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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25391.
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Exploring Lessons Learned from a Century of Outbreaks READINESS FOR 2030 V. Ayano Ogawa, Cecilia Mundaca Shah, and Anna Nicholson, Rapporteurs Forum on Microbial Threats Board on Global Health Health and Medicine Division PREPUBLICATION COPY—Uncorrected Proofs

THE NATIONAL ACADEMIES PRESS   500 Fifth Street, NW   Washington, DC 20001 This activity was supported by contracts between the National Academy of Sci- ences and the National Institute of Allergy and Infectious Diseases/National Insti- tutes of Health (10003226), Uniformed Services University of the Health Sciences (10003626), U.S. Agency for International Development, U.S. Army Medical Research and Materiel Command (10001249), U.S. Centers for Disease Control and Prevention (10002642), U.S. Department of Homeland Security (10003591), U.S. Department of Veterans Affairs (10003353), and U.S. Food and Drug Admin- istration (10002125) and by the American Society for Microbiology, EcoHealth Alliance, Infectious Diseases Society of America, Johnson & Johnson (10003710), Merck Co., Inc., Sanofi Pasteur, and The University of Hong Kong. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/25391 Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2019 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Exploring lessons learned from a century of outbreaks: Readiness for 2030: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25391. PREPUBLICATION COPY—Uncorrected Proofs

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY—Uncorrected Proofs

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY—Uncorrected Proofs

PLANNING COMMITTEE ON EXPLORING LESSONS LEARNED FROM A CENTURY OF OUTBREAKS: READINESS FOR 20301 KEIJI FUKUDA (Chair), Clinical Professor and Director, The University of Hong Kong School of Public Health DENNIS CARROLL, Director, Global Health Security and Development Unit, U.S. Agency for International Development PETER DASZAK, President, EcoHealth Alliance EMILY J. ERBELDING, Director, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, U.S. National Institutes of Health JENNIFER L. GARDY, Senior Scientist, British Columbia Centre for Disease Control; Associate Professor, School of Population and Public Health, University of British Columbia, Canada KAREN GROSSER, Former Vice President, Development, Infectious Disease, and Vaccine Therapeutic Area, Formerly Johnson & Johnson ELIZABETH D. HERMSEN, Head, Global Antimicrobial Stewardship, Merck & Co., Inc. DANIEL B. JERNIGAN, Director, Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention KENT E. KESTER, Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur JONNA A. K. MAZET, Professor of Epidemiology and Disease Ecology; Executive Director, One Health Institute, School of Veterinary Medicine, University of California, Davis SUERIE MOON, Director of Research, Global Health Centre, The Graduate Institute of International and Development Studies, Geneva DAVID NABARRO, Advisor, Health and Sustainability, 4SD—Skills, Systems, and Synergies for Sustainable Development KUMANAN RASANATHAN, Board Member, Health Systems Global PETER A. SANDS, Executive Director, The Global Fund to Fight AIDS, Tuberculosis and Malaria JAY P. SIEGEL, Retired Chief Biotechnology Officer and Head of Scientific Strategy and Policy, Formerly Johnson & Johnson 1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution. v PREPUBLICATION COPY—Uncorrected Proofs

Health and Medicine Division Staff CECILIA MUNDACA SHAH, Director, Forum on Microbial Threats, Board on Global Health V. AYANO OGAWA, Program Officer, Board on Global Health T. ANH TRAN, Research Assistant, Board on Global Health JULIE PAVLIN, Director, Board on Global Health vi PREPUBLICATION COPY—Uncorrected Proofs

