Summary of Progress
Contents:
July 2007
This document consists of a compendium of actions due to be completed within 12 months of the release of the National Strategy for Pandemic Influenza Implementation Plan (Implementation Plan), along with responses from departments and agencies.
The actions below are reproduced from the Implementation Plan. Each action is followed by a summary of progress, in italics, prepared by relevant departments and agencies for this report. The assessment is indicated directly after the action number. A determination of “complete” indicates that the measure of performance has been met but does not necessarily mean that work has ended; in many cases work is ongoing. A determination of “in progress” indicates that the measure of performance has not yet been met and additional work is being done to meet the appropriate standard.
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[Note: Chapters 1 - 3 of the Implementation Plan do not contain action items. This assessment of action item progress commences with Chapter 4.]
4.1.1.1. Complete
DOS, in coordination with HHS, USAID, DOD, and DOT, shall work with the Partnership, the Senior UN System Coordinator for Avian and Human Influenza, other international organizations (e.g., WHO, World Bank, OIE, FAO) and through bilateral and multilateral initiatives to encourage countries, particularly those at highest risk, to develop and exercise national and regional avian and pandemic response plans within 12 months. Measure of performance: 90 percent of high-risk countries have response plans and plans to test them.
We have emphasized preparedness as an important aspect in addressing the international threat of pandemic influenza – especially the preparation of response plans. The United States chaired a session at the June 2006 meeting of the International Partnership on Avian and Pandemic Influenza in Vienna and in August 2006 led the APEC Health Task Force Seminar on Assessing Pandemic Preparedness. To date, 90 percent of countries considered to be at high risk for an avian or pandemic influenza outbreak have developed response plans and many of them have been tested through exercises or real-world responses. WHO reports that 178 countries have national pandemic preparedness plans. We will continue to encourage countries to test, evaluate, and improve their response plans.
4.1.1.2. Complete
USDA, USAID, and HHS shall use epidemiological data to expand support for animal disease and pandemic prevention and preparedness efforts, including provision of technical assistance to veterinarians and other agricultural scientists and policymakers, in high-risk countries within 12 months. Measure of performance: all high-risk and affected countries have in place (1) national task forces meeting regularly with representation from both human and animal health sectors, government ministries, businesses, and NGOs; (2) national plans, based on scientifically valid information, developed, tested, and implemented for containing influenza in animals with human pandemic potential and for responding to a human pandemic.
More than 80 percent of all high-risk countries have national task forces in place and have either developed or are working to develop national plans for responding to the threat of avian and pandemic influenza. To further strengthen global preparedness and planning, we are providing technical assistance and direct support for planning efforts to government ministries, international organizations, and private sector partners, so that they can put into operation national avian and pandemic plans in 57 countries. We are also assisting efforts to increase surveillance, prevention, and containment capacity at both the national and local levels. Since 2005, we have supported training for more than 129,000 animal health workers and 17,000 human health workers.
4.1.2.1. Complete
DOS shall ensure strong USG engagement in and follow-up on bilateral and multilateral initiatives to build cooperation and capacity to fight pandemic influenza internationally, including the Asia-Pacific Economic Cooperation (APEC) initiatives (inventory of resources and regional expertise to fight pandemic influenza, a region-wide tabletop exercise, a Symposium on Emerging Infectious Diseases to be held in Beijing in April 2006 and the Regional Emerging Disease Intervention (REDI) Center in Singapore), the U.S.-China Joint Initiative on Avian Influenza, and the U.S.-Indonesia-Singapore Joint Avian Influenza Demonstration Project; and should develop a strategy to expand the number of countries fully cooperating with U.S. and/or international technical agencies in the fight against pandemic influenza, within 6 months. Measure of performance: finalized action plans that outline goals to be achieved and timeframes in which they will be achieved.
We have engaged in a broad range of bilateral and multilateral initiatives to build cooperation and capacity to fight pandemic influenza internationally. First and foremost is the President’s International Partnership on Avian and Pandemic Influenza, which has twice convened more than 90 countries and international organizations to further international coordination and will meet again. The Under Secretary of State for Democracy and Global Affairs represented the United States at both meetings. We continue to work through the APEC Health Task Force to develop exercises and protocols for an organized response to a pandemic. Progress also continues on the trilateral U.S.-Indonesia-Singapore Project. We have nearly completed an integrated U.S. Government strategy for bilateral and multilateral engagement with priority countries, which we will update as needed.
4.1.2.2. Complete
HHS shall staff the REDI Center in Singapore within 3 months. Measure of performance: USG staff provided to REDI Center.
Dr. Rod Hoff, formerly of the National Institute of Allergy and Infectious Diseases, within the HHS National Institutes of Health, became the Executive Director of the REDI Center in November 2006.
4.1.2.3. Complete
USDA, working with USAID and the Partnership, shall support the FAO and OIE to implement an instrument to assess priority countries’ veterinary infrastructure for prevention, surveillance, and control of animal influenza and increase veterinary rapid response capacity by supporting national capacities for animal surveillance, diagnostics, training, and containment in at-risk countries, within 9 months. Measure of performance: per the OIE’s Performance, Vision and Strategy Instrument, assessment tools exercised and results communicated to the Partnership, and priority countries are developing, or have in place, an infrastructure capable of supporting their national prevention and response plans for avian or other animal influenza.
With assistance from USDA and USAID, all priority countries are developing, and some have in place, infrastructure that can support their national prevention and response plans for animal outbreaks. OIE has evaluated infrastructure in 22 countries to identify any necessary improvements and to request appropriate resources from international donors. USDA and USAID are providing training, technical assistance, and emergency commodities to governments that need assistance.
4.1.2.4. Complete
USDA, in coordination with DOS, USAID, the OIE, and other members of the Partnership, shall support FAO to enhance the rapid detection and reporting of, response to, and control or eradication of outbreaks of avian influenza, within 12 months. Measure of performance: an international program is established and providing functional support to priority countries with rapid detection and reporting of, response to, and control or eradication of outbreaks of avian influenza, as appropriate to the country’s specific situation.
In 2005, we launched a Highly Pathogenic Avian Influenza International Coordination Group to manage rapid assessment and emergency response missions to combat avian influenza abroad and to serve as a focal point for interagency and FAO collaboration. USDA and USAID also support an international Crisis Management Center and work to ensure its coordination with WHO.
4.1.2.5. Complete
HHS, in coordination with USAID, shall increase rapid response capacity within those countries at highest risk of human exposure to animal influenza by supporting national and local government capacities for human surveillance, diagnostics, and medical care, and by supporting training and equipping of rapid response and case investigation teams for human outbreaks, within 9 months. Measure of performance: trained, deployable rapid response teams exist in countries with the highest risk of human exposure.
More than 2,000 pandemic influenza rapid response teams (RRTs) have been put in place at the national, provincial, and district levels in Asia alone. This includes the Southeast Asian countries that are at highest risk of human exposure to avian influenza: Cambodia, Indonesia, Laos, Thailand, and Vietnam. The HHS/CDC Global Disease Detection (GDD) Centers in Guatemala, Kenya, and Thailand have fully equipped, internationally mobile RRTs, and funding has been obligated to establish internationally mobile RRTs in China, Egypt, India, Indonesia, and Kazakhstan by the end of 2007. We have supported regional RRT trainings in Egypt, Indonesia, Kazakhstan, Kenya, Saudi Arabia, and Thailand.
4.1.2.7. Complete
Treasury shall encourage and support MDB programs to improve health surveillance systems, strengthen priority countries’ response to outbreaks, and boost health systems’ readiness, consistent with legislative voting requirements, within 12 months. Measure of performance: projects that fit relevant MDB criteria approved in at least 50 percent of priority countries.
With our encouragement, the world’s multilateral development banks have moved quickly to undertake programs that improve health surveillance systems, strengthen countries’ response to outbreaks, and boost health system readiness. The World Bank has pledged up to $500 million for country programs to deal with a pandemic and is administering a multi-donor trust fund. It is also playing a critical role in tracking and coordinating donor funding. The Asian Development Bank has pledged up to $470 million and is focusing on regional approaches to prevent and control pandemic influenza.
4.1.3.1. Complete
USAID, HHS, and USDA shall conduct educational programs focused on communications and social marketing campaigns in local languages to increase public awareness of risks of transmission of influenza between animals and humans, within 12 months. Measure of performance: clear and consistent messages tested in affected countries, with information communicated via a variety of media have reached broad audiences, including health care providers, veterinarians, and animal health workers, primary and secondary level educators, villagers in high-risk and affected areas, poultry industry workers, and vendors in open air markets.
We are providing technical assistance and support for communications and public education efforts in 52 countries to raise awareness, make accurate information about avian influenza readily available, and change behaviors that spread the virus. Working with government ministries, international organizations such as UNICEF, WHO, and FAO, as well as private sector groups and NGO networks, we have helped provide technical assistance, training, logistical support, and outreach materials for use at both the national and community level. Target audiences include health and veterinary workers, national and local leaders and spokespeople, the media, high-risk groups such as poultry farmers, and the general public.
4.1.3.2. Complete
HHS and USAID shall work with the WHO Secretariat and other multilateral organizations, existing bilateral programs and private sector partners to develop community- and hospital- based health prevention, promotion, and education activities in priority countries within 12 months. Measure of performance: 75 percent of priority countries are reached with mass media and community outreach programs that promote AI awareness and behavior change.
We are currently working in 89 percent of priority countries in coordination with WHO, UNICEF, and national governments to implement mass media, community-based, and hospital-based outreach programs that raise awareness of the risks of avian influenza and promote preventive behaviors. We are supporting mass media and community-based outreach activities designed to prevent outbreaks of avian influenza and reduce human exposure in 16 of these countries. We are also supporting activities for health facilities and healthcare workers in nine priority countries that include training for community-based health workers, developing clinical care guidance, and improving infection control and surveillance procedures.
4.1.4.1. Complete
DOS and HHS, in coordination with other agencies, shall ensure that the top political leadership of all affected countries understands the need for clear, effective coordinated public information strategies before and during an outbreak of avian or pandemic influenza within 12 months. Measure of performance: 50 percent of priority countries that developed outbreak communication strategies consistent with the WHO September 2004 Report detailing best practices for communicating with the public during an outbreak.
We have continually stressed the importance of transparency and outbreak communications in bilateral discussions and at global and regional forums. Working directly with affected and at-risk governments, as well as international organizations, we have both emphasized to governments the importance of developing outbreak communications strategies consistent with World Health Organization (WHO) guidelines and conducted worldwide training of health officials and journalists. To date, 11 of 19 priority countries have developed outbreak communications strategies consistent with WHO guidelines.
4.1.4.2. Complete
DOS and HHS, in coordination with other agencies, shall implement programs within 3 months to inform U.S. citizens, including businesses, NGO personnel, DOD personnel, and military family members residing and traveling abroad, where they may obtain accurate, timely information, including risk level assessments, to enable them to make informed decisions and take appropriate personal measures. Measure of performance: majority of registered U.S. citizens abroad have access to accurate and current information on influenza.
We have provided up-to-date information on avian and pandemic influenza to the majority of the more than two million Americans registered with our 260 Embassies or Consulates abroad. The U.S. Government’s official avian and pandemic influenza website -- www.pandemicflu.gov -- serves as the primary information resource for Americans residing and traveling abroad. Embassies have also hosted hundreds of ‘town hall’ meetings and other outreach events to inform Americans residing abroad. These continue and are supplemented by materials distributed in consular waiting rooms and through warden networks to Americans residing and traveling abroad. Our continued efforts aim to ensure that Americans outside the United States are informed of the risks of a pandemic and measures to take before and during an outbreak.
4.1.4.3. Complete
DOS and HHS shall ensure that adequate guidance is provided to Federal, State, tribal, and local authorities regarding the inviolability of diplomatic personnel and facilities and shall work with such authorities to develop methods of obtaining voluntary cooperation from the foreign diplomatic community within the United States consistent with USG treaty obligations within 6 months. Measure of performance: briefing materials and an action plan in place for engaging with relevant Federal, State, tribal and local authorities.
A plan to provide guidance to the foreign diplomatic community has been developed and implemented. The website of the State Department’s Office of Foreign Missions has been designated as the forum for communications with the foreign diplomatic community, which has already been briefed extensively on pandemic preparedness by the Under Secretary of State for Democracy and Global Affairs and other senior officials. We have also developed a plan for quickly disseminating guidance to State, local, and tribal authorities through the national organizations representing these governmental entities and directly to the governors’ and tribal leaders’ offices. Guidance for State, local, and tribal authorities has been provided as part of ongoing training exercises conducted by DHS.
4.1.4.4. Complete
USAID, USDA, and HHS shall work with the WHO Secretariat, FAO, OIE, and other donor countries within 12 months to implement a communications program to support government authorities and private and multilateral organizations in at-risk countries in improving their national communications systems with the goal of promoting behaviors that will minimize human exposure and prevent further spread of influenza in animal populations. Measure of performance: 50 percent of priority countries have improved national avian influenza communications.
With support from the U.S. Government, national communications efforts have been strengthened in 84 percent of priority countries through activities that build national communications capacity and stress awareness campaigns to promote changes in behavior. We are working with host governments and international organizations – including WHO, FAO, OIE, and UNICEF – as well as other donors and the private sector to provide both technical and operational support for such activities. We have supported the training of nearly 114,000 people -- including 102,764 people in priority countries -- to deliver messages about the hazards of avian influenza to poultry farmers and the general public.
4.1.4.5. Complete
USAID, in coordination with DOS, HHS, and USDA, shall develop and disseminate influenza information to priority countries through international broadcasting channels, including international USG mechanisms such as Voice of America and Radio Free Asia (radio, television, shortwave, internet), and share lessons learned and key messages from communications campaigns, within 12 months. Measure of performance: local language briefing materials and training programs developed and distributed via WHO and FAO channels. USAID and HHS are conducting communications activities in 52 countries in coordination with DOS and USDA, and have developed materials in four world languages (English, French, Spanish and Portuguese) as well as local languages, including both print and broadcast media.
We are using a wide variety of channels and media to disseminate key messages for preventing avian influenza and behavior change. Our partners include WHO, FAO, and UNICEF; international broadcasting networks such as the Voice of America; national media and government ministries; and non-governmental organizations such as the Red Cross and Veterinarians Without Borders (AVSF).
4.1.5.1. Complete
DOS, in coordination with other agencies, shall use the Partnership and bilateral and multilateral diplomatic contacts on a continuing basis to encourage nations to increase international production capacity and stockpiles of safe and effective human vaccines, antiviral medications, and medical material within 12 months. Measure of performance: increase by 50 percent the number of priority countries that have plans to increase production capacity and/or stockpiles.
We assisted WHO in producing a global pandemic influenza action plan to increase vaccine supply in selected developing nations and have given $10 million in support of this plan. In April 2007, WHO announced that Brazil, India, Indonesia, Mexico, Thailand, and Vietnam would each receive up to $2.5 million to develop influenza vaccine production facilities. Reports indicate that most priority countries have taken steps to establish stockpiles of antiviral, and most have plans to produce or acquire pre-pandemic vaccine. Virtually all priority countries have stockpiled personal protective equipment.
4.1.5.2. Complete
HHS and USAID shall work to coordinate and set up emergency stockpiles of protective equipment and essential commodities other than vaccine and antiviral medications for responding to animal or human outbreaks within 9 months. Measure of performance: essential commodities procured and available for deployment within 24 hours.
USAID developed an international stockpile of essential non-pharmaceutical commodities – including personal protective equipment (PPE), decontamination equipment, and equipment for safely collecting and shipping human samples of H5N1 – which are available for international deployment within 24 hours. USAID has procured a total of 1.5 million kits of personal protective equipment, 15,000 decontamination kits, and 100 lab specimen collection kits, and has deployed equipment to support avian influenza surveillance and response in more than 71 countries. Stockpiles of protective equipment are also available and can be deployed within 24 hours from U.S. Global Disease Detection Centers in Guatemala, Kenya, and Thailand, and from the CDC Office in South Africa, for use during the initial wave of the response to an outbreak of human disease.
4.1.5.3. Complete
HHS shall provide technical expertise, information, and guidelines for stockpiling and use of pandemic influenza vaccines within 6 months. Measure of performance: all priority countries and partner organizations have received relevant information on influenza vaccines and application strategies.
We have developed and produced materials on pandemic influenza vaccine strategies and capacity building that contain staff contact information and relevant FDA and WHO website links related to vaccine production and licensing. This package was disseminated to all 18 State Department-designated pandemic influenza focus countries. The package was also sent to WHO Headquarters and distributed to GHSAG (Global Health Security Action Group) countries.
4.1.5.4. Complete
USDA and USAID, in cooperation with FAO and OIE, shall provide technical expertise, information and guidelines for stockpiling and use of animal vaccines, especially to avian influenza affected countries and those countries at highest risk, within 6 months. Measure of performance: all priority countries and relevant international organizations have received information on animal vaccines’ efficacy and application strategies to guide country-specific decisions about preparedness options.
U.S. Embassies and missions have ensured that all priority countries have received international guidance on the use of animal vaccines. We are also working with academic institutions to produce a training program on the use of animal vaccines and vaccination strategies and are providing support for an international scientific conference in March 2007 on avian influenza vaccination standards, trade implications, strategies for implementation, and experiences to date.
4.1.6.3. Complete
USDA shall generate new information on avian vaccine efficacy and production technologies and disseminate to international organizations, animal vaccine manufacturers, and countries at highest risk within 6 months. Measure of performance: information disseminated to priority entities.
We have distributed information on avian influenza vaccines and vaccination to the two primary international animal health organizations (FAO and OIE) to multiple national and international animal health industry and trade associations and to representatives of international vaccine manufacturers. USDA scientists have presented information at international conferences and symposia, as well as to governments and poultry industries in key priority and at-risk countries. Video training modules have also been developed and will be distributed in FY 2007 to countries in Africa, Asia, and Central and South America. We will continue to disseminate vaccine efficacy information as new experiments are designed, implemented, and completed.
4.1.7.1. Complete
DOS shall work with HHS and USAID, in collaboration with the WHO Secretariat, to coordinate the USG contribution to an international stockpile of antiviral medications and other medical countermeasures, including international countermeasure distribution plans and mechanisms and agreed prioritization of allocation, within 6 months. Measure of performance: release of proposed doctrine of deployment and concept of operations for an international stockpile.
We have formulated a policy on our contribution to international stockpiles, as well as for the deployment and use of antiviral medications, that will serve as guidance for the distribution and allocation of supplies. The United States has also forward deployed antiviral assets from the Strategic National Stockpile overseas to assist with international containment efforts. The U.S. Government is coordinating with the World Health Organization, which is at present reviewing this strategy, which will enable us to direct and apply limited resources in an effective manner.
4.1.7.2. Complete
The Department of Justice (DOJ) and DOS, in coordination with HHS, shall consider whether the USG, in order to benefit from the protections of the Defense Appropriations Act, should seek to negotiate liability-limiting treaties or arrangements covering U.S. contributions to an international stockpile of vaccine and other medical countermeasures, within 6 months. Measure of performance: review initiated and decision rendered.
State and DOJ previously conducted two reviews to consider whether the United States should seek to negotiate liability-limiting treaties or arrangements covering U.S. contributions to an international stockpile of vaccines. We have conducted a third review and continue to find there is no compelling need to seek such arrangements. With input from HHS, State, and DOJ continue to monitor relevant factors that could warrant a change in finding.
4.1.7.3. Complete
USDA, in collaboration with FAO and OIE, shall develop and provide best-practice guidelines and technical expertise to countries that express interest in obtaining aid in the implementation of a national animal vaccination program, within 4 months. Measure of performance: interested countries receive guidelines and other assistance within 3 months of their request.
We have worked with FAO and OIE to develop and deliver best practice guidelines and technical expertise to interested countries in a number of ways. For example, we helped develop the FAO Global Strategy for progressive AI eradication and an OIE technical manuscript on emergency management. Through USDA funding, representatives from all priority countries were able to attend a vaccination seminar hosted by FAO/OIE. We also collaborated with Iowa State University to produce a multimedia training module on animal vaccines and vaccination strategies. USDA has met all requests for assistance with experts or training courses to address the various concerns.
4.1.8.2. Complete
HHS shall enhance a regional influenza genome reference laboratory in Singapore within 9 months. Measure of performance: capacity to sequence complete influenza virus genome established in Singapore; all reported novel animal influenza samples sequenced and made available on public databases.
The Genomics Institute of Singapore is now fully staffed and equipped to sequence and characterize viral genomes. The institute is working with partners in Vietnam and Indonesia to isolate and sequence the causative agents of viral pneumonias, including avian influenza. Sequences of special scientific interest will be published in a peer-reviewed journal; complete sequences will be submitted to GenBank.
4.1.8.3. Complete
USDA and USAID shall work with international organizations, governments, and scientific entities to disseminate and exchange information to bolster and apply avian influenza prevention and response plans in priority countries, within 12 months. Measure of performance: 50 percent of priority countries have national epizootic prevention and response plans based upon pragmatic, comprehensive, and scientifically valid information.
All priority countries currently have national epizootic prevention and response plans. USAID and USDA are working with more than 40 countries to improve national and local planning efforts, conduct simulations and trainings for national officials and responders, increase the availability of scientific information about H5N1 through better surveillance and greater international cooperation and transparency, and provide commodities for outbreak preparedness and response.
4.1.8.4. Complete
HHS and DOD, in coordination with DOS, shall enhance open source information sharing efforts with international organizations and agencies to facilitate the characterization of genetic sequences of circulating strains of novel influenza viruses within 12 months. Measure of performance: publication of all reported novel influenza viruses which are sequenced.
We are working with domestic and international partners to characterize genetic sequences of new influenza viruses. Last summer, we submitted more than 650 sequences of various influenza viruses to the National Center for Biotechnology Information (NCBI) of the NIH National Library of Medicine for inclusion in GenBank, a publicly available, searchable database (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide).
4.2.1.1. Complete
DOS, in coordination with other agencies, shall work on a continuing basis through the Partnership and through bilateral and multilateral diplomatic contacts to promote transparency, scientific cooperation, and rapid reporting of avian and human influenza cases by other nations within 12 months. Measure of performance: all high-risk countries actively cooperating in improving capacity for transparent, rapid reporting of outbreaks.
Transparency and rapid reporting are core principles of the International Partnership on Avian and Pandemic Influenza (IPAPI) and were highlighted formally and with the press at the major IPAPI conferences in Washington, D.C., and Vienna and at an affiliated international meeting in Bamako, Mali. This message is conveyed in nearly every discussion with bilateral and multilateral partners. We continue to work with at least 70 nations, including high-risk countries, where there is greatest risk from avian influenza and where there are manifest constraints to detecting and reporting outbreaks. Countries continue to strengthen their capacity to respond to and report on outbreaks.
4.2.1.2. Complete
HHS, in coordination with DOS, shall, to the extent feasible, negotiate bilateral agreements with key affected countries on health cooperation including transparency, sample and data sharing, and development of rapid response protocols; and develop and train in-country rapid response teams to quickly assess and report on possible outbreaks of avian and human influenza, within 12 months. Measure of performance: agreements established with Vietnam, Cambodia, and Laos, 100 teams throughout Asia, including China, Thailand, and Indonesia, trained and available to respond to outbreaks.
More than 2,000 internationally mobile rapid response teams (RRTs) have been established at the district, provincial, and national levels throughout Asia. There are more than 1,000 RRTs each in Thailand and Vietnam, as well as RRTs in most provinces, states, or districts of Bangladesh, Cambodia, India, Indonesia, and Laos. Fully equipped RRTs are ready for action at the GDD Center in Bangkok, and an RRT will be in place at the Indonesian Center for Disease Control by the end of 2007. Bilateral agreements on health cooperation have been established with the Governments of Cambodia and Vietnam, and U.S. Government support for collaborative activities with Laos is provided via a cooperative agreement with WHO regional offices.
4.2.1.3. Complete
HHS shall place long-term staff at key WHO offices and in select affected, high-risk, and at-risk countries to provide coordination of HHS-sponsored activities and to serve as liaisons with HHS within 9 months. Measure of performance: placement of staff and increased coordination with the WHO Secretariat and Regional Offices.
