Dynamic Swine Flu Threat Will Persist Through 2010, Experts Say

By Joseph Straw

The timing of H1N1 “swine” flu’s arrival makes it too late to include in the 2009-2010 seasonal flu shot, which could mean two separate flu shots over the coming winter for many Americans and as many as three for children, whose immune systems have developed minimal resistance to influenza and may thus require two shots of the novel strain, according to a leading vaccinologist.

Maj. Gen. Philip Russell U.S. Army, Ret., a physician and former head of the branch’s infectious disease program, participated in a panel discussion on H1N1 this week hosted by the George Washington University’s School of Public Health and Health Services and the Homeland Security Policy Institute in Washington, D.C.

The coming winter’s seasonal flu shots are already in production, incorporating three strains that appeared over the past winter and are expected to return. A swine flu shot may arrive mid-fall, but would likely not be widely available until early 2010, possibly requiring the implementation of administration guidelines—essentially rationing-- while supplies are still short, Russell said.

Dr. Jeffrey Levi, executive director of the Trust for America’s Health, and fellow panelists shared high praise for elements of the public health sector’s current handling of the H1N1 outbreak. They agreed, however, that the country still lacks adequate logistical planning and assets to administer vaccines or medication—like 600 million or more doses—in the midst of a severe pandemic.

Whether the America public would accede to a series of seasonal flu shots “depends on how scared people are,” Levi said. A better question is whether the pharmaceutical industry would have the capacity to produce them in a global pandemic, he added.

The H1N1 response has benefitted from sound execution of high-quality pandemic flu plans drafted in response to the deadly Asian H5N1 “bird” flu, but recent weeks have revealed omissions in the plans, said panelist Paul Jarris, executive director of the Association of State and Territorial Health Officials.

U.S. containment plans assumed that pandemic flu strains would be detected overseas, like Asia, before they spread in North America. H1N1, instead, originated in Mexico and was already spreading in the United States by the time its threat came to light, Jarris said, noting that 1918’s Spanish flu originated in Kansas.

“We forgot the past and failed to prepare for that contingency,” said Jarris, who along with other panelists warned that H1N1 will likely pose a critical public health threat for roughly 18 months.

“We are still in the early stages of this. We are several weeks into a novel outbreak, so this is not over,” Jarris said.

The panelists reserved high praise for the government’s risk communication during the outbreak. They lauded government for letting the public health sector, including Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, speak directly to the American people about the severity of the risk. The country has also benefitted from the communication skill of President Barack Obama, who said last month that the disease is “a cause for deep concern, but not panic,” Levi said.

To read more about the huge challenges of pandemic preparedness, check out "Biothreat Detection and Response" from the February issue of Security Management.


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