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Skriven 2007-07-17 23:31:02 av Whitehouse Press (1:3634/12.0)
Ärende: Press Release (070717d) for Tue, 2007 Jul 17
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Press Briefing on National Strategy for Pandemic Influenza Implementation
Plan One Year Summary
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For Immediate Release Office of the Press Secretary July 17, 2007

Press Briefing on National Strategy for Pandemic Influenza Implementation
Plan One Year Summary Room 450 Eisenhower Executive Office Building

˙˙Press Briefings

˙˙˙˙˙ In Focus: Pandemic Flu

PARTICIPANTS:

Dr. Rajeev Venkayya, Special Assistant to the President for Biodefense
Ambassador John Lange, State Department Special Representative on Avian and
Pandemic Influenza
Dr. John Clifford, USDA Chief Veterinarian
Admiral John Agwunobi, Assistant Secretary of Health
Dr. Jeff Runge, DHS Chief Medical Officer on Pandemic Preparedness

1:02 P.M. EDT

MS. BERGMAN: Good afternoon, everyone. Thank you very much for coming to
today's session. I want to welcome you to our discussion of the first year
of implementation of the National Strategy for Pandemic Influenza. And a
quick word about the logistics of today's briefing. We will begin the
briefing with remarks from Dr. Rajeev Venkayya, Special Assistant to the
President for Biodefense. From the State Department we have Ambassador John
Lange, Special Representative on Avian and Pandemic Influenza. From USDA,
we have Dr. John Clifford, USDA Chief Veterinarian. From HHS, we have
Admiral John Agwunobi, Assistant Secretary of Health. And from DHS, we have
Dr. Jeff Runge, Chief Medical Officer.

I want to remind you that today's briefing is on the record. And for
members of the media who are here in attendance, I request that you wait
until the conclusion of the stakeholder briefing and ask your questions at
that time. The participants will stick around for media questions after the
stakeholder briefing. Thank you.

And with that, I will turn it over to Dr. Venkayya.

DR. VENKAYYA: Thank you, Cynthia. And I want to thank all of you for
joining us today. We wanted to take this opportunity on or around the
one-year anniversary of the implementation plan of the National Strategy
for Pandemic Influenza to summarize our progress.

You will have received or had access to a glossy narrative report of our
progress that was available outside. That document will be made available
over the web at pandemicflu.gov, and we anticipate that being on the White
House website, as well. There's also a blow-by-blow, action-by-action
report similar to the one that we released in December around the six-month
time frame that describes our assessment as to where we are in each one of
the actions that was due to be completed within 12 months.

Just to quickly recap what events brought us here, back in November, as I
think many of you are aware, the President released the -- November of 2005
-- the President released the National Strategy for Pandemic Influenza,
largely to highlight the need to transform this from an animal health and
human health issue to a national priority -- a national security priority,
a national health priority, a national economic priority.

In addition to doing that domestically, we did that internationally. We
established the International Partnership on Avian and Pandemic Influenza,
and the Department of State has led an aggressive effort to engage our
international partners to further emphasize the importance of addressing
this pandemic threat.

The strategy is a very high-level document. It lays out the principles that
guide our international efforts. The implementation plan released in May of
last year provides over 300 actions that direct federal departments and
agencies to act in the name of the principals in the strategy itself. Each
of those has a measure of performance and a timeline for completion, hence
the report at one year. We're basically cataloguing our progress on those
12-month actions.

Before I turn to my colleagues, I'd like to just quickly run through the
reason why we're concerned about the H5N1 threat. As I think many of you
are aware, we began back in 2005 with a recognition that this new influenza
virus had been documented in about 16 countries globally. Since that time,
the number of countries with documented bird infections of H5N1 has
increased to 60.

And so this outbreak in birds does not show any sign of abating, but more
concerning -- of greater concern is the fact that we know that this virus
can infect humans. And although it hasn't infected many humans, to our
knowledge -- right around 300 individuals worldwide -- the mortality in
those that it has infected is right around 60 percent.

Now, why is this important? Well, we've faced three pandemics in the last
century; we face influenza pandemics on a regular basis, about three every
century for the past several. And the most serious of those in the 20th
century killed about 20 to 40 million individuals worldwide, and that was
with a mortality rate of 1 to 2 percent.

We don't know what's going to happen with this particular influenza virus,
but if it's not H5N1, we can be certain that some other influenza virus at
some point in the future will lead to a pandemic. More importantly, if it's
not an influenza pandemic in the next 10 years, we know -- we can almost be
certain that some other biological threat will come upon us and we will
need to be prepared for that.

Now, the media's attention has waned a bit, and the public's attention has
waned a bit to this threat, and there are understandable reasons for that.
But it's important for governments and officials at the federal, state and
local level, as well as those who are in charge of companies,
non-governmental organizations, churches, other faith-based organizations,
and individuals to keep this in mind, because this preparedness effort that
we've undertaken is not done. We had a huge gap ahead of us when we started
this in 2005; we still have a very sizeable gap in front of us.