HHS has placed long-term staff in Cambodia, China, Egypt, Indonesia, Kazakhstan, Laos, Peru, Thailand, and Vietnam to coordinate activities and technical assistance. Additionally, HHS has increased coordination capacity globally by placing staff at WHO headquarters and at its regional offices in the Republic of Congo, India, and the Philippines.
4.2.1.4. Complete
HHS shall, to the extent feasible, negotiate agreements with established networks of laboratories around the world to enhance its ability to perform laboratory analysis of human and animal virus isolates and to train in-country government staff on influenza-related surveillance and laboratory diagnostics, within 6 months. Measure of performance: completed, negotiated agreement, and financing mechanism with at least one laboratory network outside the United States.
Agreements with Institut Pasteur and the Gorgas Institute have been developed, including $1,550,066 obligated to Institut Pasteur and $775,000 to the Gorgas Institute for projects that focus on laboratory analysis and training.
4.2.1.5. Complete
HHS shall support the WHO Secretariat to enhance the early detection, identification and reporting of infectious disease outbreaks through the WHO’s Influenza Network and Global Outbreak and Alert Response Network (GOARN) within 12 months. Measure of performance: expansion of the network to regions not currently part of the network.
We are supporting WHO activities that improve global disease surveillance and response. They include: enhancement and expansion of the WHO Global Influenza Surveillance Network and the Global Outbreak Alert and Response Network; support for a joint response protocol for animal outbreaks with FAO’s Crisis Management Center; expansion of Global Disease Detection (GDD) Centers’ networks; and assistance for Field Epidemiology Training Programs (FETPs) and Field Epidemiology and Laboratory Training Programs (FELTPs) in many countries. Two new FELTPs—in Pakistan and South Africa—were established in 2006 and planning is under way to establish new FETPs in Cambodia and Vietnam. Collectively, these efforts have improved early detection, identification, and reporting of cases or outbreaks of pandemic influenza throughout the world.
4.2.1.6. Complete
USAID, in coordination with USDA, shall initiate a pilot program to evaluate strategies for farmer compensation and shall engage and leverage the private sector and other donors to increase the availability of key commodities, compensation, financing and technical support for the control of avian influenza within 6 months. Measure of performance: a model compensation program measured in value of goods and services available for compensation is developed.
To address the challenging issue of compensation, we have developed a replicable compensation model in partnership with the World Bank, FAO, and the Government of Indonesia. This program will be launched in early 2007and will integrate compensation into ongoing community-based surveillance and response efforts. We are also working with international organizations such as the World Bank to research and recommend compensation strategies, including non-monetary incentives, and to develop approaches to indemnity programs that could be used in other priority and high-risk countries.
4.2.1.7 Complete
USAID, HHS, USDA, and DOS shall support NGOs, FAO, OIE, WHO, the Office of the Senior UN System Coordinator for Avian and Human Influenza, and host governments to expand the scope, accuracy, and transparency of human and animal surveillance systems and to streamline and strengthen official protocols for reporting avian influenza cases, within 6 months. Measure of performance: 75 percent of priority countries have established early warning networks, international case definitions, and standards for laboratory diagnostics of human and animal samples.
All priority countries have established early-warning networks for H5N1 in animals and conform to disease definitions and diagnostic standards for influenza established by the World Organization for Animal Health. More than 75 percent of priority countries have human influenza early-warning capabilities and all abide by international case definitions; more than 75 percent have laboratories that meet standards for human diagnosis. We have provided technical assistance to strengthen national surveillance systems in all priority countries, support to international organizations for human and animal health to promote early warning surveillance for influenza outbreaks in affected countries, and technical training to strengthen human and animal diagnostic laboratories in the detection of influenza virus in priority countries.
4.2.2.1. Complete
HHS and USDA, in collaboration with one or more established networks of laboratories around the world, including the WHO Influenza Network, shall train staff from priority countries’ Ministries of Health and Agriculture to conduct surveillance and perform epidemiologic analyses on influenza-susceptible species and manage and report results of findings, within 12 months. Measure of performance: 75 percent of priority countries have access to multi-year epidemiology and surveillance training programs.
USDA training activities are complemented by HHS/CDC public health training efforts, which include regional Train-the-Trainer Rapid Response Team (RRT) workshops on applied epidemiology and post-event disease surveillance for avian and pandemic influenza. Master trainers who complete the regional RRT workshops train provincial-level responders, who in turn train district-level responders. Additional RRT workshops have been conducted or are planned for 2007 worldwide.
4.2.2.2. Complete
HHS and USDA shall increase support of scientists tracking potential emergent influenza strains through disease and virologic surveillance in susceptible animal species in priority countries within 9 months. Measure of performance: surveillance for emergent influenza strains expanded in priority countries.
We have expanded surveillance for emerging influenza strains in priority countries. Our efforts include: collecting and analyzing influenza viruses from animals in high-risk Asian countries; conducting North American surveillance with Canada and Mexico; supporting the USAID-sponsored Wild Bird Surveillance project in eight priority countries; expediting rapid characterization and publication of viral sequences via the NIH Influenza Genome Sequencing Project; and awarding research funds to study evolving influenza viruses. USDA is collaborating with other countries on avian influenza-related research, providing training, and helping to collect and transport field specimens to diagnostic laboratories.
4.2.2.3. Complete
HHS, in coordination with DOD, shall provide support to Naval Medical Research Unit (NAMRU) 2 in Jakarta, Indonesia and Phnom Penh, Cambodia, the Armed Forces Research Institute of Medical Sciences in Bangkok, Thailand, and NAMRU-3 in Cairo, Egypt to expand and expedite geographic surveillance of human populations at-risk for H5N1 infections in those and neighboring countries through training, enhanced surveillance, and enhancement of the Early Warning Outbreak Recognition System, within 12 months. Measure of performance: reagents and technical assistance provided to countries in the network to improve and expand surveillance of H5N1 and number of specimens tested by real-time processing.
U.S. Naval Medical Research Units 2 and 3 (NAMRU-2 and NAMRU-3), supported by funding from HHS/CDC, are providing influenza-related diagnostic assistance to 29 countries in Africa, Asia, Europe, and the Middle East. The number of influenza specimens submitted to HHS/CDC has increased significantly: from 615 in 2005 to 754 in 2006 (NAMRU-2) and 90 in 2005 to 423 in 2006 (NAMRU-3).
4.2.2.4. Complete
HHS shall enhance surveillance and response to high priority infectious disease, including influenza with pandemic potential, by training physicians and public health workers in disease surveillance, applied epidemiology and outbreak response at its GDD Response Centers in Thailand and China and at the U.S.-China Collaborative Program on Emerging and Re-Emerging Infectious Diseases, within 12 months. Measure of performance: 50 physicians and public health workers living in priority countries receive training in disease surveillance applied epidemiology and outbreak response.
More than 250 public health workers from priority countries have been trained in disease surveillance, field epidemiology, and outbreak response. Physicians in Cambodia, Laos, and Vietnam are also receiving hospital-based training in infection control and/or case management during an influenza pandemic.
4.2.3.1. Complete
HHS shall develop and implement laboratory diagnostics training programs in basic laboratory techniques related to influenza sample preparation and diagnostics in priority countries within 9 months. Measure of performance: 25 laboratory scientists trained in influenza sample preparation and diagnostics.
More than 40 laboratory scientists in priority countries have been trained in influenza sample preparation and molecular diagnostics at regional laboratory workshops in Thailand and Uganda, at the CDC in Atlanta, or in country at national public health laboratories.
4.2.3.2. Complete
HHS in collaboration with one or more established networks of laboratories, including the WHO Influenza Network, shall train staff from priority countries on influenza-related laboratory diagnostics, within 12 months. Measure of performance: 100 percent of priority countries have training programs established.
All priority countries have access to established diagnostics training programs, including hands-on trainings at WHO National Influenza Centers, regional laboratory workshops coordinated by HHS/CDC, training programs at DOD laboratories, and USAID-supported courses on sample collection, use of rapid diagnostics for human and animal samples, and international sample-shipping procedures. In addition, all priority countries have been provided with resources and technical assistance for developing and enhancing influenza-related laboratory diagnostic capacity. HHS/CDC continues to provide training to ensure that laboratory staff can perform rapid influenza-related diagnosis in priority countries.
4.2.3.3. Complete
HHS, in cooperation with the WHO Secretariat and other donor countries, shall expand an existing specimen transport fund that enables developing countries to transport influenza samples to WHO regional reference laboratories and collaborating centers, within 6 months. Measure of performance: 100 percent of priority countries funded for sending influenza samples to WHO regional reference laboratories.
To ensure that all priority countries have the ability to rapidly transport influenza samples to WHO for analysis, we have provided $400,000 to WHO to conduct five training workshops focused on proper transport of dangerous materials, as well as to provide consultations with priority African partners regarding the proper protocol for specimen transport.
4.2.3.5. Complete
HHS and USAID shall work with the WHO Secretariat and private sector partners, through existing bilateral agreements, to provide support for human health diagnostic laboratories by developing and giving assistance in implementing rapid international laboratory diagnostics protocols and standards in priority countries, within 12 months. Measure of performance: 75 percent of priority countries have improved human diagnostic laboratory capacity.
In coordination with WHO, private sector and non-governmental partners, we have helped all priority countries improve diagnostic protocols, upgrade laboratories, and reduce the amount of time required to diagnose H5N1. We have also provided direct technical assistance or equipment for laboratories in 13 of 19 priority countries and emergency sample collection and shipping kits to eight priority countries, in addition to supporting training in human surveillance for more than 15,000 people.
4.2.3.6. Complete
USDA and USAID shall work with FAO and OIE to provide technical support for animal health diagnostic laboratories by developing and implementing international laboratory diagnostic protocols, standards, and infrastructure in priority countries that can rapidly screen avian influenza specimens from susceptible animal populations, within 12 months. Measure of performance: 75 percent of priority countries have improved animal diagnostic laboratory capacity.
We have helped 95 percent of priority countries improve their capacity for surveillance and laboratory diagnosis through training, technical assistance, and the provision of commodities (such as protective gear) and rapid diagnostic materials. We are also working with FAO and other international partners to implement surveillance protocols, increase access to international reference laboratories, and strengthen national laboratories.
4.2.3.7. Complete
USDA and USAID shall provide technical expertise to help priority countries develop their cadre of veterinary diagnostic technicians to screen avian influenza specimens from wild and domestic bird populations, and other susceptible animals, rapidly and in a manner that adheres to international standards for proficiency and safety, within 12 months. Measure of performance: all priority countries have access to laboratories that are able to screen avian influenza specimens and confirm diagnoses in a manner that supports effective control of cases of avian influenza.
All priority countries now have access to laboratory diagnostic capacity for avian influenza either through national laboratories or through regional reference laboratories. USAID and USDA have provided assistance to virtually all priority countries to improve animal surveillance and early warning and to ensure access to laboratory diagnosis. In addition, we have entered into bilateral agreements with Cambodia, China, and Mexico to assist in training and in carrying out wild bird surveillance. We are developing agreements with Brazil, Greenland and Russia.
4.2.5.1. In progress
HHS and USAID shall develop, in coordination with the WHO Secretariat and other donor countries, rapid response protocols for use in responding quickly to credible reports of human-to-human transmission that may indicate the beginnings of an influenza pandemic, within 12 months. Measure of performance: adoption of protocols by WHO and other stakeholders.
With our input and support, WHO has released a revised and updated version of rapid response and containment protocols for review by stakeholders. We participated in developing protocols and guidelines for the use and coordination of international antiviral stockpiles to be used for containment. USAID is supporting the work of WHO and FAO to develop coordinated protocols for responding to avian influenza outbreaks and assisted in developing a UN Pandemic Preparedness and Humanitarian Response Plan.
4.2.5.2. In progress
HHS, in coordination with DOS and other agencies participating in the Security and Prosperity Partnership, shall pursue cooperative agreements on pandemic influenza with Canada and Mexico to create and implement a North American early warning surveillance and response system in order to prevent the spread of infectious disease across the borders, within 9 months. Measure of performance: implementation of early warning surveillance and response system.
Under the auspices of the Security and Prosperity Partnership of North America, the United States, Mexico, and Canada have drafted the North America Plan for Avian and Pandemic Influenza. This plan outlines how we will work together to combat an outbreak of avian or pandemic influenza in North America. A Laboratory and Surveillance Technical Working Group will provide technical support for addressing laboratory, surveillance, and epidemiological issues related to pandemic influenza. In addition to SPP efforts, HHS uses collaborative relationships, technical assistance, and funding through grants and cooperative agreements to help improve the North American countries’ ability to detect new influenza stains and rapidly communicate critical information to their neighbors.
4.2.5.3. Complete
USDA and USAID shall provide technical expertise to priority countries in order to expand the scope and accuracy of systematic surveillance of avian influenza cases, within 12 months. Measure of performance: 75 percent of priority countries have expanded animal surveillance capabilities.
All priority countries have expanded their animal surveillance capabilities. We have provided assistance for improving animal surveillance and diagnostic capacity, including early warning networks, in 95 percent of these countries through training, technical assistance, logistical support and equipment, and grants, including support to WHO and FAO. With our support, more than 50,000 people have been trained in animal surveillance and nearly 18,000 in human surveillance. Approximately 129,000 people have been trained to respond to poultry outbreaks and 17,000 to human outbreaks. Nearly 114,000 people – including journalists – have been trained to deliver AI messages to poultry workers and the general public.
4.2.6.1. Complete
DHS, USDA, DOI, and USAID, in collaboration with priority countries, NGOs, WHO, FAO, OIE, and the private sector shall support priority country animal health activities, including development of regulations and enforcement capacities that conform to OIE standards for transboundary movement of animals, development of effective biosecurity measures for commercial and domestic animal operations and markets, and identification and confirmation of infected animals, within 12 months. Measure of performance: 50 percent of priority countries have implemented animal health activities as defined above.
All priority countries have implemented animal health activities to improve biosecurity measures and the identification of infected animals. USDA, DOI, and USAID are supporting animal health activities related to avian influenza prevention, surveillance and diagnosis, and containment measures in 95 percent of priority countries through training, technical assistance, and financial and logistical support. We also helped to create the Global Avian Influenza Network for Surveillance to monitor avian influenza in wild birds, track genetic changes in virus isolates, and increase transparency of disease information.
4.2.7.1. Complete
DOS, in coordination with DOT, DHS, HHS, and U.S. Trade Representative (USTR), shall collaborate with WHO, the International Civil Aviation Organization (ICAO), and the International Maritime Organization (IMO) to assess and revise, as necessary and feasible, existing international agreements and regulations governing the movement and shipping of potentially infectious products, in order to ensure that international agreements are both adequate and legally sufficient to prevent the spread of infectious disease, within 12 months. Measure of performance: international regulations reviewed and revised.
We have reviewed existing international regulations and agreements governing the movement and shipping of potentially infectious products and have concluded that there is no need to revise them at this time. We believe that the current regimen is both adequate and legally sufficient to prevent the spread of infectious disease.
4.2.8.1. Complete
HHS and USAID shall develop community- and hospital-based infection control and prevention, health promotion and education activities in local languages in priority countries within 9 months. Measure of performance: local language health promotion campaigns and improved hospital-based infection control activities established in all South East Asian priority countries.
Working with UN technical agencies, national governments, and other international partners, we are supporting health promotion campaigns, hospital and health facility-based infection control activities, and public health communications planning and training in all Southeast Asia priority countries. In Cambodia, Indonesia, Laos, and Vietnam we have helped train more than 70,500 people -- including journalists -- in delivering prevention messages, and nearly 114,000 people worldwide. We have also helped develop communications materials and messages aimed at the general public and health workers.
4.3.1.2 Complete
DOS, in coordination with HHS, shall work with WHO and the international community to secure agreement (e.g., through a resolution at the World Health Assembly in May 2006) on an international containment strategy to be activated in the event of a human outbreak, including an accepted definition of a “triggering event” and an agreed doctrine for coordinated international action, responsibilities of nations, and steps they will take, within 4 months. Measure of performance: international agreement on a response and containment strategy.
WHO issued its “Rapid Operations to Contain the Initial Emergence of Pandemic Influenza” protocol in May 2007. The United States provided significant technical input to this protocol, which outlines a framework for ‘triggering’ actions. We have also implemented numerous efforts to build response and containment capacity in at-risk countries and to reinforce broad acceptance of the International Health Regulations and related WHO protocols and standards. We are finalizing protocols for the United States on responses to and containment of outbreaks and have developed a curriculum to teach principles of rapid pandemic response to public health personnel in other countries.
4.3.1.6. Complete
DOS shall lead USG engagement with the international community’s effort to develop a coordinated plan for avian influenza assistance (funds, materiel, and personnel) to streamline national assistance efforts within 12 months. Measure of performance: commitments from countries on funds, personnel, and materiel they will contribute to an integrated and prioritized international prevention, preparedness, and response effort.
Global pledges of assistance to avian and pandemic preparedness currently total approximately $2.3 billion. Of that amount, the cumulative U.S. pledge of $434 million is the largest single commitment to building cooperation and capacity to fight avian influenza and promote pandemic preparedness internationally. We continue to work closely with the United Nations and World Bank to lead the international promotion of harmonized and synchronized donor mechanisms to facilitate maximum flexibility to adjust to changes in the global avian influenza and pandemic preparedness situation and help sustain commitments from countries on funds.
4.3.1.7. Complete
DOS, in coordination with and drawing on the expertise of USAID, HHS, and DOD, shall work with the international community to develop, within 12 months, a coordinated, integrated, and prioritized distribution plan for pandemic influenza assistance that details a strategy for (1) strategic lift of WHO stockpiles and response teams, (2) theater distribution to high-risk countries, (3) in-country coordination to key distribution areas, and (4) establishment of internal mechanisms within each country for distribution to urban, rural, and remote populations. Measure of performance: commitments by countries that specify their ability to support distribution, and specify the personnel and material for such support.
We are actively supporting the central role of WHO and the UN system in leading international, regional, and country preparations for a possible global influenza pandemic. WHO has issued pandemic preparedness guidance, including information regarding in-country coordination and logistics, and reports that 178 nations now have national plans. We participated in the development of protocols and guidelines for the use and coordination of international antiviral stockpiles prepositioned by WHO. The United States also has prepositioned stockpiles of antiviral medications and essential non-pharmaceutical commodities.
4.3.1.8. Complete
DOS, in coordination with HHS, USDA, USAID, and DHS, and in collaboration with WHO, FAO, OIE, the World Bank and regional institutions such as APEC, the Association of Southeast Asian Nations and the European Community, shall, to the extent feasible, improve public affairs coordination and establish a set of agreed upon operating principles among these international organizations and the United States that describe the actions and expectations of the public affairs strategies of these entities that would be implemented in the event of a pandemic, within 6 months. Measure of performance: list of key public affairs contacts developed, planning documents shared, and coordinated public affairs strategy developed.
With our assistance, WHO has issued communication and public affairs guidelines that have been shared with public affairs contacts throughout the UN system, OIE, the World Bank, and regional organizations. We provided a public affairs network and contact list, as well as a reference to U.S. planning documents posted on www.pandemicflu.gov, and are working with WHO to expand and update the network.
4.3.1.9 Complete
DOS and DOC, in collaboration with NGOs and private sector groups representing business with activities abroad, shall develop and disseminate checklists of key activities to prepare for and respond to a pandemic, within 6 months. Measure of performance: checklists developed and disseminated.
State and DOC, in collaboration with the CDC, have compiled a checklist entitled “Pandemic Preparedness Planning for U.S. Businesses with Overseas Operations,” which has been disseminated via the pandemicflu.gov website and through trade associations for use by a wide range of non-governmental and private sector organizations. The International Trade Administration at (DOC), in conjunction with the Bureau of East Asian Affairs and the Office of Economic Policy at State, developed informational guidance for small/medium businesses targeting APEC economies. The guidance has been placed on the APEC website for use by all APEC member economies, but primarily for those APEC members that do not have robust pandemic preparedness plans.
4.3.2.2. Complete
DOD, in coordination with DOS, HHS, DOT, and DHS, will limit official DOD military travel between affected areas and the United States. Measure of performance: DOD identifies military facilities in the United States and OCONUS that will serve as the points of entry for all official travelers from affected areas, within 6 months.
DOD is prepared to support the National Strategy for Pandemic Influenza Implementation Plan throughout the phases of a pandemic. We will assess the restricted/modified movement of our agency personnel to designated points of entry. These restrictions and/or modifications will limit the potential spread of influenza by enabling proper medical screening and in some cases isolation and quarantine of personnel traveling to/from affected areas. Further assessments of logistics, medical support, and host nation coordination continue.
4.3.4.1. Complete
DOS in collaboration with the Partnership and WHO shall negotiate international instruments and/or arrangements to facilitate the flow of rapid response teams and other public health, medical, and veterinary personnel across international borders, within 12 months. Measure of performance: negotiated agreements for facilitating deployment of rapid response teams deployed across international borders using instruments and/or arrangements as detailed above, within 48 hours of request.
We have consulted within the U.S. Government and with multilateral organizations such as FAO, WHO, and the International Partnership on Avian and Pandemic Influenza to facilitate the flow of rapid response teams. The Department of State has officially contacted all foreign missions in Washington to establish prompt cooperation in granting visas to U.S. avian and pandemic influenza emergency response personnel. The USAID Office of Foreign Disaster Assistance and the CDC both report good foreign mission cooperation in granting of visas – generally within 24 hours. FAO is actively assessing its pre-deployment arrangements, including visa procurement for response teams, to improve efficiency.
4.3.5.1. Complete
DOS shall organize an interagency group to analyze the potential economic and social impact of a pandemic on the stability and security of the international community, within 3 months. Measure of performance: issues identified and policy recommendations prepared.
We have formed an interagency group to examine the potential global economic impact of a pandemic. The group has addressed a preliminary set of issues and has formulated policy recommendations. It has also succeeded in identifying border policies with the aim of preventing the arrival of a pandemic in the United States. Our efforts will help us to weigh the economic implications and costs of various policy alternatives.
4.3.5.2. Complete
Treasury shall urge the IMF to enhance its surveillance of priority countries and regions, including further assessment of the macroeconomic and financial vulnerability to an influenza pandemic, within 3 months. Measure of performance: updated, expanded IMF analysis of the potential impact of an influenza pandemic on priority countries and regions, as defined above.
In collaboration with the IMF and the multilateral development banks, we plan to ensure that financial assistance to affected economies is provided on terms consistent with the goals of restoring economic activity and maximizing economic growth (within existing international financial agreements). The IMF stands ready to help address countries’ balance of payments needs in response to a pandemic. The World Bank is tracking donor commitments for avian influenza programs and the Asian Development Bank is taking the lead in coordinating donor actions in Asia.
4.3.5.3. Complete
Treasury, in collaboration with the IMF and the multilateral development banks, shall take the lead on dialogue with creditor countries to ensure that financial assistance to affected economies is provided on terms consistent with the goals of restoring economic activity and maximizing economic growth (within existing international financial agreements), within 6 months. Measure of performance: official financing strategies in place that are consistent with the goals above.
International donors have endorsed the multi-donor framework for pandemic influenza developed by the World Bank, which calls for a flexible financing approach to take account of different kinds of contributions (cash, grants, loans, or in-kind) and donor procedures, consistent with the goals of minimizing economic disruptions and maintaining growth. The World Bank is monitoring donor disbursements to help ensure consistency with the framework. The Asian Development Bank is taking the lead in coordinating donor activities in the Asia and Pacific region. The IMF stands ready to meet members’ balance of payments needs arising from a pandemic using existing facilities, including stand-by arrangements or emergency assistance.
4.3.6.1. Complete
DOS, in coordination with HHS, USAID, USDA, DOD, and DHS, shall lead an interagency public diplomacy group to develop a coordinated, integrated, and prioritized plan to communicate U.S. foreign policy objectives relating to our international engagement on avian and pandemic influenza to key stakeholders (e.g., the American people, the foreign public, NGOs, international businesses), within 3 months. Measure of performance: number and range of target audiences reached with core public affairs and public diplomacy messages, and impact of these messages on public responses to avian and pandemic influenza.
Information on pandemic preparedness and U.S. international policy and activities for broad domestic and international audiences has been posted on U.S. Government websites, including www.pandemicflu.gov, www.state.gov/g/avianflu, and www.usinfo.state.gov. Key U.S. officials have also reached out to the American public through speeches in public forums. Through international media orientation, TV documentaries, websites, news stories, and enhanced Voice of America broadcasting, we have reached an estimated audience of more than 300 million persons.
