The recent H1N1 (swine) flu outbreak demonstrated how rapidly a new strain of flu can emerge and spread around the world. As of June 1, 2009, the H1N1 virus was reported in 62 nations, with nearly 17,500 confirmed cases and more than 100 deaths. The sudden outbreak of this novel flu virus has tested the world’s public health preparedness. H1N1 provided a real-world test that showed the strengths and vulnerabilities in the abilities of the United States and the rest of the world to respond to a major infectious disease outbreak.

  1. Investments in pandemic planning and stockpiling antiviral medications paid off;
  2. Public health departments did not have enough resources to carry out plans;
  3. Response plans must be adaptable and science-driven;
  4. Providing clear, straightforward information to the public was essential for allaying fears and building trust;
  5. School closings have major ramifications for students, parents, and employers;
  6. Sick leave and policies for limiting mass gatherings were also problematic;
  7. Even with a mild outbreak, the health care delivery system was overwhelmed;
  8. Communication between the public health system and health providers was not well coordinated;
  9. WHO pandemic alert phases caused confusion; and
  10. International coordination was more complicated than expected.


In addition to the lessons learned from H1N1, there are a number of systemic gaps in the nation’s ability to respond to a pandemic flu outbreak. To further strengthen U.S. preparedness, the following core areas must be addressed:

Strategic National Stockpile and Vaccine Development Recommendations:

1. Maintaining the Strategic National Stockpile — making sure enough antiviral medications, vac- cinations, and equipment are available to protect Americans, which includes replenishing the stock- pile when medications and supplies are used;

2. Vaccine development and production — enhancing the biomedical research and development abilities of the United States to rapidly develop and produce a vaccine; and

3. Vaccinating all Americans — ensuring that all Americans would be able to be inoculated in a short pe- riod of time.

Adaptable, Science-Based Planning and Coordination Recommendations:

4. Planning and coordination — improving coordination among federal, state, and local govern- ments and the private sector preparedness and planning activities on an ongoing basis, including taking into account how the nature of flu threats change over time;

5. School closings, sick leave, and community mitigation strategies — improving strategies to limit the spread of disease ensuring all working Americans have sick leave benefits and that com- munities are prepared to limit public gatherings and close schools as necessary; and

6. Global coordination — building trust, technologies, and policies internationally to encourage sci- ence-based, consistent decision making across borders during an outbreak.

Core Public Health Infrastructure Improvement Recommendations:

7. Resources — providing enough funding for the on-the-ground response, which is currently under- funded and overextended; and

8. Workforce — stopping layoffs at state and local health departments and recruiting the next genera- tion of public health professionals.

Surge Capacity and Care Recommendations:

9. Surge capacity — improving the ability for health providers to manage a massive influx of patients; and

10. Caring for the uninsured and underinsured — ensuring that all Americans will receive care during an emergency, which limits the spread of the contagious disease to others, and making sure hospitals and health care providers are compensated for providing care.

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