== Biosecurity Commons Review May 2010 Outline Excerpt on Swine Flu ==

””’Link to Full Report””’ [http://www.scribd.com/doc/30902475/Bio-Security-Commons-AR-May-2010]

””’Chapter 1 The Swine Flu Scare of 2009””’
”Brian J. Gorman”

””’1. Introduction””’.
” The outbreak of the H1N1 influenza virus, otherwise known as swine flu, was clearly one of the biggest events of concern to stakeholders in biosecurity over the last year.  It is believed that swine flu originated in March of 2009  and reached as many as 168 countries with infections of more than a million people by September 2009.   The swine flu was not as virulent as initially predicted, but the response to it exercised some of the capabilities of national and international public health systems.  As a result, a number of lessons were learned from the experience.  In particular, a number of systemic shortcomings that need further examination came to light.  Chief among them were vaccine supply management, global harmonization of public health policies, international communications, and intersectoral cooperation –in addition to the public’s response to the public health crisis.”

””’2. Pharmaceuticals and Pandemic””’.
”On one hand, the prospect of a devastating pandemic revealed some achievements between and amongst businesses, nation states, and NGOs.  On the other, however, it revealed some tensions”’…””’

*””’A. Supply, Demand, & Market Failure”’. Vaccine supply arose as the premier issue as dire forecasts predicted that the swine flu could progress into a pandemic of historic proportion.  The flu scare of 2009 demonstrated the dramatic shift in supply and demand from a perilous shortage to a sudden excess of supply”’…””’

*””’B. Breach of Contract –A Dangerous Practice”’.  The global vaccine marketplace is not only influenced by the gentle hand of market support, but also the sharp bite of retaliation for breach of contract”’…””’

*””’C. Public Policy & Dosing Strategies”’.  A number of issues arose in relation to U.S. vaccination strategy.  Controversial decisions abound when designing a national vaccination strategy in response to a potential pandemic.  Key among them this past season was the decision to go with 2 doses as opposed to 1 dose, whether to target the young or elderly first, and how to handle social equity issues at national and international levels.”

**””’1. National vs. International Dosing Goals”’.  The U.S. disregarded the World Health Organization’s (W.H.O.) dosing recommendation for H1N1”’…””’

””’3.  Prioritizing Immunity””’.
”Richard Zimmerman predicted in 2007 that the next threat of pandemic would require ethical policy choices of an egalitarian or utilitarian nature, but concluded that the “W” shaped mortality pattern affecting young adults during the 1918 pandemic should be taken into consideration for subsequent pandemics”’…””’

””’4.  International Communications””’.
””’…”’The lesson being that the best of allies can turn to counter-productive finger pointing when faced with an international public health emergency”.

””’5. Vaccination Participation””’.
”Scrutiny of public authorities and private entities providing products and services to fight pandemic are essential, but evaluating public response to a public health emergency is no less important”’…””’

*””’A. Mandatory Vaccinations”’.  Mandatory vaccination programs requiring flu vaccinations for health care workers have proven controversial and have had mixed results””’…”’

*””’B. Public Participation in Vaccination Programs”’  Anecdotal evidence points to the public’s perception of the risk of an infection as a strong predictor of public compliance with vaccination programs”’…””’

””’Link to Full Report””’ [http://www.scribd.com/doc/30902475/Bio-Security-Commons-AR-May-2010]

== ”Status Brief” ==
There have been several flu pandemics that have affected the United States. The first and the worst pandemic is the Spanish Flu of 1918, the Asian Flu in 1957, and the Hong-Kong Flu in 1968 (Blakely, Debra). The Spanish Flu claimed 20 to 50 million lives worldwide, and killed 550,000 in the US (Tumpey, Terrence et.al). In a short time the flu of 1918 killed more people than any other illness recorded in world history (The Associated Press). This flu infected not just lung cells, but many different cells causing this flu to be unique (Kaiser, Jocelyn).
”’Developmental Milestones/Developments to Date:”’
”’Current Assessment/State of the Field:”’

== Event: Thursday, October 1 at 8:00 a.m. Pacific; 11:00 a.m. Eastern==
Complimentary webinar sponsored by Echo360 and hosted by The Chronicle of Higher Education on preparing for a potential outbreak of swine flu.
The 1 hour webinar will offer perspectives from Australia’s Curtin University experiences with swine flu.

*Speakers:•Martin Hill, iLecture Systems Manager, Curtin University •Mike Fardon, Vice President, Echo360

*Topics will include:
* How swine flu impacted Curtin’s operations, including the temporary closing of one department during the academic year
* How instructors can utilize the institution’s library of 40,000 lecture recordings to keep students up-to-date with learning activities during emergencies
* How Curtin’s instructors and students use personal capture to stay connected from satellite campuses located in Singapore, Malaysia, and Hong Kong
* How continuity planning fits into Curtin’s comprehensive strategy for campus-wide lecture capture

*Follow the link to register [https://event.on24.com/eventRegistration/EventLobbyServlet?target=registration.jsp&eventid=162533&sessionid=1&key=74BB1F25DF951C6D4775BBB5750C4244&sourcepage=register]

== Web Resources ==
”’Centers for Disease Control and Prevention”’
*”Each week [[CDC]] analyzes information about influenza disease activity in the United States and publishes findings of key flu indicators in a report called FluView. During the week of August 30-September 5, 2009, a review of the key indicators found that influenza activity increased in the United States compared to the prior weeks.” [http://www.cdc.gov/h1n1flu/]
*A review is provided by the [[CDC]] concerning the biosafety and biosecurity issues about the 1918 Flu research.[http://www.cdc.gov/Flu/about/qa/1918flupandemic.htm]
”’Department of Defense Influenza [[Pandemic]] Preparation and Response Health Policy Guidance”’ [https://www.hsdl.org/homesec/docs/dod/nps10-051206-02.pdf&code=c054ad93b825cdd6be1d2e2019a11faf]
* [[Homeland Security]]
”’Health & Human Services Pandemic Influenza Plan Supp 4”’ [http://www.hhs.gov/pandemicflu/plan/sup4.html]
”’Department of Health and Human Servies”’, “Local [[Pandemic]] Influenza Preparedness: Vaccine and Antiviral Drug Distribution and Dispensing”, September, 2009.[https://www.hsdl.org/homesec/docs/oig/nps36-092109-02.pdf&code=9eab8e33f5e3cb46bec3f2325982fba2]

*In a 2008 review of State pandemic influenza operating plans the Assistant Secretary for Preparedness and Response (ASPR) stated that states were “doing well” with [[vaccination]] plans.
*The Department of Health and Human Services (HHS) provided states with guidelines for planning vaccine distributions
*The 8 planning areas outlined are: Receiving & Staging, Dispensing, Tracking, Vulnerable Populations, Priority Groups, Security, Storage, and Transportation.
*”Selected localities had not addressed in their planning documents most of the vaccine and antiviral drug distribution and dispensing components and preparedness items identified in HHS pandemic influenza guidance.”
*”All selected localities conducted exercises related to vaccine and antiviral drug distribution and dispensing; however most did not create After Action Reports and Improvement Plans for these exercises.”
*”All selected localities collaborated with community partners to develop and exercise their plans to distribute and dispense vaccines and antiviral drugs during an influenza pandemic.”
*The HHS provided several recommendations in this article.
*[[Homeland Security]]

== 2003 ==
”’Blakely, Debra”’, “Social Construction of Three Influenza Pandemics in The New York Times”, Journalism & Mass Communication Quartery, Vol. 80, No. 4, 2003, pg. 884-902.
* “This study looked at three influenza pandemics and examined the social construction of influenza over time.”
* “Using 835 New York Times articles, the study demonstrated that the social construction of influenza did change over time and that these changes were reflected in public-health policy frames.”
* “This research demonstrates how the popularization of science changed the social construction of disease in America.”
* [[Pandemic]]
== 2004 ==
”’MacKenzie, Debora”’, “Experts Fear Escape of 1918 Flu from Lab ,” New Scientist, October 21, 2004.[http://www.newscientist.com/article/dn6554-experts-fear-escape-of-1918-flu-from-lab.html]

