also played a role, and technological systems can be improved, said Redd, but understanding the information generated during an epidemic requires “relationships and trust.”

Response to a pandemic flu is based on the systems set up to identify and respond to seasonal influenza, Redd observed. Also, state and local health departments are essential components of these systems, because they both gather information and implement interventions. Finally, laboratory findings often constitute the lead information for pandemic preparedness, which is not necessarily the case for other kinds of emergencies.

Redd also emphasized several aspects of situational awareness. Determining what has happened and what could happen requires detection, characterization, assessment of the burden, and determination of what has changed. Situational awareness also requires knowledge of the tools that can be used to mitigate impacts, including antivirals, vaccines, and nonpharmaceutical interventions, along with knowledge of the effectiveness of those tools.

Detection and Early Response

Within a few days of detection of the 2009 H1N1 signal cases, the CDC director was receiving a daily briefing on the situation. Preparing the briefing brought people together at CDC and resulted in the preparation of slides that could be distributed within the agency and to other federal agencies. Daily calls were held with the White House, and the Domestic Readiness Group was regularly briefed, said Redd. State health officials, epidemiologists, and laboratory directors also received daily updates, which provided these officials with a common picture of what was happening.

As pandemic response progressed, daily teleconferences convened by the Department of Health and Human Services chief of staff included representatives from several federal agencies. Weekly videoconferences involved a wider range of agencies, and weekly calls with state and local health officials provided a way to provide them with the latest information. In addition, CDC established liaisons with agencies at the federal, state, and local levels.

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