Ex­perts say H1N1 pre­pared­ness paid off

Modern Healthcare - - The Week In Healthcare - Jes­sica Zig­mond

Af­ter the World Health Or­ga­ni­za­tion de­clared the H1N1 flu pan­demic over last week, pub­lic health and hos­pi­tal ad­vo­cates eval­u­ated the lessons they learned from the deadly out­break to help them man­age fu­ture pub­lic health dis­as­ters.

In a lit­tle more than a year’s time, the deadly pan­demic—the first the WHO had de­clared since 1968—spread to more than 200 coun­tries and claimed more than 18,400 lives. At a vir­tual news con­fer­ence on Aug. 10, WHO Di­rec­tor-Gen­eral Mar­garet Chan said the H1N1 virus has “largely run its course,” and the world is now in a post-pan­demic pe­riod. In this phase, lo­cal­ized out­breaks may show sig­nif­i­cant lev­els of trans­mis­sion, which means the virus wasn’t com­pletely erad­i­cated. Based on ex­pe­ri­ence from pre­vi­ous pan­demics, the WHO said it ex­pects the H1N1 strain to take on the be­hav­ior of sea­sonal flu and con­tinue to cir­cu­late for years.

In the U.S., HHS spent $5 bil­lion on the H1N1 flu pan­demic. That in­cludes about $1.16 bil­lion of ex­ist­ing funds for vac­cine devel­op­ment, in­clud­ing clin­i­cal stud­ies and man­u­fac­tur­ing of the H1N1 bulk anti­gen (a mol­e­cule rec­og­nized by the im­mune sys­tem) and ad­ju­vant (the agent used in a vac­cine to en­hance the re­cip­i­ent’s im­mune re­sponse), ac­cord­ing to HHS’ Of­fice of the As­sis­tant Sec­re­tary for Pre­pared­ness and Re­sponse.

The fig­ure also in­cludes $3.9 bil­lion that HHS put to­ward sup­ple­men­tal fund­ing for vac­cine pro­duc­tion, dis­tri­bu­tion and ad­min­is­tra­tion; do­mes­tic and in­ter­na­tional sur­veil­lance; com­mu­ni­ca­tions and com­mu­nity mit­i­ga­tion; lab­o­ra­tory sup­port for virus de­tec­tion; prepa­ra­tion of the H1N1 vac­cine for use in vials and sy­ringes; and the pur­chase of an­cil­lary sup­plies to ad­min­is­ter the vac­cine. An ad­di­tional $1.5 bil­lion was pro­vided to states and hos­pi­tals for pre­pared­ness ac­tiv­i­ties and for vac­ci­na­tion cam­paign plan­ning and im­ple­men­ta­tion, the of­fice said.

The hu­man cost of the dis­ease was much greater, and is more dif­fi­cult to quan­tify. Ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, many peo­ple with the flu do not seek med­i­cal care and only a small num­ber of those who do seek care are ac­tu­ally tested for the dis­ease. The At­lanta-based agency es­ti­mates that be­tween April 2009—when the virus was first de­tected in the U.S.—and April 2010, there were be­tween 43 mil­lion and 83 mil­lion cases de­tected with a “mid­point” of 61 mil­lion peo­ple; be­tween 195,000 and 403,000 H1N1re­lated hos­pi­tal­iza­tions, with a mid­point of 274,000 hos­pi­tal­iza­tions; and be­tween 8,870 and 18,300 deaths with a mid­point of 12,470 lives lost.

As the nation’s hos­pi­tals and pub­lic health in­fra­struc­ture were tested by the pan­demic, ex­perts cited two rea­sons why the U.S. health­care sys­tem didn’t buckle un­der the pres­sure: emer­gen­cypre­pared­ness fund­ing from the Bush ad­min­is­tra­tion (April 6, 2009, p. 6) that formed a foun­da­tion to man­age the out­break and the fact that the strain did not be­come more se­vere.

Roslyne Schul­man, di­rec­tor for pol­icy devel­op­ment at the Amer­i­can Hos­pi­tal As­so­ci­a­tion, said the fund­ing pro­vided the “seed money” for hos­pi­tals to pur­chase sup­plies and equip­ment and also build re­la­tion­ships with state health de­part­ments. She also said the pan­demic em­pha­sized the im­por­tance of timely and sci­ence-based fed­eral guide­lines for hos­pi­tals.

The pan­demic also showed that the nation’s pub­lic health sys­tem can’t “turn on a dime,” so ad­di­tional fund­ing, work­force devel­op­ment, and an en­gaged com­mu­nity—in­clud­ing state and lo­cal le­gal au­thor­i­ties—are needed to sus­tain a vi­able pub­lic health in­fra­struc­ture, said Jack Her­rmann, se­nior ad­viser for pub­lic health pre­pared­ness and re­sponse at the Na­tional As­so­ci­a­tion of County and City Health Of­fi­cials.

“The great­est les­son we learned was that the money that was put into—and has been—for the last nine years for both pub­lic health pre­pared­ness and the pan­demic cer­tainly paid off,” Her­rmann said. “Was it with­out chal­lenges? Cer­tainly not,” he said, adding that, con­sid­er­ing all of those who were vac­ci­nated, “We be­lieve that from a pub­lic health per­spec­tive, it was suc­cess­ful.”

WHO’s Chan said the out­break has “largely run its course.”

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