*”‘The potential implications of an infected lab worker – and spread beyond the lab – are terrifying,’ says D. A. Henderson of the University of Pittsburgh, a leading biosecurity expert.”
*”‘All the virologists I have spoken to have concerns,” says Ingegerd Kallings of the Swedish Institute for Infectious Disease Control in Stockholm, who helped set laboratory safety standards for the World Health Organization.'”
*”Kallings and others are calling for international discussions to resolve the issues related to such work. ‘It is time for influenza scientists to find a consensus on containment,’ she says. John MacKenzie of the University of Queensland in Australia, who investigated how the SARS virus escaped from high-level containment labs in east Asia on three occasions after lab workers became infected, agrees. ‘A meeting would be beneficial.'”
*”The team started the work at the highest level of containment, BSL-4, at Canada’s National Microbiology Laboratory in Winnipeg. Then they decided the viruses were safe enough to handle at the next level down, and did the rest of the work across the border in a BSL-3Ag lab in Madison.”
*”The main difference between BSL-4 and BSL-3Ag is that precautions to ensure staff do not get infected are less stringent: while BSL-4 involves wearing fully enclosed body suits, those working at BSL-3Ag labs typically have half-suits.”
*”Kawaoka told New Scientist that the decision to move down to BSL-3Ag was taken only after experiments at BSL-4 showed that giving mice the antiviral drug oseltamivir (Tamiflu) in advance prevented them getting sick. This means, he says, that if all lab workers take oseltamivir ‘they cannot become infected’.”
*”Terrence Tumpey’s team at the US Department of Agriculture’s poultry research lab in Athens, Georgia, got quite different results: they found that mice given oseltamivir still got sick and 1 in 10 died. It is not clear why Kawaoka’s mice fared better.”
*”Yet Kawaoka’s decision does comply with the US National Institutes of Health guidelines for BSL-3 agents: those causing ‘serious or lethal human disease for which preventive or therapeutic interventions may be [its italics] available.'”
*”By contrast, the team in Georgia, the first to experiment with genetically engineered 1918 viruses, did all its work at BSL-3Ag. Meanwhile, Michael Katze at the University of Washington at Seattle is planning to expose monkeys to aerosols of 1918-type viruses at BSL-3, a step down from BSL-3Ag. The recent SARS escapes were from BSL-3 labs.”
*”‘We would have to do any such work at BSL-4,’ says John Wood of the UK’s National Institute for Biological Standards and Control. In the US, the differing standards applied by different groups are due to the fact that experiments on engineered viruses such as the 1918 flu are approved on a case-by-case basis by Institutional Biosafety Committees (IBCs), composed of local scientists and officials. Critics say these are free to interpret the official guidelines in a way that suits them.”
*”‘There is no effective national system to ensure consistency, responsibility and good judgement in such research,’ says Edward Hammond of the Sunshine Project, a biosecurity pressure group in Austin, Texas. In a review of IBCs published this month, he found that many would not provide minutes of recent meetings as required by law.”
*”He [Hammond] says the IBC that approved the planned 1918 flu study at the University of Washington considered only one scenario that could result in workers being exposed to airborne virus – the dropping of samples. Its solution: lab workers ‘will be trained to stop breathing’.’
*[[Lab Safety]], [[Flu]], [[Canada]], [[U.K.]], [[WHO]], [[SARS]], [[Asia]], [[Academia]]

== 2005 ==
”’Altman, Lawrence, K., Santora, Marc”’, “Risk From Deadly Flu Strain Is Called Low,” NYT, April 14, 2005.
*Lab mistake contaminated specimen with dangerous 1957 strain. [[Lab Safety]]
*Mistake in sending out H2N2, Level 2 microbe subject to upgrade.

*”Al-Qa’ida documents recovered from a training camp in Afghanistan show interest in a variety of biological agents and mentioned [[plague]], [[anthrax]], [[cholera]] and [[tularemia]].”
*”To determine threat, we examine an actor’s capability and intent. We assess capability based on factors such as the actor’s level of skill or knowledge, their ability to acquire a biological agent, the materials necessary to grow the agent and their capacity to effectively disseminate a biological agent. For intent, in addition to the actor’s desire to simply use biological weapons, we discern which agents they are more likely to pursue, their preferred method of deployment and which targets they intend to attack.”
*”Last month one of our analysts provided some of the Committee members with a classified briefing on the specifics of the current bioterrorist threat to the Homeland.  I will not be able to revisit this classified threat assessment in this open forum but we would be happy to provide this information to additional members in a closed session.”
*”On occasion, we require quick access to information that does not reside within IA. In these cases, our analysts are supported to the Biodefense Knowledge Center (BKC)—a 24×7 support cell based at Lawrence Livermore National Laboratory and sponsored by the S&T Directorate. The BKC possesses vast repositories of biological technical information and is able to access SMEs from around the country, such as the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), the U.S. Army Medical Research Institute for Chemical Defense (USAMRICD), and the Armed Forces Medical Intelligence Center (AFMIC), in support of a tasking from IA. The BKC compiles the appropriate information and relays it to our analysts who integrate the information into their finished intelligence analysis.”
*”Our analysts regularly collaborate with other intelligence agencies, particularly NCTC, DIA, FBI, and CIA.  We also work with experts from government, academic, and private institutions and partner with scientists who keep us abreast of their potential areas of concern and the trends they see.  Interaction with outside public and private sector institutions keeps us well-informed of new and emerging technology that may be exploited or misused by malicious actors.  For example, IA recently hosted a workshop on emerging biotechnologies and the future biological threat.  This provided a forum for non-governmental experts to provide IA with information of which they believe we should monitor.”
*”Our analysts are broadly focused and access a wide array of information in gathering source material for our assessments. They use all-source intelligence, scientific and technical information, terrorist profiles, historical trends, and open source information such as media reports and scientific journal articles.”
*”We keep current on foreign State biological weapons program developments as these activities may have implications for future terrorist events. We look at the intent of the enemy, their capabilities, potential scenarios, and attack vectors. Working with counterterrorist experts in the Community, we develop link charts on potential associates here in the United States of operatives abroad who may have received training in [[WMD]] capabilities or have knowledge of WMD programs.”
*”we assessed the implications of the H2N2 influenza shipment in which a U.S. contractor sent a highly virulent strain of influenza to hundreds of laboratories worldwide. We also recently published an Information Bulletin advising State and local [[Law Enforcement]] officials of
indicators of covert anthrax production. Generally, our products fall into two categories: threat assessments and feasibility assessments.”
*”Threat Assessments. Threat assessments are written on known actors and are based on specific intelligence. To determine threat, we examine an actor’s capability and intent. We calculate capability based on factors such as a particular actor’s level of skill or knowledge; their ability to acquire a biological agent and the materials necessary to grow the agent; and their capacity to effectively disseminate a biological agent. For intent, we consider more than just an actor’s desire to use biological weapons. We attempt to discern which agents they are more likely to pursue, their preferred method of deployment, and which targets they intend to attack.”
*”Feasibility Assessments. Intelligence is never complete or all-knowing and we cannot wait until intelligence is received in order to consider plausible scenarios or the impact of a particular technique or technology on a bioterrorist’s capability. To move beyond this limitation, IA, in partnership with S&T, conducts assessments of biological processes, emerging technologies, and techniques and determines their feasibility for use in a bioterrorism event.  These assessments include indicators that will help to identify if a particular scenario begins to unfold so we can prevent or disrupt events before they occur. In conjunction with the feasibility assessment, we are producing unclassified excerpts with the indicators which are distributed widely to local, State, Federal officials as well as the private sector to enhance awareness in the field and to increase suspicious activity reporting and trigger investigations where necessary.”
*”IA also has produced several bioterrorism-specific ‘‘red team’’ products, which explore issues from a terrorist’s perspective using nongovernmental experts and creative thinkers. These topics have included terrorist use of genetically modified food and recombinant DNA technologies to damage the U.S. food supply; possible terrorist exploitation of a U.S. flu vaccine shortage; and the safety and security impacts of a pandemic influenza outbreak.”
*”Under the BioShield legislation, DHS is charged with assessing current and emerging threats of chemical, biological, radiological, and nuclear agents; and determining which of such agents present a material threat against the United States population. S&T, supported by IA, has been conducting Material Threat Assessments (MTAs) and Material Threat Determinations (MTDs) in order to guide near term BioShield requirements and acquisitions.”
“MTAs … are speculative and represent a best estimate of how an adversary may create a high-consequence event using the agent/weapon in question. Currently, MTAs are drafted by the S&T and IA provides comments on the assessment before it is provided to HHS. In our review, we ensure that the assessment reflects what IA assesses is the general capability of terrorist groups that are pursuing biological weapons.”
*”MTAs result in an estimate of the number of exposed individuals, the geographical extent of the exposure, and other collateral effects. If these consequences are of such a magnitude to be of significant concern to our national security, the Secretary of DHS then issues a formal Material Threat Determination to the Secretary of HHS, which initiates the BioShield process. To date, one MTA has been completed for anthrax and MTAs for plague, botulinum toxin, tularemia, radiological devices and chemical nerve agents are underway and an MTA for viral hemorrhagic fevers will be initiated next month. MTDs have been approved for four agents: smallpox, anthrax, botulinum toxin, and radiological/nuclear devices.”
*”IA, in cooperation with NCTC and the FBI, is providing WMD outreach briefings around the country. These briefings outline the terrorist WMD threat, including descriptions of the types of weapons used and indicators and warnings aimed at increase awareness and reporting. In the near future, we hope to expand these briefings to other audiences such as academia and the private sector to further increase awareness and reporting.”
*”IA will be playing a key role in supplying current intelligence to the National [[Biosurveillance]] Integration System (NBIS) operations center once it begins operation later this summer. NBIS will fuse information on human, plant, and animal health with environmental monitoring of air, food, and water systems. This information will be integrated with threat and intelligence information to provide real-time situational awareness and identify anomalies or trends of concern to the Homeland Security Operations Center.”
*[[Bioshield]], [[Al-Qaida]], [[Information Policy]], [[Academia]], [[Lab Safety]], [[Flu]], [[Vaccination]]

