	Background

To be prepared for major public health threats such as an influenza  pandemic, public health agencies need several basic capabilities, including  disease surveillance systems. One  action the department has taken is the development of a draft national  pandemic influenza plan, titled “Pandemic Influenza Preparedness and  Response Plan.”
CDC is charged with protecting the nation’s public health by directing  efforts to prevent and control diseases and responding to public health  emergencies. Existing Influenza Surveillance System and Enhancements Would Be Used to Identify an Influenza Pandemic

Surveillance is a key component in planning for an influenza pandemic,  and federal public health officials plan to rely on the nation’s existing  annual influenza surveillance system and enhancements to identify an  influenza pandemic. Federal public health officials have undertaken  several initiatives that are intended to enhance influenza surveillance  capabilities. These initiatives have been undertaken both through  programs specific to influenza as well as through programs focused more  generally on increasing preparedness for bioterrorism and other emerging  infectious disease health threats. Federal officials have also implemented  initiatives designed to improve public health communications and have  undertaken initiatives intended to improve the coordination of zoonotic  surveillance efforts. Data submitted on  influenza activity in the United States include data from more than 120  laboratories and 2,000 health care providers and mortality reports from  122 cities. Federal Agencies Have Undertaken Initiatives to Enhance Influenza Surveillance

CDC has undertaken several initiatives that are intended to enhance  influenza surveillance capabilities in preparation for an influenza  pandemic. Also, when  concerns were raised over recent influenza seasons that the avian  influenza A (H5N1) could become the next influenza pandemic, CDC led a  variety of efforts with its international partners to plan for and address  threats of increased influenza activity worldwide. For example, CDC  worked collaboratively with WHO to conduct investigations of avian  influenza A in Vietnam and to provide laboratory testing. CDC also  provided training assistance and has implemented an initiative to improve  influenza surveillance in Asia. Moreover, recent outbreaks  of human disease caused by avian influenza strains in Asia and Europe  highlight the potential for new strains to be introduced into the  population. Despite Efforts by Federal Officials, Challenges Remain regarding Preparedness for and Response to an Influenza Pandemic

Challenges regarding the nation’s preparedness for and response to an  influenza pandemic remain. For example, some decisions yet to be made include determining  the public- versus private-sector roles in the purchase and distribution of  pandemic influenza vaccines; the division of responsibility between the  federal government and the states for vaccine distribution; and how  population groups will be prioritized and targeted to receive limited  supplies of vaccines. Challenges Persist in Ensuring an Adequate and Timely Influenza Vaccine Supply

Challenges persist in ensuring an adequate and timely influenza vaccine  supply. Implementation of Control Measures to Prevent Spread of Pandemic Influenza Presents Difficulties

Another challenge in responding to an influenza pandemic involves  implementing certain control measures to prevent the spread of the  disease. Most Hospitals Lack the Capacity to Respond to Large-Scale Infectious Disease Outbreaks

A challenge identified during the SARS outbreak that may also affect  response efforts during an influenza pandemic is lack of sufficient hospital  and workforce capacity. The steps HHS is  taking to address vaccine production capacity and stockpiling of antiviral  drugs may not be in place in time to fill the current gaps in preparedness  should an influenza pandemic occur in the next several years. Since 2000, we have been urging the department to complete its pandemic  plan.
Why GAO Did This Study

Vaccine shortages and distribution problems during the 2004-2005 influenza season raised concerns about the nation's ability to respond to a worldwide influenza epidemic--or influenza pandemic--which many experts believe to be inevitable. Some experts believe that the next pandemic could be spawned by the recurring avian influenza in Asia. If avian influenza strains directly infect humans and acquire the ability to be readily transmitted between people, a pandemic could occur. Modeling studies suggest that its effect in the United States could be severe, with one estimate from the Centers for Disease Control and Prevention (CDC) ranging from 89,000 to 207,000 deaths and from 38 million to 89 million illnesses. GAO was asked to discuss surveillance systems in place to identify and monitor an influenza pandemic and concerns about preparedness for and response to an influenza pandemic. This testimony is based on GAO's 2004 report on disease surveillance; reports and testimony on influenza outbreaks, influenza vaccine supply, and pandemic planning that GAO has issued since October 2000; and work GAO has done in May 2005 to update key information.

What GAO Found

Federal public health officials plan to rely on the nation's existing influenza surveillance system and enhancements to identify an influenza pandemic. CDC currently collaborates with multiple public health partners, including the World Health Organization (WHO), to obtain data that provide national and international pictures of influenza activity. Federal public health officials and health care organizations have undertaken several initiatives that are intended to enhance influenza surveillance capabilities. While some of these initiatives are focused more generally on increasing preparedness for bioterrorism and other emerging infectious disease health threats, others have been undertaken in preparation for an influenza pandemic. For example, in response to concerns over the past few years about the potential for avian influenza to become the next influenza pandemic, CDC implemented an initiative in cooperation with WHO to improve influenza surveillance in Asia. CDC has also implemented initiatives to improve the communications systems it uses to collect and disseminate surveillance information. In addition, CDC, the Department of Agriculture, and the Food and Drug Administration have made efforts to enhance their coordination of surveillance efforts for diseases that arise in animals and can be transferred to humans, such as SARS and certain strains of influenza with the potential to become pandemic. While public health officials have undertaken several initiatives to enhance influenza surveillance capabilities, challenges remain with regard to other aspects of preparedness for and response to an influenza pandemic. In particular, the Department of Health and Human Services (HHS) has not finalized planning for an influenza pandemic. In 2000, GAO recommended that HHS complete the national plan for responding to an influenza pandemic, but the plan has been in draft format since August 2004. Absent a completed federal plan, key questions about the federal role in the purchase, distribution, and administration of vaccines and antiviral drugs during a pandemic remain unanswered. Other challenges with regard to preparedness for and response to an influenza pandemic exist across the public and private sectors, including challenges in ensuring an adequate and timely influenza vaccine and antiviral supply; addressing regulatory, privacy, and procedural issues surrounding measures to control the spread of disease, for example, across national borders; and resolving issues related to an insufficient hospital and health workforce capacity for responding to a large-scale outbreak such as an influenza pandemic.