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5.1.1.2 Complete
HHS and DHS, in coordination with the National Economic Council (NEC), DOD, DOC, U.S. Trade Representative (USTR), DOT, DOS, USDA, Treasury, and key transportation and border stakeholders, shall establish an interagency modeling group to examine the effects of transportation and border decisions on delaying spread of a pandemic, and the associated health benefits, the societal and economic consequences, and the international implications, within 6 months. Measure of performance: interagency working group established, planning assumptions developed, priorities established, and recommendations made on which models are best suited to address priorities.
We are fully engaged with an interagency working group to discuss modeling and economic analysis issues, establish Federal priorities, develop an inventory of modeling capabilities for each priority, and recommend which priorities should be modeled. We evaluated a wide range of modeling and simulation tools, to support analysis of the health, economic and international impacts of a pandemic. We developed initial planning assumptions (e.g., morbidity, mortality, absenteeism) that are included in department pandemic influenza plans.
5.1.1.3. Complete
DHS and DOT, in coordination with DOD, HHS, USDA, Department of Justice (DOJ), and DOS, shall assess their ability to maintain critical Federal transportation and border services (e.g., sustain National Air Space, secure the borders) during a pandemic, revise contingency plans, and conduct exercises, within 12 months. Measure of performance: revised contingency plans in place at specified Federal agencies that respond to both international and domestic outbreaks and at least two interagency exercises carried out to test the plans.
We have developed pandemic contingency plans to ensure their ability to secure borders and sustain the National Airspace system. Agencies within DOT and DHS have conducted nearly a dozen internal exercises of those plans, as well as an interagency exercise.
5.1.2.1. Complete
DHS and HHS, in coordination with DOT and USDA, shall review existing grants or Federal funding that could be used to support transportation and border-related pandemic planning, within 4 months. Measure of performance: all State, local, and tribal governments are in receipt of, or have access to, guidance for grant applications.
All eligible entities have received program guidance documents announcing the availability of funding from Federal agencies. Members of the DHS-HHS Grant Programs Steering Committee reviewed their respective grants and other Federal funding programs. HHS, DHS, USDA, and DOT developed a program review chart, detailing transportation and border-related pandemic planning funding activities, and disseminated the chart to all identified programs and entities. This will assist in greater leveraging of funds and less duplication, allowing awardees from one funding program to better coordinate with awardees of another funding program in the same or neighboring jurisdiction.
5.1.2.2. Complete
DOT, in coordination with DHS, HHS, and transportation stakeholders, shall convene a series of forums with governors and mayors to discuss transportation and border challenges that may occur in a pandemic, share approaches, and develop a planning strategy to ensure a coordinated national response, within 12 months. Measure of performance: strategy for coordinated transportation and border planning is developed and forums initiated.
We are working with the National Governor’s Association (NGA) to coordinate outreach efforts to State and local stakeholders. The NGA is holding regional workshops and exercises to discuss State and local level pandemic planning and to distribute best practice guidance. In conjunction with our Federal partners, DOT continues to work with the NGA to coordinate an outreach strategy to State and local officials, to serve as the vehicle for distributing pandemic best practice information and to address immediate concerns of stakeholders.
5.1.3.2 In Progress
DHS, in coordination with DOT, HHS, DOC, Treasury, and USDA, shall work with the private sector to identify strategies to minimize the economic consequences and potential shortages of essential goods (e.g., food, fuel, medical supplies) and services during a pandemic, within 12 months. Measure of performance: the private sector has strategies that can be incorporated into contingency plans to mitigate consequences of potential shortages of essential goods and services.
Over the past year, the Federal Government has produced several tools for businesses of all types and sizes to assist them in planning for a pandemic. Several checklists have been produced that provide specific recommendations for pandemic planning. These checklists include information for businesses in general (Business Pandemic Influenza Planning Checklist), as well as Planning for U.S. Businesses with Overseas Operations, the Health Insurer Pandemic Influenza Planning Checklist, and the Travel Industry Pandemic Influenza Planning Checklist. These checklists have been used by State governments, local governments, and thousands of businesses and employers in this country and worldwide to improve their pandemic planning efforts.
5.1.4.1. Complete
HHS, in coordination with DHS, DOT, and DOL, shall establish workforce protection guidelines and develop targeted educational materials addressing the risk of contracting pandemic influenza for transportation and border workers, within 6 months. Measure of performance: guidelines and materials developed that meet the diverse needs of border and transportation workers (e.g., customs officers or agents, air traffic controllers, train conductors, dock workers, flight attendants, transit workers, ship crews, and interstate truckers).
We have prepared a Travel Industry Pandemic Influenza Planning Checklist (http://www.pandemicflu.gov/plan/workplaceplanning/travelchecklist.html).
We have also developed workforce protection guidelines for:
5.1.4.2. Complete
DHS, in coordination with DOT, DOL, Office of Personnel Management (OPM), and DOS, shall disseminate workforce protection information to stakeholders, conduct outreach with stakeholders, and implement a comprehensive program for all Federal transportation and border staff within 12 months. Measure of performance: 100 percent of workforce has or has access to information on pandemic influenza risk and appropriate protective measures.
We have developed guidance on workforce protection based on current policies and authoritative documentation. As new authoritative information becomes available, guidance will be updated and disseminated. Topics include use of masks and antiviral medications, universal precautions for transportation and border personnel in preventing the spread of pandemic influenza, and specific guidance for low, medium, and high-risk exposure workplaces. Agencies have developed interactive web-based training that provides guidance and background on protective measures employees can take to minimize risks.
5.1.4.3. In Progress
HHS, in coordination with DHS, DOT, DOD, Environmental Protection Agency (EPA), and transportation and border stakeholders, shall develop and disseminate decontamination guidelines and timeframes for transportation and border assets and facilities (e.g., airframes, emergency medical services transport vehicles, trains, trucks, stations, port of entry detention facilities) specific to pandemic influenza, within 12 months. Measure of performance: decontamination guidelines developed and disseminated through existing DOT and DHS channels.
Occupational safety guidelines under development include interim guidance for:
- Airline Cleaning Crew for an Arriving Aircraft with a Suspected Case of Pandemic Influenza,
- Cleaning an Emergency Medical Transport Vehicle after Transporting a Suspected Case of Pandemic Influenza,
- Cleaning Crew for a Train with a Suspected Case of Pandemic Influenza,
- Cleaning Crew for a Truck with a Suspected Case of Pandemic Influenza,
- Custodial Personnel for a Train or Bus Station with a Suspected Case of Pandemic Influenza,
- Custodial Personnel for an International Port of Entry Detention Facility with a Suspected Case of Pandemic Influenza,
- Cruise Line Cleaning Crew for an Arriving Cruise Ship with a Suspected Case of Pandemic Influenza, and
- Cleaning Crew for an Arriving Cargo Vessel with a Suspected Case of Pandemic Influenza
5.2.1.1. Complete
HHS and USDA, in coordination with DHS, DOT, DOS, DOD, DOI, and State, local, and international stakeholders, shall review existing transportation and border notification protocols to ensure timely information sharing in cases of quarantinable disease, within 6 months. Measure of performance: coordinated, clear interagency notification protocols disseminated and available for transportation and border stakeholders.
We have reviewed notification protocols to ensure that accurate information is available to border and transportation stakeholders in a timely manner. These protocols include communication chains for notification of Federal, State, and local stakeholders, both public and private, throughout the country. The protocols codify procedures already in use: 16 notifications of embargoes of live birds or unprocessed bird products have been issued since March 2006. Information about specific embargoes, import restrictions, or other regulatory actions is available to all stakeholders and the public at the following websites: www.aphis.usda.gov/vs/ncie/country.html#HPAI and www.cdc.gov/flu/avian/outbreaks/embargo.htm.
5.2.3.1. Complete
DHS, in coordination with HHS, DOT, DOS, and DOD, shall work closely with domestic and international air carriers and cruise lines to develop and implement protocols (in accordance with U.S. privacy law) to retrieve and rapidly share information on travelers who may be carrying or may have been exposed to a pandemic strain of influenza, within 6 months. Measure of performance: aviation and maritime protocols implemented and information on potentially infected travelers available to appropriate authorities.
We are using well-established aviation and maritime protocols to acquire and track public health data related to ill passengers. We have been working to make information on potentially infected travelers available to the appropriate authorities. We have developed a memorandum of understanding between Customs and Border Patrol and the CDC to facilitate requests for information on potentially infected international travelers in the event of a health emergency. An interagency group, coordinated by DHS, is actively engaged in developing a pandemic border health plan that will provide guidance to all levels of authorities to better manage border health risks. This plan will guide future training and exercises of protocols and procedures.
5.2.4.4. Complete
DOS and HHS, in coordination with DHS, DOT, and transportation and border stakeholders, shall assess and revise procedures to issue travel information and advisories related to pandemic influenza, within 12 months. Measure of performance: improved interagency coordination and timely dissemination of travel information to stakeholders and travelers.
We have formed an interagency working group to assess procedures regarding travel information and advisories in the event of an influenza pandemic. To streamline the process by which travel information is approved by agency representatives, the group has developed a protocol for seeking agency approval on short-fuse messages targeting Americans traveling or residing abroad. Several agencies have conducted tabletop exercises to develop and modify their communications and response protocols while addressing the public’s needs during a pandemic.
5.2.4.9 Complete
DHS, in coordination with DOS, HHS, Treasury, and the travel and trade industry, shall tailor existing automated screening programs and extended border programs to increase scrutiny of travelers and cargo based on potential risk factors (e.g., shipment from or traveling through areas with pandemic outbreaks) within 6 months. Measure of performance: enhanced risk-based screening protocols implemented.
We currently prohibit certain cargo from affected countries and target potentially infected cargo from affected countries through automated targeting systems. We are developing risk-based screening protocols to engage airlines and air carriers on the issue of en route screening. We will also engage foreign governments on the issue of screening international travelers at connection and transit points.
5.2.5.1. In Progress
HHS and DHS, in coordination with DOS, DOT, DOD, DOL, and international and domestic stakeholders, shall develop vessel, aircraft, and truck cargo protocols to support safe loading and unloading of cargo while preventing transmission of influenza to crew or shore-side personnel, within 12 months. Measure of performance: protocols disseminated to minimize influenza spread between vessel, aircraft, and truck operators/crews and shore-side personnel.
We are developing occupational safety protocols to support safe loading and unloading of cargo during an influenza pandemic, in order to minimize the spread of disease among vessel, aircraft, and truck operators/crews and shore-side personnel. Steps include:
- Adapting the Business Pandemic Influenza Planning Checklist to identify preparedness activities in the cargo transportation industry and assessing its usefulness at a large international (multimodal) vessel and rail cargo shipping firm;
- Contacting key agencies, industry associations, companies, and unions to identify current pandemic influenza preparedness planning activities and existing plans;
- Evaluating the relevance of existing occupational safety guidance and recommendations; and
- Drafting occupational safety protocols that make use of “universal precautions” that can be applied during an influenza pandemic.
5.2.5.2. Complete
USDA, in coordination with DHS, DOI, and HHS, shall review the process for withdrawing permits for importation of live avian species or products and identify ways to increase timeliness, improve detection of high-risk importers, and increase outreach to importers and their distributors, within 6 months. Measure of performance: revised process for withdrawing permits of high-risk importers.
We have revised the process for reviewing and canceling high-risk permits and communicated notification protocols to stakeholders. A new electronic permitting system has increased the efficiency of permit cancellations and withdrawals.
5.2.5.3. Complete
USDA, in coordination with DOI, DHS, shall enhance protocols at air, land, and sea ports of entry to identify and contain animals, animal products, and/or cargo that may harbor viruses with pandemic potential and review procedures to quickly impose restrictions, within 6 months. Measure of performance: risk-based protocols established and in use.
We currently have protocols in place to identify and contain animals, animal products, or cargo that could harbor influenza viruses with pandemic potential. The protocols have been reviewed to ensure that restrictions can be imposed quickly. Training seminars on the handling and quarantine of live birds have been completed by designated personnel and made available via the internet.
5.2.5.4. Complete
USDA, in coordination with DHS, shall review the protocols, procedures, and capacity at animal quarantine centers to meet the requirements outlined in Part 93 of Title 9 of the Code of Federal Regulations, within 4 months. Measure of performance: procedures in place to respond effectively and efficiently to the arrival of potentially infected avian species, including provisions for adequate quarantine surge capacity.
We have updated the protocols and procedures for handling birds, including smuggled birds that are encountered at ports of entry. Based on these protocols, we have determined that current surge capacity is adequate. Birds are safeguarded until the appropriate regulatory decision, which may involve quarantine, is made. Birds imported from a country affected by H5N1, however, are not allowed into the United States under any circumstance. These procedures have been incorporated into a bird handling seminar, which has been presented at ports of entry throughout the United States. Bird handling procedures are also referenced in a manual for CBP employees.
5.2.5.5. Complete
USDA, in coordination with DHS, DOJ, and DOI, shall enhance risk management and anti-smuggling activities to prevent the unlawful entry of prohibited animals, animal products, wildlife, and agricultural commodities that may harbor influenza viruses with pandemic potential, and expand efforts to investigate illegal commodities, block illegal importers, and increase scrutiny of shipments from known offenders, within 9 months. Measure of performance: plan developed to decrease smuggling and further distribution of prohibited agricultural commodities and products with influenza risk.
Representatives from DOJ, DOI, USDA, and DHS developed a plan to decrease the smuggling and distribution of prohibited agricultural commodities and products with influenza risk. The guidance provided in the plan will facilitate a comprehensive and coordinated approach to reducing risk at ports of entry as well as in commerce. Interagency collaboration and communication will continue, ensuring that future activities are well coordinated. Federal agencies are currently using the plan to enhance anti-smuggling activities related to avian influenza.
5.2.5.6. Complete
USDA, DHS, and DOI, in coordination with DOS, HHS, and DOC, shall conduct outreach and expand education campaigns for the public, agricultural stakeholders, wildlife trade community, and cargo and animal importers/exporters on import and export regulations and influenza disease risks, within 12 months. Measure of performance: 100 percent of key stakeholders are aware of current import and export regulations and penalties for non-compliance.
Informational materials on import and export regulations and influenza disease risks have been developed and distributed to 100 percent of the initial targeted stakeholders, including the public, agricultural stakeholders, the wildlife trade community, and cargo and animal importers/exporters. The materials currently are available through pandemicflu.gov, and the USDA, CBP, DOI/FWS, and CDC websites. Posters (in English, French, and Spanish) on illegal bird smuggling are being distributed to all air, land, and sea ports throughout the United States. An import/export booklet is posted on the internet and is being printed for hard copy distribution.
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6.1.1.3. Complete
DHS, in coordination with HHS, DOJ, DOT, and DOD, shall be prepared to provide emergency response element training (e.g., incident management, triage, security, and communications) and exercise assistance upon request of State, local and tribal communities and public health entities within 6 months. Measure of performance: percentage of requests for training and assistance fulfilled.
Our exercise and evaluation program provides direct support for State, local, and tribal exercises upon request. Exercises that address pandemic influenza response are eligible for funding support and vendor assistance. We have fulfilled 70 percent of submitted training requests thus far.
6.1.2.2. Complete
HHS, in coordination with DHS, DOD, and VA, shall develop a joint strategy defining the objectives, conditions, and mechanisms for deployment under which NDMS assets, U.S. Public Health Service (PHS) Commissioned Corps, Epidemic Intelligence Service officers, and DOD/VA health care personnel and public health officers would be deployed during a pandemic, within 9 months. Measure of performance: interagency strategy completed and tested for the deployment of Federal medical personnel during a pandemic.
We have developed a “playbook” that describes the public health and medical capabilities the Federal Government will bring to bear to support the National response to pandemic influenza. Its strategic principles have been tested in multiple exercises over the past year.
6.1.2.3. Complete
HHS, in coordination with DHS, DOT, DOD, and VA, shall work with State, local and tribal governments and leverage Emergency Management Assistance Compact agreements to develop protocols for distribution of critical medical materiel (e.g., ventilators) in times of medical emergency within 6 months. Measure of performance: critical medical material distribution protocols completed and tested.
We have developed a concise protocol that provides basic information on EMAC, refers practitioners to their State emergency management agency, provides links to other resources, and provides space for documenting State-specific information.
6.1.2.4 Complete
HHS, in coordination with DOD and VA, in collaboration with medical professional and specialty societies, within their domains of expertise, shall develop guidance for allocating scarce health and medical resources during a pandemic, within 6 months. Measure of performance: guidance developed and disseminated.
HHS developed a guidance document entitled “Providing Mass Casualty Care with Scarce Resources: A Community Planning Guide” that will help community leaders, as well as planners at the institutional, State, and Federal levels to plan for and respond to a mass casualty event. The document is not intended to reflect Federal policy but rather to provide State and local planners with options to consider when planning their responses. The guide is available at www.pandemicflu.gov and has been distributed at many national meetings.
6.1.2.5. Complete
HHS shall package and offer to the States and Territories the core operating components of an ESAR-VHP system within 6 months and encourage all States and tribal entities to implement the ESAR-VHP program by providing technical assistance and orientations at State and territory request to implement and operate Federal guideline (ESAR-VHP) compliant systems within 12 months. Measure of performance: guidance and technical assistance, as requested, provided to States to implement ESAR-VHP capability, compliant with Federal guidelines, in all States and U.S. territories.
HRSA defined the core requirements and timeframes that must be met by each State and Territory. These compliance requirements will be incorporated into the next version of the national ESAR-VHP guidelines due for release in the summer of 2007. Orientations have also been provided for all States and Territories.
6.1.2.6. Complete
HHS, in coordination with the USA Freedom Corps and Citizen Corps programs, shall continue to work with States and local communities to expand the Medical Reserve Corps program by 20 percent within 12 months. Measure of performance: increase number of Medical Reserve Corps units by 20 percent, from 350 to 420 units.
MRC has grown from 350 units to more than 654 units and 122,826 members.
6.1.2.7. Complete
HHS, in coordination with DHS, DOD, VA and the USA Freedom Corps and Citizen Corps programs, shall prepare guidance for local Medical Reserve Corps coordinators describing the role of the Medical Reserve Corps during a pandemic, within 3 months. Measure of performance: guidance materials developed and published on Medical Reserve Corps website (www.medicalreservecorps.gov).
MRC Pandemic guidance was posted in May 2006 (http://www.medicalreservecorps.gov/POUpdates/PandemicFluGuidance).
6.1.2.8 Complete
DHS, in coordination with the USA Freedom Corps, shall direct other Citizen Corps programs to prepare guidance detailing appropriate pandemic preparedness activities for each program, within 3 months. Measure of performance: guidance materials developed and published on Citizen Corps website and component program websites.
We have included specific links to preparedness checklists and current information on the Citizen Corps home website (www.citizencorps.gov) with instructions on how to access updated information. Affiliates have included specific pandemic influenza guidelines on their respective websites to ensure that current information is available. We are also working with all Citizen Corps components related to developing and disseminating specific guidance on pandemic influenza preparedness activities.
6.1.3.1. In Progress
HHS, in coordination with DHS, DOS, DOD, VA, and other Federal partners, shall develop, test, and implement a Federal Government public health emergency communications plan (describing the government’s strategy for responding to a pandemic, outlining U.S. international commitments and intentions, and reviewing containment measures that the government believes will be effective as well as those it regards as likely to be ineffective, excessively costly, or harmful) within 6 months. Measure of performance: containment strategy and emergency response materials completed and published on www.pandemicflu.gov; communications plan implemented.
The U.S Government Pandemic Influenza Public Health Communications Plan was finalized in November 2006. Core Plan elements include: communications goals, strategies, and tactics during a pandemic; the planning assumptions that will frame the U.S. Government communications response; the current agreed-upon Federal messages on pandemic influenza preparedness and response; and a comprehensive listing of target audiences, credible Federal expert spokespersons, and roles and responsibilities of the relevant Federal agencies.
6.1.3.2. Complete
HHS, in coordination with DHS, shall develop, test, update and implement (if necessary) a multilingual and multimedia public engagement and risk communications strategy within 6 months. Measure of performance: risk communication material completed and published on www.pandemicflu.gov and other venues; State summit meetings held.
Multiple public engagement and risk communication materials targeting key audiences have been produced and distributed via multiple channels. All checklists are available on pandemicflu.gov. Video versions of select Q&As as well as translations of some checklists and key materials into Spanish, Chinese, and Vietnamese are also available on pandemicflu.gov. Ten regional risk communications trainings have been held, and 50 state risk communications train-the-trainer sessions were completed by November 3, 2006.
6.1.3.3. Complete
HHS, in coordination with DHS, DOD, and the VA, and in collaboration with State, local, and tribal health agencies and the academic community, shall select and retain opinion leaders and medical experts to serve as credible spokespersons to coordinate and effectively communicate important and informative messages to the public, within 6 months. Measure of performance: national spokespersons engaged in communications campaign.
The U.S. Government has undertaken a number of efforts to engage medical, public health, tribal health, and the academic community local and regional spokespersons. Efforts include risk communications trainings to discuss crisis and emergency communication, and to support pandemic community and individual actions to reduce illness and death, restore or maintain calm, and engender confidence in the operational response. Through these trainings we created a cadre of 50 train-the-trainers to increase the numbers of credible spokespersons on the topic of pandemic influenza. Pandemic message maps are routinely shared with local partners to guide their communications planning and response.
6.1.4.1. Complete
State, local, and tribal public health and health care authorities, in collaboration with DHS, HHS, and the Department of Labor (DOL), should coordinate emergency communication protocols with print and broadcast media, private industry, academic, and nonprofit partners within 6 months. Measure of performance: coordinated messages from communities identified above.
In collaboration with other Federal departments, a risk communication strategy is being developed including risk communications sessions that train participants to serve as local spokespeople before, during, and after a pandemic. Third-party outreach efforts include: (1) development of planning checklists for State and local governments, the business community, schools, healthcare groups, and faith-based and community organizations; (2) ongoing sector briefings; and (3) the development of “push” communications mechanisms to the private sector.
6.1.4.2. Complete
DOT, in cooperation with HHS, DHS, and DOC, shall develop model protocols for 9-1-1 call centers and public safety answering points that address the provision of information to the public, facilitate caller screening, and assist with priority dispatch of limited emergency medical services, within 12 months. Measure of performance: model protocols developed and disseminated to 9-1-1 call centers and public safety answering points.
We have developed two documents: EMS Pandemic Influenza Guidelines for Statewide Adoption and Preparing for Pandemic Influenza: Recommendations for Protocol Development for 9-1-1 Personnel and Public Safety Answering Points (PSAPs). Both are intended to provide guidance to State and local agencies in developing their pandemic influenza plans and operational protocols and the role of EMS and 9-1-1 in preventing the spread of the disease. They provide general guidance, considerations, references, and ideas that can enhance the optimal delivery of emergency care and 9-1-1 services during an influenza pandemic.
6.1.6.1. In Progress
HHS, in coordination with DOD, VA, and State, local, and tribal partners, shall define the mix of antiviral medications to include in the Strategic National Stockpile (SNS) and State stockpiles and develop recommendations for how the different agents are to be used, within 6 months. Measure of performance: development of policy concerning the selection, relative proportions, and use of antiviral medications in SNS and State stockpiles.
Guidance is being developed by an interagency group and will be released soon.
6.1.6.2. In Progress
HHS, in coordination with DOD, VA, and State, local, and tribal partners, shall define critical medical material requirements for stockpiling by the SNS and States to respond to the diversity of needs presented by a pandemic, within 9 months. Measure of performance: requirements defined and guidance provided on stockpiling.
Guidance is being developed by an interagency group and will be released soon.
6.1.6.4. Complete
HHS, DOD, and VA and the States shall maintain antiviral and vaccine stockpiles in a manner consistent with the requirements of FDA’s Shelf Life Extension Program (SLEP) and explore the possibility of broadening SLEP to include equivalently maintained State stockpiles, within 6 months. Measure of performance: decision made on broadening SLEP to State stockpiles.