So there is much work that needs to be done, and we need to continue to
take this -- take advantage of the time that we have.

Let me turn now to the report that's being released today. Of the actions
that were due at 12 months, we assess that 86 percent of those actions have
been completed. That's to be compared to a score of around 92 percent that
we released at the six-month mark. There are about 14 percent of the
actions that are not yet completed. We document those in the
action-by-action detailed report. We anticipate those being completed in
the 18-month time frame at the next six-month report.

I'm not going to go through the accomplishments in great detail. Suffice it
to say that on the international front, we've taken unprecedented action.
We have committed more resources to this problem than any other country in
the world. Our contribution to international efforts numbers about 20
percent of all global contributions to avian and pandemic influenza
efforts. Here domestically, the USDA and Department of Interior have
launched a phenomenal surveillance program. You've seen the outputs of
that. We found lots of low-path avian influenza. And it's good news that
it's low-path. It's also good news that it, I think, validates, to some
degree, our wild bird and domestic bird surveillance activities.

On the human health front, we've embarked on a moon-shot approach to
reestablishing vaccine production capacity and new technologies such as
adjuvants to stretch the effectiveness or the number of individuals we
could vaccinate with a single dose of vaccine. Admiral Agwunobi will speak
more about that. He will also speak about the community mitigation guidance
that was released by Dr. Gerberding in February, which essentially provides
a road map, an essential road map, we think, for communities, in light of
the hard, cold facts, and that is that we are almost certainly not going to
have sufficient health and medical capacity to take care of the large
numbers of individuals that would be presented by a several pandemic.

I think it's also 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. This, by the way, has
led to us postponing a handful of actions, postponing the deadline, if you
will. I'll just highlight a couple of them.

One is the critical question of what we're going to do at our borders
during a pandemic. I think many people on this stage get asked that
question whenever they speak about pandemic flu. The question is, will we
close the borders? And some people say -- if we say no, some people say why
not, and if we say that -- in other words, the thinking being that if
you've got a biological threat, why wouldn't you seal your borders?

The reality is that there are tremendous challenges to sealing our borders
to begin with. Secondly, we believe, and scientists concur, that if a
pandemic virus emerges anywhere on the globe, it is inevitable that it will
arrive here in the U.S., irrespective of the actions that we take at the
borders.

And so our planning approach is to plan to limit the arrival of individuals
who might be affected with a pandemic virus, those who might be affected to
place them -- to give public health -- implement public health measures to
limit onward transmission, but to do what we can to also simultaneously
preserve the flow of goods and people.

Another policy issue that we've grappled with is vaccine prioritization: In
the setting of insufficient vaccine, who should get vaccine first? The
reality is that there's not going to be a single answer. It will depend
upon the characteristics of the pandemic -- the population, the age group
that the pandemic virus seems to favor, as well as our supply, as well as
the overall impact we anticipate on our national infrastructure. And so the
Department of Health and Human Services and Homeland Security have worked
with public groups, professional societies and others to develop a draft of
that prioritization guidance that you can anticipate seeing in the coming
weeks for public comment.

Despite all the progress that's been made, in closing I just want to
highlight that we do, in fact, have a lot of work ahead. A couple of items
that I'd point to are our surveillance capacity, both internationally and
domestically. We continue to have a great deal of difficulty in determining
when outbreaks of infection occur in animals and in humans overseas. 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. We
have limited surveillance capability here in the U.S.

Now, CDC has led tremendous efforts to enhance that, and there have been
remarkable efforts in many localities to enhance that surveillance
capability. But we need to have uniform biosurveillance capability, we
believe, to prepare us not only for a pandemic but any outbreak of
infectious disease. We need to further enhance our mass casualty care
capabilities in communities, referencing back to the point that I made
about insufficient bed space and public health capacity. We need to
implement the community mitigation road map that's been laid out by the
CDC. And then finally we need to attend to a concern that's been
highlighted for us by countries that don't have access to vaccine or don't
have much hope of having access to vaccine in the near future, and that is
the issue of global vaccine access and a more equitable distribution of the
life-saving countermeasures to the international community. And we are
committed to working with the WHO and our international partners to address
that.

So with that, I will stop. That was a long overview. What I'd like to do
now is turn things over to Ambassador John Lange from the Department of
State to give us first an overview of international activities.

Ambassador Lange.

AMBASSADOR LANGE: Thank you, Rajeev. Good afternoon. I'm pleased to be with
you here today to talk about the U.S. government's international activities
related to avian and pandemic influenza.

