The three main objectives of the U.S. pandemic plan parallel those of other national pandemic preparedness plans, and of the WHO plan: to decrease the burden of disease, minimize social disruption, and reduce the economic impact associated with a pandemic (CDC, 2004c). It addresses surveillance; development and licensure of a vaccine against the strain; production of sufficient vaccine for the U.S. population and provision for its delivery; targeted distribution strategies for limited supplies of vaccine and antiviral medications; coordination with international, state, and local authorities; maintenance of medical care and other community services; and communication with community leaders, medical care providers, the public, and the media (Gellin, 2004). The plan includes the following elements (Gellin, 2004):
A core plan, which describes the protocol for national coordination and decision-making, reviews key preparedness issues, and outlines response at national, state, and local levels.
Two guides to aid planning by (1) state and local health departments and (2) public and private health care systems.
Twelve annexes providing detailed and technical information on preparedness and response issues.
Additional efforts by the federal government to prepare for pandemic influenza at the national level include a $100 million DHHS initiative in 2003 to build U.S. vaccine production. Several agencies within DHHS—including the Office of the Secretary, the Food and Drug Administration (FDA), CDC, and the National Institute of Allergy and Infectious Diseases (NIAID)—are in the process of working with vaccine manufacturers to facilitate production of pilot vaccine lots for both H5N1 and H9N2 strains as well as contracting for the manufacturing of 2 million doses of an H5N1 vaccine. This H5N1 vaccine production will provide a critical pilot test of the pandemic vaccine system; it will also be used for clinical trials to evaluate dose and immunogenicity and can provide initial vaccine for early use in the event of an emerging pandemic. Other efforts include the introduction into the U.S. Senate of the Flu Protection Act of 2004, which aims to increase safeguards against both annual influenza and epidemic/pandemic preparation. Two Senate bills introduced in 2003 also address key influenza preparedness issues: boosting vaccine production16 and promoting immunization against several diseases, including influenza.17