”’Kaiser, Jocelyn”’, “Resurrecting the “Spanish Flu”,” Sciencemag.org, October 5, 2005.
*”A closer examination of the virus revealed some other surprises. It can apparently infect many kinds of cells beside lung cells because it doesn’t rely on an enzyme that is only present inn specific cell types.”
”’Sample, Ian”’, “From frozen Alaska to the lab: a virus 39,000 times more virulent than flu,” Guardian Unlimited, October 6, 2005.
*”…many scientists were alarmed at the recreation itself and particularly that the full genetic sequence was to be made public on an online genetic database.”
”’Stobbe, Mike”’, “Researchers Reconstruct 1918 Flu Virus,” The Seattle Times. The Associated Press, October 5, 2005.
*”The reason the scientists believe their reconstructed virus poses no public health threat is that based on previous research, modern-day medicines are effective against the 1918 flu. And they think most people today are already at least partially immune.”
”’Taubenberger, Jeffery K., et. al.”’, “Characterization of the 1918 influenza virus polymerase genes,” Nature Publishing Group, vol. 437. October 6, 2005, pg. 889-893.
*”Unlike the 1957 and 1968 pandemics, however, the 1918 virus was mostly not a human/ avian reassortant virus, but rather an avian-like virus that adapted to humans ”in toto”.”
*[[1918 Flu]], [[Flu]], [[Pandemic]]
* ”Note: This article has been cited 246 times as of October 5, 2009 as recorded by the Web of Science”.
”’Tumpey, Terrence M., et. al.”’, “Characterization of the Reconstructed 1918 Spanish Influenza Pandemic virus,” Sciencemag.org, vol. 310. October 7, 2005. pg. 77-80
*”The pandemic influenza virus of 1918-1919 killed an estimated 20 to 50 million people worldwide.”
*”The pandemic’s most striking feature was the unusually high death rate among healthy adults ages 15 to 34 years, which consequently lowered the average life expectancy in the United States by more than 10 years. A similarly high death rate has not occurred in this age group in either prior or subsequent influenza A pandemics or epidemics.”
*”Because the emergence of another pandemic virus is considered likely, if not inevitable, characterization of the 1918 virus may enable us to recognize the potential threat posed by new influenza virus strains, and it will shed light on the prophylactic and therapeutic countermeasures that will be needed to control pandemic viruses.”
”’Ricks, Delthia.”’, “Reconstructing a virulent killer,” Newsday. October 6, 2005, A2
*”Traubenberger said both teams’ studies reveal that today’s bird flu and the infection of 87 years ago share many of the same genetic features.”
”’The Associated Press”’, “Researchers reconstruct killer 1918 flu virus,” MSNBC. October 5, 2005.
*”About 10 vials of virus were created, each containing about 10 million infectious virus particles…”
*”In a few months, it killed more people than any other illness in recorded world history – an estimated 20 million to 50 million worldwide, including roughly 550,000 in the United States.”
”’Kolata, Gina.”’, “Experts Unlock Clues To Spread Of 1918 Flu Virus – Path from Bird to Human,” NYT. October 6, 2005, A20
*”It infects cells deep in the lungs of mice and infects lung cells, like the cells lining air sacs, that would normally be impervious to flu. And while other human flu viruses do not kill mice, this one, like today’s bird flus, does.”

== 2006 ==
”’Brundage, John”’, “Cases and Deaths During Influenza Pandemics in the United States”, American Journal of Preventive Medicine, Volume 31, pg. 252-256, 2006.
*Estimates of the nature, magnitude, and impact of the 1918–1919 influenza pandemic inform plans for responding to the next pandemic.
*The“W-shaped” relationship between case fatality rates and age and the sharp peak of deaths among previously healthy young adults are of particular interest.
*In a future pandemic the death rates due to influenza will be different than the 1918 pandemic due to larger proportions of middle-aged and elderly adults.
*This suggests that the pandemic will target adults older than 30 rather than the younger population.
”’Berger, Matthew”’, “DHS To Award Contract To Integrate Government’s Biosurveillance,” CQ Homeland Security, May 11, 2006.
*”The program is expected to provide real-time information of emerging biological threats, both the result of terrorists and natural elements.  Already, the pilot program is being used to give information about the avian influenza.”
*”The program will integrate BioWatch, an environmental monitoring system that is used to test in major American cities.  The next version of the system…will be automated, eliminating the need for laboratories to test samples.”
*”It will also utilize data from BioSense, a national program to collect biological data from health care organizations across the country, and the Electronic Surveillance system for Early Notification of Community-Based Epidemics, or ESSENCE, which gathers data from U.S. military treatment facilities around the world.”
”’Mosquera, Mary”’, “DHS To Develop Biosurveillance System For Pandemic,” Tech News (GCN), May 12, 2006.
*”The Homeland Security Department expects to award a contract in mid-summer to develop the National Biosurveillance Integration System, a critical piece of the administrations strategy yo handle a [[pandemic]], such as the avian [[flu]].”
*”The biosurveillance system will aggregate and integrate information from food, agricultural, [[Public Health]] and environmental monitoring and the intelligence community from federal and state agencies and private sources to provide an early warning system for an outbreak or possible [[bioterrorism]] attack.”
*”The biosurveillance system will also send back to its system partner agencies completed situational awareness in real-time streams.”
*”Information will come from sources such as the Centers for Disease Control and Prevention BioSense system, which reports [[Syndromic Surveillance]] from hospitals and pharmacies, and the BioWatch system, which monitors aerosols for biothreat agents in major metropolitan areas.”
”’Baker, Michael & David Fidler”’, “Global Public Health Surveillance Under New International Health Regulations,” Emerging Infectious Diseases, Vol. 12, No. 7, pgs. 1058-1065, July 2006.
*”IHR (International Health Regulations) 2005 identifies health-related events that each country that agrees to be bound by the regulations must report to WHO.”
*”These events include any unexpected or unusual public health events regardless of its origin or source.”
*”IHR 2005 also requires state parties …to inform WHO of public health risks identified outside their territories that may cause international disease spread, as manifested by exported or imported human cases, vectors that may carry infection or contamination, or contaminated goods.”
*”IHR 2005 defines a ‘public health emergency of international concern’ (PHEIC) as ‘an extraordinary event’ which is determined by the WHO.”
*”IHR 2005 contains a ‘decision instrument’ that helps state parties identify whether a health-related event may constitute a PHEIC and therefore requires formal notification to WHO.”
*”IHR 2005 includes a list of diseases for which a single case may constitute a PHEIC and must be reported to WHO immediately.  This list consists of [[smallpox]], [[polio]]myelitis, human influenza ([[flu]]) caused by new subtypes, and severe acute respiratory syndrome ([[SARS]]).”
*”IHR 2005 also encourages state parties to consult with WHO over events that do not meet the criteria for formal notification but may still be of [[public health]] relevance.”
*”IHR 2005’s surveillance strategy, especially the decision instrument, has been specifically designed to make IHR 2005 directly applicable to emerging infectious disease events, which are usually unexpected and often threaten to spread internationally.”
*”IHR 2005’s purpose is to prevent, protect against, control, and facilitate public health responses to the international spread of disease.”
*”IHR 2005 makes surveillance central to guiding effective public health action against cross-border disease threats.”
*”Surveillance needs to be sufficiently sensitive to detect infectious agents that have not yet resulted in large numbers of diagnosed cases.”
*”One approach to this challenge is [[Syndromic Surveillance]], but such surveillance has not been effective in detecting emerging infectious diseases early.”
”’McKenna, Maryn”’” ANATOMY OF A PANDEMIC: EMERGENCY DEPARTMENTS WOEFULLY UNPREPARED FOR BIRD FLU OUTBREAK,” Annals of Emergency Medicine Volume  48, September 2006.