Current SLEP participants have stated their compliance with existing SLEP requirements as set forth in the Interagency Agreement and respective Memoranda of Agreement. DOD, HHS, and VA have determined that the inclusion of State stockpiles in the SLEP program is not feasible at this time.
6.1.7.1. In Progress
HHS, in coordination with DHS, DOJ, VA, and in collaboration with State, local, and tribal partners, shall determine the national medical countermeasure requirements to ensure the sustained functioning of medical, emergency response, and other front-line organizations, within 12 months. Measure of performance: more specific definition of sectors and personnel for priority access to medical countermeasures and quantities needed to protect those groups; guidance provided to State, local, and tribal governments and to infrastructure sectors for various scenarios of pandemic severity and medical countermeasure supply.
The draft guidance on pandemic vaccine and antiviral drugs includes recommendations targeting health care workers, emergency response personnel, and those who keep community services working.
6.1.9.1. Complete
HHS shall, to the extent feasible, work with antiviral drug manufacturers and large distributors to develop agreements supporting the Federal procurement of available stocks of antiviral drugs both during the pre-pandemic and pandemic periods, within 12 months. Measure of performance: new antiviral medications procured by SNS, within the constraints of industrial capacity; Federal contracts in place with antiviral drug manufacturers and distributors.
We have purchased a total of 37.4 million treatment courses of Tamiflu® and Relenza®, from Roche and GlaxoSmithKline respectively, for the Federal stockpile over the past 12 months. To date 29.8 million treatment courses have been received by the SNS, and the remaining 7.6 million treatment courses are due by the end of calendar year 2007. 12.6 million treatment courses of these influenza antiviral drugs will be ordered with expected delivery in 2008 to complete the Federal stockpile.
6.1.10.1. Complete
HHS, in coordination with the private sector, shall assess the ability of U.S.-based pharmaceutical manufacturing facilities to contribute surge capacity and to retrofit existing facilities for pandemic vaccine production. This assessment will be completed within 6 months and should inform efforts to expand vaccine capacity. Measure of performance: completed assessment.
Assessment of U.S. and global influenza vaccine manufacturing surge capacity is made quarterly through site visits and other communications to manufacturers, the International Federation of Pharmaceutical Manufacturers, and WHO. A summary table and graph of influenza vaccine manufacturing pandemic surge capacity and vaccine forecasts are provided after each analysis. A request for information was issued to ascertain manufacturer’s influenza vaccine capacity and needs for retrofitting existing facilities to produce pandemic influenza vaccines in an emergency. This resulted in the issuance of a RFP solicitation in June 2006 for retrofitting of existing facilities for pandemic influenza vaccine manufacturing. Two contracts for a total of $132 million were awarded in June 2007 to two vaccine manufacturers to renovate existing U.S.-based facilities for pandemic influenza vaccine production and to provide warm base manufacturing operations for at least 2 years with options for an additional 3 years. The national pandemic influenza vaccine manufacturing surge capacity is expected to double the current capacity and to provide at least 16 percent of the needed pandemic vaccine for the Nation.
6.1.10.2. In Progress
HHS, in coordination with DHS, DOD, VA, DOC, DOJ, and Treasury, shall assess within whether use of the Defense Production Act or other authorities would provide sustained advantages in procuring medical countermeasures, within 6 months. Measure of performance: analytical report completed on the advantages/disadvantages of invoking the Defense Production Act to facilitate medical countermeasure production and procurement.
An interdepartmental working group reviewed the first report on the use of the Defense Production Act (DPA) for pandemic preparedness and response in January 2007. A revised report expands upon each department’s DPA title programs, authorities and processes, newly emerging issues concerning acquisition of medical countermeasures, ancillary countermeasures, and services.
6.1.11.1. Complete
HHS shall assess its existing authorities and develop a plan of action to address any regulatory or other legal issues related to the expansion of domestic vaccine production capacity within 12 months. Measure of performance: regulatory and legal issues identified in assessment.
We have conducted an assessment of regulatory and legal issues related to expansion of domestic vaccine production capacity. Liability concerns have been remedied by the passage of the PREP Act of 2005, which provided liability immunity to vaccine manufacturers, distributors, and administrators from damage claims following the issuance of a public health threat declaration by the HHS Secretary. Whether the U.S. Government should pay royalty fees for acquisition of pre-pandemic and pandemic influenza vaccine for stockpiling has been addressed by HHS through their “order and consent” clause of the Bayh-Dole Act and the exercise of the non-exclusive licensing rights on patented inventions supported by Federal funds. The issuances of draft and final guidance by the FDA on the manufacturing of pandemic influenza vaccines in March 2006 and May 2007, respectively, have resolved and clarified any outstanding regulatory issues on the licensure of pre-pandemic and pandemic influenza vaccines.
6.1.11.2. Complete
HHS shall develop a protocol and decision tools to implement liability protections and compensation, as authorized by the Public Readiness and Emergency Preparedness Act (Pub. L. 109-148), within 6 months. Measure of performance: publication of protocol and decision tools.
Pandemic influenza PREP Act protocol and decision tools have been developed and published on www.pandemicflu.gov.
6.1.12.1. Complete
HHS shall collaborate with health care providers, industry partners, and State, local, and tribal public health authorities to develop public information campaigns and other mechanisms to stimulate increased seasonal influenza vaccination, within 12 months. Measure of performance: domestic vaccine use increased relative to historical norms.
An integrated communications campaign was launched in the fall of 2006 to increase vaccination rates for seasonal influenza. This nearly six-month campaign included traditional and new media outreach, public services announcements, paid advertising, and market research. As a result, more than 102 million doses of seasonal influenza vaccine were distributed during the 2006/2007 influenza season -- nearly 20 million doses more than ever in U.S. history.
6.1.13.1. In Progress
HHS, in coordination with DHS, DOD, VA, and DOJ, and in collaboration with State, local, and tribal partners and the private sector, shall ensure that States, localities, and tribal entities have developed and exercised pandemic influenza countermeasure distribution plans, and can enact security protocols if necessary, according to pre-determined priorities (see below) within 12 months. Measures of performance: ability to activate, deploy, and begin distributing contents of medical stockpiles in localities as needed established and validated through exercises.
Guidance and resources have been provided to State, local, tribal, and territorial governments to facilitate development of countermeasure distribution plans that describe activation, deployment, distribution, and security of assets (including antiviral drugs and other medical supplies) stored in State stockpiles and the Strategic National Stockpile (SNS). Recipients of pandemic influenza supplemental funding—which include all 50 State governments, four large cities, and eight territories—are required to complete and exercise their countermeasure distribution plans within the budget year.
6.1.13.2. In Progress
HHS, in coordination with DOD, VA, States, and other public sector entities with antiviral drug stockpiles, shall coordinate use of assets maintained by different organizations, within 12 months. Measure of performance: plans developed for coordinated use of antiviral stockpiles.
Planning continues to determine the optimal way to address the use of antiviral stockpiles and other assets.
6.1.13.4. In Progress
HHS, in coordination with DOD, VA, and in collaboration with State, local, and tribal governments and private sector partners, shall assist in the development of distribution plans for medical countermeasure stockpiles to ensure that delivery and distribution algorithms have been planned for each locality for antiviral distribution. Goal is to be able to distribute antiviral medications to infected patients within 48 hours of the onset of symptoms within 12 months. Measure of performance: distribution plans developed.
Guidance and resources have been provided to state, local, tribal, and territorial governments to facilitate completion of distribution plans for medical countermeasure stockpiles. Recipients of pandemic influenza supplemental funding are required to complete and exercise these plans within the budget year.
6.1.13.6. Complete
DOT, in coordination with HHS, DHS, State, local, and tribal officials and other EMS stakeholders, shall develop suggested EMS pandemic influenza guidelines for statewide adoption that address: clinical standards, education, treatment protocols, decontamination procedures, medical direction, scope of practice, legal parameters, and other issues, within 12 months. Measure of performance: EMS pandemic influenza guidelines completed.
We have developed two documents: EMS Pandemic Influenza Guidelines for Statewide Adoption and Preparing for Pandemic Influenza: Recommendations for Protocol Development for 9-1-1 Personnel and Public Safety Answering Points (Pass). Both are intended to provide guidance to State and local agencies in developing their pandemic influenza plans and operational protocols and the role of EMS and 9-1-1 in preventing the spread of the disease. They provide general guidance, considerations, references, and ideas that can enhance the optimal delivery of emergency care and 9-1-1 services during an influenza pandemic.
6.1.13.7. Complete
HHS, in coordination with DHS, DOT, DOD, and VA, shall work with State, local and tribal governments and private sector partners to develop and test plans to allocate and distribute critical medical materiel (e.g., ventilators with accessories, resuscitator bags, gloves, face masks, gowns) in a health emergency, within 6 months. Measure of performance: plans developed, tested, and incorporated into department plan, and disseminated to States and tribes for incorporation into their pandemic response plans.
DHS has developed and tested Pandemic Influenza Allocation and Distribution Plan: Guidance to Project Areas. The plan was tested in October 2006 and further testing of the response plan by HHS is scheduled from November 2006 to March 2007. It has been incorporated into the Department’s CDC Operations Plan and has been distributed to States for incorporation into their pandemic influenza response plans and for coordination with their respective local and tribal authorities.
6.1.14.1. In Progress
HHS, in coordination with DHS and Sector-Specific Agencies, DOS, DOD, DOJ, DOL, VA, Treasury, and State/local governments, shall develop objectives for the use of and strategy for allocating, vaccine and antiviral drug stockpiles during pre-pandemic and pandemic periods under varying conditions of countermeasure supply and pandemic severity within 3 months. Measure of performance: clearly articulated statement of objectives for use of medical countermeasures under varying conditions of supply and pandemic severity.
To plan how to best use a limited supply of pandemic influenza vaccine, experts from the Federal Government worked with States, businesses, and other organizations on how best to use vaccine to mitigate illness, to keep community services working, to protect national security, and to reduce loss to the economy. The resulting plan will soon be released for public comment.
A similar plan is being developed on the use of antiviral drugs during an actual pandemic, and will also be referred to the public for review. Experts from the Federal Government worked with State, local, and tribal public health officials to develop this guidance.
6.1.14.2. In Progress
HHS, in coordination with DHS and Sector-Specific Agencies, DOS, DOD, DOL, VA, Treasury, and State/local governments, shall identify lists of personnel and high-risk groups who should be considered for priority access to medical countermeasures, under various pandemic scenarios, according to strategy developed in compliance with 6.1.14.1, within 9 months. Measure of performance: provisional recommendations of groups who should receive priority access to vaccine and antiviral drugs established for various scenarios of pandemic severity and medical countermeasure supply.
To plan how to best use a limited supply of pandemic influenza vaccine, experts from the Federal Government worked with States, businesses, and other organizations on how best to use vaccine to mitigate illness, to keep community services working, to protect national security, and to reduce loss to the economy. The resulting plan will soon be released for public comment.
A similar plan is being developed on the use of antiviral drugs during an actual pandemic, and will also be referred to the public for review. Experts from the Federal Government worked with State, local, and tribal public health officials to develop this guidance.
6.1.14.3. In Progress
HHS, in coordination with DHS and Sector-Specific Agencies, DOS, DOD, DOL, and VA, shall establish a strategy for shifting priorities based on at-risk populations, supplies and efficacy of countermeasures against the circulating pandemic strain, and characteristics of the virus within 9 months. Measure of performance: clearly articulated process in place for evaluating and adjusting pre-pandemic recommendations of groups receiving priority access to medical countermeasures.
The draft guidance on pandemic vaccine and antiviral drugs includes a recommendation that it be reassessed at the time of a pandemic. This is important because past pandemics have been very different in their severity and in the groups that were most affected. Public health experts from the CDC will investigate outbreaks at the start of a pandemic to define how severe the pandemic is and who is at greatest risk. This information will be considered through the established policy process and vaccine and antiviral drug use guidance tailored to the specific pandemic situation.
6.1.15.1. Complete
HHS shall develop capability, protocols, and procedures to ensure that viral isolates obtained during investigation of human outbreaks of influenza with pandemic potential are sequenced and that sequences are published on GenBank within 1 week of confirmation of diagnosis in index case, within 6 months. Measure of performance: viral isolate sequences from outbreaks published on GenBank within 1 week of confirmation of diagnosis.
We support a high throughput genome sequencing center that is currently generating high quality influenza genome sequence data for avian and human influenza viruses in a state-of-the-art microbial genome sequencing facility at the Institute for Genomic Research (TIGR). As of May 21, 2007, 2,266 human and avian isolates have been completely sequenced, and genomic sequencing data has been released to GenBank in 45 days of completing the sequence for rapid and unrestricted access of the data by the scientific community. The facility is operating at a capacity to sequence 200 complete influenza genomes per month with capabilities in place to expand the number of viral genomes sequenced per month, in the event of a pandemic. In addition, the center can generate the complete viral genome sequence from a clinical sample in 2-3 days. HHS, in partnership with the Association of Public Health Laboratories (APHL), is prepared to publish sequence data on any human isolate of H5N1 detected in the United States within one week of obtaining a viral isolate.
6.1.15.2. Complete
HHS shall increase and accelerate genomic sequencing of known human and avian influenza viruses and shall rapidly make this sequence information publicly available, within 6 months. Measure of performance: increased throughput of genomes sequenced (versus FY 2005 baseline) and decreased time interval between completion of sequencing and publication on GenBank.
We support a high throughput genome sequencing center that is currently generating high quality influenza genome sequence data for avian and human influenza viruses in a state-of-the-art microbial genome sequencing facility at the Institute for Genomic Research (TIGR). As of May 21, 2007, 2,266 human and avian isolates have been completely sequenced, and genomic sequencing data has been released to GenBank in 45 days of completing the sequence for rapid and unrestricted access of the data by the scientific community. The facility is operating at a capacity to sequence 200 complete influenza genomes per month with capabilities in place to expand the number of viral genomes sequenced per month, in the event of a pandemic. In addition, the center can generate the complete viral genome sequence from a clinical sample in 2-3 days. Similarly, HHS, in partnership with the Association of Public Health Laboratories (APHL), can publish sequence data on any human isolate of H5N1 detected in the United States within one week of obtaining a viral isolate. Internationally, we work with WHO to encourage sharing of viruses from countries with avian influenza activity.
6.1.15.3. In Progress
HHS shall develop protocols and procedures to ensure timely reporting to Federal agencies and submission for publication of data from HHS-supported influenza vaccine, antiviral medication, and diagnostic evaluation studies, within 6 months. Measure of performance: study data shared with Federal agencies within 1 month of analysis and publication of clinical trial data following completion of studies.
We convened a working group that developed and approved protocols, including the mechanism for dissemination and notification of publication.
6.1.16.1. Complete
HHS shall continue to support the advanced development of cell-culture based influenza vaccine candidates. Measure of performance: research grants and/or contracts awarded to develop cell-culture based influenza vaccines against currently circulating influenza strains with pandemic potential within 6 months.
HHS/ASPR has awarded contracts totaling more than $1 billion to major influenza vaccine manufacturers for the advanced development of cell-based seasonal and pandemic influenza vaccines towards U.S.-licensure and to establish U.S.-based manufacturing facilities with a surge capacity within six months of the onset of an influenza pandemic. To date with cell-based seasonal influenza vaccines, two companies have completed Phase 2 clinical trials in the United States and another company has begun manufacturing of clinical lots for Phase 2 clinical trials. The remaining companies will start Phase 1 clinical trials in the United States in 2007.
6.1.17.1. Complete
HHS shall continue to support the development and clinical evaluation of novel vaccines and vaccination strategies (e.g., adjuvant, alternative delivery systems, common epitope vaccines). Measure of performance: research grants and/or contracts awarded to support the development of influenza vaccines (including polyvalent influenza vaccines), adjuvants and dose-sparing strategies, and more efficient delivery systems within 12 months, leading to initiation of phase I and II clinical trials to evaluate influenza vaccines and vaccination strategies.
During the past 12 months, the NIH/NIAID has made substantial progress in influenza vaccine research. The inactivated-virus H5N1 vaccine currently stockpiled by HHS has been shown in clinical trials to be relatively effective against the H5N1 virus in healthy adults, children, and seniors. We have also worked to expand and accelerate the development of additional manufacturing methods, collaborated with industry to pursue other vaccine strategies, and explored the concept of developing a vaccine that raises immunity to parts of the influenza virus that vary little from season to season and from strain to strain.
6.1.17.4. Complete
HHS shall increase access to standardized influenza reagents for use in influenza tests and research, within 6 months. Measure of performance: standardized influenza reagents distributed to domestic and international partners within 3 business days of a request.
We distribute standardized influenza reagents to diagnostic laboratories and research partners within three business days of a request, upon completion of an electronic material transfer agreement.
6.2.1.1. Complete
HHS shall provide guidance to public health and clinical laboratories on the different types of diagnostic tests and the case definitions to use for influenza at the time of each pandemic phase. Guidelines for the current pandemic alert phase will be disseminated within 3 months. Measure of performance: dissemination on www.pandemicflu.gov and through other channels of guidance on the use of diagnostic tests for H5N1 and other potential pandemic influenza subtypes.
We disseminated updated guidelines on diagnostic testing for avian influenza A (H5N1) virus and other potential pandemic influenza subtypes. “Updated Interim Guidance for Laboratory Testing of Persons with Suspected Infection with Avian Influenza A (H5N1) Virus in the United States” was prepared in collaboration with the Council of State and Territorial Epidemiologists (CSTE), the Infectious Diseases Society of American (IDSA), and other partners. It includes a case definition for suspected U.S. cases of human infection with avian influenza A (H5N1) to help decide when and how laboratory testing should be done. The guidelines have been posted on the internet (http://www2a.cdc.gov/han/ArchiveSys/ViewMsgV.asp?AlertNum=00246) and distributed to public health and medical partners via the Health Alert Network.
6.2.1.2. Complete
HHS shall ensure that testing by reverse transcriptase-polymerase chain reaction (RT-PCR) for H5N1 and other influenza viruses with pandemic potential is available at LRN laboratories and CDC within 3 months. Measure of performance: RT-PCR for H5N1 and other potential pandemic influenza subtypes and strains in use at CDC and LRN laboratories.
All members of the U.S. Laboratory Response Network (LRN)—which includes State public health laboratories—have the capacity to perform tests using the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) technique. Reagents and protocols for RT-PCR testing for H5N1 influenza have been distributed to 99 LRN laboratories across the country. Laboratory protocols for other influenza A subtypes with pandemic potential can be made available, as needed.
6.2.1.3. Complete
HHS, in coordination with DOD, VA, USDA, DHS, EPA, and other partners, in collaboration with its LRN Reference Laboratories, shall be prepared within 6 months to conduct laboratory analyses to detect pandemic subtypes and strains in referred specimens and conduct confirmatory testing, as requested. Measure of performance: initial testing and identification of suspect pandemic influenza specimens completed at LRN Reference and National Laboratories within 24 hours.
LRN laboratories in all 50 States are prepared to conduct initial or confirmatory testing of suspected pandemic strains within 24 hours of receipt, using reverse transcriptase-polymerase chain reaction (RT-PCR) primers and probes developed and validated at the CDC. Reagents and protocols for testing for H5N1 influenza have been distributed to 99 LRN laboratories throughout the country. Laboratory protocols for other influenza A subtypes with pandemic potential can be made available, as needed. Several other laboratories are also prepared to detect pandemic subtypes and strains in referred specimens and to conduct confirmatory testing.
6.2.2.1. Complete
HHS shall be prepared to provide ongoing information from the national influenza surveillance system on the pandemic’s impact on health and the health care system, within 6 months. Measure of performance: surveillance data aggregated and disseminated every 7 days, or as often as the situation warrants, to DHS, Sector-Specific Agencies, and State, territorial, tribal, and local partners.
We aggregate and disseminate influenza data to national and domestic partners on a weekly basis. During an influenza pandemic, we will disseminate data on a more frequent basis, if needed.
6.2.2.2. In Progress
HHS, in coordination with Federal, State, local, tribal, and private sector partners, shall develop real-time (same-day) tracking capabilities of pneumonia or influenza hospitalizations and influenza deaths to enhance its surveillance capabilities at the onset of and during a pandemic, within 12 months. Measure of performance: real-time (same-day) nationwide hospital census and mortality tracking system is operational for use during a pandemic.
BioSense is developing methods for gathering real-time healthcare census data (including mortality data) from two complementary sources: hospital bed census status during an emergency situation and emergency department census data.
6.2.2.3. Complete
HHS, in coordination with DOD and VA, shall expand the number of hospitals and cities participating in the BioSenseRT program to improve the Nation’s capabilities for disease detection, monitoring, and situational awareness within 12 months. Measure of performance: number of hospitals (including DOD and VA facilities) participating in the BioSenseRT program increased to 350 hospitals in 42 cities.
More than 700 hospitals are currently in some stage of implementation for sharing data with the BioSense program. These include DOD outpatient facilities, VA outpatient facilities, and 350 other healthcare organizations that provide inpatient, outpatient, and emergency department data.
6.2.2.4. Complete
HHS shall increase the frequency of reporting and the number and geographic location of reporting health care providers from which outpatient surveillance data are collected through the Sentinel Provider Network (SPN), the Emerging Infections Program (EIP) influenza project, and the New Vaccine Surveillance Network (NVSN), within 6 months. Measure of performance: number of reporting healthcare providers increased to one or more per 250,000 population.
The Sentinel Provider Network includes approximately 2,300 healthcare providers nationwide who report the number of weekly outpatient visits for influenza-like illness and submit specimens to State public health laboratories for influenza virus testing. This information helps the CDC detect emerging influenza strains and monitor disease patterns.
6.2.2.5. In Progress
HHS shall improve the speed at which it performs mortality surveillance through the 122 Cities Mortality Reporting System within 3 months. Measure of performance: mortality data collected at CDC within 1 week of decedent’s demise increased by 25 percent compared with 2005.
We have enhanced the completeness and timeliness of reporting by the 122 Cities Mortality Surveillance System, which receives reports of pneumonia and influenza-related deaths from vital statistics offices in 122 U.S. cities. This information helps us monitor the impact of influenza on health, track trends in disease spread, and identify severely affected populations. The completeness of 122 Cities reporting is now 97-98 percent, with approximately 118-119 cities reporting each week
6.2.2.7 In Progress
DHS, in collaboration with HHS, DOD, VA, USDA and other Federal departments and agencies with biosurveillance capabilities and real-time data sources, will enhance NBIS capabilities to ensure the availability of a comprehensive and all-source biosurveillance common operating picture throughout the Interagency, within 12 months. Measure of performance: NBIS provides integrated surveillance data to DHS, HHS, USDA, DOD, VA, and other interested interagency customers.
The National Biosurveillance Integration System will be fully operational by September 2008, at which time a robust biosurveillance common operating picture will become available. By incorporating information from multiple sources across these domains, NBIS intends to support three major objectives:
(1) Enable early recognition of biological events;
(2) Provide situational awareness to inform response; and
(3) Allow for information sharing and collaboration among partners.
6.2.2.8. In Progress
HHS, in coordination with DHS, DOD, and VA, and in collaboration with State, local, and tribal authorities, shall be prepared to collect, analyze, integrate, and report information about the status of hospitals and health care systems, health care critical infrastructure, and medical materiel requirements, within 12 months. Measure of performance: guidance provided to States and tribal entities on the use and modification of the components of the National Hospital Available Beds for Emergencies and Disasters (HAvBED) system for implementation at the local level.
HHS provided guidance to States in May 2006 on the use of HAvBED and adaptation of current systems to the bed standards in HAvBED. HHS cooperative agreement funds were awarded to the States in September 2006. The funds can be used for upgrading and development of systems to capture bed data. The established program performance measures are as follows: (1) Percent of participating hospitals that can report available beds, according to HAvBED definitions, to the State EOC within 60 minutes of a State request to do so; and (2) Percent of States that can report data, according to HAvBED definitions, to the SOC within four hours of the SOC requesting the data.
6.2.3.2. Complete
HHS, in coordination with DHS, DOD, and VA, shall compile an inventory of all research and product development work on rapid diagnostic testing for influenza and shall reach consensus on sets of requirements meeting national needs and a common test methodology to drive further private-sector investment and product development, within 6 months. Measure of performance: inventory developed and requirements paper disseminated.
A partnership of Federal departments and agencies developed an inventory of research and development work on rapid diagnostic testing for influenza and disseminated a set of technical requirements for further product development.
