Comments of

Governor Michael O. Leavitt

Secretary, U.S. Department of Health and Human Services (2005-2009)

Administrator, U.S. Environmental Protection Agency (2003-2005)

Governor, State of Utah (1993-2003)

Pandemics are hard to talk about. When we discuss them in advance, we sound alarmist. After a pandemic hits, no matter how much preparation has been made, it will feel inadequate. This is a time to calmly proceed with preparation, informing but not inflaming.

Over the past three years, massive progress has been made in preparing our nation.  Though we are much better prepared today than in the spring of 2005 when the H5N1 avian influenza virus emerged, significant tasks remain.

In 2005, two things happened that made it clear we needed to do more as a country than talk about the possibility of a pandemic; we needed to start preparing for it. First, the re-emergence of the deadly H5N1 avian influenza strain focused my attention. The virus had appeared briefly in Hong Kong a few years earlier, but because of aggressive containment action, the world hoped it had disappeared. When it subsequently began to spread rapidly through bird populations and occasionally to people, scientists became very concerned. The virus had similar genetic properties and clinical manifestation to the virus which caused the catastrophic 1918 pandemic.

The second event was Hurricane Katrina, which I think of as a shakedown of our national response plan. It revealed our weaknesses. I vividly recall walking through medical shelters along the gulf peninsula thinking, “As devastating as this is, a severe pandemic would be far worse because it would be happening simultaneously in all states, and might endure for more than a year.”

We have come a long way since November 2005, when President Bush mobilized the nation to prepare for an influenza pandemic. He called for the deployment of a $7.1 billion national pandemic plan. Congress responded quickly. As Secretary of HHS, I was given responsibility to implement the plan.

Ultimately, the key to preparing for a pandemic is to develop, stockpile, and prepare to distribute vaccines and antiviral medicines.  We need vaccines to prevent people from becoming infected by a virus, and antivirals to treat them if they become infected. Plans, protocols and agreements must be in place among and between governments at every level.  Analysis shows that the current level of preparedness varies among states and local communities. 

Despite the criticality of federal efforts, the foundation of pandemic readiness is local preparedness. In addition to state governors, leadership must come from mayors, county commissioners, school principals, church pastors, college presidents, corporate planners, and the entire medical community.  Even families have a role to play in making preparations. 

Any community that fails to prepare for pandemic disease because it expects that the federal government can come to the rescue will be tragically disappointed—not because the federal government lacks the will or the wallet, but because there is no way for the federal government, or even a state government to respond everywhere at the same time.

Whenever a pandemic virus emerges the development of a vaccine is a priority.  Because each virus is unique, a specific vaccine must be developed to provide protection.  Development and testing will take up to of five months. 

Once a vaccine has been developed and proven safe, production can begin.  It was clear to us in 2005 and 2006 that U.S. vaccine production capability was lacking because most of the vaccine makers had gone out of business.  We invested over $1Billion of HHS funding supporting the rebuilding of capacity.  Six companies are now in various states of implementing commercial-scale production of vaccine using a new, more efficient cell-based technique.  Others are expanding manufacturing capacity using traditional egg-based methods.  We will reach our goal of having the needed capacity to produce 300 courses of a vaccine in six months. 

If this swine flu virus emerges as a pandemic level event, it will be five months before a safe vaccine is ready.  Even then, our nation’s neglect of vaccine capacity for the previous two decades means there will be inadequate vaccine supply.

Anticipating these gaps, we began to aggressively stockpile antivirals like Tamiflu and Relenza.  The federal government has stockpiled 50 million courses itself and partnered with state governments to buy an additional 22 million.  The stockpiles being released this week are part of that effort.

To make sure that states knew the importance of this effort, we conducted a pandemic influenza summit in each of the 50 states and every one of the U.S. Territories.  I personally attended about three-quarters of the state summits.  These summits brought together health care professionals, schools, and the private sector to advance state and community preparedness. 

We purchased more the 150 million masks and respirators and have obligated $100 million for the purchase of ventilators, syringes and intravenous antibiotics for potential distribution in case of an influenza pandemic.  The federal government has also developed highly sensitive rapid–diagnostic tests for influenza. 

The United States supported pandemic influenza preparedness activities in approximately 40 countries, including Mexico.  The fact that Mexico has responded so rapidly is in part a result of our joint efforts to prepare. 

The protocols of emergency procedure that are being activated by HHS are a product of three years of work, practice and refinement.  However, our preparation is not complete.  If the H1N1 swine flu emerges as a pandemic, public health officials will need to concentrate on implementing traditional public health measures such as social distancing.  This will include measures such as school closings and the cancelling of public events. Some schools and universities are better prepared for this than others.

Businesses, governments and other organizations that do not have a pandemic plan should begin immediately to think through how they can continue functioning if a high number of employees cannot attend work because of sickness in their families.  Many states and local governments have not created adequate plans for antiviral distribution.  Starting now should be given priority. 

I do not know if the H1N1 swine flu will be the spark of the next pandemic.  Early indications have appropriately caused public health leaders around the world to react aggressively.  If this turns out to be a false alarm, we will all be glad.  At the very least it must be a reminder that pandemics happen.  Louis Pasteur taught that, “In the field of observation, chance favors only the prepared mind.”  Because pandemic disease is inevitable, our country must not lose momentum in our never-ending task of preparation.