== 2007 ==

”’Zimmerman, Richard”’, “Rationing of influenza vaccine during a pandemic: Ethical analyses”, Vaccine, 25, 2007, pg. 2019–2026.
* “Rationing of scarce vaccine supplies will likely be required when the next pandemic occurs, raising the questions about how to ration and upon what principles.”
* ” Since influenza pandemics have differing mortality patterns, such as the 1918 pandemic’s “W” shaped curve that effected healthy young adults, the particular pattern should inform rationing.”
* “ethical principles for vaccine rationing can be utilitarianism and egalitarianism.”
* “A framework that uses multiple principles to address influenza vaccine rationing in light of a shortage is recommended.”
*[[Vaccination]], [[Ethics]], [[Pandemic]], [[1918 Flu]], [[Flu]]
”’Vawter, Dorothy, et. al”’., “Allocating pandemic influenza vaccines in Minnesota:Recommendations of the Pandemic Influenza Ethics Work Group,” Vaccine 25, 2007, 6522–6536.
*” A public–private, multidisciplinary work group developed recommendations for rationing vaccines in Minnesota during a worst-case influenza pandemic. The recommendations encompass an ethical framework of principles, goals, and strategies. The primary goal is to maximize Minnesotans’ chances of surviving both the pandemic and the years immediately thereafter and to limit two major causes of death.”
”’McNeil, Jr., Donald, G”’., “U.S., Issues Guidelines on Use of Face Masks in Flu Outbreak,” NYT, May 4, 2007, A20.
* Little scientific data proving masks help/[[CDC]]/feds building mask stockpile/Gerberding/other countries’ plan rely on masks more heavily/option only for sick/sloppy changing of infected masks may increase transmission in certain situations.
”’Capua, Ilaria, Marangon, Stefano”’, “Control and prevention of avian influenza in an evolving scenario,” Vaccine 25 (2007) 5645–5652.
Continuing outbreaks of highly pathogenic avian influenza (HPAI) across Eurasia and in Africa, caused by a type A influenza virus of the H5N1 subtype appear out of control and represent a serious risk for animal and public health worldwide. It is known that biosecurity represents the first line of defence against AI, although in certain circumstances strict hygienic measures appear to be inapplicable for social and economic conditions.  The option of using vaccination against AI viruses of the H5 and H7 subtypes, has made its way in recent times—primarily as a tool to maximise the outcome of a series of control measures in countries that are currently infected, but also as a means of reducing the risk of introduction in areas at high risk of infection
[[Vaccination]]; Control; Poultry, [[Public Health]]