6.2.4.1. In Progress
HHS, in coordination with DHS, DOD, VA, USDA, and DOS, shall be prepared, within 12 months, to continuously evaluate surveillance and disease reporting data to determine whether ongoing disease containment and medical countermeasure distribution and allocation strategies need to be altered as a pandemic evolves. Measure of performance: analyses of surveillance data performed at least weekly during an outbreak with timely adjustment of strategic and tactical goals, as required.
The CDC evaluates influenza data on a weekly basis, taking into account the seven components of the U.S. national influenza surveillance system: laboratory surveillance, outpatient surveillance, hospitalization surveillance, pediatric mortality surveillance, State-level assessments, and pneumonia- and influenza- related mortality surveillance in 122 cities. During an influenza pandemic, the CDC will evaluate influenza data on a more frequent basis and will adjust strategic and tactical goals as needed.
6.2.4.2 Complete
DHS, in coordination with Sector-Specific Agencies, HHS, DOD, DOJ, and VA and in collaboration with the private sector, shall be prepared to track integrity of critical infrastructure function, including the health care sector, to determine whether ongoing strategies of ensuring workplace safety and operational continuity need to be altered as a pandemic evolves, within 6 months. Measure of performance: tracking system in place to monitor integrity of critical infrastructure function and operational continuity in near real time.
We completed a platform for the tracking system to monitor the integrity of critical infrastructure function and operational continuity in near real time. We are working with sector-specific agencies, Federal partners, and the private sector to develop the data and reporting requirements.
6.2.4.3 In Progress
DOD and VA shall be prepared to track and provide personnel and beneficiary health statistics and develop enhanced methods to aggregate and analyze data documenting influenza-like illness from its surveillance systems within 12 months. Measure of performance: influenza tracking systems in place and capturing beneficiary clinical encounters.
VA’s existing national electronic medical record currently facilitates limited tracking of patient health statistics. To improve surveillance and facilitate data collection, VA is developing a national electronic healthcare-associated infection and influenza surveillance system. One part of this surveillance system development includes adapting, and optimizing a DOD surveillance program for VA. VA anticipates that the surveillance prototype will be completed by the end of calendar year 2007. In 2008, VA plans to test the system in the 13 VA hospitals that currently report data to the CDC’s National Health Safety Network. If successful, the VA will expand to its entire healthcare system. A national VA system to track employee and staff health statistics is in the initial stages of development. DOD is currently collecting data from all outpatient visits to military treatment facilities in the Continental United States. The system is designed to identify whether a disease trend is forming, and, if so, whether it is a naturally occurring event or part of a deliberate attack. DOD is also examining whether applications developed for wartime operations can be used to support civilian health care authorities in the United States and is working with the CDC to expand its ability to track trends using inpatient hospital visits. DOD plans to consolidate these surveillance activities under one organization – the Armed Forces Health Surveillance Center.
6.2.5.1. Complete
HHS, in coordination with DOD and DHS, shall develop and maintain a real-time epidemic analysis and modeling hub that will explore and characterize response options as a support to policy and decision makers within 6 months. Measure of performance: modeling center with real-time epidemic analysis capabilities established.
Using the capabilities of the Defense Department’s Defense Threat Reduction Agency and software from other agencies, HHS has established an epidemic analysis capability that is focused on public health and emergency preparedness.
6.3.2.1. Complete
HHS, in coordination with DHS, DOT, Education, DOC, DOD, and Treasury, shall provide State, local, and tribal entities with guidance on the combination, timing, evaluation, and sequencing of community containment strategies (including travel restrictions, school closings, snow days, self-shielding, and quarantine during a pandemic) based on currently available data, within 6 months, and update this guidance as additional data becomes available. Measure of performance: guidance provided on community influenza containment measures.
Working in consultation with State and local health departments, the Institute of Medicine, professional societies, mathematical modelers, ethicists, historians, and others, we have developed a Community Mitigation Strategy for Pandemic Influenza. Especially during the early days of pandemic—before pandemic vaccine is available—non-pharmaceutical, community-containment measures will be major tools in slowing disease spread. The Community Strategy lays out a plan of early, targeted, layered use of selected non-pharmaceutical interventions. These interventions include: voluntary isolation of persons with an influenza-like illness that may be due to a pandemic influenza strain; voluntary quarantine of household contacts of ill persons; dismissal of classes for school-age children, closure of child care facilities, and measures to prevent congregation of children outside of school; and the institution of work-place and community social distancing measures for adults.
6.3.2.2. In Progress
HHS shall provide guidance on the role and evaluation of the efficacy of geographic quarantine in efforts to contain an outbreak of influenza with pandemic potential at its source, within 3 months. Measure of performance: guidance available within 72 hours of initial outbreak.
The recently developed Community Strategy for Pandemic Influenza Mitigation includes recommendation for voluntary quarantine. Additional specific guidance is being developed and will be released soon.
6.3.2.3. Complete
HHS, in coordination with DHS and DOD and in collaboration with mathematical modelers, shall complete research identifying optimal strategies for using voluntary home quarantine, school closure, snow day restrictions, and other community infection control measures, within 12 months. Measure of performance: guidance developed and disseminated on the use of community control.
The Community Strategy for Pandemic Influenza Mitigation (http://www.pandemicflu.gov/plan/community/commitigation.html) provides guidance on community disease control measures such as:
- Voluntary isolation of persons with an influenza-like illness;
- Voluntary quarantine of household contacts of ill persons;
- Dismissal of classes for school-age children, closure of child care facilities, and measures to prevent congregation of children outside of school;
- Institution of work-place and community social distancing measures for adults.
The Community Strategy includes Planning Guides for Individuals and Families, Elementary and Secondary Schools, Childcare Programs, Colleges and Universities, Faith-based and Community Organizations, and Businesses and Other Employers.
6.3.2.5 Complete
All HHS-, DOD-, and VA-funded hospitals and health facilities shall develop, test, and be prepared to implement infection control campaigns for pandemic influenza, within 3 months. Measure of performance: guidance materials on infection control developed and disseminated on www.pandemicflu.gov and through other channels.
HHS’s guidance on hospital infection control during an influenza pandemic is provided at www.hhs.gov/pandemicflu/plan/sup4.html. The supplement includes recommendations for infection control in healthcare settings that cover basic infection control practices for healthcare personnel. We have posted supplementary information on the use of PPE on www.pandemicflu.gov (Interim Guidance on Planning for the Use of Surgical Masks and Respirators in Healthcare Settings during an Influenza Pandemic). VA has a national infection prevention campaign called “Infection: Don’t Pass It On“ campaign (www.publichealth.va.gov/InfectionDontPassItOn ) that develops and distributes materials and messages for patients, visitors, and clinical and non-clinical staff in preventing transmission of infections, including seasonal and pandemic influenza. The campaign provides advice on the correct use of personal protective equipment.
6.3.2.7. Complete
HHS, in coordination with DHS, DOC, DOL, and Sector-Specific Agencies, and in collaboration with medical professional and specialty societies, shall develop and disseminate infection control guidance for the private sector, within 12 months. Measure of performance: validated, focus group-tested guidance developed, and published on www.pandemicflu.gov and in other forums.
Infection control guidance for use during an influenza pandemic has been developed for many private sector stakeholders—including businesses, healthcare workers, agricultural workers, educators, and airline workers—and posted on www.pandemicflu.gov and other government websites. Topics covered include respiratory hygiene and cough etiquette, social distancing, and use of masks. We have also developed communications tools to assist States and localities in providing information to the public before and during a pandemic.
6.3.3.1. Complete
HHS, in coordination with DHS, VA, and DOD, shall develop and disseminate guidance that explains steps individuals can take to decrease their risk of acquiring or transmitting influenza infection during a pandemic, within 3 months. Measure of performance: guidance disseminated on www.pandemicflu.gov and through VA and DOD channels.
We have developed guidance that explains steps individuals can take to decrease their risk of acquiring or transmitting influenza infection during a pandemic. This is posted on www.pandemicflu.gov and disseminated through medical and public health partners, as well as through interagency channels, including DOD and VA websites. We have also developed communications tools to assist States and localities in providing information to the public before and during a pandemic. These include public service announcements and standardized public health messages.
6.3.3.2. Complete
HHS, in coordination with DHS, DOD, VA, and DOT and in collaboration with State, local, and tribal partners, shall develop and disseminate lists of social distancing behaviors that individuals may adopt within 6 months and update guidance as additional data becomes available. Measure of performance: guidance disseminated on www.pandemicflu.gov and through other channels.
Lists of social distancing behaviors for different audiences are provided in six Planning Guides in the Community Strategy for Pandemic Influenza Mitigation (http://www.pandemicflu.gov/plan/community/commitigation.html). The Planning Guides address the needs of individuals and families, businesses and employers, faith-based and community organizations, childcare programs, elementary and secondary schools, and colleges and universities.
6.3.4.2. In Progress
HHS, in coordination with DHS, DOD, and VA, and in collaboration with States, localities, tribal entities, and private sector health care facilities, shall develop strategies and protocols for expanding hospital and home health care delivery capacity in order to provide care as effectively and equitably as possible, within 6 months. Measure of performance: guidance and protocols developed and disseminated.
Numerous strategy documents and protocols for expanding hospital and home health care delivery capacity have been developed and disseminated including the Medical Surge Capacity and Capability Handbook, the report: Reopening Shuttered Hospitals to Expand Surge Capacity, the Health Emergency Assistance Line and Triage Hub (HEALTH) Model, Project XTREME: Cross-Training Respiratory Extenders for Medical Emergencies, the Hospital Preparedness and Home Health Care Services Checklists, and the new Community Planning Guide for the allocation of scare resources. The VA also has a Home Based Primary Care program in place and pandemic influenza-specific homecare guidance and a supplies checklist in its Pandemic Influenza Plan. Finally, HHS is developing a Home Health Delivery Resource Handbook, which will be available to the public in November 2007.
6.3.4.3. Complete
HHS shall work with State Medicaid and SCHIP programs to ensure that Federal standards and requirements for reimbursement or enrollment are applied with the flexibilities appropriate to a pandemic, consistent with applicable law. Preliminary strategies shall be developed within 6 months. Measure of performance: draft policies and guidance developed concerning emergency enrollment in and reimbursement through State Medicaid and SCHIP programs during a pandemic.
We have held meetings with State Medical Directors, who have confirmed that existing Medicaid and SCHIP flexibilities are sufficient to meet their needs in the event of pandemic influenza. Pandemic-specific policies for Medicare, frequently asked questions, and instructions to contractors are in the final stages of review and approval. Questionnaires have been issued to States. A working group has been established that includes representatives from State Survey Agencies, provider associations, accreditation organizations, and resident/patient advocates.
6.3.4.4 Complete
DHS assets, including NDMS medical materiel and mobile medical units, and HHS assets, such as the USPHS Commissioned Corps and FMSs, shall be deployed in a manner consistent with pre-defined strategic considerations. Measure of performance: development, within 6 months, of strategic principles for deployment of Federal medical assets in a pandemic; consistency of deployments during a pandemic with these principles.
The National Disaster Medical System has developed strategic principles to ensure the appropriate use of Federal medical assets in the event of a pandemic. A playbook that describes the public health and medical capabilities the Federal Government will bring to bear to support the national response to pandemic influenza.
6.3.4.6. Complete
HHS shall deploy the USPHS Commissioned Corps and FMSs, if available and in combination or separately as circumstances warrant, to augment efforts of State/local governments as part of the Federal response. Measure of performance: USPHS Commissioned Corps personnel trained on FMSs within 9 months; Commissioned Corps personnel and FMSs deployed within 72 hours of order to mobilize during a pandemic.
Five Rapid Deployment Force Teams of 105 officers each have completed training with a component of the Federal Medical Stations. The teams have been pre-identified, rostered, trained, and equipped for service. The first event requiring this resource was deployed for Tropical Storm Ernesto. The RDF was on station within 48 hours of notification. RDF#2 team was deployed to provide medical support at the Ford State Funeral, a designated National Special Security Event. RDF#2 medical strike teams provided the primary medical support at three medical treatment tents. Additionally, RDF#2 providing field operations command during the event and remained on-call in support of possible contingencies associated with the State Funeral at the National Cathedral. RDF#2 had completed their mission rosters within 6 hours of their alert status for this event.
6.3.5.1. Complete
HHS, in coordination with DHS, DOL, Education, VA, and DOD, shall develop and disseminate guidance and educational tools that explain steps individuals can take to decrease their risk of acquiring or transmitting influenza infection during a pandemic, within 6 months. Measure of performance: interim guidance disseminated on www.pandemicflu.gov and through VA, DOD, and other channels within 3 months; complementary educational tools on social distancing, personal hygiene, mask use, and other infection control precautions developed within 6 months.
We have disseminated the following guidance and educational tools. Topics covered include respiratory hygiene and cough etiquette, social distancing, and use of masks. This information is available on www.pandemicflu.gov and on other government websites. Guidance products for the public that are posted on the internet include:
- A Guide for Individuals and Families (in English and Spanish)
- Pandemic Flu Planning Checklist for Individuals and Families (in English and Spanish)
- Family Emergency Health Information Sheet
- Faith-Based and Community Organizations Pandemic Influenza Preparedness Checklist (in English and Spanish)
- Interim Public Health Guidance for the Use of Facemasks and Respirators in Non-Occupational Community Settings During an Influenza Pandemic
- Planning Guide for Faith-Based and Community Organizations (Appendix 8 of the Community Strategy for Pandemic Influenza Mitigation)
- Planning Guide for Individuals and Families (Appendix 9 of the Community Strategy for Pandemic Influenza Mitigation)
- Stopping the Spread of Germs at Home, Work & School
- A video broadcast entitled: Pandemic Flu Preparedness: What Every Community Should Know
- Guidelines and Recommendations Interim Guidance about Avian Influenza A (H5N1) for U.S. Citizens Living Abroad
- Fact Sheet: Control of Pandemic Flu Virus on Environmental Surfaces in Homes and Public Places, Appendix to: Interim Guidance on Environmental Management of Pandemic Influenza A Virus
6.3.5.2. In Progress
HHS, in collaboration with State, local, and tribal governments, shall develop and disseminate recommendations for the use, if any, of antiviral stockpiles for targeted post-exposure prophylaxis in civilian populations, within 3 months. Measure of performance: States, localities, and tribal entities have received recommendations for incorporation into response plans.
The draft guidance on antiviral drugs includes recommendations for antiviral treatment and prophylaxis.
6.3.7.1. Complete
HHS, in coordination with DHS, DOD, VA, and DOT, and as the lead for ESF #8, shall identify public health and medical capabilities required to support a pandemic response and work with other supporting agencies to identify and deploy or otherwise deliver the required capability or asset, if available. Measure of performance: inventory of public health and medical capabilities within 6 months; available public health or medical capabilities or assets deployed or delivered during a pandemic.
We have developed an Emergency Support Function #8 Pandemic Influenza Playbook that describes the public health and medical capabilities the Federal Government will bring to bear to support the National response to pandemic influenza. These strategic principles have been tested in multiple exercises over the past year.
6.3.7.2 Complete
DOD and VA assets and capabilities shall be postured to provide care for military personnel and eligible civilians, contractors, dependents, other beneficiaries, and veterans and shall be prepared to augment the medical response of State, territorial, tribal, or local governments and other Federal agencies consistent with their ESF #8 support roles, within 3 months. Measure of performance: DOD and VA pandemic preparedness plans developed; in a pandemic, adequate health response provided to military and associated personnel.
We currently have pandemic influenza plans in place that address how we would take care of DOD and VA patient populations and others as well. DOD and VA are authorized to provide care to persons who are not their usual patients in the event of national or local emergencies or disasters.
6.3.7.3 Complete
VA shall develop draft emergency policies and directives allowing VA personnel and resources to be used for the treatment of non-veteran patients with pandemic influenza within 3 months. Measure of performance: emergency policies and directives drafted.
We currently have pandemic influenza plans in place that address how we would take care of VA patient populations and others. VA is authorized by several laws and policies to provide care to persons who are not their usual patients in the event of national or local emergencies or disasters.
6.3.7.4 Complete
VA shall develop, test, and implement protocols and policies allowing VA personnel and resources to be used for the treatment of non-veteran patients with pandemic influenza within 3 months. Measure of performance: protocols and policies developed and implemented.
We are already authorized to provide care to persons who are not our usual VA patients in the event of national or local emergencies or disasters. We have included information on these policies and laws in our emergency plans and our pandemic influenza plan.
6.3.8.1. Complete
HHS, in coordination with DHS, DOD, and VA, shall develop and disseminate a risk communication strategy within 6 months, updating it as required. Measure of performance: implementation of risk communication strategy on www.pandemicflu.gov and elsewhere.
Effective risk communication guides the public, the news media, health-care providers, and other groups in responding appropriately to outbreak situations and adhering to public health measures. U.S. Government risk communications principles are based on the “World Health Organization’s Outbreak Communications Guidelines,” which include building trust; making announcements of outbreaks early; communicating in a way that is candid, easy to understand, complete, and factually accurate; seeking to understand and respond to the public’s beliefs, opinions, and knowledge about the risk; and incorporating communication into preparedness planning.
6.3.8.2 Complete
DOD and VA, in coordination with HHS, shall develop and disseminate educational materials, coordinated with and complementary to messages developed by HHS but tailored for their respective departments, within 6 months. Measure of performance: up-to-date risk communication material published on DOD and VA pandemic influenza websites, the HHS website pandemicflu.gov, and in other venues.
We have developed pandemic influenza educational materials that are tailored to our personnel and patients and that are aligned with messages of other agencies. Specific topics include general information on pandemic influenza, how to protect oneself and one’s family from respiratory illnesses, how to wash hands and control coughing and sneezing, how to correctly put on and take off protective equipment, and how to care for someone who is sick with influenza. These materials are available in our agencies distribution systems, and some are available to the public at www.publichealth.va.gov/InfectionDontPassItOn and http://deploymenthealthlibrary.fhp.osd.mil.
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7.1.1.1. Complete
USDA, in coordination with DHS, HHS, DOD, and DOI, and in partnership with State and tribal entities, animal industry groups, and (as appropriate) the animal health authorities of Canada and Mexico, shall establish and exercise animal influenza response plans within 6 months. Measure of performance: plans in place at specified Federal agencies and exercised in collaboration with States believed to be at highest risk for an introduction into animals of an influenza virus with human pandemic potential.
We have led or participated in multiple exercises of Federal and State response plans in States at high risk for avian influenza introduction and worked with tribal nations to refine and coordinate influenza response plans. Many exercises have involved industry experts, and at least two major exercises focused on national stockpile issues, including assessment of materiel to be stockpiled and methods of materiel delivery. We have also established contracts for the development and delivery of additional influenza exercises.
7.1.2.1. Complete
USDA shall partner with State and tribal entities to establish, organize, train, and exercise incident management teams and a veterinary reserve corps within 12 months. Measure of performance: a veterinary reserve corps and incident management teams trained for each of the States believed to be at highest risk for an introduction into an animal population of an influenza virus with human pandemic potential.
The National Animal Health Emergency Response Corps (NAHERC) has been established in every State and we continue to expand its membership and capacity. NAHERC’s goal is to provide trained animal health responders at the county, State, and Federal levels. Veterinary Response or Incident Management Teams (IMTs) also are trained and in place in 40 States, including all of the priority poultry States. These teams are augmented with six USDA national IMTs. Our IMTs participate in many training exercises and have handled significant real-world crises, such as major hurricanes and disease outbreaks. Currently, the States and the Federal Government have more than 4,000 people available to respond if an event, such as an AI outbreak, were to occur.
7.1.2.2. Complete
USDA, in coordination with DOD, HHS, DHS, and DOI, shall partner with States and tribal entities to ensure sufficient veterinary diagnostic laboratory surge capacity for response to an outbreak of avian or other influenza virus with human pandemic potential, within 6 months. Measure of performance: plans and necessary agreements to meet laboratory capacity needs for a worst case scenario influenza outbreak in animals validated by utilization in exercises.
Plans are in place to ensure sufficient veterinary diagnostic laboratory surge capacity at 52 National Animal Health Laboratory Network (NAHLN) facilities in 45 States.
7.1.3.1. Complete
USDA, in coordination with DHS, shall develop, disseminate, and encourage adoption of best practices and recommendations for maintaining the biosecurity of animals, especially poultry and swine, against infection and spread of influenza viruses and for reporting suspected cases of influenza with human pandemic potential in animals to State or Federal authorities, within 4 months. Measure of performance: incorporation of best practices by industry.
We have significantly enhanced Biosecurity for Birds, an informational campaign targeted at maintaining the biosecurity of domesticated animals. The program specifically encourages the reporting of signs of influenza infection and provides a toll-free reporting number. The campaign has distributed nearly one million copies of materials to 50 States and more than 50 countries, and it has placed bilingual information on more than 1.7 million poultry feed sacks, ads on national and regional agricultural radio networks reaching 23 million listeners, and ads in newspapers and magazines with nearly 30 million readers. A training module will be completed and distributed this year.
7.1.3.2. Complete
USDA, in coordination with DHS, shall partner with State and tribal entities, and industry groups representing poultry and swine producers and processors, and other stakeholders, to define and exercise response roles and capabilities within 9 months. Measure of performance: exercises involving State or tribal entities, at least one poultry industry group, and one swine industry group, conducted and after action reports produced.
We have conducted numerous exercises with local, tribal, State, and Federal officials, as well as representatives from poultry and swine industries. We plan to hold more exercises and to complete an analysis of all the after-action reports delivered during the State exercise program.
7.1.3.3. Complete
HHS, in coordination with USDA, DHS, and the Department of Labor (DOL), shall work with the poultry and swine industries to provide information regarding strategies to prevent avian and swine influenza infection among animal workers and producers, within 6 months. Measure of performance: guidelines developed and disseminated to poultry and swine industries.
HHS has developed response guidelines to reduce the risk of transmission between domestic animals and wildlife during an influenza outbreak in animals. Federal partners have specified roles, responsibilities, and the timing of actions to be taken in outbreak scenarios involving wildlife and domestic animals. Actions in these guidelines have been incorporated into agency response plans that continue to be updated. Response guidelines, informational material, and communication plans have been disseminated to State and Federal partners, including wildlife agencies and diagnostic laboratories. USDA has posted draft guidance for the swine industry: Management of Highly Pathogenic Avian Influenza H5N1 Virus: Policy Impact and Management of Swine (USDA Draft, 2006).
7.1.3.4. Complete
USDA, in coordination with DOI, shall collaborate with DHS and other Federal partners, with State, local, and tribal partners, including State wildlife authorities, and with industry groups and other stakeholders, to develop guidelines to reduce the risk of transmission between domestic animals and wildlife during an animal influenza outbreak, within 6 months. Measure of performance: guidelines for various outbreak scenarios produced, disseminated, and incorporated by partners.
We have developed response guidelines to reduce the risk of transmission between domestic animals and wildlife during an influenza outbreak in animals. Federal partners have specified roles, responsibilities, and the timing of actions to be taken in outbreak scenarios involving wildlife and domestic animals. Actions in these guidelines have been incorporated into agency response plans that continue to be updated. Response guidelines, informational material, and communication plans have been disseminated to State and Federal partners, including wildlife agencies and diagnostic laboratories.
7.1.3.5. Complete
DOI, in coordination with USDA, shall work with other Federal, State, and tribal partners to develop appropriate response strategies for use in the event of an outbreak in wild birds, within 4 months. Measure of performance: coordinated response strategies in place that can rapidly be tailored to a specific outbreak scenario.
The Federal Government, in coordination with State and tribal partners, has adopted a common response strategy for an outbreak of HPAI H5N1 in wild birds -- intensified surveillance, containment, coordinated interagency situational assessment, and activating or supporting an ICS/unified command when needed. In total, these elements serve to establish a response strategy for an outbreak of HPAI H5N1 in wild birds that can be rapidly tailored to a specific outbreak scenario.
7.1.4.1. Complete
USDA shall augment the current stockpile of 40 million doses of avian influenza vaccine with an additional 70 million doses within 9 months. Measure of performance: avian influenza vaccine stockpiles increased to 110 million doses.
