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Immediate action is needed to prepare the United States for a deadly pandemic of influenza, the Infectious Diseases Society of America (IDSA) is telling policymakers.
In meetings with congressional and administration leaders, IDSA has explained that the H5N1 "bird flu" spreading in Asia has the potential to develop into a pandemic like the one that claimed more than half a million American lives in 1918. Even if this strain does not emerge as a pandemic, infectious disease experts agree that another flu pandemic is just around the corner. The Centers for Disease Control and Prevention (CDC) predicts even a "mild" pandemic could kill at least 100,000 people if the nation is not prepared.
"This year's serious problems with flu vaccine supply showed us just how unprepared we are," says Andrew T. Pavia, chair of IDSA's Pandemic Influenza Task Force. "If this had been a pandemic year, we would have been in serious trouble. Now is the time to fix these problems and develop the ability to respond, before the pandemic strikes."
IDSA has outlined seven steps to prepare for a flu pandemic. The first four recommendations should be applied immediately. The last three are longer-term:
Secure vaccine and antiviral supplies. Enough vaccine and antivirals need to be in place before a pandemic strikes, as well as a plan to distribute them. IDSA is calling for a stockpile of antiviral drugs that is adequate to treat at least 50 percent of the U.S. population.
Strengthen liability protections during emergency outbreak response. In case of a declared influenza emergency, it will be vital to immunize and treat large numbers of people. Even rare adverse reactions associated with a therapy would become more common when millions are treated. Health care workers and medical facilities administering emergency therapeutics, as well as the companies that make them, should be protected from lawsuits stemming from these adverse events so long as they follow standard medical and manufacturing procedures. A fund should be established to cover the medical costs and lost earnings of anyone who develops complications due to vaccination or treatment.
Require healthcare workers to be vaccinated. Unfortunately, healthcare workers caring for sick people often spread patients' infections. To prevent unnecessary deaths and disease, an annual flu vaccination should be mandatory for all healthcare workers who have contact with patients.
Strengthen education. Healthcare workers and the public need to better understand the seriousness and potential impact of an influenza pandemic, as well as how to prevent and treat it.
Create financial incentives. Most pharmaceutical companies have left the vaccine business because demand is extremely unpredictable. Even this season, after starting out with a shortage, millions of doses of flu vaccine will likely be thrown away. To secure vaccine supplies for the future, the government needs to guarantee it will buy a set amount of vaccine each season, and buy back a percentage of unsold vaccine at the end of the season.
Also, the United States does not have the manufacturing capacity to produce enough vaccine and antivirals to meet its needs in a pandemic. Tax credits should be offered to encourage companies to build new manufacturing facilities in this country so that the United States is not dependent on foreign suppliers. Tax incentives and patent extensions should be available for companies that research and develop new anti-flu therapies.
Strengthen federal agencies' responses. The Food and Drug Administration should "fast-track" vaccine and antiviral review, and streamline regulation of the manufacturing process. Congress should increase CDC's budget for global surveillance to detect influenza strains with pandemic potential. The U.S. Department of Agriculture should develop a plan for culling poultry or other livestock and compensating farmers in the event of a pandemic, if necessary.
Improve coordination, communication, and planning. The Department of Health and Human Services should develop a detailed plan to coordinate pandemic response at all levels, from local to national to international, including links between federal authorities and clinicians throughout the country.
IDSA is working with congressional leaders to integrate these recommendations into bio-preparedness legislation now being considered on Capitol Hill. The Society is working to achieve bipartisan support for this effort.
"Even in a 'normal' year, 36,000 Americans die of influenza," says Walter E. Stamm, MD, president of IDSA. "These recommendations will make the nation better prepared for both pandemic flu and the perennial flu threat."