HHS focuses on flu pandemic preparedness plan.(Clinical Rounds)

BALTIMORE -- Acknowledging that "flu has a huge news factor," Bruce Gellin, M.D., spelled out the federal influenza pandemic preparedness plan at a biodefense research meeting sponsored by the American Society for Microbiology.

The Department of Health and Human Services' draft Pandemic Influenza Response and Preparedness Plan, developed in August 2004, includes influenza control, stockpiling vaccines, developing antiviral drugs and prophylaxis, providing quality medical care, and maintaining community services, said Dr. Gellin, director of the National Vaccine Program Office, a division of HHS. The World Health Organization originally developed pandemic preparedness guidelines in 1999 for other organizations to follow.

"There are a lot of unknowns," said Dr. Gellin. "When will a pandemic occur? How bad will it be? And will there be major social and economic fallout? We need to continue to identify unmet questions."

Improving vaccine preparedness is a major focus of the HHS plan. To that end, Dr. Gellin said the United States must enhance annual influenza vaccine use, ensure a year-round egg supply, increase and diversify U.S. manufacturing capacity, and improve the ability to rapidly develop reference strains.

As for antiviral drugs, the U.S. government currently stockpiles 2 million doses of Tamiflu (oseltamivir) and 4 million doses of Flumadine (rimantadine). He acknowledged the need for a greater stockpile of these drugs, as well as a push for other therapies besides antivirals.

Even in the case of a mild pandemic, Dr. Gellin emphasized the heightened need for inpatient medical services and effective triaging of patients, noting there would be an estimated 25% increase in demand for inpatient beds, ICU beds, and ventilators.

A few key issues remain unresolved, according to Dr. Gellin, including determining priority groups for early vaccine and antiviral use in the event of a pandemic; purchase and distribution of public- and private-sector vaccinations; and legal issues, including indemnification, liability protection, and compensation.