FORUM ON MICROBIAL THREATS1 PETER DASZAK (Chair), President, EcoHealth Alliance KENT E. KESTER (Vice Chair), Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur MARY E. WILSON (Vice Chair), Clinical Professor of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco KEVIN ANDERSON, Senior Program Manager, Science and Technology Directorate, U.S. Department of Homeland Security TIMOTHY BURGESS, Director, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences DENNIS CARROLL, Director, Global Health Security and Development Unit, U.S. Agency for International Development EMILY ERBELDING, Deputy Director, Division of AIDS, National Institute of Allergy and Infectious Diseases, U.S. National Institutes of Health MARCOS A. ESPINAL, Director, Communicable Diseases and Health Analysis, Pan American Health Organization KEIJI FUKUDA, School Director and Clinical Professor, The University of Hong Kong School of Public Health JENNIFER GARDY, Senior Scientist, British Columbia Centre for Disease Control; Associate Professor, School of Population and Public Health, University of British Columbia, Canada JESSE L. GOODMAN, Professor of Medicine and Infectious Diseases; Director, Center on Medical Product Access, Safety, and Stewardship, Georgetown University EVA HARRIS, Professor, Division of Infectious Diseases and Vaccinology, University of California, Berkeley CAROLINE S. HARWOOD, Gerald and Lyn Grinstein Professor of Microbiology, University of Washington ELIZABETH D. HERMSEN, Head, Global Antimicrobial Stewardship, Merck & Co., Inc. RIMA F. KHABBAZ, Deputy Director for Infectious Diseases; Director of Office of Infectious Diseases, U.S. Centers for Disease Control and Prevention MICHAEL MAIR, Acting Director, Office of Counterterrorism and Emerging Threats, U.S. Food and Drug Administration 1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution. vii PREPUBLICATION COPY—Uncorrected Proofs

JONNA A. K. MAZET, Professor of Epidemiology and Disease Ecology; Executive Director, One Health Institute, School of Veterinary Medicine, University of California, Davis SALLY A. MILLER, Professor of Plant Pathology and State Extension Specialist for Vegetable Pathology, Ohio Agricultural Research and Development Center, The Ohio State University SUERIE MOON, Director of Research, Global Health Centre, The Graduate Institute of International and Development Studies, Geneva DAVID NABARRO, Advisor, Health and Sustainability, 4SD—Skills, Systems, and Synergies for Sustainable Development RAFAEL OBREGON, Chief of Communications for Development, United Nations Children’s Fund KUMANAN RASANATHAN, Board Member, Health Systems Global GARY A. ROSELLE, Chief of Medical Service, Veterans Affairs Medical Center; Director, National Infectious Disease Services, Veterans Health Administration PETER A. SANDS, Executive Director, The Global Fund to Fight AIDS, Tuberculosis and Malaria THOMAS W. SCOTT, Distinguished Professor, Department of Entomology and Nematology, University of California, Davis JAY P. SIEGEL, Retired Chief Biotechnology Officer, Head of Scientific Strategy and Policy, Formerly Johnson & Johnson PAIGE E. WATERMAN, Lieutenant Colonel, U.S. Army; Director, Translational Medicine Branch, Walter Reed Army Institute of Research MATTHEW ZAHN, Medical Director, Division of Epidemiology and Assessment, Orange County Health Care Agency National Academies of Sciences, Engineering, and Medicine Staff CECILIA MUNDACA SHAH, Director, Forum on Microbial Threats, Board on Global Health V. AYANO OGAWA, Program Officer, Board on Global Health T. ANH TRAN, Research Assistant, Board on Global Health (until March 2019) NATALIE LUBIN, Research Assistant, Board on Global Health (from March 2019) JULIE PAVLIN, Director, Board on Global Health viii PREPUBLICATION COPY—Uncorrected Proofs

Reviewers T his Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: KEIJI FUKUDA, The University of Hong Kong School of Public Health SUZET MCKINNEY, Illinois Medical District DAVID NABARRO, 4SD—Skills, Systems, and Synergies for Sustainable Development Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by DAVID R. CHALLONER, University of Florida. He responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies. ix PREPUBLICATION COPY—Uncorrected Proofs

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Acknowledgments T he Forum on Microbial Threats staff and planning committee of the workshop deeply appreciate the many valuable contributions from individuals who assisted us with this project. Thank you to Nancy Cox, Lawrence Gostin, Gabriel Leung, and David Relman for their input during the planning of the pre-workshop event, as well as Elvis Garcia and Liana Rosenkrantz Woskie for authoring the commissioned paper. The pre- workshop, workshop, and this proceedings would not be possible without the presenters and discussants, who gave so generously of their time and expertise. A full list of the speakers and moderators from both events and their biographical information may be found in Appendix E. xi PREPUBLICATION COPY—Uncorrected Proofs

