1. Raymond A. Strikas, MD Associate Director for Adult Immunization Immunization Services Division National Immunization Program Coordinating Center for Infectious Diseases Centers for Disease Control and Prevention Pandemic Influenza Preparedness and Response National Strategy

2. TM Defining a Pandemic: WHO Phases Phase 1.No new influenza virus subtypes detected in humans. If animals are infected, risk to humans is low. Phase 2.No new influenza virus subtypes detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease. Phase 3.Isolated human infections, no human-to-human spread except rare close contacts. Phase 4.Small, highly localized cluster(s), limited human-to- human transmission. Phase 5.Larger localized cluster(s) limited human-to-human spread. Substantial pandemic risk. Phase 6.Pandemic phase: Sustained transmission among humans occurs.

3. TM Current Situation National plan revised, available 11/2/05 H5N1 vaccine –Clinical trials, 90 mcg (30 mcg?) x2 –Adjuvants or Intradermal? Antiviral drugs –Drug resistance, stockpile supplies Isolation and quarantine –Executive order April 2005

4. TM FY2006 Emergency Supplemental Budget: $3.8 Billion $350 million for upgrading State and local response capacity $162 million for Strategic National Stockpile $50 million for laboratory capacity and research at CDC $246 million for international activities, disease surveillance, vaccine registries, research, and clinical trials ($150 m. to CDC) $2,750 million to support, at the Secretary’s discretion, other core preparedness activities, such as expanding the domestic production capacity of influenza vaccine, developing and stockpiling pandemic vaccine, and stockpiling antivirals and other medical supplies necessary to protect and preserve lives in the event of an outbreak of pandemic influenza.

5. TM National Strategy for Pandemic Influenza - 1 Announced 11/1/05 Available at www.pandemicflu.govwww.pandemicflu.gov Goals: –Stopping, slowing, otherwise limiting spread of a pandemic to the United States –Limiting domestic spread, and mitigating disease, suffering, and death –Sustaining infrastructure and mitigating impact to economy and functioning of society

6. TM National Strategy for Pandemic Influenza - 2 Three Pillars of the National Strategy: –Preparedness and Communications –Surveillance and Detection –Response and Containment

7. TM National Strategy for Pandemic Influenza - 3 Preparedness and Communications –Planning for a pandemic –Communicating expectations –Producing and stockpiling vaccines, antivirals, and medical material –Establishing distribution plans for vaccines and antivirals –Advancing scientific knowledge and accelerating development

8. TM National Strategy for Pandemic Influenza - 4 Surveillance and Detection –Ensuring rapid reporting of outbreaks –Using surveillance to limit spread

9. TM National Strategy for Pandemic Influenza - 5 Response and Containment –Containing outbreaks –Leveraging national medical and public health surge capacity –Sustaining infrastructure, essential services and the economy –Ensuring effective risk communications

10. TM Roles and Responsibilities - 1 Federal –Advancing international preparedness –Supporting establishment of countermeasure stockpiles and production capacity –Ensuring federal depts., agencies have developed, exercised plans –Facilitating state and local planning –Providing guidance to the private sector and the public, in conjunction with states and communities

11. TM Roles and Responsibilities - 2 States and localities –Ensuring all reasonable measures taken to limit spread of outbreak –Establishing comprehensive, credible preparedness and response plans, and exercising them –Integrating non-health entities into planning –Establishing state and community-based stockpiles and distribution systems –Identifying key spokespersons –Providing public education campaigns

12. TM Roles and Responsibilities - 3 Private Sector –Establishing an ethic of infection control in the workplace –Establishing contingency systems to maintain delivery of essential goods and services –Establishing mechanisms to allow workers to provide services from home (where possible) –Establishing partnership with other sector members to maintain essential services

13. TM Roles and Responsibilities - 4 Individuals and families –Taking precautions to prevent spread of infection if an individual or family member has symptoms of influenza –Being prepared to follow public health guidance – may include limits on public gatherings and travel –Keeping supplies at home to support essential needs for several days if necessary

14. TM National Pandemic Influenza Plan Issued 11/2/05, revised from draft of 8/04 Two parts: –Strategic Plan –Public Health Guidance to State and Local Partners

15. TM National Pandemic Influenza Plan Doctrine - 1 Preparedness will require coordination in all sectors An informed and responsive public is essential to minimizing pandemic health effects Domestic vaccine production capacity sufficient to produce vaccine for the entire US population is critical Quantities of antiviral drugs sufficient to treat 25% of the population should be stockpiled

16. TM National Pandemic Influenza Plan Doctrine - 2 Sustained human-to-human transmission anywhere in the world will trigger US pandemic response Protective public health measures will be employed to reduce transmission, prevent or delay outbreaks (when possible) At onset of a pandemic, HHS will procure vaccine and distribute to state and local health departments for pre-determined priority groups At onset of a pandemic, antiviral drugs from public stockpiles will be distributed to health care providers for administration to pre-determined priority groups

17. TM

18. National Pandemic Influenza Plan, Part 2: Public Health Guidance to State and Local Partners Introduction Surveillance Laboratory Diagnostics Healthcare Planning Infection Control Clinical Guidelines Vaccine Distribution and Use Antiviral Drug Distribution and Use Community Disease Control and Prevention Managing Travel-related Risks of Disease Public Health Communications Workforce Support: Psychosocial Considerations and Information Needs

19. TM State & Local Pandemic Planning: Accomplishments All states submitted a plan by July ’05 Plans under formal review by CDC; feedback due soon 29/49 have conducted tabletop exercises (ASTHO survey, 11/05) 14/49 have conducted functional (e.g., vaccination) exercises to form more comprehensive response

20. TM State Level Pandemic Planning: Challenges Indeterminate availability of vaccine or antiviral drugs Surge capacity of health care system

21. TM So Now What for State Planning? Ensure all appropriate planning partners are involved Ensure coordination Establish incident command/control Promote/facilitate development of local plans Ensure tribes are involved/addressed Review legal authorities Annual review/updating of plan Move beyond “plan to plan” See State and Local Pandemic Planning Checklist, http://www.cdc.gov/flu/pandemic/pdf/PandemicFluCh ecklist.pdf

22. TM CDC Roles Refine CDC Concept of Operations plan Refine role in HHS Pandemic Plan Train and equip Laboratory Response Network Consult overseas via WHO Manage overseas assets Special lab capacity: vaccine seed, antivirals’ efficacy and safety testing, reagents Research Business and private sector roundtables Strategic National Stockpile Carry out DHHS assignments

23. TM Remember… “[Hurricane] Katrina was the most anticipated natural disaster in American history, and still government managed to fail at every level.” David Brooks, NY Times, 9/11/05

24. TM Resources www.pandemicflu.gov http://www.cdc.gov/flu/pandemic/ http://www.who.int/csr/disease/avian_influenza/en/ http://www.astho.org/templates/display_pub.php?pub_id=1383&admin=1 http://www.cste.org/specialprojects/Influenzaplans/StateMap.asp http://www.naccho.org/topics/infectious/emerging/avian.cfm