Expert Panel: Todd Damrow Cheryl Juntunen Susan Keady Michael Skeels ? Q & A Expert Panel: Todd Damrow Cheryl Juntunen Susan Keady Michael Skeels ?

Question #1 for Todd & Cheryl At what stage of development is your state/local/tribal plan for responding to pandemic influenza? Compared to other pressing issues, what level of priority does the planning activity have within your jurisdiction? Why?

Nature’s terrorist attack Pandemic Flu…. Let’s move on now and talk about influenza….not just any old flu, but pandemic influenza. …..as a public health professional, it scares me more than any other communicable disease on this planet….even more so than the agents at the top of our nation’s priority list of biologic weapons….anthrax, smallpox and plague. Anthrax, smallpox and plague are NOTHING compared to what pandemic flu can do. Take anthrax….it can be a killer….mortality rates above 90%. But it’s not communicable, i.e., people are not contagious. Anthrax would not encircle the globe, unlike pandemic flu Well, what about smallpox, you say, this is communicable. Yes, but we also have 200 million doses of vaccine available, unlike pandemic flu. The potential for death and destruction due to pandemic flu exceeds that for any other known biologic agent. Compared to a flu pandemic, SARS would be something to smile about. And we’re overdue for a good one. Flu pandemics cycle about every 50 years. The last one occurred in 1918.

“When the dying stopped, ….the forgetting began”. 1918 Spanish Flu “When the dying stopped, ….the forgetting began”. Dr. Alfred W. Crosby Eighty-six years ago…..so we’re 36 years overdue already. It was known as the great 1918 Spanish Flu epidemic. It has been cited as the most devastating epidemic in world history. More people died of flu in a single year than in the 4 years of the Black Death Bubonic Plague. It was a global disaster….affected over half of the total human population on the planet….and this was even before commercial airline traffic! And as if that’s not tragic enough, (CLICK), when the dying stopped, the forgetting began….and it’s progressed to the point where most people have not even heard of pandemic flu, let alone be concerned about it. Almost a century after the Spanish flu, the U.S. remains largely unprepared for pandemic flu.

Question #2 for Susan & Mike How does planning for pandemic influenza relate to the components (surveillance, laboratory testing, vaccine distribution, etc) of your routine ongoing inter-pandemic influenza control program? What is similar? Different? Complementary?

Similar Activities Annual Flu and Pandemic Flu Viral culture surveillance Influenza-like illness (ILI) surveillance Promote routine influenza and pneumococcal immunization Promote appropriate use of antivirals Information for clinicians Risk communication and public education

How is pandemic flu different? Immunization is not the primary strategy in the early stages Effective immunization (when available) may require two doses Need to characterize epidemiology of the specific strain to prioritize immunization and antiviral use Increased social and cultural concerns

Pandemic Response Components Pandemic influenza disease Interventions to decrease transmission Provide quality medical care Infection control in medical & long term care settings Maintain essential community services/ emergency response activities Impact Antiviral treatment & prophylaxis Vaccination Time Diagram source: Ben Schwartz; National Vaccine Program

Question #3 for Cheryl & Susan What are the major barriers to having an effective plan that you are facing (or anticipate facing)? Logistical concerns? Ethical concerns? How are you addressing these barriers?

Local Challenges Vaccine Distribution: Client Misperceptions: National Coordination, Production Delays and Shortages, Communication with Locals Client Misperceptions: Efficacy, Contamination, Availability Private/Public Delivery System: Coordination of Efforts, Targeting High Risk Individuals, Institutional Special Populations, Education of Private Sector Assessment Data: Measuring Progress

Question #4 for Mike & Todd Who needs to be at the table to assure that the planning is effective? Who is responsible for orchestrating the system of response?

Who needs to be at the table? State & local epidemiologists & immunization staff Clinical & PH laboratories Infection control practitioners Hospital administrators Clinicians Tribal health representatives Emergency response agencies

Who orchestrates the response? State PH agency: monitor & distribute information; surveillance & testing for novel strains; manage & distribute support/supplies; create and maintain current/consistent public messages Local health departments: disease surveillance; dispensing pharmaceuticals & vaccines; facilitate cooperation between local parties; provide community PH guidance; isolate or quarantine individuals if necessary

Question #5 for all panelists What is your biggest concern about planning for pandemic flu? Do you have some examples of innovation/creativity in developing your approach to this planning?