandemic influenza virus will spring from some other root.

HHS is committed to continuing its strong role in public communications about 

seasonal and pandemic influenza. We recognize that we need multiple channels 

to disseminate preparedness messages and materials; and we constantly are 

alert to opportunities to try new approaches and strengthen existing ones.

Public Education

Pandemic planning is a shared responsibility. Even families and 

individuals have a role in preparing for a pandemic. To encourage 

individuals to take a few steps now to prepare for a pandemic, HHS 

reached out to well-respected organizations and leaders, including 

non-governmental organizations, to develop a public education 

campaign to provide community leaders such as faith-based and 

civic leaders, healthcare providers, and local employers with the 

information and resources they can use to help those they influence 

prepare now for a pandemic. 

Nearly 100 organizations participated in a one-day Pandemic Flu Leadership 

Forum to discuss the development of this public education campaign. 

Participants included the American Medical Association, Catholic Health 

Association, Red Cross, Lions Clubs, and the U.S. Chamber of Commerce. 

These organizations helped shape the Take the Lead: Working Together to 

Prepare Now campaign, which was launched in December 2007. 

Communications and Outreach

13

“This really highlights our 

own roles (including those 

of us who aren’t necessarily 

‘community leaders’) in 

putting the word out.” 

– Anonymous Pandemic Flu 

Leadership blogger

December 2007 – 3-day web dialogue on vaccine allocation

December 2007 – first human case confirmed in Pakistan

December 2007 – HHS launches “The Great Pandemic” 

historical overview of 1918 pandemic

February 2008 – EU FDA-counterpart gives preliminary 

approval to pre-pandemic vaccine

December 2007 – HHS launches “Take the Lead: Working 

Together to Prepare Now” campaign 

March 2008 – HHS holds first of 3 state 

pandemic planning webinars

December 2007 – March 2008
To extend the dialogue around the importance of individual planning beyond 

the one-day Washington, DC Leadership Forum held in June 2007, HHS 

held its first-ever blog on pandemic planning. Over a five-week period, ten 

prominent leaders contributed online to the topic of pandemic planning and 

the importance of individual planning. Over the course of this “Blog Summit,” 

(http://blog.pandemicflu.gov/ ) there were more than 35,000 unique visitors, 1,600 

comments, and more than 300 in-bound links from other websites, blogs, and 

message boards. 

Pandemicflu.gov, the Federal government-wide website, launched a 

new collection of historical documents related to the 1918 pandemic, the 

“Great Pandemic” (http://1918.pandemicflu.gov/index.htm). Along with 

information about the pandemic itself, the site also gives greater detail 

about the Nation’s health and medical care system at that time and how 

these were affected. 

There are still many in our country whose lives do not fall within the 

traditional public health channels for communicating, and they are 

among the hardest groups to reach. These include the homeless and 

non-English speakers, among other groups. To help remedy this situation, 

HHS has begun a series of activities to ensure that these groups are included 

in the pandemic planning process. A project will get underway this year that 

will first help clarify this audience’s knowledge, attitudes, beliefs, capabilities 

and communication message needs, especially as they relate to community 

mitigation recommendations. In a second stage, appropriate messages will 

be crafted, tested, and then distributed through non-traditional means.

Stakeholder Outreach

Over the last six months, the Department has made a significant effort to obtain input 

from a range of stakeholders, including State and local officials, public health and 

medical professionals, the business community, organized labor, and individuals from 

all walks of life. They have contributed their knowledge and viewpoints to inform the 

development of several complex and critical pandemic flu planning policies.

Ultimately, these policies will have a significant impact on how States, 

communities, families, and individuals prepare for and respond to a pandemic. 

This is an unprecedented effort on the part of HHS and the Federal government. 

It builds upon the work conducted in 2006 and early 2007. 

To broaden this outreach and allow as many people as possible to participate 

in these discussions, HHS utilized new communication technologies, including 

blogs and other web-based tools. Additionally, we held large public forums, 

smaller group meetings, and conference calls to discuss these critical issues. 

Communications and Outreach (cont.)

14

“The point of preparing for 

pandemic is it’s much more 

than the health sector, it’s 

much more than emergency 

room, it’s all society.” 

– Dr. Bruce Gellin, 

Director, HHS National 

Vaccine Program Office
15

Communications and Outreach (cont.)

In 2008, we will continue to reach out to stakeholders to shape some of the 

most difficult pandemic planning issues facing the Nation. The input we have 

received thus far will result in policies and guidances to be released later in 2008. 