== 2008 ==

”’Garoon, Joshua P., Duggan, Patrick S”’., “Discourses of disease, discourses of disadvantage: A critical analysis of National [[Pandemic]] Influenza Preparedness Plans,” Social Science & Medicine, 67, 2008, 1133–1142.
* “The threat of pandemic influenza to global health has led to increased emphasis on pandemic influenza preparedness planning. Previous analysis of national pandemic preparedness plans has revealed that those plans paid scant attention to the needs and interests of the disadvantaged. This paper investigates those findings via critical discourse analysis of the same plans as well as World Health Organization guidance documents. The analysis reveals that the texts operate within and as parts of an ordered universe of discourse.Unless the plans recognize their discursive construction,implementation of the policies and practices they prescribe runs the risk of further disadvantaging those very populations most likely to require protection.”
* [[Ethics]]
”’McNeill Jr., Donald, G”’., NYT, January 22, 2008, D1 (continued D8) “A Pandemic That Wasn’t but Might Be,” –[[Vaccination]], [[Pandemic]] /preparations/better vaccine/European Center for Disease Prevention and Control, Stockholm/poor countries/faster lab tests/international/recommend vaccinating millions.
”’Mydans, Seth”’, “Indonesian Chickens, and People, hard Hit by Bird Flu,” NYT, A3, Feb. 1 2008.
*Virus infected at least 357 people in 14 countries, killing 224.
”’Grimaldi, Christine”’, “Avian Flu [[Pandemic]] Could Cost United States Billions,” CQ Homeland Security, Jan. 18, 2008.
*Mere seasonal flu kills 36,000 per year, costs $37.5 billion and 111 million work days.
”’Ortu, Giuseppina, Mounier-Jack, Sandra, Coker, Richard”’, “Pandemic influenza preparedness in [[Africa]] is a profound challenge for an already distressed region: analysis of national preparedness plans,” Health Policy and Planning 2008 23(3):161-169. [http://heapol.oxfordjournals.org/cgi/content/full/23/3/161]
*Thirty-five of 53 African countries now have national strategic pandemic influenza preparedness plans.
*Many plans are developmental in nature, and although they place particular emphasis on early detection of animal outbreak and early containment of animal outbreaks, attention to human containment is less developed.
*The health care sector is ill-prepared for pandemic influenza, and contingency planning for essential services is largely absent from plans.
*Operational planning is almost entirely absent from countries’ plans for [[pandemic]] influenza.
”’Oshitani, Hitoshi, Kamigaki, Taro, Suzuki, Akira”’,  “Major Issues and Challenges of Influenza [[Pandemic]] Preparedness in [[Developing Countries]].” Emerg Infect Dis. 2008 June; 14(6): 875–880. [http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=18507896]
*”Deaths attributable to an influenza pandemic could be substantially higher in developing countries than in industrialized countries. Pharmaceutical interventions such as vaccines and antiviral agents are less likely to be available in developing countries.”
*” The most critical limiting factor for stockpiling of neuraminidase inhibitors in developing countries is their high cost. One treatment course of oseltamivir (i.e., 10 tablets) costs US $15, even at a discount rate (16), which is far too expensive for developing countries. Some industrialized countries have set a target to stockpile oseltamivir to treat 25% of the general population. To purchase adequate oseltamivir for 25% of the total population, only 0.11% of the total annual health expenditure is required in high-income countries. In low-income countries, however, the expense would be 12.9% of the annual expenditure (Table 1). Therefore, it is not feasible for low-income countries to allocate scarce resources to stockpile sufficient quantities of oseltamivir for an unpredictable influenza pandemic.” [[Vaccination]]
”’Hsu, Spencer”’, “Modest Gains Against Ever-Present Bioterrorism Threat; An Attack Could Be Hard To Predict With Current Tools,” The Washington Post, A Section, Pg. A10, Aug 3, 2008.
*”The result: modest gains, at best, toward preventing another attack similar to the one in 2001, in which [[anthrax]] bacteria killed five people and sickened 17.”
*”‘The potential for something to happen is much greater now than it was in 2001, simply because of developments of technology and education.'”
*”The government has not developed a general-use anthrax vaccine.  A new generation of sensors that would sniff out threats more quickly has been delayed.  A coordinated plan to respond to a widespread outbreak still doesn’t exist.  And the rapid increase in the number of researchers registered to work with biological agents, now 15,000 people, has come without enough oversight.”
*”A significant bright spot…is the dramatic improvement in government preparations to respond to threats such as [[smallpox]], botulism ([[botulinum]]), [[plague]] and other biological agents.”
*”The Strategic National Stockpile, a emergency cache of critical pharmaceuticals that can be sent within 12 hours to counter outbreaks, has been greatly expanded.”
*”The stockpile…has 60 million treatment courses of antibiotics for anthrax and pneumonic plague.  About 300 million doses of smallpox vaccine can also be shipped.”
*”Officials say that the government is retooling efforts to encourage drug companies to invest in BioShield projects. and that the effort is paying off in new antitoxins for anthrax and botulism.”
*”All 50 states now can receive urgent disease reports around-the-clock and conduct year-round surveillance for diseases such as in[[flu]]enza.”
*”But the nation still lacks plans and an organized structure to respond to a massive disease outbreak with thousands of victims.”
== 2009: ”Newspapers/Magazines” ==
”’Brown, David”’, “System Set Up After SARS Epidemic Was Slow To Alert Global Authorities,” The Washington Post, A-Section, pg. A01, Apr 30, 2009.
*”Despite huge efforts in the past six years to make the reporting of disease outbreaks fast and automatic, there were significant delays in bringing Mexico’s swine [[flu]] outbreak to the full attention of international authorities.”
*”The delay in making the global health community aware happened despite the adoption in 2005 of international health regulations regarding nations to report to the WHO within 24 hours any disease outbreak that is serious, unusual, at risk of spreading internationally or potentially disruptive by trade.”
*”By the time international authorities became fully aware of the outbreak, there were about 800 cases and at least 50 deaths, and the virus was unknowingly bring carried into other countries.”
*”The (international health) regulations descend from the First International Sanitary Conference, held in Paris in 1851 to fight [[cholera]].  In content, they owe much to the severe acute respiratory syndrome ([[SARS]]) epidemic of 2003.”
”’EDs”’, “Swine flu roots traced to Spanish flu,” CBC News, May 1 ,2009.
*”They performed the tests at a biosafety Level 4 laboratory and animal cubicle at the National Centre for Foreign Animal Disease in Winnipeg, where Weingartl works.”
*”They discovered that there wasn’t a significant difference in the effects on the pigs between the two viruses, as both caused a mild respiratory disease, mirroring the symptoms first reported in 1918 and 1930.”
*”The CDC in the U.S. said on Friday the new strain is “a very unusual” combination of human genes and genes from swine and avian flu viruses found in North America, Asia and Europe.”
”’Landau, Elizabeth”’, “1918 flu survivors share memories as research continues,” CNN, May 4, 2009.
*”Crowe said he was shocked to find B cells that produce 1918 flu antibodies from the blood of flu survivor volunteers 90 years after they got the illness.”
*”In the Nature study, supported by the National Institutes of Health, Crowe and colleagues took these rare B cells from survivors’ blood and cloned the antibody genes from these cells to produce antibodies in the laboratory.”
*”Applying this technique to the 2009 H1N1 virus, researchers could use blood from swine flu survivors to develop an antibody molecule, which is “a biologic drug that we could give to people to protect them against the current swine flu, or possibly to treat them,” he said.”
”’Dearne, Karen”’, “Real-Time Data Vital In Flu Fight,” The Australian, Finance Section, pg. 25, May 5, 2009.
*”‘If there is an e-health infrastructure, we have the potential to deal with disease outbreaks before they become [[pandemic]]s.'”
*”Once doctors, hospitals, labs and researchers are all using e-health software, it becomes possible to automatically analyze patient records or medical processes to identify risks, flag alerts and speed up diagnostic or treatment responses.”
*”‘You need a way of capturing data across medical specialties at a central point so you can detect threats early enough to allow time to develop therapies and reduce the risk of a pandemic…We need to be able to share this information across borders and as close to real-time as we can get.'”
”’Kyodo News Service”’ “[[Japan]] revamps policy to tackle H1N1 flu, removes onboard health checks,” BBC Worldwide Monitoring, May 22, 2009.
*”The Japanese government adopted a new policy on battling new strains of influenza in the face of the domestic outbreak of an apparently milder form of the infection.”
*”The new policy, intended to allow for more flexible responses to minimize the impact on people’s daily lives and business activity, regroups affected areas into two – one with a limited number of confirmed infections and the other where infections are spreading rapidly.”
”’Ryerson-Cruz, Geraldine”’, “As Flu Pandemic Declared, Leaders Must Focus On Poor Countries To Avert Bleaker Picture”, WORLDVISION.ORG, June 11, 2009. http://www.worldvision.org/content.nsf/about/20090611-flu-pandemic
* Africa and Central America
* “With limited access to health services, extreme poverty, high malnutrition rates, and the slower-burning pandemics of HIV and AIDS, tuberculosis, and malaria already stretching society’s coping mechanisms, the poor are more at risk than the general population,” said Stefan Germann, World Vision International’s Geneva-based director for global health partnerships.
*[[Developing Countries]], [[Pandemic]], [[Public Health]]
”’Somerville, Margaret”’, “A world of competing sorrows; There’s a flu [[pandemic]] and health-care resources are scarce. How do we decide who lives and who dies?” The Globe and Mail ([[Canada]]), Pg. A17, July 16, 2009.
*”H1N1 flu presents us with what we call in [[ethics]] “a world of competing sorrows” – that is, one in which there is no response that does only good and not also harm.”
*”How do we decide who gets a chance to live and who dies, when those outcomes depend on who gets access to or is denied scarce health-care resources? Who should decide? On what basis? Using which processes? The H1N1 influenza pandemic raises a large cluster of such ethical issues.”
”’Grady, Denise”’, “System Tracks Flu Cases at Colleges,” NYT, A 17, Sept. 3, 2009.
*”Students back at college have already begun coming down with the flu, according to a new tracking system that uses reports from 165 universities in the United States with two million students.”
*”The tracking system was set up by the American College Health Association, which will post weekly case data and cumulative figues on its Web site.”
*[[Biosurveillance]], [[Flu]], [[Academia]]
”’National Briefing, NYT”’ September 8, 2009, A16., “Washington: Swine Flu Outbreak Eases at University.”
*”A swine flu outbreak at Washington State University that is suspected of sickening at least 2,200 students may be tapering off.”
*40 to 50 students a day contacted the health service at the campus … down from roughly 150 a day last week.”
”’McNeil, Donald, G”’., “One Shot Seen as Protective For Swine Flu: Vaccine Should cover High-Risk Groups,” NYT, A1, September 11, 2009.
*”…clinical trials are showing that the new H1N1 swine flu vaccine protects with one dose instead of two, so the vaccine supplies now being made will go twice as far as had been predicted.”
*”…the government hopes to have 195 million doses by year’s end.”
*”The H1N1 swine flu pandemic has now reached 168 countries.  It arrived in the United States late in the spring and infected more than one million people.”
*”Cases are surging again, especially in the Southeast where many schools and universities reopen earlier than the rest of the country.”
*”There were no deaths or dangerous side-effects [from the trials].  Almost half of the participants reported sore arms or headaches, but that is normal with flu shots.”
*”The authors from the Australian study said the robust respose implied that there was some previously unsuspected crossover protection from having had previous strains of H1N1 seasonal flus or from teh H1N1 components of seasonal flu shots.”
”’McNeil, Donald, G”’., “Machine for Breathing Troubles May Aid in Swine Flu Care, Researchers Say, NYT, September 16, 2009, A23.
*”british researchers [reported in the Lancet]… that some patients with severe breathing problems do better if their blood is run through a heart-lung machine than if they are attached to a conventional ventilator.”
*”Only 80 too 100 hospitals in the United States have them”
*”He [Dr. Zwischenberger] said that young flu patients with previously healthy lungs would be ideal candidates.”
”’Associated Press”’, “Vaccine is Approved,” NYT September 16, 2009, A23.
*”The Food and Drug Administration approved the new swine flu vaccine. … Limited supplied should start trickling out the first week of October.”
”’Associated Press”’, “U.S. to Share Vaccine, Obama Says,” NYT, September 18, 2009, A22.
*”President Obama said the united States will share 10 percent of its swine [[flu]] vaccine with other nations.  The White House said the vaccine to counter the virus known as H1N1 would be available through the World Health Organization to nations taht otherwise would not have access to the vaccine.”
”’McNeil, Donald, G. & Zraick, Karen”’, “New York Health Care Workers Resist Flu Vaccine Rule,” NYT, September 21, 2009. A17.
*”emergency health regulation adopted this summer by State Health Department making all hospital home health and hospice workers get seasonal and swine flu vaccinations was a stratling and radical step.”
*”federal officals say, only about 42 percent of all health care workers get an annual flu shot.”
*”Dr. Julie Gerberding, the former director of the Centers for Disease Control and Prevention …pushed for years for mandatory vaccinations — not just to protect health care workers, she explained, but to protect their patients, who are often aged, have weakened immune systems or are bedridden after surgery, which increases pneumonia risks.”
