PANDEMIC INFLUENZA PREPAREDNESS: STATE CHALLENGES

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Carmel Freeman
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2 PANDEMIC INFLUENZA PREPAREDNESS: STATE CHALLENGES A Presentation to the Council of State Governments Health Policy Forum by Jeffrey Levi, Ph.D., Executive Director Trust for America s Health June 23, 2006

3 Any community that fails to prepare and expects the federal government will come to the rescue is tragically wrong. It s not because we don t care, don t want to, or don t have the money, but because it s impossible. Secretary of Health and Human Services Mike Leavitt, February, 2006

4 OVERVIEW

5 Questions I Hope to Answer Today What is pandemic influenza and why are public health officials so worried? What are the relative roles and responsibilities of the federal government and the states? What activities have been delegated to the states? What are the gaps in preparedness? How does flu preparedness relate to overall public health and emergency preparedness? What can you do to educate your constituents?

6 PANDEMIC INFLUENZA

7 What is Pandemic Influenza? Flu Terms Defined: Seasonal (or annual or common) flu is a respiratory illness that can be transmitted person to person. Most people have some immunity, and a vaccine is available. Avian (or bird) flu is caused by influenza viruses that occur naturally among wild birds. The H5N1 variant is deadly to domestic fowl and can be transmitted from birds to humans. There is no human immunity and no vaccine is available.

8 What Causes a Flu Virus to Spark a Pandemic? Pandemic flu is virulent human flu that causes a global outbreak, or pandemic, of serious illness. Must be a novel strain of influenza virus that has the ability to jump species and infect people. Humans must lack a pre-existing immune response; there is no existing vaccine. The virus must be able to transmit efficiently from human-to-human.

9 How Often Do Flu Pandemics Occur? Pandemics generally occur three to four times every century: 1918 Pandemic Spanish flu (H1N1) was the most devastating flu pandemic in recent history, killing more than 500,000 people in the United States, and 20 million to 50 million people worldwide Pandemic Asian flu (H2N2) was first identified in China and caused roughly 70,000 deaths in the United States during. Because this strain has not circulated in humans since 1968, no one under 30 years old has immunity to this strain Pandemic Hong Kong flu (H3N2) was first detected in Hong Kong and caused roughly 34,000 deaths in the United States. H3N2 viruses still circulate today.

10 What Are the Differences Between Pandemic Influenza and Seasonal Flu? Seasonal Vaccination is effective because the virus strain in circulation each winter can be fairly reliably predicted. Antiviral drugs are generally available for those most at risk of serious illnesses. Pandemic A vaccine against pandemic flu may not be available at the start of a pandemic. New strains of viruses must be accurately identified, and producing an effective vaccine could take six months or more. Antiviral drugs may be in limited supply, and their effectiveness will only be known definitively once the pandemic is underway.

11 What Are the Differences Between Pandemic Influenza and Seasonal Flu? Seasonal Pandemic Occurs every year during the winter months. Affects 5-20 percent of the U.S. population. Globally, kills 500,000-1 million people each year, 36,000 to 40,000 in the U.S. Most people recover within a week or two. Deaths generally confined to at risk groups, such as the elderly (over 65 years of age); the young (children aged 6-23 months); those with existing medical conditions like lung diseases, diabetes, cancer, kidney, or heart problems; and people with compromised immune systems. Occurs three to four times a century and can take place in any season. May come in waves of flu activity that could be separated by months. Experts predict an infection rate of percent of the U.S. population, depending on the severity of the virus strain. Usually associated with a higher severity of illness and consequently a higher risk of death. All age groups may be at risk for infection, not just at risk groups. Otherwise fit adults could be at relatively greater risk, based on patterns of previous epidemics. For example, adults under age 35 (a key segment of the U.S. workforce) were disproportionately affected during the 1918 pandemic.

12 What Are the Potential Health Impacts of Pandemic Flu?

13 What Are the Potential Economic Impacts of Pandemic Flu? Annual flu costs the U.S. economy over $10 billion in lost productivity and direct medical expenses. Congressional Budget Office estimates: A severe pandemic would reduce GDP by 5% or $675 billion, sparking a recession in the U.S. A mild pandemic would reduce GDP by 1.5% or $160 billion. There could be serious disruptions in the global just in time economy.

14 What Are the Potential Societal Impacts of Pandemic Flu? Surge in demand for medical care and supplies; current health care system will not be able to respond. Ethical issues over rationing healthcare Disruption in all aspects of a community Civil liberties implications of confinement and quarantine Psychosocial effects on community, where great numbers are ill and dying

15 AVIAN OR BIRD FLU

16 Should I Be Worried About Bird Flu? All influenza viruses emanate from avian species, but H5N1 is a more virulent strain. The H5N1 outbreak among domestic chickens and ducks in Asia is widespread and uncontrolled. H5N1 is a PANDEMIC in birds and foul. H5N1 first identified in Asia in Since the beginning of this year the disease has 30 additional countries on two more continents. Experts predict H5N1 will arrive in the U.S. this year. Human infections and deaths due to the avian H5N1 virus have occurred; a little over half of those infected have died. BUT

17 Should I Be Worried About Bird Flu? The H5N1 virus has not yet developed the ability to pass easily from person to person and cause outbreaks in humans. It may never do so. However, it may mutate and spark a pandemic in humans or another influenza strain may be the guilty party. No one can say with any certainty when a pandemic will occur or how severe it will be. OK. Since no one knows for sure about this becoming a pandemic, is all of this hype much ado about nothing -- another Y2K-type scare? Hurricanes and earthquakes happen. Pandemics happen. Preparedness is prudent and will have pay-offs in the event of another health emergency.