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Contents ACRONYMS AND ABBREVIATIONS xix 1 INTRODUCTION 1 Workshop Objectives, 2 Organization of the Proceedings of a Workshop, 4 2 IS THE WORLD READY TO RESPOND TO THE NEXT INFLUENZA PANDEMIC? 7 Opening Remarks, 7 Historical Influenza Pandemics, An In-Depth Examination of the 1918 Influenza Pandemic, 10 2009 H1N1 Influenza Pandemic, 15 Potential Impacts of a Modern Pandemic, 17 Discussion, 20 3 GLOBAL PROGRESS TO PREPARE FOR THE NEXT INFLUENZA PANDEMIC 23 Scientific Advances in Countering Pandemic Influenza, 23 Progress Toward a Universal Influenza Vaccine, 26 Global Governance to Bolster Pandemic Preparedness, 31 A One Health Approach for Preparedness, 34 Discussion, 38 xiii PREPUBLICATION COPY—Uncorrected Proofs

xiv CONTENTS 4 REFLECTIONS ON A CENTURY OF INFECTIOUS DISEASE OUTBREAKS AND PANDEMICS 43 Impact of Outbreaks and Pandemics on People, Communities, and Economies, 43 A Century of Evolving Pandemic and Emerging Infectious Diseases Challenges, 52 Discussion, 59 5 BUILDING LOCAL AND NATIONAL CAPACITIES FOR OUTBREAK PREPAREDNESS 61 Lessons from the Middle East Respiratory Syndrome Outbreak in Saudi Arabia, 62 Lessons from the Ebola Virus Disease Epidemic in Liberia, 63 Lessons from the Severe Acute Respiratory Syndrome Outbreak in Hong Kong, 65 Lessons from Working in the Frontlines with Local Communities and International Organizations, 68 Discussion, 69 6 A SPECTRUM OF CONSIDERATIONS FOR PANDEMIC VACCINES 75 Global Coordination in Vaccine Development: A Snapshot of the Global Influenza Surveillance and Response System, 75 Regulatory Pathways, 76 Manufacturing Capacity and Production, 80 Timing and Deployment of Vaccines, 81 World Health Organization’s Role and Legal Considerations in Vaccine Response, 82 Discussion, 85 7 THE DEVELOPMENT OF THE PIP FRAMEWORK: GLOBAL LESSONS ON EQUITY AND FAIRNESS FOR PANDEMIC PREPAREDNESS 91 Context for the Development of the PIP Framework: Perspective from Indonesia, 92 Context for the Development of the PIP Framework: Perspective from the United States, 93 Process of Developing the PIP Framework, 94 Potential Challenges and Opportunities for the PIP Framework, 94 Discussion, 97 PREPUBLICATION COPY—Uncorrected Proofs

CONTENTS xv 8 OVERCOMING IMPEDIMENTS TO ACHIEVING GREATER PREPAREDNESS 101 Institutionalizing Preparedness, 102 U.S. Leadership in Advancing Global Preparedness, 103 Making the Case for Local Preparedness, 105 Broadening the Concept of Health Security, 106 Discussion, 108 Small-Group Discussions: Potential Strategies to Systematize and Integrate Preparedness, 116 9 VISIONS ON POTENTIAL PRIORITIES AND ACTIONS FOR PREPAREDNESS BY 2030 121 Bolstering Public Understanding and the Organizational, Resource, and Technological Commitments for Preparedness, 122 Political Prioritization and Strategies for Preparedness, 123 Building Preparedness Capacities on Day-to-Day Systems, 127 Improving Local, National, Regional, and Global Capacities for Preparedness: A Perspective from the Pan American Health Organization, 127 Discussion, 130 Closing Remarks, 134 REFERENCES 137 APPENDIXES A COMMISSIONED PAPER 149 B WORKSHOP STATEMENT OF TASK 183 C PRE-WORKSHOP AGENDA 185 D WORKSHOP AGENDA 187 E BIOGRAPHICAL SKETCHES OF PRE-WORKSHOP AND WORKSHOP SPEAKERS AND MODERATORS 191 PREPUBLICATION COPY—Uncorrected Proofs