*”unions do not oppose vaccination ‘but we oppose a mandatory program.'” saaid Joel Shufro, executive director of a coalition of 200 local unions.
*Dr. Thomas R. Frieden, Director of the CDC said, “he would not push to make [[vaccination]]s mandatory.”
*”Every state already requires health workers to be immunized against measles, mumps and polio, and the unions do not object.”
*”Immunologists generally agree that real protection against any disease requires vaccination rates over 90 percent.”
*”only two hospital groups in the country, Virginiaa Mason in Seattle and BJC HealthCare in St. Louis, now make all their employees get flu shots or face dismissal.”
*”With volunteers ‘the best you  get is usually between 50 to 60 percent,’ said Dr. William Schaffner.”
*”Surveys of 8,500 Hong Kong health care workers published last month in BMJ, formerly the British Medical Journal, found that more than half planned to refuse the new vaccine if they could.”
*”Overall, virologists say, of every 100 people who fatihfully get flu shots, only about 70 are fully protected every year.”
”’McNeil, Donald, Jr.”’, “[[China]]: Swine [[Flu]] Campaign, First in world, Begins in Beijing,” NYT, A11, September 22, 2009.
*”The Health Ministry said it hoped to vaccinate 65 million people, about 5 percent of the population, by year’s end.  Besides students, other groups with top priority include border and customs guards, transit workers, the military and the police, and people with heart and lung diseases.  The Health Ministry has reported over 13,000 confirmed cases of the flu across the nation.”
* [[Vaccination]], [[Law Enforcement]]
”’Pollack, Andrew”’, “In Vaccine Additive, Benefit and Doubt, NYT, D1, Sept. 22, 2009.
*”Are Americans obliged to use an unproven vaccine to help protect people in other countries from the flu pandemic?  That is the crux of a debate over adjuvants”
*”Early studies suggest that adjuvants (pronounced AD-joo-vants) could allow four times as many people to be immunized against H1N1 pandemic influenza with a given amount of vaccine.”
*”But while Canada and some European nations will use vaccines containing adjuvants, American officials have decided against it for now.”
*”Officials also fear that using an adjuvant would raise public fears about vaccine safety at a time when their challenge might be about to shift from producing enough vaccine to persuading people to use it.”
*”…There’s a concern that people would be reluctant to get vaccinated,’ said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.”
*”Officials say, one reason to use adjuvants is that they can increase a vaccines’s potency against a virus to which it is poorly matched.  But the swine flu vaccine is well matched to the virus, which has not mutated.”
*[[Vaccination]], [[Flu]], [[Canada]], [[Europe]], [[Adjuvant]]
“Swine Flu Pandemic Will Reveal 21st Century’s Poverty Pandemic”, GLOBAL HEALTH POLICY AT NYU-WAGNER, Sept 27, 2009. http://globalhealthpolicynyu.wordpress.com/2009/09/27/swine-flu-pandemic-will-reveal-21st-century%E2%80%99s-poverty-pandemic/
* historically influenza not an “equal opportunity” disease
* “people with coexisting conditions are more susceptible to poor health outcomes” and “most developng countries have high incidence of malnourished children and adults with many coexisting medical conditions.”
* socioeconomic factors- “poor resources for clean water and sanitation, no health care system or inadequate resources to seek medical attention”
* [[Ethics]], [[Developing Countries]], [[Pandemic]], [[Vaccination]], [[Public Health]]
”’McNeil, Donald, G”’., “Swine [[Flu]] Officials Message: Don’t Blame Shots for All Ills,” NYT, A1, Septmeber 28, 2009.
*Preemptive public relations strategy by [[CDC]] targeting media for reporting coincidental maladies and powerful antivaccine activists.  Due in part from lessons learned from 1976 flu vaccination campaign which was suspended due to questions over relationship with Guillain_Barre syndrome.
*”Every year there are 1.1 million heart attacks in the United States, 795,000 strokes and 876,000 miscariages, and 200,000 Americans have their first seizure.”
*”Some antivaccine groups are raising fears of thimerosal, a preservative used in some brands of vaccines.  Others issue dire warnings about squalene, an immune-booster used in military vaccines but not in any American ones.”
”’Bakalar, Nicholas”’, “In 1918 Pandemic, Another Possible Killer: Aspirin,” NYT, D5, Oct. 13, 2009.
*”Now it appears that a small number of the deaths [attributed to the 1918 pandemic] may have been caused not by the virus, but by a drug used to treat it: aspirin.”
*”high doses of aspirin, amounts considered unsafe today, were commonly used to treat the illness, and symptoms of aspirin overdose may have been difficult to distinguish from those of the flu.”
”’Shear, Michael D.”’ “Obama declares flu emergency to ease restrictions for hospitals,” The Washington Post, October 25,2009.
* “President Obama has declared H1N1 swine flu a national emergency, clearing the way for his health chief to give hospitals wider leeway in how they handle a possible surge of new patients, administration officials said Saturday.”
* “The H1N1 is moving rapidly, as expected,” White House spokesman Reid Cherlin said Saturday. “By the time regions or health-care systems recognize they are becoming overburdened, they need to implement disaster plans quickly.”
* “Obama’s declaration could sharply increase demand for the vaccine, which is becoming available much more slowly than originally expected.”
* “Although officials had hoped at least 40 million doses of vaccine would be available by this time, production problems have delayed the federal government’s ambitious inoculation campaign. Only about 16 million doses have become available.”
*[[Flu]], [[Pharma]]
”’Medina, Jennifer”’, “In New York, Opting Out of Schools’ H1N1 Vaccine,” NYT, A4, Oct. 29, 2009.
*”Fewer than half of new York City parents with children in elementary school have given permission for their children to receive the vaccine at school.”
*”5 to 50 percent of parents had given consent for their children to receive the vaccine at schools that had begun to offer it.”
*”Health officials had estimated a 30 percent to 50 percent participation rate.”
*”But in Charleston, W.Va., which is seeing high levels of swine flu infection, demand in schools has exceeded supply, with 50 percent of parents already consenting.”
*”a computer model developed several years ago by epidemiologists at Emory University based on expereinces with mandatory flu shots for Japanese schoolchildren suggested that, when 50 percent of children are vaccinated, the community’s risk of seasonal flu falls by two thirds, and when 70 percent are vaccinated, the risk drops to 4 percent.”
*[[Vaccination]], [[Flu]]
”’McNeil, Donald”’, G., “New Advice on Swine FLu Doses for Pregnant Women,” NYT, A16, Nov. 3, 2009.
*”One dose of swine flu vaccine protects pregnant women against the flu, but children under 10 still need two doses, federal officials said Monday announcing further results of clinical trials of the vaccine.”
*”The officials also announced the formation of a panel of experts from outside the government to watch for any rare or unexpected side effects as millions of Americans get vaccinated.”
*”The World Health Organization last week recommended one dose of vaccine for all children, but the United States is ignoring that advice.  The organization’s primary goal is to make sure that the world’s vaccine supplies stretch as far as possible among the world’s children.  It endorses vaccine-stretching adjuvants and favors one dose per child so more children can get one.”
*”[Federal officials in the US] decided not to use adjuvants, even though they think they are safe, because anti-vaccine lobbyists have campaigned against them, calling them dangerous, and some officials feared that some Americans would be scared away from being vaccinated.”
*”Most European countries and Canada use vaccines with adjuvants, which are usually mixtures of water and oil that, for unknown reasons, increase the immune response and make smaller doses of vaccine work better.”
*[[Vaccination]], [[WHO]], [[Flu]]
”’McNeil, Donald, G.”’, “Nation Is Facing Vaccine Shortage For Seasonal Flu: An Increase in Demand,” NYT, A1, Nov. 5, 2009.
*”The current problems began years ago, experts said, when vaccine companies started abandoning the American market.  Vaccines, which involve living viruses, are much harder to make than most drugs.  Profits are lower and unused flu vaccine expires after a few months.  Also, vaccines are primarily intended for children, and Americans frequently sue when a child is injured.”
*”Little was done to lure companies back until bioterrorism fears emerged after the anthrax attacks of 2001 and H5N1 avian flu virus, which kills about 60 percent of humans infected with it, emerged in 2003, Dr. Fauci said.”
*”The drawback of relying on foreign plants was made clear recently when the Australian government pressured CSL to keep its vaccine at home instead of fulfilling its contract for 36 million doses of swine flu vaccine for the United States.”
*”Although the government itself ordered and paid for all this year’s swine flu vaccine, about 90 percent of each year’s seasonal vaccine is made for the private sector.”
*”They [vaccine makers] are under pressure to make more to donate or sell to the World health Organization.  Even optimistic predictions say the world’s poorest countries will get only 10 percent of the vaccine they need by winter’s end.”
*[[Vaccination]], [[Flu]], [[Australia]], [[WHO]], [[Developing Countries]]
”’Pollack, Andrew”’, “New Drug For H1N1 Flu Offers Hope,” NYT, B1, Nov. 6, 2009.
*”Peramivir might also be a life saver for its developer, BioCryst Pharmaceuticals, an unprofitable biotechnology company in Birmingham, Ala.”
*”On Thursday, the federal government ordered on an emergency basis, 10,000 treatment courses or peramivir for its national stockpile.”
*”Peramivir is given intravenously,  making it usable by hospitalized patients who are too ill to take two approved flu drugs that work against the virus in similar ways.”
*”The F.D.A. granted authority for the drug to be used in emergencies.”
*”Before that, peramivir had been available only through a more cumbersome ‘compassionate use’ procedure.  Of the 32 patients who received the drug that way, 29 are still alive.”
*”Some of the push to make the drug more widely available is coming from investors in BioCryst, including Kleiner Perkins Caufield & Byers, the prominent Siliconvalley venture capital firm.”
*”Other investors — both supporters of BioCryst stock and those betting the price will fall — have commented at government meetings on flu preparations, ofetn without revealing their finanical interests.”
*”There had been 237 requests to use the drug since the emergency use authorization was granted nearly two weeks ago.”
*”It also says it has signed up partners to try to win sales in Brazil, Mexico, Isreal and China.”
*”Virtually all money to develop the drug comes from $180 million in grants from the Department of Health and Human Services.  Yet the company gets to keep as profit anything it makes from selling the drug to the federal government or to other governments.”
”’Wong, Edward”’, “China’s Tough Policy Seems to Slow Swine Flu,” NYT, A 1, Nov. 12, 2009.
*”Quarantines and medical detentions are among the aggressive measures that Chinese officials have taken to slow the transmission of H1N1.”
*”Local authorities canceled school classes at the slightest hint of the disease and ordered students and teachers to stay home.”
*”Now, Chinese and foreign health officials say that some of those contested measures — more easily adopted by an authoritarian state — may have helped slow the spread of the disease in the world’s most populous country.”
*”The United States Embassy in Beijing said that 2,046 American citizens had been quarantined by the end of October, with 215 testing positive for H1N1.”
*”But Mr. Feng and Dr. O’Leary also say that the social and financial cots of China’s tough measures will have to be evaluated to see whether they were worth the benefits.”
*”From the beginning, the W.H.O. has said that tightening borders would not keep the disease out, and that closing borders or automatically quarantining specific groups of travelers — as China did for a brief period with holders of Mexican passports — would have no benefit.”
*”The State Department implicitly criticized the Chinese policies by issusing travel warnings on the quarantine procedures.”
*[[Quarantine]], [[Flu]], [[China]], [[WHO]], [[State Department]], [[Mexico]]
”’Belluck, Pam”’, “Nations Hit by Swine Flu Getting Emergency Drugs,” NYT A11, Nov. 13, 2009.
*”Emergency supplies of antiviral drugs are being sent to Ukraine, Afganistan and other countries in Eastern Europe and Cental Asia, where hospitals report that they are being overwhelmed by patients with swine flu, the World Health Organization said Thursday.”
*”The agancy [WHO] said it was revising its guidelines and urging more people to take antiviral medication even before they are sure they have the flu.”
*”the agency was not yet confident, as it is now, about the safety and efficacy of the antivirals, Tamiflu and Relenza.  Doctors there were also worried about shortages.”
*”The agency said the countries most affected were Afganistan, Mongolia, Belarus, Ukraine, Azerbaijan and Kyrgyzstan.”
*”When the authorities in Lviv, in western Ukraine, officiallyconnected the deaths to swine flu and called for quarantine measures, frightened residents began buying up masks, prices of home remedies like garlic and lemon shot up and ambulance calls increased fivefold.”
*[[Flu]], [[Vaccination]], [[WHO]], [[Quarantine]], [[Afganistan]], [[Mongolia]], [[Belarus]], [[Ukraine]], [[Azerbaijan]], [[Kyrgyzstan]]
”’McNeill, Donald, G., Jr.”’, “Shifting Vaccine For Flu To Elderly,” D1, NYT, Nov. 24, 2009.
*”reports of price gouging have grown more frequent.  That also happened in 2004, when sterility problems at a British plant cut the American flu vaccine supply in half; prices shot up as high as $90 a dose, from the normal level of $8 to $9.”
*”Gouging is illegal in about half the satets, but each state varies in how big a price increase constitutes gouging and as to whether an emergency must have been declared for the law to kick in.”
*”‘To pursue a case, we need to show it’s not just a couple of dolars but is very significant,’ said Attorney General Richard Blumenthal of Connecticut, who has opened an investigation.”
*”‘if distributors were ‘masquerading or fraudulently claiming to have vaccine,’ that could end in criminal charge.”
*[[Law Enforcement]], [[Flu]], [[Vaccination]]