Of course, infectious diseases know no borders. And a key aspect of our
campaign to contain the spread of highly pathogenic avian influenza and to
prepare for the possibility of a human pandemic is large-scale global
engagement that has unfolded since the seriousness of the threat became
apparent a few years ago -- specifically ongoing efforts by governments,
international organizations, and the private sector.

In September 2005, President Bush announced the International Partnership
on Avian and Pandemic Influenza. And the goals of the international
partnership are to elevate avian and pandemic influenza on national agendas
in governments around the world; to coordinate efforts among donors and
affected nations; to mobilize and leverage resources; to increase
transparency in disease reporting and improving surveillance, a point that
Dr. Venkayya made about the importance of surveillance; and to build local
capacity to identify, contain and respond to an influenza pandemic.

As many of you know, the international partnership convened in Washington
in 2005, in Vienna, Austria, in 2006, and it will meet again in New Delhi,
India, in December 2007. The Under Secretary of State for Democracy and
Global Affairs Paula Dobriansky leads interagency delegations at each of
these meetings.

There have been some other political-level international conferences in
Beijing, China, and Bamako, Mali, that took place in 2006. Well over 100
nations and 20 international and regional organizations have participated
in these events. And at these events, donor governments and the
multilateral development banks and international financial institutions
have really stepped forward, and the total pledges, as of last December,
the last pledging conference, were $2.3 billion. The United States has made
the largest pledge of any country, totaling $434 million, by the end of
last year, and we anticipate further commitments will be forthcoming this
year.

In sum, the world has been engaged and continues to be engaged on avian and
pandemic influenza. This global engagement involves a really enormous,
multi-faceted effort.

In the United States, as Dr. Venkayya mentioned, the Department of State
coordinates the U.S. government's international efforts, along the lines of
the three pillars that are in the National Implementation Plan that was
released in May of last year: preparedness and communication, surveillance
and detection, and response and containment.

These international efforts, while coordinated by the Department of State,
are really an interagency enterprise, including the agencies that are up
here with me today. It involves not only the State Department but the
Department of Agriculture, the Department of Health and Human Services, the
Department of Homeland Security, Department of Defense, our major
international assistance through the U.S. Agency for International
Development, and various other federal entities all working
internationally.

In terms of international organizations, we have cooperated very closely
with the United Nations System Influenza Coordinator, Dr. David Nabarro,
and with the institutions internationally who are very focused on
programmatic activities in line with the concerns -- the Food and
Agriculture Organization of the United Nations, and the World Organization
for Animal Health, known as OIE by its French initials, are focusing on the
animal health side; the World Health Organization on the human health side.
And then there's the World Bank and many other multilateral institutions.

And they've really all been engaged in actions in light of the alarming
spread of the avian influenza virus in poultry, as Dr. Venkayya mentioned,
now in 60 countries, as well as the possibility that there will be this
global pandemic.

So what has this global engagement meant, in terms of specific
accomplishments, as well as actions planned for the near future? I know
there isn't a lot of time available for this so I'll just mention a few.
And you, of course, have the results that have been printed today in the
progress report.

The United States is supporting preparedness efforts in more than 65
countries, working in collaboration with WHO, FAO, OIE and other partners.
We've deployed scientists, veterinarians, public health experts,
physicians, emergency response teams, all to either affected or high-risk
countries, to assist in the development and implementation of emergency
preparedness plans relevant to both avian influenza and to pandemic
influenza.

With our neighbors Canada and Mexico, we're finalizing an avian and
pandemic influenza plan that will be issued next month as part of the
Security and Prosperity Partnership of North America. And this plan will
lay out a sound, coordinated trilateral approach to prepare for and respond
to the possibility of the arrival on this continent of highly pathogenic
avian influenza, possibly in migratory birds or in poultry, or a human
influenza pandemic.

We're supporting activities in more than 50 countries to generate public
awareness about the threat of avian influenza and to promote behaviors that
reduce the risk of disease transmission from poultry to people.

We're also providing up-to-date information on avian and pandemic influenza
to the majority of over 2 million Americans registered with our embassies
and consulates abroad by using websites, town hall meetings hosted by our
embassies and consulates, publications and other means.

We've supported efforts to expand and enhance animal and human disease
surveillance systems, and we're working with partners to improve capacity
for detection and laboratory diagnoses, as well as early warning networks
in 75 countries.

With WHO and FAO, we've provided training for thousands of policy and
technical experts globally who will lead efforts to contain and mitigate
the effect of animal and pandemic outbreaks.

And to prepare for this, we did this -- total on this, we've supported the
training of more than 129,000 animal health workers and 17,000 human health
workers in surveillance and response.

This is only a partial accounting, and it's very much done by a multitude
of U.S. government agencies acting internationally. We're going to continue
that global engagement, and in particular, we look forward to the next
meeting of the International Partnership on Avian and Pandemic Influenza in
India this December.

Thank you.

