A panel of top public health officials gathered at AAAS recently to discuss the H1NI swine flu, but their focus quickly turned to a pandemic that struck 91 years earlier.
Considered to be the worst pandemic in modern history, the 1918/1919 Spanish influenza virus infected an estimated 500 million—one-third of the world's population—killing between 500,000 to 750,000 in the United States.
As the flood of stories chronicling the more recent H1N1 swine flu begins to lessen, four top public health officials speaking to a packed AAAS auditorium warned that the full impact outbreak—declared a pandemic in June 2009—may not be felt until the Northern Hemisphere's flu season later this fall.
Despite the potential for another Spanish Flu, the panel, all key officials charged with developing the nation's response to H1N1 swine flu pandemic, told the audience that they are cautiously optimistic about the government's preparedness.
Anthony Fauci, M.D., director of the National Institutes of Health (NIH) National Institute of Allergy and Infectious Diseases, said that the federal government has been aggressively preparing for an infectious disease outbreak for the past several years. Beyond forming a response to a potential bioterrorist attack, scientists and policy makers have been closely studying previous outbreaks such as the H5N1 avian Flu earlier this decade, which has killed around 225 people, mostly in Asia.
"[We] have a window of opportunity," to prevent a huge pandemic of the 2009 H1N1 influenza, said Fauci, adding that a vaccine is already being prepared in pilot lots and will soon undergo clinical trials.
Rear Admiral Anne Schuchat, M.D.
Retired Rear Admiral Kenneth W. Bernard, M.D.
Held 2 July at AAAS headquarters in Washington, D.C., the briefing featured Fauci alongside Rear Admiral Anne Schuchat, M.D., assistant U.S. surgeon general and director of the National Center for Immunization and Respiratory Diseases; retired Rear Admiral Kenneth W. Bernard, M.D., former special assistant to the president for biodefense; and Captain Kenneth Cole, medical director of the Office of the Deputy Assistant to the Secretary of Defense for Chemical and Biological Defense and Chemical Demilitarization Programs.
The event was sponsored by the AAAS Center for Science, Technology, and Security Policy; the AAAS International Office; and the AAAS Center for Science, Technology, and Congress.
Harvey Fineberg, M.D., panel chair and president of the Institute of Medicine at the National Academies, said that epidemiologists and public health officials are always keeping in mind the Spanish flu pandemic of 1918/1919 when talking about potential disease outbreaks.
"It was the worst natural cataclysm of the 20th century," said Fineberg, "and lessons from the past have strong implications for the future." He added that influenza pandemics of lesser, but still serious severity, occurred in 1957 [Asian Flu] and 1968 [Hong Kong Flu]. There were also important lessons from the swine flu immunization campaign of 1976, which went forward in the absence of a pandemic.
Kavita Berger, project director for the AAAS Center for Science, Technology, and Security Policy, said that when dealing with a disease outbreak, especially a pandemic, it is important that public health officials communicate with the public.
"To contain the spread of a pathogen and get help to those who need it, public health officials need to receive information quickly, analyze it, and be able to communicate the risks appropriately with the public," said Berger.
Among the largest challenges the government faces moving forward is communicating the risks and steps to control the outbreak, while correcting misinformation, said Schuchat. In addition, she said that the government is going to seek public input to help inform policy decisions on issues such as vaccination programs.
Previous public engagement focused on community interventions such as the closing of schools. While some consider closing schools a sensible response to a local outbreak, Schuchat pointed out that schools provide vital functions, including lunches and supervision and a goal is to "strike an appropriate balance with the beneficial and adverse consequences of our interventions."
Fauci said that the government and pharmaceutical companies are working "full speed" to produce a vaccine by the beginning of the Northern Hemisphere's flu season this fall. The flu virus is most communicable in cool, dry conditions, he explained.
While encouraged about the vaccine production process, Schuchat warned that several critical questions remain including the vaccine's protection level, safety across different demographics, proper dosage, and the order in which citizens are immunized.
In a 9 July speech to state and territorial public health officials, U.S. Health and Human Services Secretary Kathleen Sebelius said that the federal government will offer the vaccine, administered in two doses separate from the seasonal flu vaccine, to schools and community centers as soon as this fall. The article noted that swine flu appears to affect older children and young adults, in contrast to the seasonal flu which disproportionately afflicts the elderly and the very young.
Fauci added that the vaccine has a high likelihood of being very effective if it turns out to be sufficiently immunogenic (promoting a resistance response) as the virus does not appear to have mutated significantly since it was first analyzed in April.
Bernard described H1NI as a national security threat, and said that the U.S. government has a clear responsibility to protect U.S. citizens. During international health meetings, poorer countries have expressed concerns that once a vaccine is ready, richer nations will get a disproportionate share of the supply.
Captain Kenneth Cole
"The U.S. government must figure out a way to protect its citizens while at the same time we cannot neglect citizens in other nations," said Bernard. "It's a delicate balance."
Cole, who helps ensure that U.S. armed forces and other specialists are protected against health threats, said that the Department of Defense has people in many countries around the world.
"It's vital that we be able to operate under any conditions, potentially including areas where infectious diseases have been detected," said Cole. He emphasized that "global surveillance is vitally important" to track the spread of pathogens and potentially anticipate where they will strike next.
"Our biggest concern is to provide the best possible, high-quality, care for military employees," he said, adding that this includes stockpiling antibiotics.