Pandemic Influenza: U.S. Government Perspective on International Issues

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1 Pandemic Influenza: U.S. Government Perspective on International Issues James Lawler, M.D., M.P.H. Director for Biodefense Policy White House Homeland Security Council

2 A 1918-Like Pandemic Would Have a Significant Toll Today Severe Pandemic (1918-like) in the U.S. Illness 90 million (30%) Outpatient medical care 45 million (50%) Hospitalization 9, 900,000 ICU care 1,485,000 Mechanical ventilation 745,500 Deaths 1,903,000 Congressional Budget Office estimates 4.75% reduction in U.S. GDP, not including years of productivity lost

3 1900-Present All Cause Death Rates per 100,000 with a 1918-like Pandemic Today 1918 Age-specific Attack Rates and CFRs Applied to Current Population 2,000 1, years 5-9 years years 1, years

4 Vaccine Production After A Pandemic Begins Vaccine Production After Pandemic Virus Emerges 300 Production Target Scenario A Scenario B Scenario C Scenario D Scenario E Scenario F Scenario G 50 0 Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Months After Pandemic Begins

Implementation Plan for the National Strategy Released on May 3, 2006 Contains over 300 actions for Federal Departments and Agencies Chapter 4

5 Implementation Plan for the National Strategy Released on May 3, 2006 Contains over 300 actions for Federal Departments and Agencies Chapter 4 International Efforts Solidifies U.S. commitment Frames U.S. international efforts Preparedness and Communication Surveillance and Detection Response and Containment

6 International Considerations Prevent and Contain Outbreaks Abroad Global Threat: Outbreak anywhere threatens populations everywhere. International efforts to fight PI essential. Best Line of Defense: Contain AI outbreaks in animals, educate now to prevent animal to human transmission, prepare now to contain any human to human outbreaks. Build National Capacity: Help countries at risk strengthen ability to prevent, detect, respond to, contain suspected outbreaks Build International Capacity: Strengthen international health organizations ability to respond rapidly to outbreaks and to help countries at risk build capacity Support Coordinated International Response: Coordinate assistance/rapid response support to at risk countries; encourage cross-border cooperation to prevent/contain outbreaks

7 International Action Preparedness and Communication Over 172 countries have developed pandemic plans Includes all nations in the Western Hemisphere Success of international partnerships International Partnership on Avian and Pandemic Influenza (IPAPI) - among others International donor (and loan) pledges now $2.35 billion U.S. pledge of $434 million is most of any nation Special bilateral engagements moving forward Mexico and Canada through Security and Prosperity Partnership (SPP) Indonesia and Singapore through Tangerang Trilateral Project China Project

8 International Action Surveillance & Detection Human and animal disease International Health Regulations (IHRs) will improve reporting U.S. led international call for early, voluntary implementation Lessons learned Indonesia: Increased coordination, capabilities, transparency and political will necessary Rapid response, particularly in the agriculture sector is difficult Earliest stages of human-to-human spread are difficult to detect: complexity of diagnosis, route of transmission, and lack of organized reporting State Department leads interagency group focused on Indonesia Continued focus on priority areas of concern: Indonesia, China and Africa

9 International Action Response & Containment International Stockpile: USG has forward-positioned antiviral medications to contain human- to-human transmission in early stages of a pandemic Treatment courses at secure location in Pacific Rim Additional sites possible Potential access to stockpile encourages reporting Rapid-response capability of UN organizations increasing Creation of Food and Agriculture Organization s (FAO) Crisis Management Center WHO strengthening rapid response and containment protocol and the Global Outbreak Alert Response Network

10 AI: International Situation as of 12/13/06

WORLD BANK RESPONSE TO INFLUENZA A(H1N1) Rakesh Nangia Director, Strategy & Operations Human Development Network

WORLD BANK RESPONSE TO INFLUENZA A(H1N1) Rakesh Nangia Director, Strategy & Operations Human Development Network Tokyo, July 2009 World Bank Response to A(H1N1) Influenza A(H1N1) Global Health and Risks