By Angela Knudson
September 14, 2009

The President’s Council of Advisors on Science and Technology (PCAST), an advisory group appointed by the President, released a report on August 7 examining the likely resurgence of H1N1 this Fall. U.S. Preparations for 2009-H1N1 Influenza, a report compiled by the nation’s leading scientists and engineers, reviews response options geared towards minimizing the negative impact and provides a set of recommendations on key policy decisions concerning the epidemic. The report lays the foundation for the medical, social, scientific, and financial decisions the President and the federal government will soon face.

2009-H1N1 influenza has caused significant morbidity and mortality worldwide, and is only expected to worsen. While impossible to predict, H1N1 is expected to infect 30-50 percent of the United States population, hospitalize 1.8 million Americans, cause 30,000-90,000 deaths, and pose high risks for those with pre-existing conditions. With an expected comeback beginning as early as September, and peaking mid-October, issues arise surrounding timing. Significant availability of a vaccine is expected in mid-October, and once vaccinated, it may take several weeks for a person to develop protective immunity. Because of this mismatch in timing, PCAST recommends that healthcare systems prepare to deal with a surge in demand, and ensure that the most vulnerable populations and protected.

PCAST believes that current measures taken across the government are the best effort taken in preparation for a pandemic. The breadth and depth of thinking, energy devoted, and awareness of potential pitfalls are impressive. Despite this success, there is room for improvement with the decision making and preparation process. Suggested actions, some of which are already underway, fall into seven categories: coordination, scenarios, surveillance, response, barriers, communication, and future preparedness. PCAST would like to see the following actions:

• a single person in the White House coordinate all decision-makers;

• the federal government develop and disseminate specific planning scenarios for federal, state, and local entities to asses capacities and plans for both medical and non-medical interventions;

• upgrade national surveillance systems by Fall resurgence;

• accelerate the delivery/use of vaccines, develop plans to protect vulnerable populations and ensure access to intensive care facilities;

• federal government and others work to overcome legal, social, and financial barriers that reduce compliance with recommended measures for mitigation;

• strengthen communication plans by the government to state, health workers, and general public, and;

• eliminate gaps in the U.S.’s capacity to combat epidemics, including vaccine production and anti-viral drug development.

Decisions on how to respond to H1N1 must be made quickly, and depend on timely and accurate information, a lot of which must come from state and local decision-makers. Mayors, in particular, must understand the situations in their community, ultimately helping federal decision-makers respond to the epidemic. Knowing how many people are becoming infected, how the numbers are changing over time, who is becoming infected and at greatest risk, how the virus is changing, if medical and public health systems are responding adequately, and how well medical and public health responses work are critical questions mayors must be able to answer.

Further recommendations are all detailed in PCAST’s report and can be accessed by visiting the website WhiteHouse.gov.