DR. VENKAYYA: Thanks, Dr. Lange. I'd like to now turn it over to Dr. John
Clifford from the Department of Agriculture.

DR. CLIFFORD: Thanks, Dr. Venkayya. I appreciate the opportunity to report
on USDA's progress in protecting against and preparing for highly
pathogenic H5N1 avian influenza. We have worked very hard to ensure that we
have an aggressive, thorough and detailed response plan in the event of a
detection of a high-path, H5N1.

We've also worked very hard in an international basis to prevent the spread
of high-path H5N1 overseas, thereby better protecting our borders.

I'm pleased to be here with my counterparts from HHS, DHS, and State
Department. And because we worked very closely together with them, as well
as state and other federal agencies, to ensure we are well coordinated and
are ready to respond, not as one agency, but as the United States
government.

In fact, I'm pleased to report that USDA has accomplished all 48 tasks for
which our department was given primary responsibility in the implementation
plan to complete in one year. This involved a tremendous commitment by many
people, both within Animal and Plant Health Inspection Service, where I
work, and throughout USDA, from the Foreign Agriculture Service to our
colleagues from Agricultural Research Service to Food Safety Inspection
Service. I will certainly not attempt to review all of the areas in which
we've made progress, but I would like to share just a few of them with you
today.

APHIS's emergency coordinators have participated in more than 50 state and
county level tabletop exercises to ensure that we are ready, not only at
the federal government level, but that we are working closely with our
state and local officials to ensure well coordinated response.

We've expanded the national veterinary stockpile to attain another 40
million doses of avian influenza vaccine for birds. This brings our total
supply to 140 million doses of kill vaccine to protect older birds. We also
have a contract in place that will quickly give us access to another 500
million doses of live pox recombinant H5N1 vaccine to protect younger
birds.

I should mention that it is impractical to attempt to vaccinate all
poultry, as we've seen in other countries. In the event of a highly
pathogenic AI detection, vaccines can be used to protect healthy birds
outside the perimeter of the outbreak.

We have contracts in place and are continuing to test them to ensure
delivery within 24 hours of the supplies we would need to respond to an
outbreak. These include such things as personal protective gear,
antivirals, AI field test kits, portable satellite communication equipment,
portable vaccine shipment and storage containers, disinfectants,
depopulation, decontamination and disposal service contracts.

We've tried to anticipate and address potential problems that might slow
our ability to respond to an outbreak. For example, we recognize that in
some instances, states have expressed a concern regarding the use of
veterinarians working in an emergency response who are not licensed in
their state. We are working to develop an emergency management assistance
compact that would allow us to use veterinarians from neighboring states to
work in the event of an outbreak.

Along with our partners from the Department of Interior and state wildlife
agencies, we continue our comprehensive surveillance of wild birds in every
North America fly zone, to ensure we have a strong early warning system in
place. Between the 1st of April, 2006, and the 31st of March, 2007, we've
tested over 84,000 wild birds and 50,000 environmental fecal samples. Since
April of this year, we've already tested more than 5,000 wild birds and 400
fecal samples. All wild bird and environmental samples have been negative
for highly pathogenic H5N1.

We are also monitoring wild birds in Russia, Greenland and Mexico as early
warning if the virus approaches the U.S. in these species.

To meet the demands of 45 laboratories in the National Animal Health
Laboratory Network and all 50 state wildlife agencies, APHIS conducted six
avian influenza workshops to increase communication between all parties
involved in wild bird surveillance. The workshops reviewed laboratory and
communication protocols to ensure an effective and efficient response to
high-path AI detection in wild birds. Our hope is that our international
efforts will help to ensure that high-path H5N1 never reaches our borders.

I'll mention just a few of our accomplishments on the international front.
USDA personnel are part of rapid assessment and rapid response teams that
are working in more than 30 countries worldwide. There are about 130
volunteers available for international deployments, either through the FAO
or bilaterally between the infected country and the U.S. We also have a
system in place to rapidly deploy USDA assets when needed internationally,
without compromising U.S. domestic response capabilities. We've worked in
more than 50 countries to help deliver and disseminate educational
materials to prevent the spread of high-path H5N1. We have helped train
more than 100,000 people in other countries, ranging from animal health
workers and wildlife biologists to government policy makers.

I believe we're making a real difference, in terms of global understanding
of the virus, how to combat it, and how to protect against it. We have
worked with international health organizations to ensure all priority
countries have established early warning networks, an important
accomplishment. They all have or are working on response plans, and all
priority countries also have access to our training.

We have delivered rapid detection kits to 26 countries and have worked with
international partners to ensure all priority countries have access to lab
diagnostic services. In other words, every priority country has lab testing
services available, either from the U.S. or an accredited lab in another
region of the world.

