Pandemic Influenza Response

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Pandemic Influenza Response Can you say
OUTBREAK
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Quotes re Quarantine Pandemic Influenza
Quarantine and isolation were widely imposed, but
probably did little to stop the contagion.
Predictably, quarantine could delay spread
somewhat but, having no impact on population
susceptibility, could do nothing to reduce the
numbers who would eventually fall ill.
Quarantine measures were applied in several
countries and were generally found to be
ineffective, managing at best to postpone the
onset of an epidemic by a few weeks to two
months. The WHO expert panel found that spread
within some countries frequently followed public
gatherings, such as conferences and festivals,
with infection dispersed as participants returned
home. The banning of public gatherings and the
closing of schools were considered the only
measures that could dampen the spread of pandemic
influenza.
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Antivirals Not A Panacea

• Antiviral resistance and side effects may limit
  use
• Global production capacity limited high cost
• Ability to use antivirals to limit spread depends
  on rapid case detection and contact tracing
• Need to start treatment early
• Effectiveness on serious illnesses and mortality
  unknown
• Prophylaxis may require ongoing use for 6 weeks
  or longer

Orders placed now (102005) Delivery 2008
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Pandemic Vaccines No Magic Bullet

• Evolving virus Unpredictable target
• Production limited
• High dose required
• Limited (if any) efficacy data
• Logistics issues
• Priority groups
• Labeling
• Distribution

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Public Health Measures Scope I
Decrease contact Decrease contact Decrease contact
Isolate cases Quarantine contacts Restrict travel Restrict mixing
Hospital Advisory School closure
Home Screening exit / entry Ban mass gatherings
Conveyances Ban Avoid crowded places
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Public Health Measures Scope II
Decrease effective contact Decrease effective contact Decrease effective contact
Case hygiene Contact hygiene Environment hygiene
Wear mask Wear mask Disinfection
Wash hands Wash hands Ventilation
Respiratory hygiene
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Public Health and Border Measures

• To avert a pandemic or appreciably slow the
  spread of a novel virus, prior to the development
  of efficient and sustained human to human
  transmission

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Ways to Increase Effective Social Distance

• Social distance is defined as The proximity to
  which a member of one group permits members of
  another group to his/her person
• Implement Snow Day restrictions
• Close schools, daycare centers, etc.
• Cancel large public gatherings (concerts,
  theaters)
• Minimize other exposures (markets, churches,
  public transit)
• Ask non-essential workers to stay home

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Priority Issues for SD MAR
Implementation requires the trust and
participation of the general public

• Communication
• Logistics resources
• Economic
• Special needs populations
• Psychological Psychosocial
• Tipping points Flashpoints
• Communication

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HHS Interagency Public Affairs Committee
onInfluenza Preparedness and Response

• Mission
• Established in July 2005 as a subgroup of the HHS
  Secretary's Interagency Task Force on Influenza
  Preparedness.
• Primary focus is government-wide coordination of
  public affairs activities related to pandemic
  influenza.
• Chaired by HHS with invited representatives from
  all U.S. government departments and agencies.  In
  addition, membership is also extended to
  interested state and local partners, foreign
  governments, and other appropriate U.S. and
  international non-government organizations.

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Why Communication and Outreach are Critical
Components of Pandemic Influenza Preparedness

• Research continues to document the importance of
  risk communication and early public discussion
  for effective health/emergency preparedness
  activities
• Need to begin laying the foundation of
  expectation with communities (business,
  education, labor)..
• Preparedness tool communication is a critical
  part of our preparedness efforts
• Will be one of the few, if not the only tool,
  available in the early days of a pandemic

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National Survey of US Public

• To measure the publics general awareness of
  pandemic influenza
• To measure the publics level of concern and
  beliefs about pandemic influenza
• To assess amount of confidence in and attitudes
  toward public health measures that might be
  employed during a pandemic

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Study Method ConsumerStyles Survey

• Mail survey administered every year in April and
  May since 2002 by Porter Novelli, a public
  relations firm.
• Covers a wide variety of U.S. consumer behaviors
  including media choices and general health
  attitudes.
• 2005 survey sent to a stratified random sample of
  20,000 potential respondents from a panel of
  600,000 households
• 63 response rate
• Data post-stratified and weighted to U.S. Census
  Current Population Survey on gender, age, income,
  race, and household size
• confidence interval approximately /- 1

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Conclusions

• Awareness of pandemic influenza is generally very
  low
• Respondents expressed some concern, although a
  large number (20) were not concerned and feel
  pandemic influenza risk is being exaggerated.
• There is a lack of public awareness about vaccine
  and antiviral availability and lack of confidence
  that they will be distributed fairly.
• Most respondents feel that federal and local
  health officials are not prepared to respond to
  an influenza pandemic.
• Many predict they will not be willing to comply
  with public health measures.

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Preliminary Recommendations

• Efforts are needed to increase public awareness
  of pandemic influenza and why this is a concern
  now.
• Messages and materials for use during a pandemic
  (on prioritization of vaccines and antivirals,
  quarantine and isolation, home care, and other
  pandemic response measures) should be drafted and
  tested now.
• Focus group and community forum experiences
  suggest that providing the rationale for response
  measures may increase acceptance.

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Findings, Recommendations, Comments

• Flu vs. emerging infection
• Google for information
• Desire for more information
• Immediacy and preparedness
• Misunderstanding about vaccines and therapeutics
  how used
• Concern about fairness
• priority groups

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Challenges for Community Continuity Planning

• Uncertainty and denial
• Lack of understanding of potential threat
• Focus on what others the government, potential
  leaders should do
• Lack of awareness of personal responsibility

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What do we need?

• Risk communication
• Dynamic, actionable, context-rich products
• What you need to know
• What you need to watch for
• What you can do (you your family)
• Just in time plans, procedures, policies
• Training
• Resources
• Response
• Recognizing uncertain timelines, competing
  priorities, and an evolving problem

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What should we do?

• Dont reinvent the wheel
• Dont buy a square wheel
• Share your plans, policies, procedures fears
• Develop a clearing house for
• Best practices
• Resource assessment
• Expert advice
• Recognize that self-reliance will be the norm

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Risk communication Actionable Information
Simple But Effective Interventions
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Dr. Stephen Prior National Security Health Policy
Center sprior_at_potomacinstitute.org Office
703-562-4512