PANDEMIC INFLUENZA PREPAREDNESS: THE FEDERAL ROLE Avian Flu, Pandemic Diseases, and their Economic and Social Consequences The College of Physicians of Philadelphia September 28, 2006 Jeffrey Levi, Ph.D., Executive Director
Overview ď Ž
What are the core elements of preparedness and what level(s) of government have taken responsibility for them? What is the federal government doing to prepare? What are the key policy issues that require closer attention?
What Are the Potential Health Impacts of Pandemic Flu?
Division of Labor Between Federal and State/Local Governments
Federal focus on science, production capacity, global issues, resources and guidance to states and localities.
Unprecedented investment in public health ($5.6 billion in 2006 of the $7.1 billion request by the President) Unprecedented level of attempted coordination within the federal government
National Strategy is truly government wide, with accountability measures
Traditional role of states and localities as “implementers” of public health policy
Resources for planning and exercising ($600 million to date)
Elements of Preparedness: Research and Development
Better surveillance systems
Technology Human/lab capacity (global and domestic)
Better diagnostics Better vaccines Better antivirals
Traditional a federal responsibility (NIH, CDC) Need for private sector investment
Elements of Preparedness: Vaccine Manufacturing and Distribution
Current domestic production capacity and potential need in a pandemic Major government investment in increasing domestic production capacity ($1.7 billion)
What should the target be?
Cover the U.S. population? What is our global responsibility?
Who should stockpile a pre-pandemic vaccine? Who should determine how limited supply is distributed? Liability and compensation issues
Elements of Preparedness: Antiviral Manufacturing, Stockpiling and Distribution
Target is 25% of the U.S. population Potential to achieve stockpile by end of 2007 Financing strategy
44 million courses purchased by federal government Optional purchase by states (31 million courses)
How will the stockpile be used?
Contain pandemic abroad? Prophylaxis vs. treatment? Reserve for critical workers?
Where You Live May Determine Whether Your Survive a Pandemic ď Ž
Should there be a single hierarchy for distribution of vaccines? Of antivirals? Should the federal government assure equitable access to vaccines and antivirals?
Elements of Pandemic Preparedness: Surge Capacity (1)
We can’t meet the level of demand: how do we accommodate? How do we communicate to the public how little (if any surge) we have? Who should assure there is increased capacity?
Some things can be addressed: stockpiling supplies (PPE, needles, chronic disease meds)
Who should determine how we do triage for accessing care and critical life-support systems?
Elements of Pandemic Preparedness: Surge Capacity (2)
How do we assure there is a workforce to staff hospitals and other health care facilities? Money for planning, but not implementation What agency should be responsible? How do we keep hospitals and clinics financially viable during a pandemic and after the pandemic? How do we assure that the uninsured and under-insured seek care for public health reasons?
Elements of Preparedness: Mitigation Strategies
Health care setting
Better science Uniform policies
Schools Public gatherings Border closings; transportation restrictions
Antivirals Pre-pandemic vaccination
Elements of Preparedness: Vulnerable Populations
Uninsured Underinsured (e.g., stockpiling drugs) Undocumented Those without sick leave Those dependent on social services that might be disrupted Those most affected by disruption in economy
Lost wages if workplace shuts down
Elements of Preparedness: Recovery ď Ž
Must take steps now to assure that an economy that might be severely disrupted can emerge quickly from a pandemic Need to assure that the health care system is financially viable after a pandemic
Ask More of the Federal Government
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
“Return on Investment” in Preparedness
Strengthens our capacity to respond to other emergencies Improves our response to seasonal flu
Reduce 36,000 annual deaths
Raises important social and structural questions in a public health context
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
www.pandemicfluandyou.org www.pandemicflu.gov www.healthyamericans.org 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