We have completed acquisition of an additional 40 million doses of killed avian influenza vaccine. The product has been manufactured and is available for use. In addition, the National Veterinary Stockpile (NVS) has entered into a contract for delivery of up to 500 million doses of live pox recombinant H5 avian influenza vaccine. The NVS does not own the product but has guaranteed access. Currently, there are 140 million doses of killed avian influenza vaccine available for use, with 75 million doses effective against H5 avian influenza virus.
7.1.4.2. Complete
USDA shall stockpile diagnostic reagents, PPE, antiviral medication for protection of response personnel, and other response materiel within 9 months. Measure of performance: materiel pre-positioned for rapid delivery to areas where poultry or other animals are believed to be at highest risk for an introduction of an influenza virus with human pandemic potential.
We have contracts with distributors and manufacturers of PPE, diagnostic reagent commercial entities, and other veterinary suppliers for just-in-time delivery to incident sites. These contracts include processes for call and delivery within 24 hours. We also maintain, in strategic locations, sufficient PPE and other materials to protect workers and support 310 people for 10 days.
7.1.5.3. Complete
USDA shall sequence genomes of all available avian influenza viruses to provide diagnostic sequences, identify possible vaccine antigens, and provide potential information on viral evolution, relationships, and determinants of virulence within 12 months. Measure of performance: genomes of avian influenza viruses sequenced and submitted to GenBank, and information reported on potential diagnostic sequences and viral relationships.
We have collected and continue to collect virus isolates from wild birds, waterfowl, and domestic birds worldwide. We have sequenced a significant number of these isolates and have submitted the initial batch of sequencing data to GenBank. Information about potential diagnostic sequences and viral relationships has been reported at numerous scientific venues worldwide. Because the vast number of samples collected (more than 1,000 viral isolates to date) will take months to complete, analysis will be ongoing. The data from this effort will continue to evolve and will be disseminated as new and useful information is derived.
7.1.5.5. Complete
USDA, in coordination with DHS, shall identify any deficiencies relative to needs for Federal animal research facility capacity, including appropriate biosafety levels, for performing studies of avian, swine, and other animal influenza viruses with pandemic potential, and establish a plan of action to ensure that needed facilities will be available to carry out those studies, within 6 months. Measure of performance: deficiencies in capacity of Federal animal research facilities identified and plans developed for addressing those needs.
We have evaluated the existing bio-containment facilities for USDA’s AI research program and concluded that new facilities are needed. Currently, there are no Federal bio-containment facilities to study animal influenza viruses with pandemic potential in large animal species, such as swine. We have submitted a budget request to design a new, modernized facility, which will include space for animals, laboratories, and administrative offices. The proposed facility also will include a farm to house breeding colonies of disease-free chickens to be used for research.
7.1.5.6. Complete
USDA, in coordination with DHS, DOI, and DOD, shall partner with State and tribal authorities to refine disease mitigation strategies for avian influenza in poultry or other animals through outbreak simulation modeling, within 6 months. Measure of performance: simulation models produced and reports issued on the results of influenza outbreak scenario modeling.
Two outbreak simulation models were developed and are providing data to refine mitigation strategies for avian influenza. The models simulate the spread, mitigations, and impacts of two animal pathogens (HPAI and FMD). USDA and DHS continue to improve the models, which already are providing information to improve response planning at the State, industry, and national level. DOI and USDA also are involved in a cooperative agreement with Colorado State University to examine how HPAI spreads within wild bird populations and how the agent might move from wild bird populations to farmed bird populations.
7.2.1.1. Complete
DOI and USDA shall collaborate with State wildlife agencies, universities, and others to increase surveillance of wild birds, particularly migratory water birds and shore birds, in Alaska and other appropriate locations elsewhere in the United States and its territories, to detect influenza viruses with pandemic potential, including HPAI H5N1, and establish baseline data for wild birds, within 12 months. Measure of performance: reports detailing geographically appropriate wild bird samples collected and influenza virus testing results.
We have collaborated with State wildlife agencies and others to develop a U.S. Interagency Strategic Plan for wild bird surveillance, which was finalized in March 2006. The four North American Flyway Councils subsequently stepped down that national strategy to flyway specific surveillance strategies, all of which were completed and approved by July 2006. DOI and USDA agencies, and their State Cooperators, collected and tested more than 110,000 bird samples and 50,000 fecal samples during the 2006 surveillance year.
7.2.1.2. Complete
USDA and DOI shall collaborate to develop and distribute information to State and tribal entities on the detection, identification, and reporting of influenza viruses in wild bird populations, within 6 months. Measure of performance: information distributed and a report available describing the type, amount, and audiences for the information.
The HPAI Early Detection Data System (HEDDS) was established to distribute information on the detection, identification, and reporting of influenza viruses in wild birds. Specific test results of 145,066 samples from all 50 States, Puerto Rico, Guam, and five Freely Associated Pacific Islands are available to partner agencies, and summaries are available to the public. HEDDS also catalogues all LPAI viruses detected by DOI and USDA (available at http://wildlifedisease.nbii.gov/ai/LPAI-Table.jsp). An online listing of wildlife mortality events nationwide also provides information on causes of wildlife mortalities. We have provided extensive training on early detection, surveillance, and sampling techniques for AI nationally and internationally, and we have distributed informational materials to partner agencies and to all 50 states.
7.2.1.3. Complete
USDA shall work with State and tribal entities and industry groups to perform surveys of game birds and waterfowl raised in captivity, and implement surveillance of birds at auctions, swap meets, flea markets, and public exhibitions, within 12 months. Measure of performance: samples collected at 50 percent of the largest auctions, swap meets, flea markets, and public exhibitions held in at least five States or tribal entities believed to be at highest risk for an avian influenza introduction.
Cooperative agreements with 39 States have been established, and more than $2 million has been made available to conduct AI surveillance in upland game birds (i.e., pheasants, quail, and ducks raised for release in the wild or in hunting preserves). The States are responsible for partnering with tribal entities and industry within their States through these cooperative agreements. States are required to report on their surveillance activities quarterly. We estimate that approximately 16,000 surveillance tests will be conducted each quarter. To date, no HPAI or LPAI positive results have been received from this surveillance.
7.2.1.4. Complete
USDA shall work with State and tribal entities to provide additional personnel in additional locations to increase the number of facilities inspected and number of samples collected for avian influenza virus testing within the LBMS, within 12 months. Measure of performance: number of facilities inspected and sampled increased by 50 percent compared to previous year.
Cooperative agreements with 39 States have been established and nearly $4 million has made available to enhance AI Surveillance in live bird markets as well as to conduct AI surveillance in auction markets, swap meets, flea markets, and public exhibitions.
7.2.2.1. Complete
USDA shall increase the capacity of the NVSL and the NAHLN to process influenza surveillance samples from commercial and LBMS sources, as well as wild birds, and develop and contract for the production of test reagents for distribution at no cost to collaborating State and industry laboratories within 12 months. Measure of performance: national capacity for laboratory testing increased by 100 percent compared to previous year and contracts for production of required avian influenza test reagents in place.
The testing capacity of the National Animal Health Laboratory Network (NAHLN) laboratories will more than double this year. USDA epidemiologists ranked States according to risk of entry and spread of HPAI in the U.S. poultry industry, and the new equipment was distributed accordingly. NAHLN laboratories will use high throughput equipment to bolster veterinary diagnostic laboratory surge capacity during an influenza outbreak. A contract for the production of required avian influenza test reagents is in progress; an interim purchase of reagents was made based on last year’s contract.
7.2.2.2. Complete
USDA shall partner with State and tribal entities to provide additional support for laboratory activities associated with NPIP surveillance for avian influenza within 12 months. Measure of performance: cooperative support agreements with States and tribal entities developed and implemented.
Cooperative agreements with 45 States were established and nearly $6 million was made available to enhance ongoing AI surveillance in commercial poultry and risk-based surveillance in small NPIP flocks. The States will partner with tribal entities and industry through these cooperative agreements.
7.2.2.3. Complete
DOI and USDA shall increase the wild bird testing capacity of the NWHC and the National Wildlife Research Center, respectively, to process avian influenza samples from wild birds, within 12 months. Measure of performance: national wild bird testing capacity for avian influenza virus increased by 50 percent compared to previous year.
Between April 1, 2006 and March 31, 2007 (the 2006 surveillance season for the National Program for the Early Detection of Highly Pathogenic Avian H5N1 in the United States), we increased laboratory wild bird sample testing capacity 10-fold, in terms of personnel and in terms of capability to run avian influenza molecular tests and, when appropriate, to conduct virus isolation and sequencing activities. The NWHC PCR-tested nearly 26,000 wild bird samples (primarily migratory waterfowl and shorebirds), while the NWRC tested more than 50,000 environmental (fecal) samples from wild birds. Both DOI’s NWHC, as a participant in the National Animal Health Laboratory Network, and the USDA’s NWRC work closely with USDA’s National Veterinary Services Laboratory in Ames, Iowa. Altogether we tested more than 145,000 samples from wild birds in all 50 States and seven Freely-Associated States and Territories during the 2006 surveillance season, and all samples tested negative for highly pathogenic avian influenza virus.
7.2.3.1. Complete
USDA shall develop an integrated database, or enhance existing databases, to support the national initiative for comprehensive surveillance for influenza viruses with pandemic potential in domestic animals using data collected from multiple sources, within 12 months. Measure of performance: functioning animal influenza surveillance database producing reports for a variety of queries and supporting multiple analyses of data.
In the past year, we have created or enhanced several fully automated surveillance streams, which are providing reports for a variety of queries and supporting multiple analyses of data. These surveillance streams include wild bird reporting, as well as a summary reporting tool that represents the “broiler” portion of the chicken industry. We also have produced databases for several industry surveillance programs.
7.2.3.2. Complete
DOI, in coordination with USDA, shall work with State and tribal entities, universities, and others to implement the Avian Influenza Data Clearinghouse developed by the NWHC to support the integrated surveillance program for influenza in wild birds within 12 months. Measure of performance: a functional wild bird influenza data clearinghouse utilized by multiple stakeholders.
We have developed Highly Pathogenic Avian Influenza Early Detection Data System (HEDDS) as a data management tool for use by all agencies, organizations, and policy-makers. HEDDS is now a widely accepted and accessed resource for avian influenza surveillance information and is an example of interagency cooperation. As of January 2007, there were 1,197 registered users of HEDDS, including 171 Federal, State, tribal, NGO, and private contributors, averaging more than 1,500 unique visits a week. HEDDS includes interagency data, analyzed by multiple laboratories, and made available on a common web platform of surveillance data and assessment. The 2006 surveillance season’s (April 1, 2006 - March 31, 2007) HEDDS Public Site (http://wildlifedisease.nbii.gov/ai) displays more than 145,000 wild bird avian influenza surveillance sample test results, displayed for all 50 states, as well as Washington, DC and seven Freely Associated States and Territories. In addition, the HEDDS site also boasts a public access site, a joint DOI-USDA table of avian influenza virus results of the low pathogenic subtypes (LPAI table), and an electronic mailing list.
7.3.1.3. Complete
USDA shall be prepared to provide near real-time technical information and policy guidance for State and tribal entities, animal industries, and individuals, on best practices to prevent the spread of avian influenza in commercial and other domestic birds and animals during an outbreak, within 4 months. Measure of performance: information and guidance distributed within 72 hours of confirmed outbreak and report available describing type and amount of information, and audiences to whom delivered.
We have developed, and continue to update, response guidelines that incorporate best practices to prevent the spread of avian influenza during an outbreak. These response plans are a joint effort among industry and Federal, State, and tribal governments. Plans are in place to provide near real-time technical information and policy guidance to our response partners and members of the public affected by the outbreak. Information and guidance is also provided through ongoing media communications and industry outreach efforts.
7.3.2.1. Complete
USDA shall activate plans to distribute veterinary medical countermeasures and materiel from the NVS to Federal, State, local, and tribal influenza outbreak responders within 24 hours of confirmation of an outbreak in animals of influenza with human pandemic potential, within 9 months. Measure of performance: NVS materiel distributed within 24 hours of confirmation of an outbreak.
The NVS recently deployed PPE and disinfectant in response to an LPAI outbreak at a U.S. turkey farm. This response demonstrated that the NVS has procedures in place to deliver, within 24 hours and at minimal cost, critical supplies to the right place at the right time.
7.3.3.1. Complete
USDA, in coordination with DOS, shall partner with appropriate international, Federal, State, and tribal authorities and with veterinary medical associations, including the American Veterinary Medical Association, to reduce barriers that inhibit veterinary personnel from crossing State or national boundaries to work in an animal influenza outbreak response, within 9 months. Measure of performance: agreements or other arrangements in place to facilitate movement of veterinary practitioners across jurisdictional boundaries.
We have agreements and other provisions in place to allow veterinary professionals to practice across jurisdictional boundaries in emergency situations. The most expeditious mechanisms are the Emergency Management Assistance Compact and the federalization of private veterinarians. In addition, we established an international agreement to allow non-U.S. veterinarians to practice in the United States when needed.
7.3.4.1. Complete
USDA shall assess the outbreak response surge capacity activities that other Federal partners, including the DOD, may be able to support during an outbreak of influenza in animals and ensure that mechanisms are in place to request such support, within 6 months. Measure of performance: written assessment completed and all necessary activation mechanisms in place.
The resources and surge capacity activities that Federal partners will be able to provide during an animal influenza outbreak have been assessed through an interagency process. We have produced a document that defines the processes to be used to obtain those resources, along with the roles and responsibilities of various partner agencies. As a result, necessary activation mechanisms have been clarified and are in place.
7.3.5.1. Complete
USDA, in coordination with DHS, DOI, and HHS, shall work with State, local, and tribal partners, industry groups, and other stakeholders to develop, clear and coordinated pre-scripted public messages that can later be tailored to the specifics of a given outbreak and delivered by trained spokespersons, within 3 months. Measure of performance: appropriate informational and risk mitigation messages developed prior to an outbreak, then shared with the public within 24 hours of an outbreak.
We developed pre-scripted risk mitigation messages in partnership with DOI, HHS, and DHS that were finalized and reformatted into a series of three avian influenza scenarios and key messages to be used in the event of a detection in the United States. The messages were posted on the pandemicflu.gov and www.usda.gov/birdflu websites in 2006. We continue to work with our partners to develop additional messages about animal health, food safety, and guidance for the public.
7.3.5.2. Complete
USDA and HHS, in coordination with DHS, State, local, and tribal partners, industry groups, and other stakeholders, shall develop guidelines to assure the public of the safety of the food supply during an outbreak of influenza in animals, within 6 months. Measure of performance: guidelines for various outbreak scenarios produced and shared with partners; within first 24 hours of an outbreak, appropriately updated guidelines on food safety shared with the public.
Food safety guidelines for avian influenza have been developed in the form of message maps for various potential influenza outbreak scenarios. These guidelines have been shared with stakeholders and are available at the website www.usda.gov/birdflu. The messages can be quickly modified, as needed, to serve other outbreak scenarios.
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8.1.1.2 Complete
DHS, in coordination with DOJ, HHS, DOL, and DOD, shall develop a pandemic influenza tabletop exercise for State, local, and tribal law enforcement/public safety officials that they can conduct in concert with public health and medical partners, and ensure it is distributed nationwide within 4 months. Measure of performance: percent of State, local, and tribal law enforcement/public safety agencies that have received the pandemic influenza tabletop exercise.
A tabletop exercise template has been developed for use by public health authorities. DHS is continuing to work with Federal partners to develop pandemic influenza tabletop exercises for State, local, and tribal law enforcement/public safety officials that can be conducted in concert with medical and public health entities.
8.1.2.1. Complete
DOJ, in coordination with HHS, DOL, and DHS, shall convene a forum for selected Federal, State, local, and tribal law enforcement/public safety personnel to discuss the issues they will face in a pandemic influenza outbreak and then publish the results in the form of best practices and model protocols within 4 months. Measure of performance: best practices and model protocols published and distributed.
DOJ sponsored a forum in Chicago for more than 200 criminal justice professionals in May 2006. A website (www.ojp.usdoj.gov/BJA/pandemic/pandemic_main.html) is being used to post information covered at the forum. As an outgrowth of the forum, a consortium of justice system experts was created to facilitate assisting local justice system planning efforts.
8.1.2.2. Complete
DOJ shall advise State Governors of the processes for obtaining emergency Federal law enforcement assistance, within 3 months. Measure of performance: all State Governors advised.
On May 31, 2006, the Attorney General sent a letter to each Governor outlining the procedures for obtaining Federal law enforcement assistance under the Emergency Federal Law Enforcement Assistance provisions of the Justice Assistance Act of 1984. The letter recognized that pre-event collaborative planning would have improved the Katrina response and stressed that the goal was “to ensure that any future response, whether to a natural disaster, a pandemic influenza outbreak, or an act of terrorism occurs as expeditiously as possible.” A sample form for making the required written response was provided, as well as the name and telephone number of a person to contact with any questions regarding the procedures.
8.1.2.3. Complete
DOJ shall advise State Governors of the processes for requesting Federal military assistance under the Insurrection Act within 3 months. DOD, after coordination with DOJ, shall publish updated policy guidance on Military Assistance during Civil Disturbances, within 6 months. Measure of performance: all State Governors advised and guidance published.
A protocol was developed in consultation with DOD and DHS, and a letter was sent to all State Governors, detailing the processes required for requesting aid as described above.
8.1.2.4. Complete
HHS and DOJ shall ensure consistency of the CDC Public Health Emergency Law Course with the National Strategy for Pandemic Influenza (Strategy), this Plan and other Federal pandemic documents and then disseminate the CDC Public Health Emergency Law Course across the United States within 6 months. Measure of performance: distribution of presentations of reviewed public health emergency law course to all States.
DOJ and HHS collaborated on the design and delivery of the PHEL course, which largely reflected the model of the CDC’s experience with “Forensic Epidemiology.” The course has been distributed to all States PHEL was delivered to the CDC professional staff in mid-March 2006. A working group composed of Federal, State, and local law enforcement and public health experts has also been created to address additional initiatives related to pandemic and other hazard preparedness.
8.1.2.6 Complete
DOD, in consultation with DOJ, shall advise State Governors of the procedures for requesting military equipment and facilities, training and maintenance support as authorized by 10 U.S.C. §§ 372-74, within 6 months. Measure of performance: all State governors advised.
DOD and DOJ are supporting other agencies in the coordination/liaison for Federal/State response and support. An all-States memorandum to the Adjutant General of each State is currently being distributed. There have been numerous conferences, tabletop Exercises, and Field Training Exercises to prepare for dealing with a broad range of hazards.
8.1.2.7 Complete
DHS, in coordination with DOJ, DOD, DOT, HHS, and other appropriate Federal Sector-Specific Agencies, shall convene a forum for selected Federal, State, local, and tribal personnel to discuss EMS, fire, emergency management, public works, and other emergency response issues they will face in a pandemic influenza outbreak and then publish the results in the form of best practices and model protocols within 4 months. Measure of performance: best practices and model protocols published and distributed.
In a February 2007 forum hosted by the U.S. Fire Administration, participants reviewed interim guidance and formally adopted a pandemic influenza planning and preparation model of best practices for national publication and distribution. The Best Practices and Model Protocols are available on the USFA’s website: http://www.usfa.dhs.gov/fireservice/subjects/ems/pandemicflu/. The Best Practices and Model Protocols will be provided to the USFA Publications Catalog/library for stakeholder access as well.
8.1.3.1 Complete
HHS, in coordination with DOL, shall provide clear guidance to law enforcement and other emergency responders on recommended preventive measures, including pre-pandemic vaccination, to be taken by law enforcement and emergency responders to minimize risk of infection from pandemic influenza, within 6 months. Measure of performance: development and dissemination of guidance for law enforcement and other emergency responders.
Working in partnership with the Department of Justice, the CDC has prepared pandemic influenza checklists for law enforcement personnel and other emergency responders. These documents have received extensive review from police unions and professional organizations. Documents include “Correctional Facilities Pandemic Influenza Planning Checklist” (for use in jails and prisons) and “Law Enforcement Pandemic Influenza Planning Checklist” (for police chiefs and sheriffs).
8.3.1.1. In Progress
HHS, in coordination with DOJ, DOS, and DHS, shall determine when and how it will assist States in enforcing their quarantines and how it will enforce a Federal quarantine, within 9 months. Measure of performance: guidelines on quarantine enforcement available to all States.
The CDC has developed guidance on the use of:
- Voluntary quarantine, which is one of the interventions recommended in the Community Strategy for Pandemic Influenza Mitigation (http://www.pandemicflu.gov/plan/community/commitigation.html) ,
- Mandatory quarantine, which is unlikely to be recommended except in a few special situations during the earliest stages of a pandemic when there are no or only a few cases of pandemic disease in the United States and individuals refuse requests for voluntary quarantine (Voluntary Household Quarantine as a Community Mitigation Tool During an Influenza Pandemic, in preparation).
8.3.2.2. Complete
DHS, in coordination with DOJ, DOD, DOT, HHS, and other appropriate Federal Sector-Specific Agencies, shall engage in contingency planning and related exercises to ensure they are prepared to sustain EMS, fire, emergency management, public works, and other emergency response functions during a pandemic, within 6 months. Measure of performance: completed plans (validated by exercise(s)) for supporting EMS, fire, emergency management, public works, and other emergency response functions.
During the USFA forum that was conducted, stakeholders reviewed interim guidance and formally adopted a pandemic influenza planning and preparation model of best practices for national publication and distribution.
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9.1.1.1 Complete
DHS, in coordination with HHS, DOD, and DOL shall provide pandemic influenza COOP guidance to the Federal departments and agencies within 6 months. Measure of performance: COOP planning and personnel protection guidance provided to all departments for use, as necessary, in updating departmental pandemic influenza response plans.
We worked within a Homeland Security Council-led interagency process to develop pandemic influenza continuity-of-operations guidance for the Federal departments and agencies that was distributed in a memo to the interagency community in March 2006.
9.1.1.2. Complete
The Office of Personnel Management (OPM), in coordination with DHS, HHS, DOD, and DOL, shall provide guidance to the Federal departments and agencies on human capital management and COOP planning criteria related to pandemic influenza, within 3 months. Measure of performance: guidance provided to all departments for use, as necessary, in adjusting departmental COOP plans related to pandemic influenza.
We developed and distributed web-based human capital management guidance to Federal departments and agencies for use in protecting the civilian Federal workforce and ensuring continuity of operations of the Federal Government in the event of a pandemic influenza outbreak. In addition, we provided training for the Federal human resources and emergency management communities regarding this guidance. Finally, in coordination with other key Federal agencies, we have scheduled a series of “Town Hall” meetings to present information to Federal employees on planning for a possible pandemic health crisis.
9.1.1.3. Complete
OPM, in coordination with DHS, HHS, DOD, and DOL, shall update the guides Telework: A Management Priority, A Guide for Managers, Supervisors, and Telework Coordinators; Telework 101 for Managers: Making Telework Work for You; and, Telework 101 for Employees: Making Telework Work for You, to provide guidance to Federal departments regarding workplace options during a pandemic, within 3 months. Measure of performance: updated telework guidance provided to all departments for use, as necessary, in updating departmental COOP plans related to pandemic influenza.
We developed and distributed web-based guidance regarding policies and procedures to be followed by Federal agencies if and when it becomes necessary for civilian Federal employees to work at home or at another location -- i.e., “telework” -- in the event of a pandemic influenza outbreak. In addition, we provided training for the Federal human resources and emergency management communities regarding this guidance. Finally, in coordination with other key Federal agencies, we have scheduled a series of “Town Hall” meetings to present information to Federal employees on telework and other strategies for dealing with a possible pandemic health crisis.
9.1.2.1. In Progress
DHS, in coordination with Sector-Specific Agencies, critical infrastructure owners and operators, and States, localities and tribal entities, shall develop sector-specific planning guidelines focused on sector-specific requirements and cross-sector dependencies, within 6 months. Measure of performance: planning guidelines developed for each sector.
In coordination with the interagency partners, DHS developed a plan to produce final guidelines for all 17 CI/KR sectors. DHS will directly support the 17 CI/KR Sector Coordinating Councils (SCC) and Government Coordinating Councils (GCC) by co-hosting focused forums/workshops to develop sector-specific pandemic planning guidelines. The Final CI/KR Guide, which sets the framework for the sector-specific guides, was released for publication in October 2006.