From a veterinarian's perspective, I can tell you that I'm very pleased we
began preparing in 2005 as if the arrival of H5N1 was imminent. I believe
that's part of the reason USDA has accomplished every task for which we
have held primary responsibility. Of course, I'm very pleased that H5N1 has
not reached the U.S., but I can tell you this: It is with great confidence
that I say that we are fully prepared to respond to a high-path H5N1 if it
does reach our borders in the U.S.

If that happens, it's important to remember a few key points. USDA has two
decades of experience responding to AI, including both low-path and
high-path forms of the virus. In high-path AI cases, USDA has worked
aggressively to eradicate the disease and the virus from the premises. For
low-path AI, USDA has worked closely with state and industry partners to
put in place response and containment plans that ensure effective response
to low-path AI incidents, and elimination of the virus from these premises.
These plans are developed to be more efficient and effective for their
state and their segment of the overall industry.

A detection of H5N1 high-path AI in birds does not signal the start of a
human pandemic. USDA has clear aggressive action plans to eradicate the
virus if it is detected in domestic poultry and backyard birds. We have
much more advanced protection and response plans than existing countries
where the virus has moved from birds to humans.

In the event of an outbreak, we have a plan in place to prevent affected
poultry from entering the food supply. Having said that, it's important to
mention that fully cooking poultry kills the AI virus, so it is safe to eat
properly prepared poultry.

In closing, I just want to take a moment to commend the media. Many of us
who work in the animal health worry that the detection of a low-path H5N1,
which we refer to at a North American strain of H5N1, would spark panic
stories about the dangerous bird flu arriving in the U.S. Nothing could be
further from reality. We've now had several detections of low-path H5N1 in
both wild and domestic birds. Instead of sparking panic, the stories
sounded the all-clear by presenting factual information when low-path AI is
not a concern.

I know that reporters are under tremendous pressure to turn stories
quickly, and I want to express our appreciation for the way you've handled
reporting on AI.

And thank you for the opportunity to be here.

DR. VENKAYYA: Thanks, Dr. Clifford. I'd like to now turn to Admiral John
Agwunobi from the Department of Health and Human Services.

ADMIRAL AGWUNOBI: Thank you, Dr. Venkayya. As many of you know, the
Department of Health and Human Services -- and I should point out,
especially our agencies of the Centers for Disease Control, the National
Institutes for Health, and the Food and Drug Administration have worked
tirelessly on this issue from the very beginning.

The waterfront of activity is so large and so broad, quite frankly, tens of
hundreds, many hundreds of sub-tasks have trickled down from the tasks that
are presented to you today. So I'm not going to keep -- I'm not going to
have a lot of comments at this point. I'll let your questions direct where
we go. I'll try to keep my comments a little short.

The Department of Health and Human Services, like other federal agencies
here today, has been working diligently, as I've said, to prepare for
pandemic influenza, and, quite frankly, as we have in preparing for many
other public health emergencies that might arise.

Our work, like our colleagues' here today, has been based on the
President's three strategic pillars, including, as my colleague the
Ambassador mentioned, preparedness and communication, surveillance and
detection, and of course, response and containment.

Now, since 2005, Congress and the people of our nation very appropriately
invested and provided $5.6 billion in funds to assist HHS in mobilizing the
nation to prepare for pandemic influenza, and the results are quite
obvious.

For the first time ever, HHS has licensed -- and I think this was in April
of this year -- a pre-pandemic vaccine that can help carry through the
early months of a pandemic. Enough antiviral drugs are now stockpiled among
state and federal governments for the treatment of more than 50 million
Americans affected by pandemic influenza.

Communities now have a series of interim guidelines to assist them with
their planning. I'm very proud of the fact that HHS helped host the
pandemicflu.gov website, which is a really good resource for communities,
for individuals, and indeed, for government, as we share information across
the many different branches -- federal, state and local.

The therapies, of course, of our guidelines offered to the public has been
the CDC's community strategy for pandemic influenza mitigation. I just
would insert here that all of our interim guidelines -- all of our
guidelines are interim, and the very nature of pandemic preparedness is
such that as science advances, as experience is accumulated, we will update
all of these guidelines over time.

Interim advice on the use of surgical masks and respirators is now
available, and several public discussions of vaccine prioritization have
been held. Now, the results of these discussions will, we hope, help inform
how we use vaccine, both pre-pandemic and pandemic vaccine, should the need
arise.

Through a series of exercises with senior government officials and the
media -- we've actually had sessions where we sat with our colleagues in
the media at roundtables and discussed what we would do under different
scenarios, a better understanding of how government interacts with the
media, and how media interacts with government in a crisis resulted.

HHS has worked to explain the importance of pandemic preparedness at the
global level -- our colleagues at the Department of State -- but also at
the local level, as we work with local leaders and how they interact with
their populations. We've released a series of radio and television public
service announcements to help better inform citizens and individuals.