== 2009: ”Journals” ==
”’Verweij, Marcel”’, “Health Inequities In Times Of A Pandemic”, PUBLIC HEALTH ETHICS, Volume 2, Issue 3, pgs 207-209, 2009.
* people in low-income countries may have no access to vaccination despite being more vulnerable to the significant negative effects of H1N1
* “Australia, Canada, and the Netherlands expect to have sufficient vaccines to immunise the whole population”
*[[Ethics]], [[Developing Countries]], [[Pandemic]], [[Vaccination]], [[Public Health]]
”’Department of Health and Human Servies”’, “Local [[Pandemic]] Influenza Preparedness: Vaccine and Antiviral Drug Distribution and Dispensing”, September, 2009
*In a 2008 review of State pandemic influenza operating plans the Assistant Secretary for Preparedness and Response (ASPR) stated that states were “doing well” with [[vaccination]] plans.
*The Department of Health and Human Services (HHS) provided states with guidelines for planning vaccine distributions
*The 8 planning areas outlined are: Receiving & Staging, Dispensing, Tracking, Vulnerable Populations, Priority Groups, Security, Storage, and Transportation.
*”Selected localities had not addressed in their planning documents most of the vaccine and antiviral drug distribution and dispensing components and preparedness items identified in HHS pandemic influenza guidance.”
*”All selected localities conducted exercises related to vaccine and antiviral drug distribution and dispensing; however most did not create After Action Reports and Improvement Plans for these exercises.”
*”All selected localities collaborated with community partners to develop and exercise their plans to distribute and dispense vaccines and antiviral drugs during an influenza pandemic.”
*The HHS provided several recommendations in this article.
*[[Homeland Security]]
”’Yamada, Tadataka”’, “Poverty, Wealth, and Access to Pandemic Influenza Vaccines”, THE NEW ENGLAND JOURNAL OF MEDICINE. September 17, 2009. Volume 361, Number 12, pgs. 1129-1131., http://content.nejm.org/cgi/content/full/NEJMp0906972?query=TOC
*do developing countries have the manufacturing capacity, cost, and delivery systems and resources available to get vaccines?
*only a few countries in the world have plants for manufacturing influenza vaccine and 3 companies account for most of the world’s manufacturing capacity: GlaxoKlineSmith, Sanofi-Aventis, and Novartis.
* problem- “much if not most of the manufacturing capacity is already spoken for through purchasing contracts held by many of the world’s wealthy countries.”
* steps to ensure global community has vaccinations: identify strategies and mechanisms to make vaccines more accessible
* [[Developing Countries]], [[Pandemic]], [[Vaccination]], [[Public Health]], [[Ethics]]
”’Franco-Paredes, Carlos, Carrasco, Peter, Preciado, Jose Ignacio Santos”’, “The first influenza [[pandemic]] in the new millennium: lessons earned hitherto for current control efforts and overall pandemic preparedness,” Journal of Immune Based Therapies and Vaccines, 2009, 7:2, [http://www.jibtherapies.com/content/pdf/1476-8518-7-2.pdf],
*“it has become clear that responding to the current pandemic or preparing for future ones, nation states need to develop or strengthen their laboratory capability for influenza diagnosis as well as begin preparing their vaccine/antiviral deployment plans. Vaccine deployment plans are the critical missing link in pandemic preparedness and response. Rapid containment efforts are not effective and instead mitigation efforts should lead pandemic control efforts.” [[vaccination]]
”’Moloney, Anastasia”’, “Questions Raised Over Response To Influenza A Outbreak,” The Lancet, Vol. 373, No. 9675, pg. 1591, May 9, 2009.
*”In early April, analysts working at Veratect – a US biosurveillance consultancy – picked up a string of reports about unusual respiratory diseases in several states in Mexico, including a health alert in the state of Veracruz on April 6.”
*”WHO has also said it was monitoring the situation from April 10 on the basis of reports from Mexican authorities about unusual respiratory cases, and had immediately asked Mexican authorities to investigate.  Health officials in Mexico reported back to WHO concluding there was no epidemic.”
*”On April 16, the death of a woman with diabetes from acute pneumonia in Oaxaca state prompted Mexican health authorities to alert PAHO about a possible epidemic brewing.”
*”WHO issued its first public response about the in[[flu]]enza A outbreak on April 24.  That was 18 days after Mexican health officials first raised the alarm locally.  By then, the virus had spread across Mexico’s borders to the USA.  It was when the USA confirmed seven cases of influenza A (H1N1) on April 24 that international agencies started to respond quickly.”
*”So far, the exact source of the outbreak remains a mystery.  Un-confirmed rumors point to La Gloria, a dusty town in the southern Mexican state of Veracruz, where it is believed that 5-year-old Edgar Hernandez became infected with the A (H1N1) virus in late March.  Some local residents in La Gloria blame the nearby US-owned industrial pig farms for the outbreak of the disease.”
*[[Biosurveillance]], [[Flu]], [[Mexico]]
”’Sasaki, Asami, et al”’., “Evidence-based Tool for Triggering School Closures during Infl uenza Outbreaks, Japan,”
Emerging Infectious Diseases , Vol. 15, No. 11, November 2009.
* ”Using empirical data on absentee rates of elementary school students in Japan, we developed a simple and practical algorithm for determining the optimal timing of school closures for control of infl uenza outbreaks.”
*”Infl uenza pandemic preparedness and seasonal infl uenza control programs have focused on vaccine development and antiviral drugs, which are only partially effective and not always available to all persons at risk (1–3). Nonpharmaceutical interventions, such as social distancing, represent additional key tools for mitigating the impact of outbreaks.”
*”Because children are a major factor in the transmission of infl uenza within communities and among households, school closure may be a valuable social distancing method (4,5).”
*” We evaluated the optimal infl uenza-related absentee rate for predicting outbreaks of infl uenza.”
*” Our analysis suggests that a single-day at a threshold infl uenza-related absentee rate of 5%, double-days >4%, or triple-days >3% are optimal levels for alerting school administrators to consider school closure. The double- and triple-day scenarios performed similarly, and gave better results than the singleday.  Thus, the double-day scenario might be the preferred early warning trigger.”
*” We used the Youden index for calculating optimal thresholds (7). The Youden index = (sensitivity) + (specificity) – 1. A perfect test result would have a Youden index of 1. For the single-day scenario, the optimal threshold was 5%, with a sensitivity of 0.77 and specifi city of 0.73.”
*[[Flu]], [[Public Health]], [[Prophylaxis]], [[Biosurveillance]], [[Japan]]

