Currently, there is no pandemic flu. In 1997 a new strain of avian flu jumped from poultry directly to humans in Hong Kong, causing several human deaths. It has since been reported in domestic poultry and/or wild birds in more than 50 countries in Asia, Europe and Africa. Also since 2003, it has infected more than 270 people (and killed more than 160 deaths) in ten countries. If a flu pandemic were to occur in the next several years, the U.S. response would be affected by the limited availability of a vaccine (the best preventive measure for flu), as well as by limited availability of certain drugs used to treat severe flu infections, and by the general lack of surge capacity within our healthcare system. It also discusses WHO and U.S. preparedness plans and their context in broader emergency preparedness efforts. While reference is made when relevant to global preparedness efforts and to animal health impacts, this report focuses on U.S. domestic public health preparedness and response planning, and the projected impacts of an influenza pandemic on Americans. This report will be updated to reflect changing circumstances. The 1918 Spanish Flu (H1N1) pandemic is estimated to have killed more than 50 million people worldwide, and at least 675,000 in the United States. Global containment efforts continue. In addition to response efforts in the public health and medical sectors, a serious pandemic would trigger the National Response Plan (NRP), developed by the Department of Homeland Security (DHS) as a blueprint for the coordination of federal agencies during an emergency. Described below are a number of preparedness and response plans to assist U.S. federal, state and local agencies in specific preparedness and response for a flu pandemic. Response and Containment: Actions to limit the spread of the outbreak and to mitigate the health, social and economic impacts of a pandemic. A serious flu pandemic would affect many sectors of society, not just the public health and medical communities. WHO monitors the spread of H5N1 avian flu and other novel flu viruses, and will make formal announcements of changes in pandemic threat status including, were it to occur, the onset of pandemic, defined as sustained human-to-human transmission of a novel flu virus. While HHS had been the lead federal agency for pandemic planning prior to 2005, the White House Homeland Security Council appears now to be the hub through which federal preparedness activities are coordinated. Emergency declarations pursuant to the Stafford Act were made in response to West Nile virus in 2000, so there is precedent for a presidential emergency declaration, (providing a lower level of federal assistance) in response to an infectious disease threat. The matter of presidential authority to declare a major disaster (providing a higher level of federal assistance) in response to an infectious disease threat generally, and a flu pandemic specifically, is less clear. However, the Administration view is that the President's authority to declare a major disaster pursuant to the Stafford Act could be applied to an influenza pandemic. But, because of continuous changes in the genes of flu viruses, vaccines must be "matched" to specific strains to provide good protection. Since a vaccine could not be mass produced against a pandemic flu strain until that strain emerged, planning assumes that a matched flu vaccine would not be available for initial global pandemic control. One means to increase domestic vaccine production capacity is to expand manufacturing infrastructure.
In 1997, a new avian influenza ("flu") virus emerged in Asia and jumped directly from birds to humans, killing six people. The virus has since spread to more than 50 countries in Asia, Europe and Africa, where it has killed millions of birds and infected more than 270 people, killing more than 160 of them. The virus bears some similarity to the deadly 1918 Spanish flu, which caused a global pandemic estimated to have killed more than 50 million people worldwide. The current spread of avian flu raises concerns about another human flu pandemic.
Global pandemic preparedness and response efforts are coordinated by the World Health Organization (WHO). Domestic preparedness efforts are led by the White House Homeland Security Council, with the U.S. Department of Health and Human Services (HHS) playing a major role. Domestic response efforts would be carried out under the all-hazards blueprint for a coordinated federal, state and local response laid out in the National Response Plan, overseen by the Department of Homeland Security (DHS). HHS officials would have the lead in the public health and medical aspects of a response. The federal government has released several pandemic flu plans to govern federal, state, local and private preparedness activities.
There are concerns about how a domestic public health and medical response would be managed during a flu pandemic. There is precedent, under the Stafford Act, for the President to declare an infectious disease threat an emergency (which provides a lower level of assistance), but no similar precedent for a major disaster declaration (which provides a higher level of assistance). In any case, many of the needs likely to result from a flu pandemic could not be met with the types of assistance provided pursuant to the Stafford Act, even if a major disaster declaration applied.
Vaccination is the best flu prevention measure. But because of continuous changes in the genes of flu viruses, vaccines must be "matched" to specific strains to provide good protection. A pandemic flu strain would, by definition, be novel. Stockpiled vaccine would not match, so stockpiling in anticipation of a pandemic is of limited value. In addition, global and domestic capacity to produce flu vaccine is limited. The U.S. government, primarily through HHS, has launched an aggressive effort to expand domestic vaccine production capacity, and to develop technologies to support more rapid production of a matched vaccine at the onset of a pandemic.
Since matched vaccine would not be available at the outset of a flu pandemic that occurred within the next several years, planning efforts focus on measures to slow the spread of disease, and mitigate its effects. These include stockpiling of antiviral drugs to prevent or treat flu infection, planning for medical surge capacity, and continuity planning for businesses and utilities.
This report discusses pandemic flu in general, WHO and U.S. preparedness and response plans, and a number of relevant policy issues. The focus of this report is U.S. domestic public health preparedness and response planning, and the projected impacts of an influenza pandemic on Americans. This report will be updated to reflect changing circumstances.