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Ten Lessons Learned from the H1N1 (Swine) Flu Outbreak

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The H1N1 outbreak showed how quickly a new flu strain can emerge and travel around the world. The sudden outbreak of this novel flu strain has tested the world's public health preparedness. H1N1 provided a real-world test that revealed both the strengths and the weaknesses of the ability of the United States and the rest of the world to respond to a major infectious disease outbreak.

We learned a number of lessons from the initial response to the outbreak -- and it's important we take the time to learn from these lessons since there's a real possibility that H1N1 will re-emerge in the fall -- either in its current form or as a more virulent strain, or a different version of the flu, like the H5N1 bird flu could emerge.

Overall, it was clear that all of the pandemic planning and preparations over the last several years have significantly improved our nation's ability to respond to an outbreak. However, it was also clear that the H1N1 did not really test the limits of our response system.

In a new report we released this week with the Robert Wood Johnson Foundation and the Center on Biosecurity, "Pandemic Flu: Lessons from the Frontlines," we identified 10 key lessons learned from the initial H1N1 response:

1. Investments in pandemic planning and stockpiling antiviral medications paid off.
2. Public health departments did not have enough resources to carry out plans.
3. Response plans must be adaptable and science-driven.
4. Providing clear, straightforward information to the public -- from the president on down to local officials -- was essential for allaying fears, building trust, and acting to contain the spread of the virus.
5. School closings have major ramifications for students, parents and employers.
6. Sick leave and policies for limiting mass gatherings were also problematic.
7. Communication between the public health system and health providers was not well coordinated, with many private clinicians not receiving guidance on a timely basis.
8. The World Health Organization pandemic alert phases caused confusion.
9. International coordination was more complicated than expected.

Addressing the gaps in our nation's preparedness will require an increased investment. Over the last few weeks, the Administration recognized the importance of providing additional funding on the response to H1N1 by requesting $2 billion in an emergency supplemental on April 30th. This week, an additional request was sent to Congress, which would bring the total in new funding potentially available to $11.6 billion. This Administration clearly recognizes that purchasing the H1N1 vaccine is a public responsibility.

But we have two concerns associated with this request. First, while this represents a significant amount of money, it may not be sufficient to establish a system that could vaccinate all Americans. This would require a publicly-directed program that would make sure the highest priority individuals are vaccinated first, that we are able to monitor closely for side effects, and that we have a recall system in place to assure that people can return for a second dose, if necessary. And we need to act quickly to get the money to state and local health departments now so they are able to put these systems in place by the fall.

Second, the Administration's request, as it is currently formulated, will come at the expense of other vitally important programs. In particular, the Administration proposes diverting $2.9 billion from Project Bioshield programs to support H1N1 vaccine development. That means taking money away from the development and procurement of antivirals and vaccines that would respond to other important threats, such as smallpox and anthrax. This is a robbing-Peter-to-pay-Paul approach, and that doesn't fit with this Administration's commitment to transparent budgeting. If we need this money for an H1N1 vaccine, it should appropriated directly.

Overall, the county is significantly more prepared to respond to a pandemic now than we were a few short years ago, but there are still major gaps in our core public health capabilities that must be addressed if we're going to be able to protect the American public from future threats.