== 2009:Reports ==

”’Guidance for Industry and FDA Staff”’: “In Vitro Diagnostic 2009 H1N1 Tests for Use in 2009 H1N1 Emergency”, The United States Department of Health and Human Services.

*”This document applies to 2009 H1N1 tests while the declaration of emergency under section 564b of the FD& C Act concerning 2009 H1N1 Influenza is in effect.”
*”During a declared emergency under section 564(b)(1) of the FD&C Act, public health authorities must take measures to prepare for, respond to, and contain the emergency. Diagnostic devices are an essential and critical element of public health protection; it is imperative that those managing the public health response are assured of the performance of the devices used to diagnose the disease or condition associated with the emergency.”
“In the case of a determination by the Secretary of HHS, the Secretary must determine that a public health emergency exists under section 319 of the Public Health Service Act that affects, or has a significant potential to affect national security, and that involves a specified biological, chemical, radiological, or nuclear agent or agents, or a specified disease or condition that may be attributable to such agent or agents.”
*”On April 26, 2009, the Secretary declared an emergency for justifying the authorization of the emergency use of certain in vitro diagnostic devices for detection of 2009 H1N1 virus.”
== Declarations ==
“Declaration Of A National Emergency With Respect To The 2009 H1N1 Influenza Pandemic:By The President Of The United States of America; A Proclamation,” October 24, 2009.

* On April 26, 2009, the Secretary of Health and Human Services first declared a public health emergency under section 319 of the Public Health Service Act, U.S.C. 247d.
* As the president stated, “I, Barack Obama, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, including sections 201 and 301 of the National Emergencies Act(50 U.S.C. 1601) and consistent with section 1135 of the Social Security Act as amended, do hereby find and proclaim that, given the rapid increase in illness across the Nation may overburden health care resources and that the temporary waiver of certain standard Federal plans, the 2009 H1N1 influenza pandemic in the United States constitutes a National Emergency.”
*Section 1135 of the Social Security Act permits the Secretary of Health and Human Services to waive certain requirements for healthcare facilities in response to emergencies.
*The President must declare an emergency or major disaster through a Stafford Act Declaration or National Emergencies Act declaration.

”’*The Robert T. Stafford Disaster Relief and Emergency Assistance Act:
*Emergency means any occasion or instance for which, in the determination of the President,Federal assistance is needed to supplement State and local efforts and capabilities to save lives and to protect property and public health and safety, or to lessen or avert the threat of a catastrophe in any part of the United States.
*Major disaster means any natural catastrophe(including hurricane,tornado,storm,high water,wind driven water,tidal wave,tsunami,earthquake,volcanic eruption), or regardless of cause,any fire,flood,or explosion in any part of the United States, which in the determination of the President causes damage of sufficient severity and magnitude to warrant major disaster assistance under this Act to supplement the efforts and available resources of States, local governments, and disaster relief organizations in alleviating the damage,loss,hardship,or suffering caused thereby.

Link to Flow Chart [http://www.scribd.com/doc/27810908/H1N1-Emergency-Declaration-of-2009-pdf]
*[[Flu]], [[Law]]

== 2010 ==
”’Editors”’. “Swine Flu (H1N1 Virus)” New York Times. Jan. 4, 2010. Retrieved from NewYorkTime.com on March 23, 2011. [http://topics.nytimes.com/top/reference/timestopics/subjects/i/influenza/swine_influenza/index.html]
* “The outbreak highlighted many national weaknesses: old, slow vaccine technology; too much reliance on foreign vaccine factories; some major hospitals pushed to their limits by a relatively mild epidemic… Vaccine supply was a problem, but one small dose was enough.”
* “The origins of the flu are unclear; it seems to have first surfaced in Mexico or the southwestern United States. The outbreak was first identified in March 2009 in Mexico, where health authorities became alarmed over the deaths of several young and healthy adults.”
* “Pandemic flus — like the 1918 flu and outbreaks in 1957 and 1968 — often strike young, healthy people the hardest. This flu strain it appears to infect an unusually high percentage of young people. The median age of patients is 17.”
* “International health experts, who say the epidemic will spread regardless of attempts at containment, advised against closing borders. They encouraged governments to focus on mitigating the disease’s spread through public health measures…Many countries ignored the advice against containment efforts, leading to a welter of bans, advisories and alerts on certain pork products. In China, authorities quarantined Mexican travelers in hospitals and hotels — many of whom had shown no sign of illness. Mexico City, one of the world’s largest cities, temporarily closed schools, gyms, swimming pools, restaurants and movie theaters. Mexicans donned masks for protection outdoors.”
* “American health officials took a more cautious approach, which observers now credit with containing the pandemic with minimal disruption to the economy… In retrospect,the biggest mistake made by the government was its prediction in early summer that it would have 160 million vaccine doses by late October. It ended up with less than 30 million, leading to a public outcry and Congressional investigations.”
*[[Emergency Response]], [[Flu]], [[Pandemic]]
”’McNeill, Donald, G.”’, “Transfers of Surplus FLu Vaccine Are Going Slowly to Countries That Need It,” NYT, A15, February 2, 2010.
*”There is now so much unused swine flu vaccine in the world that rich nations, including the United States, are trying to get rid of their surpluses.”
*”…95 countries that told the World Health Organization last year that tehy had no means of getting flu vaccine…”
*”… countries that can afford vaccines save themselves first and, when the worst has passed, transfer their leftovers to the poor, using the W.H.O. as a clearinghouse. …’it’s a very complex operation.'”
*”Each country must submit a plan proving it can store and refrigerate vaccine, give it to those who need it most, inject it safely and do medical follow-up.  It must also sign letters exempting donors from legal liability, and the W.H.O. has to certify the vaccine as safe if the country has no regulatory agency.”
*”Bill Gates … dismissed flu vaccine shipments a ‘a pipe dream.’  ‘It’s not practical; they have no infrastructure to deliver it.’
*”At first , there was deep skepticism; 80 percent of French residents polled said they would refuse.  But after a few deaths were reported, such huge lines formed that, in Lyon, the riot police were called.”
*”The chairman of the Swiss pharmaceutical company Novartis, Daniel Vasella, recently warrned governments breaking their contracts might not be be first in line in the next pandemic.  ‘Reliable partners will be treated preferentially,’ Mr. Vasella said.”
*”Canada recently lent Mexico five million doses because Mexico’s first shipments were not due to arrive until this month.  Similar bilateral deals took place between Western and Eastern Europe, a W.H.O. spokesman said.”
*”The [U.S.] cancellation of 22 million doses out of 36 million ordered from CSL Ltd., an Australian manufacturer that fell behind on orders anyway…”
*”The [US] country also promised 25 million doses to the W.H.O. [and the rest will be stockpiled in bulk antigen form, i.e. a portion of which will not placed in viles.] an extra step that involves a seperate payment.”
*[[Vaccination]], [[Flu]], [[WHO]], [[Pandemic]], [[Poland]], [[Canada]], [[Mexico]], [[France]], [[Australia]]

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