	Synopsis

On June 11, 2009, in response to the global spread of a new strain of H1N1 influenza ("flu"), the World Health Organization (WHO) declared the outbreak to be a flu pandemic, the first since 1968. The novel "H1N1 swine flu" virus was first identified in California in late April. Since then, cases have been reported around the world. HHS has established a government-wide informational website ( www.flu.gov ) with information for planners, health care providers, and the public. To address the H1N1 outbreak, the Obama Administration requested $2 billion in FY2009 emergency supplemental appropriations, and transfer authority for an additional amount of almost $7 billion from existing HHS accounts. On June 26, the President signed P.L. The President has twice requested portions of the contingent funding. A voluntary national pandemic vaccination campaign is underway. There have been a number of problems associated with shortfalls of actual (versus predicted) vaccine availability, and charges that vaccine would not be available for most of the individuals in designated priority groups until after the peak of pandemic virus transmission had passed. This report provides information about selected federal emergency management authorities and actions taken by DHS and HHS, and actions taken by state and local authorities, in response to the pandemic. It then lists congressional hearings held to date; provides information about appropriations and funding for pandemic flu preparedness and response activities; summarizes U.S. government pandemic flu planning documents; and lists sources for additional information about the pandemic. An Appendix describes the WHO process to determine the phase of a threatened or emerging flu pandemic, and touches on several related issues. Because a public health emergency declaration was already in effect, the declaration under the National Emergencies Act provided the authority for the Secretary of HHS to waive the Social Security Act requirements in order to make it easier for health care facilities to manage surges in patient volume during the pandemic. All of the government-purchased vaccines have been approved through the routine licensing process used for seasonal flu vaccines. The Emergency Use Authorization and other federal emergency management authorities that have been invoked or could be invoked for the response to the H1N1 flu pandemic are depicted in Figure 1 . However, requirements have been established by the Department of Defense, and by some states and private health systems, for the vaccination of health care workers. The PREP Act waives liability and establishes an injury compensation program for the use of certain "covered countermeasures." 111-32 ), signed on June 24, 2009, provided $1.9 billion in supplemental appropriations immediately, and an additional $5.8 billion contingent upon a presidential request documenting the need for additional funds. The U.S.
On June 11, 2009, in response to the global spread of a new strain of H1N1 influenza ("flu"), the World Health Organization (WHO) declared the outbreak to be an influenza pandemic, the first since 1968. The novel "H1N1 swine flu" was first identified in California in late April. Since then, cases have been reported around the world.
When the outbreak began, U.S. officials adopted a response posture under the overall coordination of the Secretary of Homeland Security. Among other things, officials established a government-wide informational website (http://www.flu.gov), released antiviral drugs from the national stockpile, developed new diagnostic tests for the H1N1 virus, and published guidance for the clinical management of patients and the management of community and school outbreaks.
Several federal emergency management authorities have been invoked for the response to the pandemic, including a presidential declaration of a national emergency, and a declaration by the Secretary of Health and Human Services (HHS) of a public health emergency. Among other things, these authorities have allowed federal officials to make certain unapproved drugs available to patients with severe cases of influenza, and to ease certain requirements on hospitals to aid them in caring for surges in the volume of patients.
Federal health officials have purchased millions of doses of H1N1 pandemic flu vaccine, approved through the routine licensing process used for seasonal flu vaccines. A voluntary nationwide vaccination program is underway, largely coordinated by state and local health officials and carried out through public clinics, private health care providers, schools, and others. The Secretary of HHS has implemented waivers of liability and an injury compensation program in the event of unforeseen vaccine safety problems. Allocation schemes were developed to give priority for limited vaccine doses to those in high-risk groups. However, there have been a number of problems associated with shortfalls of actual (versus predicted) vaccine availability, and charges that vaccine would not be available for most of the individuals in designated priority groups until after the peak of pandemic virus transmission had passed. Some Members of Congress and others have questioned the adequacy of federal activities to improve the capacity for and timeliness of flu vaccine production.
To address the outbreak, the Obama Administration requested $2 billion in FY2009 emergency supplemental appropriations, and transfer authority for an additional amount of almost $7 billion from existing HHS accounts. On June 26, the President signed P.L. 111-32, the Supplemental Appropriations Act, 2009, which provided $1.9 billion immediately and an additional $5.8 billion contingent upon a presidential request documenting the need for, and proposed use of, additional funds. The President has subsequently asked for most of the contingent amount. A balance of almost $1.3 billion remains available.
This report provides a synopsis of key events in the H1N1 pandemic response, followed by information about selected federal emergency management authorities and actions taken by DHS, HHS, and state and local authorities. It then lists congressional hearings held to date; discusses appropriations and funding for pandemic flu preparedness and response activities; summarizes U.S. government pandemic flu planning documents; and lists sources for additional information. An Appendix describes the WHO process to determine the phase of an emerging flu pandemic.