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Sustaining Focus on Pandemic Preparedness: National and International Efforts

March 25, 2009

1 In February 2009, the General Accountability Office issued a report on the status of pandemic influenza planning. This is the first substantive post in a series of three in depth reviews of the results that were arrived at in the report. The next two posts are linked here: Federal Efforts and Further Actions and Accountability.

This post is focused on these sections of the report: Efforts Are Underway to Improve the Surveillance and Detection of Pandemic-Related Threats in Humans and Animals, but Targeting Assistance to Countries at the Greatest Risk Has Been Based on Incomplete Information, and Pandemic Planning and Exercising Has Occurred in the United States and Other Countries, but Planning Gaps Remain.

The first take-home from the surveillance section is that the United States is playing the role of the rich Uncle Sam, having accounted for 31% ($629MM) of the total monies targeted toward international avian and pandemic flu prevention efforts by April 2008. As befitting intractable problems that aren’t receiving the amount of attention that they warrant, the money has been targeted at those places where the risk is considered highest. Places like Vietnam, Indonesia and Nigeria have all benefited from international pandemic flu money.

There is a worry, though, that because of the incomplete picture of the burden of H5N1 avian influenza, these risk-based targeted efforts might be misplaced. If places like Indonesia does not release the genetic sequences of flu outbreaks, then the international community cannot correctly judge the risk and money might be sent to the wrong place. While not mentioned in the report, it should be noted that places like China, that don’t routinely and promptly report novel outbreaks (see SARS), can also potentially screw up the risk equation. Lest we think we’re perfect in this regard, the lack of oversight of animal surveillance is also a problem in the United States. The report notes that local, state and federal animal inspection agencies do not currently have a good grasp on the location or numbers of backyard birds nor any way to surveil them; though it is noted that efforts to fix that are underway.

The next section of the report talks about pandemic planning. It is still assumed that a pandemic will occur, despite our best surveillance and detection efforts, so extensive planning and exercising should take place. The report makes mention of a lack of coordination among federal planners  and responders both internally and with state and local planners and responders, though tangentially. Both the report and this series cover this problem area more in depth in another section.

At the international level, it is reported that 141 countries have submitted pandemic influenza plans. The United States has worked with partner countries to develop a framework for pandemic response that is compatible with the US strategy and includes the appointment of a United Nations System Influenza Coordinator and global conferences to review and refine plans.

The report makes no judgement about quality of the plans submitted, though, and says that there is significant differences between the best and the worst. Most countries (145) have exercised some sort of pandemic response, though only 25% reported that testing took place at the federal and local levels. Further more, only 45 countries have taken the lessons learned from those exercises and updated their plans.

This report relied heavily on the August 2007 GAO report on the National Pandemic Strategy and  Implementation Plan, and echoed many of the concerns initially voiced there. Among the most egregious of these continuing concerns:

The documents fully address only one of the six characteristics, by reflecting a clear description and understanding of problems to be addressed. Further, the National Pandemic Strategy and Implementation Plan do not address one characteristic at all, containing no discussion of what it will cost, where resources will be targeted to achieve the maximum benefits, and how it will balance benefits, risks, and costs. Moreover, the documents do not provide a picture of priorities or how adjustments might be made in view of resource constraints.

and

[S]tate and local jurisdictions that will play crucial roles in preparing for and responding to a pandemic were not directly involved in developing the National Pandemic Implementation Plan, even though it relies on these stakeholders’ efforts.

and finally

[R]elationships and priorities among actions were not clearly described, performance measures were not always linked to results, and insufficient
information was provided about how the documents are integrated with other response related plans, such as the NRF. We recommended that the HSC establish a process for updating the National Pandemic Implementation Plan and that the updated plan should address these and other gaps. HSC did not comment on our recommendation and has not indicated if it plans to implement it.

Animal outbreaks are not much better planned for, and states and locals, well:

[A]n HHS-led interagency assessment of states’ plans found on average that states had “many major gaps” in their influenza pandemic plans in 16 of 22 priority areas, such as school closure policies and community containment, which are community-level interventions designed to reduce the transmission of a pandemic virus. The remaining 6 priority areas were rated as having “a few major gaps.”

The report touches, very briefly, on the status of private sector pandemic preparedness, choosing to focus on the financial sector, which has been identified as critical infrastructure. In this sector, only one of seven surveyed corporations had completed a formal plan.

Next up, federal efforts.

Image credit: GAO

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