There is still additional work that needs to be done, and I'll close by
saying, today we present, I think, a summary of the activities that are
ongoing, almost the tip of the iceberg. 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.

DR. VENKAYYA: Thanks, Dr. Agwunobi.

I'd like to now turn to Dr. Jeff Runge, from the Department of Homeland
Security.

Jeff.

DR. RUNGE: Thanks, Dr. Venkayya.

Good afternoon. I'm actually very thrilled to be up here with this group
that we have been in lockstep and lock-armed with since the President
announced this as a major priority. And I'd be remiss if I didn't point out
that there are others in the room, sitting in the audience, who have
actually been here with us every step of the way -- the Department of
Transportation, Interior, Defense, the Vice President's Office. This truly
has been a remarkable effort, in the true spirit of the Department of
Homeland Security, and the integration of all these players has been really
rewarding for me, personally, and for Secretary Chertoff.

In addition, there are other partners, which we understand have a big stake
in this -- police, fire, EMS, emergency management, and especially the
private sector -- both the medical private sector and non-medical private
sector.

DHS has been focused on several major areas of activity; first of all, in
supporting our sister agencies, particular USDA and HHS, to ensure their
success in the event of an avian outbreak or a pandemic. But in addition,
we have the unique responsibility of the protection of our nation's
critical infrastructures. I don't hesitate to remind you that 85 percent of
those critical infrastructures are privately owned and, therefore, depend
on the investment of both time and resources of the private sector.

We are focused on management of our nation's borders, and especially
management of the overall incident, if the institutions of the United
States are threatened by a high-category pandemic, including integrated
bio-surveillance, planning and exercising our plans for incident
management. Maintaining domestic security and civil order falls within our
bailiwick, as well as assisting in providing mass care and coordination of
federal resources in the event of a high-category pandemic, as well.

Some highlights also that I will just toss out to you is that our incident
management planning team has completed work on the Federal Con-Plan -- the
concept plan which pulls in all of the federal agencies' plans and turns
them into a single document from which other operational plans will be
cascading. Our critical infrastructure partnership division published a
critical infrastructure and key resource guide last July to help our
private sector critical infrastructure partners to figure out what they
need to do in order to make sure that they are able to function in the
event of pandemic.

In so doing, our private sector office and policy -- and our Critical
Infrastructure Protection Office have conducted over 100 symposia around
the country with the private sector, large and small businesses, EMS,
state, local officials, police and fire. In May, DHS released the 17
all-hazards sector-specific plans as part of the National Infrastructure
Protection Plan, which systematizes the ability of critical infrastructure
to maintain their business operations.

Currently, the Office of Health Affairs is coordinating the incident
management planning teams' border management policy with our components and
with the interagency involved, especially many of the individuals who will
be involved will be state and local health officials -- I'm pleased to see
Dr. Jaris here from ASTHA -- State and Territory Health official -- who are
assisting us with this border management thinking.

CBP -- Customs Border Protection -- is coordinating with Canada and Mexico
on trilateral border preparedness. We have developing guidelines and best
practices for law enforcement, EMS, public works, and emergency management
through a series of conferences. And TSA is leading a group of officials
from CBP, the CDC, State Department, DOD and FAA to develop a plan for the
management of the nation's commercial aviation system in the event of a
pandemic.

But a few things that the department is involved with -- I would like to
echo Dr. Venkayya's comment that these activities, though they are intended
for the mitigation of a human influenza pandemic, will indeed provide the
structure to deal with any other biological threat, whether natural or an
instrument of terrorism. We at DHS are focused on multi-use institutions
that we can put into place for whatever emergencies arise.

So with that, I'll turn it back over to Dr. Venkayya. Thanks.

Q My question is for Dr. Venkayya. And I guess I'll start with, thanks for
this briefing, and also thank you for setting I think an incredibly
important example of government accountability. You set out a series of
tasks and you dutifully reported on them. And I think that's a model for
how public health should be done and how government should work in general.

My question for you is, as we learn more about what it takes to respond to
a pandemic -- and I'm sure there will be some groans from some of agency
people here -- will you be adding tasks to this implementation strategy
that will reflect that changing knowledge and some of the new efforts
you've undertaken? And the example that immediately springs to mind is the
community mitigation guidance identified a whole series of things that the
federal government and state and local governments need to be doing to make
those real, and so will there be revisions to the underlying document that
reflects those additional tasks?

DR. VENKAYYA: Thank you. Just to recap in case anyone didn't hear that, the
question is, given the evolving nature of the threat, our understanding of
the threat, and the advancements that we have in various areas, some versus
others, will we be amending the implementation plan?

We actually, when we released the implementation plan, in the front of that
document, tried to address your point. And I'm going to reaffirm that, and
that is that it is a living document and we know much more about this
virus; we also know much more about what we need to do to enhance our all
hazards preparedness now than we did when that document came out. And so we
have revised actions as we've gone forward.

