U.S. Pandemic Influenza Preparedness and Response: Update & Progress Report “The pandemic influenza clock is ticking. We just don’t know what time it is.” “This is the one health threat we’re preparing for that we know will happen”

When Will the Next Influenza Pandemic Occur? 1976 – H1N1 Swine flu 1986 – H1N1 Swine virus 1988 – H1N1 Swine virus 1993 –Swine/avian recombinant 1995 – H7N7 Duck virus 1997 – H5N1 Avian virus 1999 – H9N2 Quail virus 2003– H5N1 Avian virus 2003 – H7N7 Avian virus 2004 – H5N1 Avian virus Timeline of human infection with novel influenza viruses (since the 1968 pandemic) 2004 – H7N3 Avian virus 2004 – H7N1 Avian virus

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

U.S. Pandemic Influenza Preparedness Activities, 1 Enhanced surveillance CDC request for proposals for surveillance in Asia HHS support for WHO surveillance activities Vaccine security and supply HHS funding to assure year-round egg availability and to promote expansion and diversification of U.S. influenza vaccine production NIH is obtaining and testing pilot lots of H5N1 vaccine

U.S. Pandemic Influenza Preparedness Activities, 2 Antiviral drugs Establishment of an oseltamivir stockpile State/local preparedness Continued support for State planning activities HHS funding for health care system preparedness Development of software to predict impacts and tabletop exercises to practice State/local plans

Estimated Impact of an Influenza Pandemic on Healthcare in Atlanta CategoryNumber% of Total Hospitalizations191526% ICU beds 40145% Ventilators 20129% Peak-week impacts estimated using Flu-surge software. Assumes an 8-week period of illness in a community. Note: Hospitals usually run near full capacity; thus, addressing this burden would require emptying or adding beds CDC, FluSurge software, 2004

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

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

Pandemic Vaccine Purchase Options: Public/Private Sector Roles PurchasePublic sector roles & planning needs All public Best opportunity to target priority groups Requires planning for mass distribution Increased public Public sector focus on target groups and underserved populations Requires coordination with private sector Current (mostly private) system Public sector focus on limited target groups and children via VFC

Vaccine Purchase and Distribution: Potential for Changes Over Time First waveSecond wave Vaccine available All public Current Increased public Timeline and waves of pandemic disease Note: This is presented as an illustration and not to endorse as a preferred option

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

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