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March 11, 2020

National Strategy for Pandemic Influenza

Influenza is a serious disease that leads to the sickness, hospitalization and death of millions of people around the world every year. According to a study conducted by the Centers for Disease Control and Prevention (CDC), on average, eight percent of the U.S. population gets sick from the flu each season, with a range of between three percent and eleven percent, depending on the season. Even though many people do not take the influenza seriously, the greatest death event in the 20th century was caused by an influenza pandemic. The 1918 Spanish Flu killed more people than the Great War (World War I), at somewhere between 21 and 50 million people worldwide in a time when our transportation and global communication systems were not as advanced. 

More recently, during the 2009 H1N1 swine flu pandemic, it was estimated that between 700 and 1400 million people worldwide contracted the illness, including 60.8 million Americans. Based on previous pandemics, we know that a new pandemic can have catastrophic consequences. This is not a matter of “if,” this is a matter of “when”; history suggests that a different influenza virus will emerge and result in the next pandemic. 

A potential influenza pandemic can overwhelm our health and medical capabilities as a result of hundreds of thousands of deaths and millions of hospitalizations. It will also disrupt the social life and cause substantial economic damage, which primarily result from lost work time and reduced productivity of patients and caregivers. Therefore, in 2005, the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Homeland Security (DHS) developed the HHS Pandemic Influenza Plan and the National Strategy for Pandemic Influenza, respectively, to prevent, control, and mitigate the effects of influenza A(H5N1) and other influenza viruses assessed to pose high risk to humans. While our national strategy to respond to an influenza pandemic is very comprehensive, I believe that there are two things we need to do: we must continue engaging globally by investing in global health programs and we need to emphasize the one health approach to influenza. 

Global Health: One of the main health challenges that poses global concerns is the fact that public health threats, health emergencies and infectious diseases do not recognize or respect political borders. While the National Strategy for Pandemic Influenza argues that “the most effective way to protect the American population is to contain an outbreak beyond the borders of the U.S.,” earlier this month, the Trump Administration decided to cut more than $3 billion in global health programs, including half of the annual funding to the World Health Organization. While the Fiscal Year 2021 budget invests $998 million to continue on-going influenza activities in the U.S., the U.S. government cannot isolate itself from the rest of the world. This major budget cut worries me not only because it threatens our preparedness measures for an influenza pandemic, but also to any major health emergency. The news came out in a time when the world is fighting a coronavirus outbreak that was declared as a Public Health Emergency of International Concern (PHEIC). 

One Health Approach to Influenza: The concept of One Health recognizes that the health of people is connected to the health of animals and the environment. Both documents discussed the highly pathogenic avian influenza A(H5N1) virus, which mainly occurs in birds. Avian influenza viruses do not normally infect humans. However, these viruses can undergo genetic mutation or exchange of genetic material with a human influenza virus, which make them transmit efficiently between humans. 

While the existing efforts that deal with an influenza pandemic are multi-disciplinary, there is an obvious emphasis on the human and animal components and de-emphasis on the environment component. There are still some global shortenings in environmental and epidemiological detection measures implemented in live poultry markets. For instance, when H7N9 was first reported in China in 2013, multi-sectorial approach was not taken until the number of human infections rapidly spiked. Therefore, when there is an outbreak in a poultry market, we must recognize that this is not only a problem for the Department of Agriculture to address; there will be a great need for coordination and cooperation among local governments, veterinarians, environmental experts, disease control and market management departments.

Mohammed Jibriel (G’20) is a graduate student at the Department of Microbiology and Immunology studying Biohazardous Threat Agents and Emerging Infectious Diseases and a Legislative fellow with the office of Congresswoman Nydia M. Velázquez.