USG Policy Perspectives on Global Influenza IOM Committee for the Assessment of DoD-GEIS Influenza Surveillance & Response Programs Ms. Ellen P. Embrey Deputy Assistant Secretary of Defense Force Health Protection and Readiness December 2006
Agenda Disease Status Progress in National Pandemic Strategy Implementation Plan tasking Surveillance Considerations Vaccine and Anti-viral Considerations Budget Watch board 2
Pandemic influenza and H5N1 bird flu The avian influenza virus (H5N1) currently meets two of the three key WHO criteria for pandemic influenza: 1. Appearance of a new influenza virus strain to which the general population has little or no immunity 2. The new strain must be capable of causing disease in humans 3. The influenza virus must be easily spread by human-tohuman transmission 3
Confirmed human cases of H5N1 infection Reported to WHO, data as of November 19, 2006 Slide modified from Roche presentation 4
H5N1 Status As of 29 Nov: 258 Cases 154 Deaths Indonesia remains hot spot with 55 cases and 45 deaths this year No change in epidemiology Clade 2 predominates Clusters still occur Age distribution unchanged 5
Applicable Guidance & Authority National Strategy HSC oversight POTUS signed Nov 2005 Establishes 3 pillars Preparedness and Communication Surveillance and Detection Response and Containment National Implementation Plan HSC oversight POTUS signed May 2006 Directs Departments and Agencies to develop supporting plans Assigns 323 USG tasks domestic and international HSC identified 4 planning priorities DOD added 5th Protection of Health/Safety of Personnel/Resources Determination of Essential Functions/Services Support to Federal-State-Local levels Effective Communications Support to Int l Partners, Int l Stability and Security DOD has USG lead for 31 tasks and supports additional 83 tasks DoD Implementation Plan - DEPSECDEF signed Aug 2006 Top priority protection of DOD forces critical military, civilian, contractors and resources to maintain readiness priority consideration...given to protect DOD beneficiaries Assigns roles and responsibilities across DOD domestic and international 6
Requirements Timeline DoD Implementation Plan Approved, August 2006 DoD is USG lead for 31 tasks in the President s plan DoD provides White House quarterly status on 31 tasks 20 of 21 DHP Tasks have suspense on or before February 2008. 9 of 10 non-dhp Tasks have suspense on or before February 2008. Force Health Protection aspects of the Plan s requirements, risks and options have been identified for FY 07/08: Sustain FY06 expanded surveillance infrastructure Acquire Vaccines for DoD s population at risk Non-medical Plan requirements, risks and options for FY07/08 are still being evaluated 7
DoD s Tasks National Implementation Plan 114 total tasks for DoD: 31 of 114 Tasks: DoD is USG lead 20 of which are Force Health Protection related 83 of 114 Tasks: DoD supports USG lead 53 of which are Force Health Protection related 8
DoD National Pandemic Implementation Plan Taskings DoD Tasks are On schedule Met all 6 month suspense taskings On track with all 18 month suspense taskings DoD fully integrated with interagency efforts Antiviral prioritization Vaccine prioritization Risk communication 9
Overall DoD Strategy Community Based, Layered approach Health Surveillance Human Animal Social Distancing Tailored to local requirements Infection Control Pharmacologic (Vaccine and Antivirals) Communication Providers Beneficiaries DoD Leaders/Employees 10
Surveillance Considerations DoD surveillance activities - critical capabilities for pandemic response Provides early outbreak detection and enables rapid isolation response FY06: DoD expanded its global surveillance capabilities from 30 to 56 countries DoD to markedly expand operations where DoD serves as the lead for USG 11
FY 06 Surveillance Requirements and Geographical Scope Expand DoD global influenza surveillance capabilities where PI is most likely to emerge Rapid, accurate laboratory testing Expand equipment, supplies Serve as a platform for testing rapid diagnostic tools Logistics Support Expand staff and response personnel Identify risks and expand capability in concert with HHS, CDC, DoS, USDA, WHO Original countries covered by DoD as of Dec 05 = 30 FY06 investments added 26 additional countries (as of Nov 06) Critical countries to add in future Mexico, Panama, Brazil, Hungary and Georgia 12
Pre-Pandemic Influenza Vaccine Considerations New Pre-Pandemic Influenza Vaccine Program Annual procurement of pre-pandemic vaccine is new requirement Existing DoD stockpile acquired with FY 06 Supplemental PI funds Protective Effect of Pre-Pandemic Vaccine Unknown: Vaccines from pre-pandemic strains will likely confer some immunity Current pre-pandemic vaccine requires two injections to achieve some immunity Shelf life of pre-pandemic vaccine is 18 months Highest potency within 12 months 13
Vaccine & Antiviral Interventions in a Pandemic There are limitations to the role of vaccines in a pandemic: Seasonal vaccines not likely to be effective for a pandemic A vaccine which fully matches the pandemic strain will not be available for 6-9 months after a pandemic emerges Manufacturing capacity for pandemic vaccine will likely be less than optimal during a pandemic Antivirals: Can be used for treatment or prophylaxis Best to take antivirals as soon as possible after symptom onset 14
Budget No supplemental funding for FY07 PI Plan funding for FY07 ($100M) PI Plan funding for FY 08 ($100 M) 15
Communication MHS Watchboard transitioning to DoD site Will incorporate non-medical DoD activities as well as previous MHS content DoD Pandemic Flu Watchboard https://fhp.osd.mil/aiwatchboard/index.html 16
DoD PI Watchboard Has direct link to and from Pandemicflu.gov Expanding risk communication library Beneficiaries with web access Providers to download and modify to suit local requirements Provider link Clinical guidelines, policies, guidance Changes to guidance and recent developments in clinical knowledge 17
Watchboard Future content Q & A and FAQ library Ability to post questions Public Health Emergency Officer s corner 18
Backup Material 19
Human H5N1 Infections Worldwide 20
China China 2003-2006 2003-2006 21 21 cases cases 14 14 deaths deaths Egypt Egypt 2006 2006 15 Iraq 15 cases cases Iraq 7 2006 7 deaths deaths 2006 3 3 cases cases 2 Thailand 2 deaths deaths Thailand 2004-2006 2004-2006 25 25 cases cases 17 17 deaths deaths Reflects WHO lab-confirmed cases only, as of 29 November 2006 Indonesia Indonesia 2005-2006 2005-2006 74 74 cases cases 57 57 deaths deaths 22
Summary of DoD Public Health Surveillance Infrastructure by FY Capability FY05 FY06 FY07 Comment Total # Countries in Network 30 56 65 Increases in S Amer, Africa, Mid East, SE Asia Sampling Capacity # Specimens / year ~9000 ~16000 ~18000 Increased surge capacity and improved analysis capability # Biosafety Level 3 Labs in Network 3 4 8 USAMRIID + new BL-3: LRMC, AFRIMS, NHRC Data Integration No Yes Yes Coord Center: synthesis for leadership, 24/7 23