	Background Information on H1N1

In April 2009, a novel influenza virus began to spread around the world. WHO refers to the virus as Influenza A(H1N1). The U.S. Centers for Disease Control and Prevention (CDC) and other Administration officials refer to it as 2009 H1N1 flu. Throughout this report, the virus is referred to as H1N1. The virus does not appear to be as lethal as H5N1 avian influenza—which reemerged in 2005—but is slightly more lethal than seasonal flu. Although H1N1 has spread enough to be characterized as a pandemic, researchers are not yet sure how virulent the virus will become. As of June 22, 2009, WHO reported that more than 50,000 human cases of H1N1 had been confirmed in more than 80 countries and territories, including 231 deaths ( Table A-1 and Figure A-1 ). The United Nations Food and Agricultural Organization (FAO), the World Organization for Animal Health (OIE), and WHO agree that there is no risk of contracting the virus from consumption of well-cooked pork or pork products. WHO also advises that "limiting travel and imposing travel restrictions would have very little effect on stopping the virus from spreading, but would be highly disruptive to the global community." WHO has tested those who received treatments in Mexico and the United States and found that older antiviral drugs have not been very effective against H1N1, though oseltamivir (brand name Tamiflu®) and zanamivir (brand name Relenza®) are. WHO has been maintaining a global stockpile of approximately 5 million adult treatment courses of oseltamivir that were donated by manufacturers and donor countries. This stockpile was initiated after the onset of H5N1 bird flu outbreaks. WHO has already distributed some of the treatments and is distributing 3 million adult treatment courses from the stockpile to developing countries in need. There is no available vaccine against the current strain of H1N1, though CDC, WHO, and others are working on developing one. As of May 18, 2009, the United States has provided more than $16 million to assist countries in Latin America and the Caribbean respond to H1N1 outbreaks. At the onset of the outbreak, CDC sent experts out to the field to help strengthen laboratory capacity and train health experts to control the spread of a virus. In total, the Administration aims to distribute 2 million courses in Latin America and the Caribbean. The U.S. Agency for International Development

USAID announced on April 28, 2009, that it would provide an additional $5 million to WHO and the Pan American Health Organization (PAHO) in support of efforts to respond to the H1N1 virus in the Latin America and the Caribbean, with particular emphasis placed on advanced disease surveillance and control measures. The assistance includes support to FAO for animal surveillance efforts in Mexico and other parts of Latin America and the Caribbean and provision of commodities. In May 2009, it distributed more than 100,000 personal protection equipment (PPE) kits valued at more than $1 million from its avian and pandemic influenza stockpile to protect first responders in the region from contracting or spreading the disease. USAID also announced that it had already pre-positioned 400,000 PPE kits in 82 countries in preparation of a possible influenza pandemic. The $949 million was provided for the following efforts:
$319 million for bilateral activities; $196 million for support to international organizations, including WHO, the U.N. Food and Agriculture Organization (FAO), the U.N. Development Program (UNDP), the International Federation of the Red Cross and Red Crescent Societies (IFRC), the U.N. System Influenza Coordinator (UNSIC), the World Organization for Animal Health (OIE), and the U.N. Children's Fund (UNICEF); $123 million for regional programs, including disease detection sites; $83 million for a global worldwide contingency, available to address the evolving nature of the threat; $77 million for international technical and humanitarian assistance and international coordination; $71 million for international influenza research (including vaccines and modeling of influenza outbreaks) and wild bird surveillance, including the U.S. launch of the Global Avian Influenza Network for Surveillance (GAINS) for wild birds, with a collection of tens of thousands of samples for H5N1 analysis; $67 million for stockpiles of non-pharmaceutical supplies, including over 1.6 million PPE kits, approximately 250 laboratory specimen collection kits and 15,000 decontamination kits for use in surveillance, outbreak investigation and emergency response and containment efforts; and $13 million for global communications and outreach. Investments that the United States and other international players have made to prepare for a possible influenza pandemic, and to monitor the spread of other infectious diseases, have been applied to the most recent global response to H1N1. Some health experts are concerned that some of the poorer countries may not yet have the capacity to sufficiently monitor and respond to H1N1. Questions still remain about whether the virus could change or reassort its genes, particularly should outbreaks in countries simultaneously contending with H5N1 bird flu cases occur (such as Egypt, Vietnam, and Indonesia).
In April 2009, a novel influenza virus began to spread around the world. The World Health Organization (WHO) refers to the virus as Influenza A(H1N1). The U.S. Centers for Disease Control and Prevention (CDC) and other Administration officials refer to it as 2009 H1N1 flu. Throughout this report, the virus is referred to as H1N1. The virus does not appear to be as lethal as H5N1 avian influenza—which reemerged in 2005—but is slightly more lethal than seasonal flu. Although the virus has been characterized as a pandemic, researchers can not predict how virulent the virus will be ultimately.
As of June 22, 2009, WHO confirmed that more than 50,000 human cases of H1N1 had occurred in more than 80 countries and territories, including 231 deaths. With the exception of Britain and Australia, all human deaths have occurred in the Americas. About 87% of all deaths have occurred in Mexico (49%) and the United States (38%). The United Nations Food and Agricultural Organization (FAO), the World Organization for Animal Health (OIE), and WHO agree that there is no risk of contracting the virus from consuming well-cooked pork or pork products. WHO asserts that limiting travel and imposing travel restrictions would minimally affect the spread of the virus, but would be highly disruptive to the global community.
The strain of H1N1 circulating the globe is treatable with two antiviral drugs, oseltamivir (brand name Tamiflu®) and zanamivir (brand name Relenza®), though there is no available vaccine. WHO has been maintaining a global stockpile of approximately 5 million adult treatment courses of oseltamivir that were donated by manufacturers and donor countries. This stockpile was initiated after the onset of H5N1 bird flu outbreaks. WHO has already distributed some of the treatments through the WHO Regional Offices and is distributing 3 million treatment courses from the stockpile to developing countries in need.
As of May 18, 2009, the United States had provided more than $16 million to assist countries respond to H1N1 outbreaks. Global responses by U.S. agencies to H1N1 are conducted primarily by CDC and the U.S. Agency for International Development (USAID), though DOD does provide some support to global aid. CDC has sent experts to Latin America and the Caribbean to help the countries strengthen laboratory capacity and train health experts. HHS has already sent 400,000 treatment courses to Mexico, accounting for less than 1% of the total American stockpile. In total, the Administration aims to provide 2 million courses to Mexico. USAID announced on April 28, 2009, that it would provide an additional $5 million to WHO and the Pan American Health Organization (PAHO) for interventions against H1N1 in Mexico and Central America. To date, USAID has provided $6.2 million for international H1N1 assistance. The assistance includes support to FAO for animal surveillance efforts in Mexico and other parts of Central America, and the provision of personal protection equipment (PPE) kits from its avian and pandemic influenza stockpile to prevent first responders from contracting or spreading the disease. In May 2009, it distributed more than 100,000 PPE kits in Mexico City and announced that it had already pre-positioned 400,000 PPE kits in 82 countries in preparation of a possible influenza pandemic.
Investments that the United States and other stakeholders have made to prepare for a possible influenza pandemic, and to monitor the spread of other infectious diseases, have been applied to the most recent global response to H1N1. While health experts have made considerable gains against the disease, questions remain. Some health experts are concerned that poorer countries may not yet have the capacity to sufficiently monitor and respond to H1N1. Others warn that H1N1 transmission might accelerate in winter months. Questions still remain about whether the disease can change or reassort, particularly in countries simultaneously contending with H5N1 bird flu cases occur (such as Egypt, Vietnam, and Indonesia).