Just to give you a couple of examples: There are 14 actions that have been
postponed this time around. The last time, back in December, we postponed,
I think, 12 actions that were related to community mitigation guidance
because we knew that because of additional consultation, those actions
couldn't be completed until we released the guidance in February. And we've
now gone and worked toward getting those done. I think most of those, if
not all, are done.

A similar situation with those 14 -- we've actually worked with, in the
case of the border and transportation actions, we've worked with DHS to
bundle actions together so that we can check the box on multiple actions
with a handful of activities.

As far as adding to the list, I will tell you that that implementation plan
represents just a small fraction of the activities around government that
are going on in the name of pandemic preparedness. As Admiral Agwunobi
alluded to, in the case -- he didn't say this explicitly, but CDC, for
instance, has over a thousand actions that they're undertaking in the name
of -- and I believe they're all connected to pandemic preparedness. It's
remarkable. And I think that that's -- while that may be an extreme
example, I think that's the case at every federal department and agency.

We want to be careful about balancing the burden that we place on agencies
with reporting requirements and so on, by adding to the implementation plan
and the need to get the work done. And so we're using a variety of vehicles
to get these other things, to move the ball forward in these other areas.
And those fall into our traditional policy process, which does have
taskings and does have deliverables. We don't report on them in the same
manner, but we are ensuring accountability within the government.

Q I guess just as a follow-up, my plea would be that, without creating a
huge burden, as we identify some of these additional tasks -- I mean, the
beauty of this is that there is a way for the public and for everyone who
is concerned about this issue to really know -- to monitor the progress
that is happening. And while there may be other vehicles that work
internally to the government for you to monitor what is happening, it's
much harder for the government to do that monitoring.

DR. VENKAYYA: Point taken. Thank you.

Q There's a couple things going on in the financial services sector about
addressing if there's a pandemic -- a work-at-home strategy. And we're
working with NCS and doing some modeling there. I think the model is, we
know it's going to happen, there's not going to be enough bandwidth to work
at home because everybody is going to be working at home, and kids are
going to be at home downloading stuff and there's not going to be enough
bandwidth there. We're also doing some studies -- actually, a whole
exercise in the fall -- I believe a few hundred, maybe even a few thousand
institutions participate, financial institutions, and doing a series of
injects over a three-week period. I think Treasury is helping fund that.

But your thoughts in general about maybe a national policy, if this does
hit, can there be ways to actually restrict bandwidth or usage of that
bandwidth to critical infrastructures, so there isn't gaming and other
things going on and using all the bandwidth out there?

DR. RUNGE: That's a great comment. Thank you very much for bringing this
up. As groups like yours begin to engage -- and we affectionately call that
the last-mile task force, because the concern is that the last mile of
telecom is really the most vulnerable piece of this. Unbeknownst to me as a
physician, but working with NTIA and the Department of Commerce and your
group and others -- Secretary Chertoff has actually asked the question to
us recently, what additional authorities should we have in place in the
event of a pandemic that we may not have now. Our general counsel is
looking at this issue, particularly the issue that you raised about the
large proportion of our vital bandwidth is consumed by playing video games
over the Internet. If the technology exists, there may be some development
of compatible authorities in order to deal with that.

Q I'm an emergency physician and health care practitioner. I think that
clearly, the efforts made by government and others have been very
admirable, and the coordination and collaboration both domestically and
internationally is truly impressive. However, at the same time,
domestically, our health care system is quite taxed, particularly if you
look at emergency departments you'll see that the latest CDC statistics out
just a couple of weeks ago show greater than 115 million visits in the last
year.

So in a period where you have increased demand, increased need from folks
who are ill, some of them quite seriously ill, I'd like to hear more how
you're going to address two components -- one is, how we're going to
educate the public to not overtax the system unless it's really necessary;
and two, how we're going to help particular the private sector deal with
the dramatic increase in demand at a point where we're already close to
being maxed out?

ADMIRAL AGWUNOBI: My boss, Secretary Michael Leavitt, has often expressed
that his main concern is our ability to prepare and maintain the surge
capacity in our health system, a capacity to surge up to the increased
demands that we might see in a pandemic. Obviously there's another part to
that, and that is to recover and get back to its baseline after a pandemic
has passed.

With that in mind, a lot of work has gone on. When the Secretary makes it a
priority and when the administration makes it a priority, you can well
imagine that it becomes something that we're all very engaged in. A series
of activities are ongoing today with a view to trying to adequately define
what the gaps might be under the different pandemic scenarios, where they
might be. All too often we talk about ventilators, which is an important
part of the equation, but there are other issues that go into the care of
the critically ill associated with a pandemic, to speak of everyone else
who have ongoing health care needs, as well.

