Excerpt

Research has identified three essential prerequisites for the start of a pandemic: transmission of a novel viral subtype to humans; viral replication causing disease in humans; and efficient human-to-human transmission of the virus. Since 1997, the first two prerequisites have been met on four occasions; the most recent occurred early this year in Vietnam and Thailand. With H5N1 at or near endemic levels in poultry in many parts of Asia, the world stands at the verge of pandemic and is likely to remain there for years. A recent expert consultation convened by the World Health Organization concluded that “the unpredictability of influenza viruses and the speed with which transmissibility can improve mean that the time for preparedness planning is right now.”

To address these urgent concerns, the Institute of Medicine's Forum on Microbial Threats hosted a public workshop on June 16 and 17, 2004. Through invited presentations and discussions among participants, the workshop informed the Forum, the public, and policy makers of the likelihood of an influenza pandemic and explored issues critical to the preparation and protection of the global community. Topics and questions considered during the workshop's presentations and discussions included the following: Learning from the past - pandemics and other threats to public health; Global preparations against pandemic influenza; Preparing the United States for pandemic influenza; State and local preparation measures; Strategies to prevent and control transmission in birds and other animals; Biomedical approaches to preventing or controlling a pandemic; Legal issues in pandemic prevention and control; Improving preparedness: surveillance, prediction, and communication.

Contents

• The National Academies
• Forum on Microbial Threats
• Board on Global Health
• Reviewers
• Preface
• Acknowledgments
• In Memoriam
• Summary and Assessment
  • ORGANIZATION OF WORKSHOP SUMMARY
  • SECURING THE FUTURE
  • THE STORY OF INFLUENZA: 1918 AND BEYOND
  • TODAY'S PANDEMIC THREAT: H5N1 INFLUENZA
  • THE PLANNED RESPONSE TO PANDEMIC THREAT
  • TOWARD PREPAREDNESS: OPPORTUNITIES AND OBSTACLES
  • REFERENCES
• 1. The Story of Influenza
  • OVERVIEW
  • 1918 REVISITED: LESSONS AND SUGGESTIONS FOR FURTHER INQUIRY
  • CHASING THE ELUSIVE 1918 VIRUS: PREPARING FOR THE FUTURE BY EXAMINING THE PAST
  • PANDEMIC INFLUENZA AND MORTALITY: PAST EVIDENCE AND PROJECTIONS FOR THE FUTURE
  • SUMMARY
  • REFERENCES
• 2. Today's Pandemic Threat: H5N1 Influenza
  • OVERVIEW
  • GENESIS OF A HIGHLY PATHOGENIC AND POTENTIALLY PANDEMIC H5N1 INFLUENZA VIRUS IN EASTERN ASIA^,,
  • AVIAN INFLUENZA OUTBREAK IN THAILAND: CURRENT POLICIES
  • THE 2003–2004 H5N1 AVIAN INFLUENZA OUTBREAK IN VIETNAM
  • REFERENCES
• 3. Toward Preparedness: Opportunities and Obstacles
  • OVERVIEW
  • WHO CONSULTATION ON PRIORITY PUBLIC HEALTH INTERVENTIONS BEFORE AND DURING INFLUENZA PANDEMIC EXECUTIVE SUMMARY
  • PANDEMIC INFLUENZA PREPAREDNESS AND RESPONSE PLAN
  • CONSIDERATIONS FOR PANDEMIC INFLUENZA PLANNING: A STATE PERSPECTIVE
  • PREPARING FOR PANDEMIC INFLUENZA: THE NEED FOR ENHANCED SURVEILLANCE
  • PREPAREDNESS OPPORTUNITIES AND OBSTACLES
  • PANDEMIC INFLUENZA VACCINES: OBSTACLES AND OPPORTUNITIES
  • STATEMENT FROM MEDIMMUNE, INC., REGARDING REVERSE GENETICS TECHNOLOGY
  • PERSPECTIVES ON ANTIVIRAL USE DURING PANDEMIC INFLUENZA
  • PARTNERING WITH THE PRIVATE MEDICAL SYSTEM
  • REFERENCES
• 4. Strategies for Controlling Avian Influenza in Birds and Mammals
  • OVERVIEW
  • STANDARDS AND ACTIVITIES OF THE OIE RELATED TO AVIAN INFLUENZA
  • U.S. STRATEGIES FOR CONTROLLING AVIAN INFLUENZA IN AGRICULTURAL SYSTEMS
  • LOW-PATHOGENICITY AVIAN INFLUENZA OUTBREAKS IN COMMERCIAL POULTRY IN CALIFORNIA
  • REFERENCES
• 5. Emerging Technical Tools
  • OVERVIEW
  • CONTROL OF INFLUENZA VIRUS INFECTION BY IMMUNITY TO CONSERVED VIRAL FEATURES
  • GENERATION OF TRANSGENIC CHICKENS RESISTANT TO AVIAN INFLUENZA VIRUS
  • MOLECULAR DIAGNOSTICS IN AN INSECURE WORLD
  • MODELING PANDEMIC PREPAREDNESS SCENARIOS: HEALTH ECONOMIC IMPLICATIONS OF ENHANCED PANDEMIC VACCINE SUPPLY
  • REFERENCES
• 6. Beyond the Biomedical Response
  • OVERVIEW
  • THE ECONOMIC IMPACT OF PANDEMIC INFLUENZA IN THE UNITED STATES: PRIORITIES FOR INTERVENTION
  • INCREASING AWARENESS AND UPTAKE OF INFLUENZA IMMUNIZATION
  • STRATEGIES TO REMEDY PANIC IN A PANDEMIC: LESSONS FROM BIODEFENSE
  • PUBLIC HEALTH PREPAREDNESS AND ETHICAL VALUES IN PANDEMIC INFLUENZA
  • REFERENCES
• Appendixes
  • Appendix A Pandemic Influenza: Assessing Capabilities for Prevention and Response
  • Appendix B Selected Bibliography
  • Appendix C The Critical Path to New Medical Products
  • Appendix D Forum Members, Speakers, and Staff Biographies

This project was supported by the U.S. Department of Health and Human Services’ National Institutes of Health (Contract No. N01-OD-4-2139, TO#129), Centers for Disease Control and Prevention (200-2000-00629, TO#25), and Food and Drug Administration; U.S. Agency for International Development; U.S. Department of Defense (Contract No. DAMD-17-03-P- 1331), U.S. Department of State; U.S. Department of Veterans Affairs (V101(93)P-2159); U.S. Department of Agriculture; American Society for Microbiology; Aventis Pasteur; Burroughs Wellcome Fund; Pfizer; GlaxoSmithKline; and The Merck Company Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report is based on the proceedings of a workshop that was sponsored by the Forum on Microbial Threats. It is prepared in the form of a workshop summary by and in the name of the editors, with the assistance of staff and consultants, as an individually authored document. Sections of the workshop summary not specifically attributed to an individual reflect the views of the editors and not those of the Forum on Microbial Threats. The content of those sections is based on the presentations and the discussions that took place during the workshop.