9.1.2.2. Complete
DHS, in coordination with States, localities and tribal entities, shall support private sector preparedness with education, exercise, training, and information sharing outreach programs, within 6 months. Measure of performance: preparedness exercises established with private sector partners in all States and U.S. territories.
In coordination with interagency partners, DHS has developed an exercise program plan. DHS is directly supporting the 17 CI/KR Sector Coordinating Councils (SCC) and Government Coordinating Councils (GCC) by assisting each to develop and implement focused preparedness education, exercise, training, and information-sharing outreach programs for their CI/KR public and private sector businesses. Tabletop exercises are to be completed in concert with the regional meetings.
9.1.3.1. In Progress
DHS, in coordination with all the Sector-Specific Agencies, shall conduct forums, conferences, and exercises with key critical infrastructure private sector entities and international partners to identify essential functions and critical planning, response and mitigation needs within and across sectors, and validate planning guidelines, within 6 months. Measure of performance: planning guidelines validated by collaborative exercises that test essential functions and critical planning, response, and mitigation needs.
We have formally released the CI/KR Pandemic Guide, and funding from the 2006 Supplemental Spend Plan is being applied to this activity. We have conducted multiple workshops and forums attended by more than 30 stakeholders with critical infrastructure entities (e.g., operations centers, retail operations, supply warehousing operations, and supply distributors) to identify essential functions and critical planning elements and to discuss continuity of business operations during a pandemic.
9.1.3.2 Complete
DHS, in coordination with all the Sector-Specific Agencies, shall develop and coordinate guidance regarding business continuity planning and preparedness with the owners/operators of critical infrastructure and develop a Critical Infrastructure Influenza Pandemic Preparedness, Response, and Recovery Guide tailored to national goals and capabilities and to the specific needs identified by the private sector, within 6 months. Measure of performance: Critical Infrastructure Influenza Pandemic Preparedness, Response, and Recovery Guide developed and published (www.pandemicflu.gov).
DHS and the other agencies worked collaboratively to create the Critical Infrastructure Influenza Pandemic Preparedness, Response, and Recovery Guide. This guide is available at www.pandemicflu.gov and www.ready.gov.
9.1.4.1. Complete
HHS, in coordination with DHS, DOL, OPM, Department of Education, VA, and DOD, shall develop sector-specific infection control guidance to protect personnel, governmental and public entities, private sector businesses, and CBOs and FBOs, within 6 months. Measure of performance: sector-specific guidance and checklists developed and disseminated on www.pandemicflu.gov.
HHS has developed sector-specific infection control guidance for individuals and families, educators at schools and colleges, faith-based and community organizations, healthcare workers, businesses, State and local governments, agricultural workers, transportation workers, and law enforcement workers. Guidance products include 14 audience-specific checklists (http://www.pandemicflu.gov/index.html) and six audience-specific Planning Guides that include information on social distancing (see: Community Strategy for Pandemic Influenza Mitigation; http://www.pandemicflu.gov/plan/community/commitigation.html). Additional guidance products cover such infection-control topics as respiratory hygiene, cough etiquette, and use of masks.
9.1.4.2. Complete
HHS, in coordination with DHS, DOL, EPA, Department of Education, VA, and DOD, shall develop interim guidance regarding environmental management and cleaning practices including the handling of potentially contaminated waste material, within 3 months, and revise as additional data becomes available. Measure of performance: development and publication of guidance and checklists on www.pandemicflu.gov and disseminated through other channels.
We have developed Interim Guidance on Environmental Management of Pandemic Influenza A Virus, which includes a Fact Sheet for the public entitled Control of Pandemic Flu Virus on Environmental Surfaces in Homes and Public Places. These documents provide information on:
- Cleaning and disinfection of surfaces in healthcare facilities, homes, schools, and businesses
- Cleaning and disinfection of laundry
- Disposal of solid wastes
- Disposal of regulated medical waste
Additional information for businesses is provided in two documents from the Occupational Safety and Health Administration, Department of Labor (OSHA/DOL): Guidance for Preparing Workplaces for an Influenza Pandemic and Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employees.
9.3.1.1 Complete
DHS shall map and model critical infrastructure interdependencies across and within sectors to share critical information with sectors and identify national challenges during a pandemic, within 6 months. Measure of performance: critical infrastructure modeling capability established and mapping of critical infrastructure interdependencies completed.
DHS has established a critical infrastructure modeling capability and mapping of critical infrastructure interdependencies. A report on this modeling capability was submitted to the Homeland Security Council.
9.3.1.2. Complete
DHS shall develop and operate a national-level monitoring and information-sharing system for core essential services to provide status updates to critical infrastructure dependent on these essential services, and aid in sharing real-time impact information, monitoring actions, and prioritizing national support efforts for preparedness, response, and recovery of critical infrastructure sectors within 12 months. Measure of performance: national-level critical infrastructure monitoring and information-sharing system established and operational.
We completed the IT Architecture/Platform for the tracking system -- which is compatible with the Common Operating Picture (COP) -- to monitor the integrity of critical infrastructure function and operational continuity in near real time. This platform is currently capable of near real-time information collection, tracking, and collaboration with Critical Infrastructure and Key Resource (CI/KR) owners and operators, including the healthcare sector. This web-based architecture meets the requirement for near real- time data and is only dependent on the end user entry of data. This architecture is compatible with the DHS Common Operating Picture (COP) Platform so that information from this system can be integrated into the COP. This system is currently in place and operational in accordance with the NRP.
The Federal Government remains highly engaged in pandemic preparedness activities. The following activities are outstanding and will be reported on in the future.
4.1.2.6. DOD, in coordination with DOS, host nations, and regional alliance military partners, shall assist in developing priority country military infection control and case management capability through training programs, within 18 months. Measure of performance: training programs carried out in all priority countries with increased military infection control and case management capability.
4.1.6.1. DOS, in coordination with HHS and other agencies, shall continue to work through the Partnership and other bilateral and multilateral venues to build international cooperation and encourage countries and regional organizations to develop diagnostic, research and vaccine manufacturing capacity within 24 months. Measure of performance: global diagnostic and research capacity increased significantly compared to 24 months earlier; significant investments made to expand international vaccine manufacturing capacity.
4.1.6.2. HHS, in coordination with the WHO Secretariat, shall establish at least six new sites for Collaborative Clinical Research on Emerging Infectious Diseases to conduct collaborative clinical research on the diagnostics, therapeutics, and natural history of avian influenza and other human emerging infectious diseases. In addition, within 18 months it will provide in-country support for one or more partner countries for human avian influenza clinical trials. Measure of performance: cooperative programs established in six new sites, to include the initiation of research protocols and design of clinical trials.
4.1.8.1. HHS shall support the Los Alamos H5 Sequence Database and the Institute for Genomic Research (TIGR), for the purpose of sharing avian H5N1 influenza sequences with the scientific community within 24 months. Measure of performance: completed H5 sequences entered into both the Los Alamos database and GenBank and annotated.
4.1.1.3 DOD, in coordination with DOS and other appropriate Federal agencies, host nations, and regional alliance military partners, shall, within 18 months: (1) conduct bilateral and multilateral assessments of the avian and pandemic preparedness and response plans of the militaries in partner nations or regional alliances such as NATO focused on preparing for and mitigating the effects of an outbreak on assigned mission accomplishment; (2) develop solutions for identified national and regional military gaps; and (3) develop and execute bilateral and multilateral military-to-military influenza exercises to validate preparedness and response plans. Measure of performance: all countries with endemic avian influenza engaged by U.S. efforts; initial assessment and identification of exercise timeline for the military of each key partner nation completed.
4.2.2.5. DOD shall develop active and passive systems for inpatient and outpatient disease surveillance at its institutions worldwide, with an emphasis on index case and cluster identification, and develop mechanisms for utilizing DOD epidemiological investigation experts in international support efforts, to include validation of systems/tools and improved outpatient/inpatient surveillance capabilities, within 18 months. Measure of performance: monitoring system and program to utilize epidemiological investigation experts internationally are in place.
4.2.2.6. DOD shall monitor the health of military forces worldwide (CONUS and OCONUS bases, deployed operational forces, exercises, units, etc.), and in coordination with DOS, coordinate with allied, coalition, and host nation public health communities to investigate and respond to confirmed infectious disease outbreaks on DOD installations, within 18 months. Measure of performance: medical surveillance “watchboard” reports show results of routine monitoring, number of validated outbreaks, and results of interventions.
4.2.2.7. DOD, in coordination with DOS and with the cooperation of the host nation, shall assist with influenza surveillance of host nation populations in accordance with existing treaties and international agreements, within 24 months. Measure of performance: medical surveillance “watchboard” expanded to include host nations.
4.2.3.4. HHS shall invest in the development and evaluation of more accurate rapid diagnostics for influenza to enhance the ability of the global healthcare community to rapidly diagnose influenza, within 18 months. Measure of performance: new grants and contracts issued to researchers to develop and evaluate new diagnostics.
4.2.3.8. DOD, in coordination with HHS, shall develop and refine its overseas virologic and bacteriologic surveillance infrastructure through Global Emerging Infections Surveillance and Response System (GEIS) and the DOD network of overseas labs, including fully developing and implementing seasonal influenza laboratory surveillance and an animal/vector surveillance plan linked with WHO pandemic phases, within 18 months. Measure of performance: animal/vector surveillance plan and DOD overseas virologic surveillance network developed and functional.
4.2.3.9. DOD, in coordination with HHS, shall prioritize international DOD laboratory research efforts to develop, refine, and validate diagnostic methods to rapidly identify pathogens, within 18 months. Measure of performance: completion of prioritized research plan, resources identified, and tasks assigned across DOD medical research facilities.
4.2.3.10. DOD shall work with priority nations’ military forces to assess existing laboratory capacity, rapid response teams, and portable field assay testing equipment, and fund essential commodities and training necessary to achieve an effective national military diagnostic capability, within 18 months. Measure of performance: assessments completed, proposals accepted, and funding made available to priority countries.
4.2.4.1. HHS and USAID shall, in coordination with regional and international multi-lateral organizations, develop village-based alert and response surveillance systems for human cases of influenza in priority countries, within 18 months. Measure of performance: 75 percent of all priority countries have established a village alert and response system for human influenza.
4.2.4.2. DOD shall incorporate international public health reporting requirements for exposed or ill military international travelers into the Geographic Combatant Commanders’ pandemic influenza plans within 18 months. Measure of performance: reporting requirements incorporated into Geographic Combatant Commanders’ pandemic influenza plans.
4.2.7.2. USDA shall provide technical assistance to priority countries to increase safety of animal products by identifying potentially contaminated animal products, developing screening protocols, regulations, and enforcement capacities that conform to OIE avian influenza standards for transboundary movement of animal products, within 36 months. Measure of performance: all priority countries have protocols and regulations in place or in process.
5.1.1.1. DHS and DOT shall establish an interagency transportation and border preparedness working group, including DOS, HHS, USDA, DOD, DOL, and DOC as core members, to develop planning assumptions for the transportation and border sectors, coordinate preparedness activities by mode, review products and their distribution, and develop a coordinated outreach plan for stakeholders, within 18 months. Measure of performance: interagency working group established, planning assumptions developed, preparedness priorities and timelines established by mode, and outreach plan for stakeholders in place.
5.1.1.4. DHS and DOT, in coordination with DOD, HHS, USDA, USTR, DOL, and DOS, shall develop detailed operational plans and protocols to respond to potential pandemic-related scenarios, including inbound aircraft/vessel/land border traffic with suspected case of pandemic influenza, international outbreak, multiple domestic outbreaks, and potential mass migration, within 18 months. Measure of performance: coordinated Federal operational plans that identify actions, authorities, and trigger points for decision-making and are validated by interagency exercises.
5.1.2.3. DOT and DHS, in coordination with HHS, USDA, and transportation stakeholders, shall develop planning guidance and materials for State, local, and tribal governments, including scenarios that highlight transportation and border challenges and responses to overcome those challenges, and an overview of transportation roles and responsibilities under the NRP, within 18 months. Measure of performance: State, local, and tribal governments have received or have access to tailored guidance and planning materials.
5.1.2.5. DHS and DOT, in coordination with DOD and States, shall develop a range of options to cope with potential shortages of commodities and demand for essential services, such as building reserves of essential goods, within 20 months. Measure of performance: options developed and available for State, local, and tribal governments to refine and incorporate in contingency plans.
5.1.3.1. DHS, in coordination with DOT, HHS, and USDA, shall conduct tabletop discussions and other outreach with private sector transportation and border entities to provide background on the scope of a pandemic, to assess current preparedness, and jointly develop a planning guide, within 18 months. Measure of performance: private sector transportation and border entities have coordinated Federal guidance to support pandemic planning, including a planning guide that addresses unique border and transportation challenges by mode.
5.2.4.1. HHS, in coordination with DHS, DOT, DOS, DOC, and DOJ, shall develop policy recommendations for aviation, land border, and maritime entry and exit protocols and/or screening and review the need for domestic response protocols or screening within 18 months. Measure of performance: policy recommendations for response protocols and/or screening.
5.2.4.2. HHS, DHS, and DOT, in coordination with DOS, DOC, Treasury, and USDA, shall develop policy guidelines for international travel restrictions during a pandemic based on the ability to delay the spread of disease and the resulting health benefits, associated economic impacts, international and domestic implications, and operational feasibility, within 18 months. Measure of performance: interagency travel curtailment policy guidelines developed that address both voluntary and mandatory travel restrictions.
5.2.4.5. DOT and DHS, in coordination with HHS, DOD, DOS, airlines/air space users, the cruise line industry, and appropriate State and local health authorities, shall develop protocols to manage and/or divert inbound international flights and vessels with suspected cases of pandemic influenza that identify roles, actions, relevant authorities, and events that trigger response, within 18 months. Measure of performance: interagency response protocols for inbound flights completed and disseminated to appropriate entities.
5.2.4.6. HHS, in coordination with DHS, DOT, DOS, DOD, air carriers/air space users, the cruise line industry, and appropriate State and local health authorities, shall develop en route protocols for crewmembers onboard aircraft and vessels to identify and respond to travelers who become ill en route and to make timely notification to Federal agencies, health care providers, and other relevant authorities, within 18 months. Measure of performance: protocols developed and disseminated to air carriers/air space users and cruise line industry.
5.2.4.7. DHS, DOT, and HHS, in coordination with transportation and border stakeholders, and appropriate State and local health authorities, shall develop aviation, land border, and maritime entry and exit protocols and/or screening protocols, and education materials for non-medical, front-line screeners and officers to identify potentially infected persons or cargo, within 18 months. Measure of performance: protocols and training materials developed and disseminated.
5.2.4.8. DHS and HHS, in coordination with DOT, DOJ, and appropriate State and local health authorities, shall develop detection, diagnosis, quarantine, isolation, EMS transport, reporting, and enforcement protocols and education materials for travelers, and undocumented aliens apprehended at and between Ports of Entry, who have signs or symptoms of pandemic influenza or who may have been exposed to influenza, within 18 months. Measure of performance: protocols developed and distributed to all ports of entry.
5.2.2.1. DHS, in coordination with HHS and DOD, shall deploy human influenza rapid diagnostic tests with greater sensitivity and specificity at borders and ports of entry to allow real-time health screening, within 12 months of development of tests. Measure of performance: diagnostic tests, if found to be useful, are deployed; testing is integrated into screening protocols to improve screening at the 20-30 most critical ports of entry.
5.1.1.5. DOD, in coordination with DHS, DOT, DOJ, and DOS, shall conduct an assessment of military support related to transportation and borders that may be requested during a pandemic and develop a comprehensive contingency plan for Defense Support to Civil Authorities, within 18 months. Measure of performance: Defense Support to Civil Authorities plan in place that addresses emergency transportation and border support.
5.1.1.6. DOT, in coordination with DHS, DOD, DOJ, HHS, DOL, and USDA, shall assess the Federal Government’s ability to provide emergency transportation support during a pandemic under NRP ESF #1 and develop a contingency plan, within 18 months. Measure of performance: completed contingency plan that includes options for increasing transportation capacity, the potential need for military support, improved shipment tracking, potential need for security and/or waivers for critical shipments, incorporation of decontamination and workforce protection guidelines, and other critical issues.
5.2.4.3. DOS, in coordination DHS, DOT, and HHS, in consultation with aviation, maritime, and tourism industry stakeholders as appropriate, and working with international partners and through international organizations as appropriate, shall promote the establishment of arrangements through which countries would: (1) voluntarily limit travel if affected by outbreaks of pandemic influenza; and (2) establish pre-departure screening protocols for persons with influenza-like illness, within 18 months. Measure of performance: arrangements for screening protocols are negotiated.
5.3.4.8. DOD, in coordination with DHS and DOS, shall identify those domestic and foreign airports and seaports that are considered strategic junctures for major military deployments and evaluate whether additional risk-based protective measures are needed, within 18 months. Measure of performance: identification of critical air and seaports and evaluation of additional risk-based procedures, completed.
5.2.4.10. HHS, DHS, and DOT, in coordination with DOS, State, community and tribal entities, and the private sector, shall develop a public education campaign on pandemic influenza for travelers, which raises general awareness prior to a pandemic and includes messages for use during an outbreak, within 18 months. Measure of performance: public education campaign developed on how a pandemic could affect travel, the importance of reducing non-essential travel, and potential screening measures and transportation and border messages developed based on pandemic stages.
5.3.5.6. DOT and DHS, in coordination with NEC, Treasury, DOC, HHS, DOS, and the interagency modeling group, shall assess the economic, safety, and security related effects of the pandemic on the transportation sector, including movement restrictions, closures, and quarantine, and develop strategies to support long-term recovery of the sector, within 6 months of the end of a pandemic. Measure of performance: economic and other assessments completed and strategies implemented to support long-term recovery of the sector.
6.1.1.2. HHS, in coordination with DHS, shall review and approve State Pandemic Influenza plans to supplement and support DHS State Homeland Security Strategies to ensure that Federal homeland security grants, training, exercises, technical, and other forms of assistance are applied to a common set of priorities, capabilities, and performance benchmarks, in conformance with the National Preparedness Goal, within 18 months. Measure of performance: definition of priorities, capabilities, and performance benchmarks; percentage of States with plans that address priorities, identify capabilities, and meet benchmarks.
6.1.5.1. HHS shall encourage and subsidize the development of State, territorial, and tribal antiviral stockpiles to support response activities within 18 months. Measure of performance: State, territorial, and tribal stockpiles established and antiviral medication purchases made toward goal of aggregate 31 million treatment courses.
6.1.6.3. DOD, as part of its departmental implementation plan, shall conduct a medical materiel requirements gap analysis and procure necessary materiel to enhance Military Health System surge capacity, within 18 months. Measure of performance: gap analysis completed and necessary materiel procured.
6.1.7.3. HHS in collaboration with State/local partners shall procure and allocate sufficient stockpiles of countermeasures to ensure continuity of critical medical and emergency response operations, within 18 months, within the constraints of industrial capacity. Measure of performance: sufficient quantities of antiviral medications and other countermeasures procured and distributed between SNS and State stockpiles.
6.1.7.4. DOD shall establish stockpiles of vaccine against H5N1 and other influenza subtypes determined to represent a pandemic threat adequate to immunize approximately 1.35 million persons for military use within 18 months of availability. Measure of performance: sufficient vaccine against each influenza virus determined to represent a pandemic threat in DOD stockpile to vaccinate 1.35 million persons.
6.1.8.1. HHS shall, to the extent feasible, work with the pharmaceutical industry to develop, within 60 months, domestic vaccine production capacity sufficient to provide vaccine for the entire U.S. population within 6 months after the development of a vaccine reference strain. Measure of performance: domestic vaccine manufacturing capacity in place to produce 300 million courses of vaccine within 6 months of development of a vaccine reference strain during a pandemic.
6.1.9.2. HHS, in collaboration with the States, shall purchase sufficient quantities of antiviral drugs to treat 25 percent of the U.S. population, with reserve of 6 million treatment courses for outbreak containment within 18 months, within the constraints of industrial capacity. Measure of performance: 50 million treatment courses of antiviral drugs procured by SNS; States and tribes make stockpile purchases toward aggregate 31 million treatment course goal.
6.1.9.3. DOD shall procure 2.4 million treatment courses of antiviral medications and position them at locations worldwide within 18 months. Measure of performance: aggregate 2.4 million treatment courses of antiviral medications in DOD stockpiles.
6.1.13.3. HHS, in collaboration with State, territorial, tribal, and local health care delivery partners, shall develop and execute strategies to effectively implement target group recommendations as described below, within 18 months. Measure of performance: guidance on strategies to implement target group recommendations developed and disseminated to State, local, and tribal authorities for inclusion in pandemic response plans.
6.1.13.5. HHS, in coordination with DHS, DOS, DOD, DOL, VA, and in collaboration with State, local, and tribal governments and private sector partners, shall develop plans for the allocation, distribution, and administration of pre-pandemic vaccine, within 18 months. Measure of performance: department plans developed and guidance disseminated to State, local, and tribal authorities to facilitate development of pandemic response plans.
6.1.13.8. DOD shall supply military units and posts, installations, bases, and stations with vaccine and antiviral medications according to the schedule of priorities listed in the DOD pandemic influenza policy and planning guidance, within 18 months. Measure of performance: vaccine and antiviral medications procured; DOD policy guidance developed on use and release of vaccine and antiviral medications; and worldwide distribution drill completed.
6.1.13.9. HHS, in coordination with DOD, VA, and in collaboration with State, territorial, tribal, and local partners, shall develop/refine mechanisms to: (1) track adverse events following vaccine and antiviral administration; (2) ensure that individuals obtain additional doses of vaccine, if necessary; and (3) define protocols for conducting vaccine- and antiviral- effectiveness studies during a pandemic, within 18 months. Measure of performance: mechanism(s) to track vaccine and antiviral medication coverage and adverse events developed; vaccine- and antiviral- effectiveness study protocols developed.
6.1.16.2. HHS shall support the renovation of existing U.S. manufacturing facilities that produce other FDA-licensed cell-based vaccines or biologics and the establishment of new domestic cell-based influenza vaccine manufacturing facilities, within 36 months. Measure of performance: contracts awarded for renovation or establishment of domestic cell-based influenza vaccine manufacturing capacity.
6.1.17.3. HHS, in coordination with DHS, shall develop and test new point-of-care and laboratory-based rapid influenza diagnostics for screening and surveillance, within 18 months. Measure of performance: new grants and contracts awarded to researchers to develop and evaluate new diagnostics.
6.2.2.9. DOD shall enhance influenza surveillance efforts within 6 months by: (1) ensuring that medical treatment facilities (MTFs) monitor the Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE) and provide additional information on suspected or confirmed cases of pandemic influenza through their Service surveillance activities; (2) ensuring that Public Health Emergency Officers (PHEOs) report all suspected or actual cases through appropriate DOD reporting channels, as well as to CDC, State public health authorities, and host nations; and (3) posting results of aggregated surveillance on the DOD Pandemic Influenza Watchboard; all within 18 months. Measure of performance: number of MTFs performing ESSENCE surveillance greater than 80 percent; DOD reporting policy for public health emergencies, including pandemic influenza completed.
6.2.3.1. HHS, in coordination with DHS and DOD, shall work with pharmaceutical and medical device company partners to develop and evaluate rapid diagnostic tests for novel influenza subtypes including H5N1 within 18 months. Measure of performance: new investment in research to develop influenza diagnostics; new rapid diagnostic tests, if found to be useful, are available for influenza testing, including for novel influenza subtypes.
6.2.3.3. HHS, in coordination with DOD, VA, and DHS, shall encourage and expedite private-sector development of rapid subtype- and strain- specific influenza point-of-care tests within 12 months of the publication of requirements. Measure of performance: rapid point-of-care test available in the marketplace within 18 months.
6.3.2.4. As appropriate, DOD, in consultation with its COCOM commanders, shall implement movement restrictions and individual protection and social distancing strategies (including unit shielding, ship sortie, cancellation of public gatherings, drill, training, etc.) within their posts, installations, bases, and stations. DOD personnel and beneficiaries living off-base should comply with local community containment guidance with respect to activities not directly related to the installation. DOD shall be prepared to initiate within 18 months. Measure of performance: the policies/procedures are in place for at-risk DOD posts, installations, bases, stations, and for units to conduct an annual training evaluation that includes restriction of movement, shielding, personnel protection measures, health unit isolation, and other measures necessary to prevent influenza transmission.