18 WHAT ARE THE RELATIVE ROLES OF DIFFERENT LEVELS OF GOVERNMENT?

19 What is the Federal Government Doing to Prepare? White House National Strategy on Pandemic Preparedness Surveillance and Detection Response and Containment Preparedness and Communications Request of $7.1 billion to implement Congress has provided funding through two emergency supplemental spending bills

20 Government-wide Strategy Detailed, agency-by-agency outline of policies and programs to be implemented Specific timelines for making critical decisions Demonstrates the breadth of the impact of a pandemic Many decisions deferred until the start of a pandemic Still a very narrow definition of the government s role

21 What is Federal Government Doing to Prepare? Department of Health and Human Services Pandemic Plan Develop new technologies and manufacturing capacity for a pandemic vaccine Stockpile antivirals, medications and other supplies Provide support for state and local health department preparedness activities

22 What is Missing in the Federal Response? Remaining shortfalls at every level of government and in a pandemic, we are only as strong as the weakest link. Insufficient investment in vaccine Insufficient stockpiles of medicine and supplies Insufficient attention on developing medical surge capacity No technical assistance to state and local health departments Inadequate risk communications to all sectors of society Inattention to projecting costs for delivery of care and vaccine during a pandemic; all current funds are for planning and exercises Stand-by Medicaid benefit Sick leave Stockpiling routine medications

23 What Are Other Levels of Government Doing to Prepare? State Pandemic Plans Provide command-and-control structures Legal authorities Guidance to counties and localities Federal government requiring states to update and exercise plans and complete after action reports Congress providing $350 million to support; another $250 million is pending Local Pandemic Plans Various stages of development

24 What Are Priorities for State Preparedness? State-wide plan that defines responsibilities of different levels of government Advance articulation of priorities for vaccines and anti-virals State-wide assessment of surge capacity; investment in expanded capacity Determine potential cost for building surge California special investment in surge capacity building for all emergencies State-level decision on stockpiling anti-virals

25 What Are Priorities for State Preparedness? (2) Exercising of capacity to mass vaccinate Use of seasonal flu vaccine to test and promote public health Advance communication with the public Advance decisions regarding social distancing and other mitigation strategies Particular focus on vulnerable populations Need to build resiliency in populations for all emergencies Exercise, after-action reports, revise plans, and exercise again

26 Ask More of the Federal Government Where you live should determine your level of protection Only the federal government can assure adequate supply of vaccines and medicine Only the federal government can assure that access to care and financing of care is equitable across the country In a global economy with major businesses crossing state (and national) boundaries, only the federal government can assure that key businesses plan for all contingencies Only the federal government has the capacity to provide the financial resources for state and local preparedness across the country

27 PANDEMIC PREPAREDNESS IS PUBLIC HEALTH EMERGENCY PREPAREDNESS

28 Is This the Scare-of-the-Month? Real levels of concern among scientists With the exception of stockpiling specific drugs and vaccines, the elements of flu preparedness are central to a response to any major catastrophe: natural disasters, bioterrorist attacks, or disease outbreaks Much of the capacity that is being built today is making up for inadequate investment in public health over the last few decades

29 All Sectors Must Prepare A pandemic will affect all sectors of society and states must assure that all sectors are prepared Business Infrastructure Education Community and faith-based organizations Overall government continuity issues Individuals

30 EDUCATE YOUR CONSTITUENTS

31 What Individuals Can Do Practice good infection control Hand washing; cough etiquette; distance from those who are ill Seasonal flu vaccination Stay home when sick Prepare for an emergency Stockpile medicines Stockpile water and food Have key information on hand Plan for alternative child care and transportation arrangements

32 Resources Trust for America s Health brochures Individuals Businesses (produced with the U.S. Chamber of Commerce) Health Professionals (produced with the American Medical Association) Community and Faith-based organizations TFAH s Pandemic Preparedness Initiative is funded by the Pew Charitable Trusts

University of Colorado Denver. Pandemic Preparedness and Response Plan. April 30, 2009

University of Colorado Denver. Pandemic Preparedness and Response Plan. April 30, 2009 University of Colorado Denver Pandemic Preparedness and Response Plan April 30, 2009 UCD Pandemic Preparedness and Response Plan Executive Summary The World Health Organization (WHO) and the Centers for