On May 13, 2009, The George Washington University Homeland Security Policy Institute (HSPI) and GW's School of Public Health and Health Services (SPHHS) co-hosted a Policy and Research Forum entitled, "Pandemic Preparedness and Response Policy: Combating H1N1."  The event featured Paul Jarris, MD, MBA, Executive Director of the Association of State and Territorial Health Officials (ASTHO); Robert Kadlec, MD, MTH&H, MA, former Special Assistant to the President for Homeland Security and Senior Director for Biological Defense Policy in the White House Homeland Security Council; Jeffrey Levi, PhD, Executive Director of Trust for America's Health (TFAH), and Associate Professor in the Department of Health Policy, SPHHS; and Major General Philip Russell, MD (USA, Ret.), former Senior Advisor in the Office of the Assistant Secretary for Public Health Emergency Preparedness at the Department of Health and Human Services.  The event was also webcast live.
 
Jarris led off the discussion by noting that in responding to the outbreak of H1N1, federal, state, and local governments have coordinated and "come together as one entity."  The communications efforts of the Centers for Disease Control (CDC) and the Department of Health and Human Services (HHS) played a crucial role in fostering public trust and confidence as information was conveyed by the experts-health professionals, with political figures in a background support role.  Jarris underscored that even through we are only in the first weeks of what could be a months-long process as the virus evolves, there are lessons to be learned.  These include the need to:  challenge our pandemic planning assumptions; bolster our domestic surveillance system to enable national analysis; support vulnerable populations such as migrant workers; and fund overall public health infrastructure as we prepare for a possible resurgence of H1N1 in the fall, or for another pandemic in the future.  "Without a workforce, we can't do anything," he stated, noting the importance of keeping critical infrastructure such as the banking system running.
 
Kadlec highlighted the need for the federal government to apply resources to preparing for a pandemic or biological attack notwithstanding the myriad of other important national security issues.  Though not always well understood, public health is part of our national security infrastructure.  When considering the economic costs, and consequences of a pandemic "superimposed" on unstable countries such as Iraq or Afghanistan, the national security threat to the United States and other nations is brought into clear relief.  According to Kadlec, we have a unique window of opportunity to make strides in getting better prepared, such as by thinking in novel ways about vaccine distribution and other logistics that will determine the success of our strategy for dealing with pandemics.   
 
Levi stated that while we are better prepared for pandemics than we were eight years ago, there are still improvements to be made:  "we can't fall into the trap of complacency because media is done covering it [H1N1]."  Needed measures include updating national preparedness strategy and plans (most federal departments last did this in 2006); improving communications to the American public about real and apparent risk; and fostering surge capacity in our hospitals.  He also cited the need to improve surveillance capacity, and questioned how well the surveillance efforts of the intelligence community meshed with those of the health (epidemiological) community in this case.   
 
Russell wrapped up the panel by focusing on the importance of vaccines in combating pandemics.  He noted the challenges of allocating a limited supply.  Hewing to prioritization may be difficult as both public and private entities distribute vaccine.  Russell also observed that only two licensed manufacturers of vaccine undertake this activity in the United States, though vaccine may be pre-purchased from elsewhere.  However, ensuring the developing world also has access to vaccine is an important moral question with significant political consequences.  Russell noted that new technology for vaccine development is on the horizon, but its implementation is still one or two decades out; unfortunately, that "technology will not be available until the next pandemic".
 
In response to a question by Rebecca Katz, Assistant Research Professor at SPHHS, Kadlec assessed the World Health Organization's response to the outbreak as effective, due to the processes put in place by the organization as well as its veteran leadership.  However, WHO's "Pandemic Stages" warning system may require re-design so as to better reflect the virulence of the virus as well as its spread. 
 
A question from Amir Afkhami, Assistant Professor at both SPHHS and GW's School of Medicine and Health Sciences (SMHS), sparked discussion, citing human behavior in the face of a pandemic as a "wildcard."  "Ultimately," said HSPI Director Frank Cilluffo, "we are trying to induce behavioral changes in the pandemic context." The panel agreed that decisionmakers need to integrate the study of human behavior as they craft policy, particularly for a sustained pandemic.
 
Larissa May, Assistant Professor at SMHS, asked the panelists to comment on the matter of logistics, in light of recent experience with H1N1.  In reply, Jarris highlighted the need to "further clarify our thinking" so that clinicians dealing with patients receive practicable guidance.
 
Concluding the event, Cilluffo emphasized the "convergence point between health and security," observing that "today's issues require that we come together as an integrated whole as part of our planning and responses."
 
The HSPI Policy & Research Forum (PRF) series is designed to spotlight cutting-edge policy solutions and innovative strategies to some of the most pressing national and international concerns. The Forum features leading officials, practitioners and thinkers in a systematic way designed to better highlight their work and promote a dialogue on effective solutions to current issues. For more information on the series, see the PRF website.