6.3.4.7. DOD shall enhance its public health response capabilities by: (1) continuing to assign epidemiologists and preventive medicine physicians within key operational settings; (2) expanding ongoing DOD participation in CDC’s Epidemic Intelligence Service (EIS) Program; and (3) within 18 months, fielding specific training programs for PHEOs that address their roles and responsibilities during a public health emergency. Measure of performance: all military PHEOs fully trained within 18 months; increase military trainees in CDC’s EIS program by 100 percent within 5 years.
6.3.7.5. DOD shall develop and implement guidelines defining conditions under which Reserve Component medical personnel providing health care in non-military health care facilities should be mobilized and deployed, within 18 months. Measure of performance: guidelines developed and implemented.
7.1.5.1. USDA and DOI shall perform research to understand better how avian influenza viruses circulate and are transmitted in nature, in order to improve information on biosecurity distributed to local animal owners, producers, processors, markets, auctions, wholesalers, distributors, retailers, and dealers, as well as wildlife management agencies, rehabilitators, and zoos, within 18 months. Measure of performance: completed research studies provide new information, or validate current information, on the most useful biosecurity measures to be taken to effectively prevent introduction, and limit or prevent spread, of avian influenza viruses in domestic and captive animal populations.
7.1.5.2. USDA and DOI shall perform research to develop and validate tools that will facilitate environmental surveillance for avian influenza viruses, especially in wild birds, through the evaluation of feathers, feces, water, or nesting material, within 24 months. Measure of performance: new environmental surveillance tools researched and made available for use by Federal, State, tribal, university, and other entities performing avian influenza surveillance.
7.1.5.4. USDA shall perform research to improve vaccines and mass immunization techniques for use against influenza in domestic birds within 36 months. Measure of performance: an effective avian influenza vaccine that can be delivered simultaneously to multiple birds ready for commercial development.
8.1.2.5. DOD, in consultation with DOJ and the National Guard Bureau, and in coordination with the States as such training applies to support of State law enforcement, shall assess the training needs for National Guard forces in providing operational assistance to State law enforcement under either Federal (Title 10) or State (Title 32 or State Active Duty) in a pandemic influenza outbreak and provide appropriate training guidance to the States and Territories for units and personnel who will be tasked to provide this support, within 18 months. Measure of performance: guidance provided to all States.
8.3.2.1. DOJ, DHS, and DOD shall engage in contingency planning and related exercises to ensure they are prepared to maintain essential operations and conduct missions, as permitted by law, in support of quarantine enforcement and/or assist State, local, and tribal entities in law enforcement emergencies that may arise in the course of an outbreak, within 18 months. Measure of performance: completed plans (validated by exercise(s)) for supporting quarantine enforcement and/or law enforcement emergencies.
Some actions in the plan are specifically targeted at State, local and other non-Federal entities. Over the coming year, we intend to continue and intensify our work with non-Federal entities.
5.1.2.4. State, community, and tribal entities, in coordination with neighboring States and communities, the private sector, transportation providers, and health professionals, should develop transportation contingency plans that identify a range of options to respond to different stages of a pandemic, including support for public health containment strategies, maintaining State and community functions, transportation restriction options and consequences, delivery of essential goods and services, and other key regional or local issues, within 18 months.
5.1.3.3. Private sector transportation and border entities, in coordination with States and customers, should develop pandemic influenza plans that identify challenges and outline strategies to sustain core functions, essential services, and mitigate economic consequences, within 16 months.
6.1.1.1. The Federal Government shall, and State, local, and tribal governments should define and test actions and priorities required to prepare for and respond to a pandemic, within 6 months. Measure of performance: completion and communication of national, departmental, State, local, and tribal pandemic influenza response plans; actions and priorities defined and tested.
6.1.2.1. All health care facilities should develop and test infectious disease surge capacity plans that address challenges including: increased demand for services, staff shortages, infectious disease isolation protocols, supply shortages, and security.
6.2.1.4. All Federal, State, local, tribal, and private sector medical facilities should ensure that protocols for transporting influenza specimens to appropriate reference laboratories are in place within 3 months. Measure of performance: transportation protocols for laboratory specimens detailed in HHS, DOD, VA, State, territorial, tribal, and local pandemic response plans.
6.2.1.5. State, local, and tribal entities should be prepared, in the event of a pandemic, to increase diagnostic testing for influenza and increase the frequency of reporting to CDC.
6.2.2.10. State, local, and tribal public health departments shall develop relationships with hospitals and health care systems within their jurisdictions to facilitate collection of real-time or near real-time clinical surveillance data from domestic acute care settings such as emergency departments, intensive care units, and laboratories.
6.2.2.11 State, local, and tribal public health departments should provide weekly reports on the overall level of influenza activity in their States or localities, with assistance from CDC epidemiologists and field officers posted within each State health department in collecting and reporting these data.
6.2.3.5. State, local, and tribal public health departments should acquire and deploy rapid diagnostic tests that are specific and sensitive for pandemic influenza strains, as soon as those tests are available.
6.3.1.1. State, local, and tribal pandemic preparedness plans should address the implementation and enforcement of isolation and quarantine, the conduct of mass immunization programs, and provisions for release or exception.
6.3.2.6. All health care facilities should develop, test, and be prepared to implement infection control campaigns for pandemic influenza, within 6 months.
6.3.4.1. Major medical societies and organizations, in collaboration with HHS, DHS, DOD, and VA, should develop and disseminate protocols for changing clinical care algorithms in settings of severe medical surge. Measure of performance: evidence-based protocols developed to optimize care that can be provided in conditions of severe medical surge.
6.3.4.8. All hospitals should be prepared to treat patients with pandemic influenza (i.e., equipped and ready to care for: (1) a limited number of patients infected with a pandemic influenza virus, or other novel strain of influenza, as part of normal operations; and (2) a large number of patients in the event of escalating transmission of pandemic influenza).
6.3.4.9. All hospitals and health care systems should develop, test, and be ready to employ business continuity plans and identify the critical links in their supply chains as well as sources of emergency.
6.3.4.10. All health care systems, individually or collaborating with other facilities to develop local or regional stockpiles maintained under vendor managed inventory systems, should consider stockpiling consumable critical medical materiel (including but not limited to food, fuel, water, N95 respirators, surgical and /or procedural masks, gowns, and ethyl-alcohol based gels) sufficient for the peak period of a pandemic wave (2-3 weeks).
6.3.6.1. Prior to the declaration of a public health emergency, State, local, and tribal public health authorities should examine existing Federal laws, regulations, and requirements, State public health and medical licensing laws, the provisions of interstate emergency management compacts and mutual aid agreements, and other legal and regulatory arrangements to determine the extent to which they address barriers to the flow of qualified public health and medical personnel across jurisdictional lines or between health care facilities.
8.1.1.1. States should ensure that pandemic response plans adequately address law enforcement and public safety preparedness across the range of response actions that may be implemented, and that these plans are integrated with authorities that may be exercised by Federal agencies and other State, local, and tribal governments.
8.1.1.3. State, local, and tribal governments should review their legal authorities that may be needed to respond to an influenza pandemic, identify needed changes in the law, and pursue legislative action as appropriate.
8.1.1.5. States should ensure pandemic response plans address EMS, fire, public works, emergency management, and other emergency response and public safety preparedness.
8.1.4.1. State, local, and tribal law enforcement agencies should coordinate with appropriate medical facilities and countermeasure distribution centers in their jurisdictions (as recognized in Chapter 6, security at these facilities will be critical in the event of an outbreak) to coordinate security matters within 6 months.
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Within the next year, the Federal Government intends to exercise many of the capabilities detailed in action items below.
4.3.1.1. DOS, in coordination with HHS, USDA, USAID, and DOD, shall coordinate the development and implementation of U.S. capability to respond rapidly to assess and contain outbreaks of avian influenza with pandemic potential abroad, including coordination of the development, training and exercise of U.S. rapid response teams; and coordination of U.S. support for development, training and exercise of, and U.S. participation in, international support teams. Measure of performance: agreed operating procedures and operational support for U.S. rapid response, and for U.S. participation in international rapid response efforts, are developed and function effectively.
4.3.1.3. HHS, in coordination with DOS, and the WHO Secretariat, and USDA, USAID, DOD, as appropriate, shall rapidly deploy disease surveillance and control teams to investigate possible human outbreaks through WHO’s GOARN network, as required. Measure of performance: teams deployed to suspected outbreaks within 48 hours of investigation request.
4.3.1.4. DOS, in coordination with HHS, and the WHO Secretariat, and USDA, USAID, DOD, as appropriate, shall coordinate United States participation in the implementation of the international response and containment strategy (e.g., assigning experts to the WHO outbreak teams and providing assistance and advice to ministries of health on local public health interventions, ongoing disease surveillance, and use of antiviral medications and vaccines if they are available). Measure of performance: teams deployed to suspected outbreaks within 48 hours of investigation request.
4.3.1.5. USDA and USAID, in coordination with DOS, HHS, and DOD, and in collaboration with relevant international organizations, shall support operational deployment of rapid response teams and provide technical expertise and technology to support avian influenza assessment and response teams in priority countries as required. Measure of performance: all priority countries have rapid access to avian influenza assessment and response teams; deployment assistance provided in each instance and documented in a log of technical assistance rendered.
4.3.2.1. DOS, in coordination with DHS, HHS, DOD, and DOT, and in collaboration with foreign counterparts, shall support the implementation of pre-existing passenger screening protocols in the event of an outbreak of pandemic influenza. Measure of performance: protocols implemented within 48 hours of notification of an outbreak of pandemic influenza.
4.3.3.1. DOS, in coordination with HHS, USAID, USDA, and DOD, shall work with the Partnership to assist in the prompt and effective delivery of countermeasures to affected countries consistent with U.S. law and regulation and the agreed upon doctrine for international action to respond to and contain an outbreak of influenza with pandemic potential. Measure of performance: necessary countermeasures delivered to an affected area within 48 hours of agreement to meet request.
4.3.4.2. DHS shall assist in the expeditious movement of public health, medical, and veterinary officials, equipment, supplies, and biological samples for testing through U.S. ports of entry/departure. Measure of performance: delivery of persons, equipment, and samples involved in the detection of and response to outbreaks of avian or pandemic influenza within 48 hours of decision to deploy.
4.3.6.2. DOS, in coordination with HHS, shall provide at least monthly updates to its foreign counterparts, through diplomatic channels and USG websites, regarding changes to national policy or regulations that may result from an outbreak, and shall coordinate posting of such information to USG websites (e.g., www.pandemicflu.gov). Measure of performance: foreign governments and key stakeholders receive authoritative and regular information on USG avian influenza policy.
4.3.6.3. USDA, in coordination with DHS, USTR, and DOS, shall ensure that clear and coordinated messages are provided to international trading partners regarding animal disease outbreak response activities in the United States. Measure of performance: within 24 hours of an outbreak, appropriate messages will be shared with key animal/animal product trading partners.
5.3.1.1. DOS and DHS, in coordination with DOT, DOC, HHS, Treasury, and USDA, shall work with foreign counterparts to limit or restrict travel from affected regions to the United States, as appropriate, and notify host government(s) and the traveling public. Measure of performance: measures imposed within 24 hours of the decision to do so, after appropriate notifications made.
5.3.1.2. DOS, in coordination with DOT, HHS, DHS, DOD, air carriers, and cruise lines, shall work with host countries to implement agreed upon pre-departure screening based on disease characteristics and availability of rapid detection methods and equipment. Measure of performance: screening protocols agreed upon and put in place in countries within 24 hours of an outbreak.
5.3.1.3. DOS, in coordination with HHS, DHS, and DOT, shall offer transportation-related technical assistance to countries with outbreaks. Measure of performance: countries with outbreaks receive U.S. offer of technical support within 36 hours of an outbreak.
5.3.1.4. DHS, in coordination with DOS, USDA and DOI, shall provide countries with guidance to increase scrutiny of cargo and other imported items through existing programs, such as the Container Security Initiative, and impose country-based restrictions or item-specific embargoes. Measure of performance: guidance, which may include information on restrictions, is provided for increased scrutiny of cargo and other imported items, within 24 hours upon notification of an outbreak.
5.3.1.5. DHS, in coordination with DOT, HHS, DOS, DOD, USDA, appropriate State and local authorities, air carriers/air space users, airports, cruise lines, and seaports, shall implement screening protocols at U.S. ports of entry based on disease characteristics and availability of rapid detection methods and equipment. Measure of performance: screening implemented within 48 hours upon notification of an outbreak.
5.3.1.6. DHS, in coordination with DOT, HHS, USDA, DOD, appropriate State, and local authorities, air carriers and airports, shall consider implementing response or screening protocols at domestic airports and other transport modes as appropriate, based on disease characteristics and availability of rapid detection methods and equipment. Measure of performance: screening protocols in place within 24 hours of directive to do so.
5.3.2.1. DHS, DOS, and HHS, in coordination with DOT and USDA, shall issue travel advisories/public announcements for areas where outbreaks have occurred and ensure adequate coordination with appropriate transportation and border stakeholders. Measure of performance: coordinated announcements and warnings developed within 24 hours of becoming aware of an outbreak and timely updates provided as required.
5.3.2.2. DHS and DOT, in coordination with DOS and Treasury, and international and domestic stakeholders, shall consider activating plans, consistent with international law, to selectively limit or deny entry to U.S. airspace, U.S. territorial seas (12 nautical miles offshore), and ports of entry, including airports, seaports, and land borders and/or restrict domestic transportation, based on risk, public health benefits, and economic impacts. Measure of performance: measures implemented within 6 hours of decision to do so.
5.3.2.3. DHS, in coordination with USDA, DOS, DOC, DOI, and shippers, shall rapidly implement and enforce cargo restrictions for export or import of potentially contaminated cargo, including embargo of live birds, and notify international partners/shippers. Measure of performance: measures implemented within 6 hours of decision to do so.
5.3.3.1. HHS and USDA, in coordination with DHS, DOT, DOS, and DOI, shall provide emergency notifications of probable or confirmed cases and/or outbreaks to key international, Federal, State, local, and tribal transportation and border stakeholders through existing networks. Measure of performance: emergency notifications occur within 24 hours or less of events of probable or confirmed cases or outbreaks.
5.3.3.2. DHS and DOT, in coordination with DOS, shall gather information from the private sector, international, State, local, and tribal entities, and transportation associations to assess and report the status of the transportation sector. Measure of performance: decision makers have current and accurate information on the status of the transportation sector.
5.3.4.1. DHS and DOT shall notify border and transportation stakeholders and provide recommendations to implement contingency plans and/or use authorities to restrict movement based on ability to limit spread, economic and societal consequences, international considerations, and operational feasibility. Measure of performance: border and transportation stakeholders receive notification and recommendations within no more than 24 hours (depending on urgency) of an outbreak or significant development that may warrant a change in stakeholder actions or protective measures.
5.3.4.2. DHS and DOT shall consider activating contingency plans as needed to ensure availability of Federal personnel at more critical facilities and higher volume crossings or hubs. Measure of performance: Federal services sustained at high-priority/high-volume facilities.
5.3.4.3. DHS, if needed, will implement contingency plans to maintain border control during a period of pandemic influenza induced mass migration. Measure of performance: contingency plan activated within 24 hours of notification.
5.3.4.4. DHS and DOT, in coordination with USDA, DOI, DOC, and DOS, shall consult with the domestic and international travel industry (e.g., carriers, hospitality industry, and travel agents) and freight transportation partners to discuss travel and border options under consideration and assess potential economic and international ramifications prior to implementation. Measure of performance: initial stakeholder contacts and solicitation for inputs conducted within 48 hours of an outbreak and re-established if additional countries affected.
5.3.4.5. DOT shall issue safety-related waivers as needed, to facilitate efficient movement of goods and people during an emergency, balancing the need to expedite services with safety, and States should consider waiving state-specific regulatory requirements, such as size and weight limits and convoy registration. Measure of performance: all regulatory waivers as needed balance need to expedite services with safety.
5.3.4.6. DOJ and DHS shall protect targeted shipments of critical supplies and facilities by providing limited Federal security forces under Emergency Support Function #13 - Public Safety and Security (ESF #13) of the NRP, as needed. Measure of performance: all appropriate Federal, State, local, and tribal requests for Federal law enforcement and security assistance met via activation of ESF #13 of the NRP. (See also Chapter 8 - Law Enforcement, Public Safety, and Security.)
5.3.4.7. DHS, in coordination with DOS, DOT, DOD, and the Merchant Marine, shall work with major commercial shipping fleets and the international community to ensure continuation of maritime transport and commerce, including activation of plans, as needed, to provide emergency medical support to crews of vessels that are not capable of safe navigation. Measure of performance: maritime transportation capacity meets demand and vessel mishaps remain proportional to number of ship movements.
5.3.5.1. DOT, in coordination with DHS and other ESF #1 support agencies, shall monitor and report the status of the transportation sector, assess impacts, and coordinate Federal and civil transportation services in support of Federal agencies and State, local, and tribal entities (see Chapter 6 - Protecting Human Health, for information on patient movement (ESF #8)). Measure of performance: when ESF #1 activated, regular reports provided, impacts assessed, and services coordinated as needed.
5.3.5.2. DOT, in coordination with DHS and other ESF #1 support agencies, shall coordinate emergency transportation services to support domestic incident management, including transport of Federal emergency teams, equipment, and Federal Incident Response supplies. Measure of performance: all appropriate Federal, State, local, and tribal requests for transportation services provided on time via ESF #1 of the NRP.
5.3.5.3. DOT, in coordination with DHS, State, local, and tribal governments, and the private sector, shall monitor system closures, assess effects on the transportation system, and implement contingency plans. Measure of performance: timely reports transmitted to DHS and other appropriate entities, containing relevant, current, and accurate information on the status of the transportation sector and impacts resulting from the pandemic; when appropriate, contingency plans implemented within no more than 24 hours of a report of a transportation sector impact or issue.
5.3.5.4. DOT, in support of DHS and in coordination with other ESF #1 support agencies, shall work closely with the private sector and State, local, and tribal entities to restore the transportation system, including decontamination and re-prioritization of essential commodity shipments. Measure of performance: backlogs or shortages of essential commodities and goods quickly eliminated, returning production and consumption to pre-pandemic levels.
5.3.5.5. DOD, when directed by Secretary of Defense and in accordance with law, shall monitor and report the status of the military transportation system and those military assets that may be requested to protect the borders, assess impacts (to include operational impacts), and coordinate military services in support of Federal agencies and State, local, and tribal entities. Measure of performance: when DOD activated, regular reports provided, impacts assessed, and services coordinated as needed.
5.3.6.1. DOT and DHS, in coordination with HHS, DOS, and DOC, shall conduct media and stakeholder outreach to restore public confidence in travel. Measure of performance: outreach delivered and traveling public resumes use of the transportation system at or near pre-pandemic levels.
5.3.6.2. DHS and DOT, in coordination with DOS, DOD, HHS, USDA, DOI, and State, local, and tribal governments, shall provide the public and business community with relevant travel information, including shipping advisories, restrictions, and potential closing of domestic and international transportation hubs. Measure of performance: timely, consistent, and accurate traveler information provided to the media, public, and business community.
6.1.7.2. HHS shall establish and maintain stockpiles of pre-pandemic vaccines adequate to immunize 20 million persons against influenza strains that present a pandemic threat, as soon as possible within the constraints of industrial capacity. Measure of performance: procurement of 20 million courses of pre-pandemic vaccine against influenza strains presenting a pandemic threat.
6.1.13.10. DOJ, in coordination with HHS, DHS, DOS, and DOC, shall lead the development of a joint strategic plan to ensure international shipments of counterfeit vaccine and antiviral medications are detected at our borders and that domestic counterfeit drug production and distribution is thwarted through aggressive enforcement efforts. Measure of performance: joint strategic plan developed; international and domestic counterfeit drug shipments prevented or interdicted.
6.1.14.4. HHS, in coordination with DHS and Sector-Specific Agencies, DOS, DOD, DOL, VA, and Treasury, shall present recommendations on target groups for vaccine and antiviral drugs when sustained and efficient human-to-human transmission of a potential pandemic influenza strain is documented anywhere in the world. These recommendations will reflect data from the pandemic and available supplies of medical countermeasures. Measure of performance: provisional identification of priority groups for various pandemic scenarios through interagency process within 2-3 weeks of outbreak.
6.1.17.2. HHS shall collaborate with the pharmaceutical, medical device, and diagnostics industries to accelerate development, evaluation (including the evaluation of dose-sparing strategies), licensure, and U.S.-based production of new antiviral drugs and diagnostics. Development activities should include design of preclinical and clinical studies to collect safety and efficacy information across multiple strains and seasons of circulating influenza illness, and advance design of protocols to obtain additional updated information to support revisions in product usage during circulation of novel strains and evolution of pandemic spread. Such collaborations should involve early and frequent discussions with the FDA to explore the use of accelerated regulatory pathways towards product approval or licensure. Collaborations concerning diagnostic tests should include CDC to facilitate access to pandemic virus samples for validation testing and ensure that the test is one that can be used to promote and protect the public health during an influenza pandemic. Measure of performance: initiation of clinical trials of new influenza antiviral drugs and diagnostics.
6.2.3.4. HHS-, DOD-, and VA-funded hospitals and health facilities shall have access to improved rapid diagnostic tests for influenza A, including influenza with pandemic potential, within 6 months of when tests become available. Measure of performance: diagnostic tests, if found to be useful, are accessible to federally funded health facilities.
6.3.4.5. DHS shall activate NDMS teams, if available, to augment efforts of State, local, and tribal governments as part of the Federal response. Measure of performance: number of NDMS teams activated and deployed during a pandemic.
6.3.5.3. HHS, in coordination with DHS, shall allocate and assure the effective and secure distribution of public stocks of antiviral drugs and vaccines when they become available. HHS and DHS are currently prepared to distribute stockpile as soon as countermeasures become available. Measure of performance: number of doses of vaccine and treatment courses of antiviral medications distributed.
7.3.1.1. USDA, in coordination with DHS, HHS, DOI, and the Environmental Protection Agency, shall partner with State and tribal entities, animal industries, individual animal owners, and other affected stakeholders to eradicate any influenza outbreak in commercial or other domestic birds or domestic animals caused by a virus that has the potential to become a human pandemic strain, and to safely dispose of animal carcasses. Measure of performance: at least one incident management team from USDA on site within 24 hours of detection of such an outbreak.
7.3.1.2. USDA shall coordinate with DHS and other Federal, State, local, and tribal officials, animal industry, and other affected stakeholders during an outbreak in commercial or other domestic birds and animals to apply and enforce appropriate movement controls on animals and animal products to limit or prevent spread of influenza virus. Measure of performance: initial movement controls in place within 24 hours of detection of an outbreak.
7.3.1.4. DOI shall coordinate with Federal, State, local, and tribal officials to identify and apply appropriate measures to limit the spread of influenza virus should an outbreak occur in free-ranging wildlife populations. Measure of performance: initial control measures implemented within 24 hours of detection of an outbreak in free-ranging wildlife.
7.3.5.3. USDA, in coordination with DOI, shall collaborate in working with Federal partners, with State, local, and tribal partners, including State wildlife authorities, and with industry groups and other stakeholders, to update and distribute guidelines to reduce the risk of transmission between domestic animals and wildlife and reduce the risk of spread to other wildlife species during an animal influenza outbreak. Measure of performance: guidelines updated and shared with the public within first 24 hours of an outbreak.
8.1.1.4. DOJ shall ensure that appropriate Federal and State Court personnel are provided the information necessary to enable them to plan for the continuity of critical judicial functions during a pandemic. Measure of performance: this plan made available to all appropriate Federal and State court personnel.
9.3.2.1. DHS shall coordinate Federal, State, local, and tribal actions/options/capability requirements (legislative and regulatory additions/changes and waivers, personnel and material resources, and financial) to develop and implement tailored support packages to address critical infrastructure systems and essential operational requirements at each phase of the pandemic: planning, preparedness, response, mitigation, and recovery. Measure of performance: support packages ensure essential functions of all critical infrastructure sectors sustained during a pandemic.
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