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Boxes, Figures, and Table BOXES 3-1 Influenza Vaccinology: Some Persistent Needs and Challenges, 27 3-2 Development of a One Health Approach for H5N1 in Hong Kong, 35 4-1 The U.S. National Biodefense Strategy (2018), 44 4-2 Potential Areas for Greatest Impact on Building Readiness Against Infectious Disease Threats in the 21st Century, 50 5-1 Risk of Influenza Transmission in Mass Gatherings, 64 7-1 Some Challenges and Concerns about the Pandemic Influenza Preparedness (PIP) Framework, 96 8-1 U.S. Leadership in Global Efforts to Combat Antimicrobial Resistance, 104 8-2 Potential Priorities for Ending the Cycle of Panic and Neglect, 117 FIGURES 2-1 Global distribution of deaths associated with the first year of 2009 pandemic H1N1, 17 xvii PREPUBLICATION COPY—Uncorrected Proofs

xviii BOXES, FIGURES, AND TABLE 3-1 Adjusted influenza vaccine effectiveness estimates in the United States, 27 3-2 Iterative pathway to a universal influenza vaccine, 30 3-3 Increasing number of human cases of novel influenza A infections, 1959–2017, 36 4-1 Pandemic vaccine response targets, 45 4-2 Combined interventions suppress the epidemic curve, 50 4-3 Pneumonia and influenza mortality in influenza pandemics, 54 4-4 Proposed phases of epidemic and pandemic alert and response developed in 2008, 57 5-1 Progressive introduction of market-based interventions in Hong Kong to help reduce influenza transmission, 67 6-1 Global monthly vaccine deliveries made through the World Health Organization Deployment Initiative, 2009–2010, 83 9-1 Status of core capacities by sub-region in the Americas, 128 TABLE 2-1 Historical Influenza Pandemics, 1173–1889, 8 PREPUBLICATION COPY—Uncorrected Proofs

Abbreviations and Acronyms AAAS American Association for the Advancement of Science APHA American Public Health Association ASPR Assistant Secretary for Preparedness and Response BARDA Biomedical Advanced Research and Development Authority CBER Center for Biologics Evaluation and Research CDC U.S. Centers for Disease Control and Prevention CEPI Coalition for Epidemic Preparedness Innovations CoV coronavirus CVV candidate vaccine virus FAO Food and Agriculture Organization of the United Nations FBI U.S. Federal Bureau of Investigation FEMA U.S. Federal Emergency Management Agency GDP gross domestic product GHSA Global Health Security Agenda GISN Global Influenza Surveillance Network GISRS Global Influenza Surveillance and Response System GLASS Global Antimicrobial Surveillance System GOARN Global Outbreak Alert and Response Network GPMB Global Pandemic Monitoring Board xix PREPUBLICATION COPY—Uncorrected Proofs

xx ACRONYMS AND ABBREVIATIONS HA hemagglutinin HHS U.S. Department of Health and Human Services IHR International Health Regulations IPAPI International Partnership for Avian and Pandemic Influenza IRAT Influenza Risk Assessment Tool IVPP influenza viruses with pandemic potential JEE Joint External Evaluation MERS Middle East respiratory syndrome NA neuraminidase NIAID National Institute of Allergy and Infectious Diseases NPI non-pharmaceutical intervention NVPO National Vaccine Reporting Office OIE World Organisation for Animal Health PAHO Pan American Health Organization PIP Pandemic Influenza Preparedness SARS severe acute respiratory syndrome SDG Sustainable Development Goal UN United Nations USDA U.S. Department of Agriculture WHO World Health Organization PREPUBLICATION COPY—Uncorrected Proofs

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In November 2018, an ad hoc planning committee at the National Academies of Sciences, Engineering, and Medicine planned two sister workshops held in Washington, DC, to examine the lessons from influenza pandemics and other major outbreaks, understand the extent to which the lessons have been learned, and discuss how they could be applied further to ensure that countries are sufficiently ready for future pandemics. This publication summarizes the presentations and discussions from both workshops.

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