American Academy of Family Physicians

Printer-friendly version

Share this on AAFP Connection

Share this page

Trust for America's Health

H1N1 Outbreak Shows Flaws in Pandemic Preparedness, Says Report

By News Staff

A new report from the Trust for America's Health gives U.S. public health officials high marks for communication, coordination and ability to adapt to a rapidly changing situation during the recent outbreak of novel H1N1 influenza, but the report (24-page PDF; About PDFs) also says the outbreak revealed that the nation's public health capacity would be overwhelmed by a more severe or widespread outbreak.
"H1N1 is a real-world test of our initial emergency response capabilities," said Jeff Levi, Ph.D., executive director of the Trust for America's Health, in a June 4 news release. "All of the planning and preparations have paid off. The country is significantly ahead of where we were a few years ago.

"However, the outbreak also revealed serious gaps in our nation's preparedness for pandemic flu and other public health emergencies."

The report, "Pandemic Flu Preparedness: Lessons from the Front Lines," says that investments in pandemic planning and stockpiling antiviral medications proved worthwhile, but public health departments lacked staffing and other resources needed to carry out plans. Specifically, state health departments lacked adequate ability to track, investigate and contain the disease outbreak.

According to the report, which was developed in conjunction with the Robert Wood Johnson Foundation and the Center for Biosecurity at University of Pittsburgh Medical Center, the nation has 50,000 fewer public health workers than it did 20 years ago, and it calls on federal, state and local governments to recruit, train and retain the next generation of workers.

The report also says that although the outbreak has been mild in the United States relative to what originally was feared, the health care delivery system still has been overwhelmed. Outpatient facilities had inadequate personal protective equipment and limited understanding of infection control measures.

In addition, although the "worried well" overburdened many emergency departments, concerns about health care costs were a barrier for some patients, especially the under- and uninsured, who did not seek early care.

Some physicians reported that they did not receive guidance documents in a timely fashion from the CDC, and others complained that the guidance they did receive lacked clinically relevant information and practical instructions.

Despite the criticisms, Anne Schuchat, M.D., interim deputy director for the CDC's Science and Public Health Program, said the extensive report was helpful because it identified what has worked and what did not.

"This is the kind of review that we really encourage organizations and communities to do to think about where the gaps are and what we need to do to strengthen those gaps," Schuchat said in a June 4 news conference. "As we've been saying, this is not over."

On June 5, the CDC reported that there were more than 13,000 confirmed and probable cases of novel H1N1 infection in the United States, including 27 deaths. The World Health Organization reported on June 8 that there were 25,288 laboratory-confirmed cases, including 139 deaths, in 73 countries.

Schuchat said the CDC is working with partners in the Southern Hemisphere to understand the course of illness there, while also making extensive preparations for the U.S. flu season this fall. Those preparations include consideration of potential vaccination, laboratory and epidemiologic needs.

In its report, the Trust for America's Health makes ten recommendations aimed at addressing core vulnerabilities in the nation's pandemic preparedness. Among those recommendations:
  • The federal government should take responsibility for updating and restocking the national stockpile of vaccines, antiviral medications and equipment, and HHS should develop a plan for use and stockpiling of antiviral drugs. As of January, states had purchased only 23 million doses of antiviral medications, far below the goal of 31 million.
  • U.S. vaccine development and production capabilities should be enhanced. Sanofi-Pasteur's two domestic influenza vaccine production facilities have a combined capacity of 150 million doses, and GlaxoSmithKline's U.S. facility is not yet operational. Bottom line: the nation will be dependent on highly sought-after imported vaccine in the event of a global pandemic.
  • A system is needed to rapidly vaccinate all Americans. According to CDC officials, it could cost $8 billion to procure the 600 million doses needed to immunize 300 million Americans (if the vaccine requires two doses). That figure does not include needles, syringes, distribution, etc. A registry also would be needed in the case of a two-dose pandemic vaccine.
  • Federal, state, local and private planning and coordination should be ongoing.
  • Strategies to mitigate an outbreak include ensuring that working Americans have sick leave benefits so they do not spread the disease at work. Currently, nearly half of U.S. workers have no paid sick days.
  • A state-of-emergency health benefit should be created to ensure that all Americans will be cared for during a pandemic. More than 15 million Americans lack insurance. The financial impact on the health system would be disastrous if hospitals, health centers and primary care facilities treat large numbers of uninsured patients. It also would be difficult to contain and treat the disease if the uninsured don't seek care.
The report estimates that a pandemic could result in 45 million additional outpatient visits, with as many as 9.9 million patients needing hospitalization.

Share this on AAFP Connection

Health of the Public

Study: PPI Does Not Routinely Improve Asthma Control

Recalled Oral Contraceptives Pose Pregnancy Risk

CDC to Fund 2D Vaccine Barcoding Pilot

2012 Immunization Schedules Reflect Multiple Changes

Study: Cognitive Decline Detected in Middle-aged Adults

CDC Toolkit Can Help Clinicians Fight Norovirus Infection

Patient-Centered Care Linked to Lower Mortality

Study: Inappropriate Cancer Screenings Continue

Novartis Manufacturing Plant Closes After Drug Mix-ups

FDA Announces Classwide REMS for TIRF Medications

New Infants' Acetaminophen Products Hit Store Shelves

Avoid Environmental Factors Linked to Breast Cancer

Risk for Thrombosis Prompts REMS for Rivaroxaban

Common Drugs Implicated in Most Emergency Hospitalizations

CDC Launches Campaign for Child Medication Safety

HHS Blocks Expanded OTC Access to Plan B

Push Is On to Vaccinate Pregnant, Postpartum Women

FDA Committee Votes to Broaden PCV13 Indication

AAFP Foundation Program Aims to Fight Chronic Disease

NIAAA Alcohol Screening Guide Targets Teens

Walgreens, AAFP Launch Flu Vaccine Pilot in Five States

Helping Patients Quit Smoking Starts With a Question

Trilipix Efficacy in Question, Says FDA

USPSTF Addresses Skin Cancer, Obesity, Cervical Cancer Screening

AAFP Endorses ACP Guideline on ED

ACIP Recommends Expanded HPV, Hepatitis B Vaccination

Bacterial Contamination Spurs Nasal Spray Recall

CDC Renews Call for PCV13 Vaccination

USPSTF Recommends Against PSA Screening

AAFP Supports HHS' Million Hearts Initiative

FDA Phases Out Primatene Mist Inhalers

AHRQ Guides Explain Benefits, Risks of GERD Treatments

Tar Wars Winner Gives Back

Office Champions Project Nets Smoking Cessation Gains

Multiple Lots of Oral Contraceptives Recalled

New Vaccine Review Finds Few Adverse Events

HPV Vaccination Rates Still Lag, Says CDC

Renal Injury Prompts Reclast Label Changes

High-dose Citalopram Linked to Abnormal Heart Rhythms

AHRQ Sleep Apnea Guides Review Diagnosis, Management

Board Chair Spotlights Breadth of Family Medicine Training

USPSTF Softens Stance on Bladder Cancer Screening

HHS Expands Coverage for Women's Preventive Services

Teledermatology Project Aids Underserved Patients

New Chantix Warnings Cite Cardiovascular Risk

Pertussis Outbreaks Lead to CDC Alert on PCR Testing