A series of discussions are underway to try and better define what the gap
is, and then to define how we might sequentially and incrementally fill in
those gaps over time. I think it's appropriate that I also add that the
solution to your specific questions isn't just a federal responsibility. I
mean, very clearly, each community, each state, each locality needs to
engage in discussing what the unique needs are. And the reason I say that
is because we don't have a uniform system across every state, across every
community of our nation. No two communities and their health care assets
are exactly the same.

It's also true that no two communities, in terms of their populations, are
exactly the same. The challenge in communicating with populations is
always, how do you do it in a language and in a format that is accessible
to the community that you're speaking to -- African Americans in an
inner-city region, for example, rural settings, and others. So these are
all important considerations.

We have released the community planning guide for providing mass medical
care with scarce resources. It's a tool that we've provided to the public
and to health care providers to help them begin thinking through the roles
that they might play in this partnership of preparing our health systems.
As we reach out to our public in a pandemic, I have no doubt that they will
-- that we'll have to give them guidance on triage, on what to -- on where
to take less emergent needs, and on when to present to the health system.
And we're very proud of the work that HRSAA -- our Health Resources and
Services Administration Agency -- and CDC have been doing in trying to
define how that might play out in a natural pandemic.

I'll end by saying there's no cookie-cutter solution to this. There are
many variables that are critically important to the final solution, not the
least of which being what kind of pandemic are we dealing with. The advice
that we give to the public, whether it be antiviral use or potentially
vaccine use, and prioritization, for example, and indeed, the triage
question about how to access and when to access health care, might differ
greatly depending on whether or not it's a category one, a mild pandemic
that might look more like a seasonal flu, with perhaps the elderly being
more affected than anyone else -- the advice that we'd give a community
under that circumstance might be very different than, say, a category five
pandemic like 1918, where perhaps there might be excess mortality in the
young and robust, a very different scenario that would require a very
different intervention.

I think we've stunned them. (Laughter.)

Q The 1918 flu, going back and reading some of the books about that, the
school systems in Philadelphia, they didn't close those right away and they
had a higher death rate, for instance, than in St. Louis or Minneapolis and
some of the other cities where immediately they took action to close the
schools. But then if they reopened real early, then the death rate went
back up. Is it going to be local jurisdictions that will close the schools
-- because that seems to be where most of it is transmitted -- or is it
going to be a national -- will national authorities have the ability to
actually do that, or what?

ADMIRAL AGWUNOBI: We're smiling because there's been a lot of discussion
internally and with our stakeholders on this subject. Today, we continue to
believe that the front line of the fight against a pandemic will be fought
locally. Local leadership and local communities are going to have to step
up and lead. And that's including making decisions based on the existing
infrastructure of our education system, which is local.

Having said that, we believe strongly that a coordinated approach across
the nation will be much more successful than one that is not coordinated.
And as you can well imagine, the CDC, Department of Homeland Security -- I
mean, there are work force implications that relate to school closures, as
you can well imagine, consequences, and indeed, Homeland Security and
others will all be engaged in, number one, making sure we educate local
leaders in no unclear terms as to the need to have plans that they can
implement in an emergency; exercised plans so that they've worked out the
kinks; and of the importance of doing so in a coordinated fashion.

Now, I don't want to leave you with the impression that a pandemic will hit
all at once across the entire nation simultaneously and everybody will be
asked to close their schools on the same day. It doesn't work that way, as
all of you know in the stakeholder community, pandemics roll through
communities in a somewhat unpredictable way. So the coordination that we're
talking about are a set of key epidemiological triggers that we'd urge
everyone to build into their plans and that they activate their school
closures -- actually, their non-pharmaceutical interventions, the many
non-pharmaceutical interventions that might be out there, that they would
activate them in some coordinated fashion linked to those key
epidemiological triggers.

When you look at the epidemiology waves in disease, there's a right time
and perhaps a wrong time to intervene with different interventions. Our
hope would be that we could get everybody to the point where they're
pulling the trigger based on the same coordinated set of findings. I don't
know if, Rajeev, you want to add to that in some way.

DR. VENKAYYA: Well, I know that Jeff at DHS has also thought a lot about
this. We have great concern that in an eventuality like this, where the
authority does reside at the local or state level, that you could have a
patchwork implementation approach and have, say, a community on one side of
the state line behave -- or one county behave one way, and the next county
over behave differently.

And I think it's critically important for the federal government to provide
that clear, unambiguous guidance early -- revised as needed, but provide
that early so that communities know exactly what they're on the hook --
what the federal guidance is. And if they're not going to follow federal
guidance, they probably ought to have a good explanation for their
populations, because this is -- these are, essentially, potentially
life-saving interventions. And so if a community wants to deviate from that
guidance in order to preserve something else, then I think that they're
going to owe an explanation to their populations