The US pandemic influenza implementation plan at six months

Abstract

There has been great concern recently about pandemic influenza. The US government developed a National Strategy for Pandemic Influenza in November 2005, followed by an implementation plan in May 2006. A sixmonth progress report was published in late December. The current strategies are intended to improve preparedness and response for the next influenza pandemic. In comparison with the optimistic neglect that often characterized past planning for pandemic influenza, there has been considerable progress on a number of fronts in the past year. Despite this progress, major gaps remain. These include the coordination, encouragement and funding of international surveillance and cooperation; the need for new and more agile vaccine technologies; limitations in the use and distribution of antiviral agents; and communication with, and resources for, local responders and the public. One question is why, despite an estimated 36,000 seasonal influenza deaths annually in the United States alone, and a much greater number during pandemics, relatively little new basic research has been done for decades. This emphasizes both the need for and the difficulty of sustaining pandemic preparedness. There is good reason to be concerned about a future influenza pandemic. There were three in the twentieth century, in 1918–1919, 1957 and 1968, and most virologists believe that pandemics are inevitable1. The greatest influenza pandemic, in 1918–1919, was also the worst natural disaster in recorded history, with an estimate of over 50 million deaths worldwide2–4. Concern about the state of pandemic preparedness and response has been increasing over the last decade. In 1999, when the World Health Organization (WHO) produced pandemic planning recommendations, only Canada and the UK already had plans. By 2007, 29 countries had submitted plans (available at http://www.who.int/csr/disease/avian_ influenza/links/en/index.html) to WHO. Next year will mark the 90th anniversary of the great pandemic of 1918, making it especially timely to take stock of our readiness for the next pandemic. On 1 November 2005, the President of the United States declared that “nature has presented us with a daunting challenge: the possibility of an influenza pandemic,” and announced the government’s National Strategy for Pandemic Influenza (http://www. pandemicflu.gov, under Federal Planning). This strategy is intended to address the next influenza pandemic, whichever influenza virus is the cause. Although we do not know whether the H5N1 avian influenza strain will ever develop the ability to spread readily from person to person and thus become pandemic, this virus has recently been getting close scrutiny. It has already caused serious human illness and deaths, primarily although not exclusively through close contact with infected poultry. There have also been tremendous economic losses for poultry farmers.