Issues to be considered in this on-going dialogue include proposed vaccine 

allocation plans, proposed guidance for private-sector stockpiling of antivirals 

and respirators/facemasks, shared responsibility for medical countermeasures 

stockpiling, and the importance of individual preparedness. 

Outreach on Proposed Vaccine Allocation Plan

It is very likely that a pandemic flu vaccine would only be available four to six 

months after the start of a pandemic. During that time, how could the available 

vaccines be used most wisely, including the so-called “pre-pandemic” vaccines? 

And who should get the first round of available vaccinations? 

These difficult questions are ones that no single person or government agency 

can answer. Only through public discussions, multiple consultations, and joint 

decision-making can we be sure of offering the most broadly agreed-upon 

guidance for reaching our pandemic planning goals. 

The first step toward an answer to the question of vaccine allocation came 

through consultations with people around the country. Meetings took place 

in 2006 with citizens in Las Cruces, NM, and Nassau County, NY. And in 

Washington, DC, leaders from the government, business and 

community sectors met on the issue. These groups of people learned 

first about pandemic flu and then discussed their values in relation to 

who should get vaccinated first. Their insights helped shape the first 

draft of a proposed vaccine allocation plan. 

In November 2007, HHS held two public engagement meetings with 

citizens in Hendersonville, NC and Milwaukee, WI to obtain their 

feedback to the proposed vaccine allocation plan. Approximately 

100 individuals attended each day-long meeting, representing a full 

spectrum of groups within the local communities. 

In December 2007, HHS held its first-ever web dialogue to continue 

the dialogue on the proposed vaccine allocation plan. More than 400 

people, representing 37 States, participated in the five-day on-line dialogue with 

Federal, State and local public health officials. 

Through these discussions, experts and the public identified the most important 

vaccination goals as protecting those who will be the first to 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 pregnant 

women and children. 

“We need to engage 

individuals in such a way that 

they understand the reality of 

pandemic flu, the problems 

associated with it, and how 

to prepare their families to be 

successful in either reducing 

the risk or potentially dealing 

with the infection in an 

effective way.” 

– Dr. Joseph Bocchini, 

American Academy 

of Pediatrics
16

Communications and Outreach (cont.)

In these discussions, several senior citizens made poignant comments about 

vaccine allocation. On the basis of experience with seasonal influenza and the 

three pandemics of the 20th century, medical experts expect that infants, young 

children, and the elderly would be among those facing the highest mortality risk 

during the next pandemic. This consideration alone would justify placing elderly 

individuals within the highest priority strata for immunization. Yet, several senior 

citizens stated that they willingly would give up their place in line if that would 

ensure that their grandchildren were protected first. Other seniors went further to 

include the parents of these grandchildren, arguing that to do otherwise would be 

to risk having a generation of pandemic orphans. 

Based on these dialogues and the thoughtful input of so many segments of 

society, a working group of government officials is in the process of refining the 

allocation plan with the goal to release the plan in the coming months. 

Outreach on Countermeasure Stockpiling

In the fall of 2007, HHS senior leaders and subject matter experts held nearly 

twenty meetings with a range of stakeholders to discuss the shared responsibility 

concept of stockpiling medical countermeasures (vaccines, antivirals, rapid 

diagnostic tests, and masks/respirators), as well as private sector stockpiling of 

antivirals. These meetings took place in Seattle, WA, Raleigh-Durham, 

NC, Scottsdale, AZ, Atlanta, GA, Washington, DC, and by conference 

call. Nearly 400 people participated in these sessions, representing 

governors’ and mayors’ offices, State and local public health 

departments, private employers, healthcare providers (physicians, 

hospitals, nursing homes, assisted living facilities), law enforcement, 

organized labor, and first responders. 

As more consultations take place, HHS will work to develop a draft 

guidance document that will help local decision-makers from both 

the public and private sectors as they work through their pandemic 

planning process to reach conclusions about the allocation of these critical 

preparedness elements. 

In March of this year, the Institute of Medicine will publish a two-part study 

of how antivirals could be distributed to households following exposure to 

a pandemic flu virus. The report will add an important perspective to the 

on-going discussions about antiviral allocations.

“Our nontraditional partners 

– churches, schools and PTAs, 

community organizations 

and soup kitchens – along 

with health departments...

know the community perhaps 

best, understand the unique 

challenges each community 

faces and already have 

programs in place working 

with those who are most 

vulnerable.” 

– Dr. Georges Benjamin, 

Pandemic Flu Leadership blog