Progress reported on U.S. pandemic flu preparations.

THE United States still has pandemic influenza preparedness work to do, according to a federal government report card released a year after the unveiling of the nation's pandemic flu plan.

"Though we have made significant progress over the past year to prepare the nation and the international community for the threat of an influenza pandemic, much important work lies ahead," stated the July report released by the White House Homeland Security Council. "Although we have realized progress in enhancing disease surveillance, critical gaps remain with respect to real-time disease detection and clinical surveillance in the United States."

Eighty-six percent of the actions that were supposed to be accomplished during the first year of the national plan were completed, said Rajeev Venkayya, MD, special assistant to President Bush for biodefense.

"That's to be compared to a score of around 92 percent that we released at the six-month mark," Venkayya said during a July 17 news briefing on the report.

He said the 14 percent of actions not yet completed should be finished within the next six months.

"On the international front, we've taken unprecedented action," he said. "We have committed more resources to this problem than any other country in the world."

Those resources have included work to contain avian flu outbreaks among poultry, efforts to improve laboratory diagnosis and early warning networks in more than 75 countries and offering logistical and financial support to countries hardest hit by avian influenza.

The nation's pandemic flu plan was drafted in 2005 after the H5N1 avian influenza virus had killed millions of birds and been documented in 16 countries, a number that has since jumped to 60. While the virus has reportedly infected only about 300 people worldwide, 60 percent of those infected have died.

Public health experts are predicting that a pandemic influenza, or a widespread outbreak of a virus to which humans have little or no immunity, is likely to strike in the coming years. The U.S. preparedness plan calls for vaccine stockpiling, limiting the international and domestic spread of disease, and other efforts to reduce the impact of a highly pathnogenic flu outbreak. In 1918, a pandemic flu strain killed at least 675,000 Americans and tens of millions of people worldwide.

"I think it's important to point out that there are certain things, certain policy issues that we've addressed in the past year, really tough things that we, as a government, have grappled with," Venkayya said.

For example, there's currently no consensus on what to do at the country's borders in the event of a pandemic. Deciding who should be vaccinated first if there is a limited supply is another tough, unanswered question, Venkayya said. Another concern, according to the report, is that many of the nation's hospitals and emergency departments are already operating at or near capacity and may not have the capability to treat large numbers of patients in the event of a pandemic.

"Just to be brutally honest, we have a lot of trouble determining when we have an outbreak of infectious disease in a community here in the United States," Venkayya said.

Then-Assistant Health and Human Services Secretary John Agwunobi, MD, MBA, MPH, who is an APHA member, said his department's preparedness efforts have focused on Bush's "three strategic pillars" of preparedness and communication, surveillance and detection, and response and containment.

"So much more on a daily basis is happening, I think in every agency of the federal government, as we assure a nation prepared for the next pandemic," Agwunobi said at the news briefing.

As part of an effort to both improve surveillance and other preparedness programs, the U.S. Department of Health and Human Services in July announced awarding almost $900 million to states, territories and four metropolitan areas to improve and sustain their ability to respond to public health emergencies.

Also in July, the American Medical Association and CDC recognized four communities' pandemic influenza preparedness plans for exemplary planning in times of disaster. The winners were plans from Multnomah County, Ore.; Northeastern Minnesota; Scottsdale, Ariz.; and Northern Virginia.

The full flu preparedness plan and recent report, "National Strategy for Pandemic Influenza Implementation Plan One Year Summary," are online at www.pandemicflu.gov.