The H1N1/09 virus strain, which was responsible for the 2009 swine flu pandemic had lab-confirmed deaths of 18,449 reported to the World Health Organization and lasted between Jan 2009 to August 10, 2010 (Weekly Virology Report, World Health Organization).
Outlining a year earlier, the W.H.O. (World Health Organization) had reported “426 verifiable human H5N1 [influenza A virus subtype H5N1] cases” in Asian countries (Marghella, 196). Top epidemiologists were concerned that a deadlier zoonotic virus could emerge. The 2009 H1N1 proved to be highly pathogenic, subsequently, the W.H.O. declared a pandemic on June 10, 2009 (196) As the virus was spreading across North America, global cooperation was needed to combat the virus.
Ultimately, top virologists and board members of the W.H.O, U.S. HHS, and CDC worked to draft models to counter a catastrophic outbreak. Outlined in Marghella's scientific publication, figure 21-1 outlined a plan to “identify contacts from index clusters, vaccinate these populations” to slow the spread of the virus (196). In figure 21-1, all timetables enclosing the index case were to vaccinate infected individuals, however, the most significant challenge was to develop a safe and effective vaccine against H1N1. A vital question to examine is whether quarantine efforts could have been exercised as a method of containment? Implementing quarantine measures for affected populations, while establishing contact tracing tools would have been vital for all individuals exposed to an infected person — as the spread could have been mitigated. In figure 21-1, the methodology was to locate index cases and vaccinate the individuals “until new cases of the disease cease to present” (197). For the time being, relying on measures such as quarantining would be a more reasonable method. Furthermore, the individuals who exhibit symptoms should have been placed in quarantine as well. The scientist from the W.H.O. explained how the virus “spread via human-to-human contact,” thus contact tracing measures for the symptomatic individuals should have been executed in addition to quarantining.
Former Secretary of Health and Human Services Director, Michael Leavitt secured more than five billion dollars in funds for emergency-use contracts for vaccine development back in 2008. However, the U.S. — a wealthier nation compared to the Middle East and North Africa, etc — only received thirty percent of the production capacity, thus the remaining went to foreign entities and their production facilities. Government and public health officials, working together, should have allocated funds for scarce resources — vaccine production, protective equipment, ventilators — towards richer countries first, as the facilities were capable of developing life-saving tools at record speed. In terms of vaccine production during 2008-09, the remaining seventy percent of funds went directly to foreign facilities as the “FDA hadn’t yet approved the cell-based technology [foreign countries used cell-based] for use in the United States” (198). As Marghella notes, cell-based technology expedited the vaccine development process, which would have been in line with the Federal Strategic Implementation Plan of three to six months for “develop[ment] and availab[ility] for distribution” (198).
Another major hindrance in the pandemic properness was the lack of established procedures when scarce resources were allocated to states and regions. For example, once states received SNS (Strategic National Stockpile) platform resources, it was up to them to determine how and to whom supplies were provided” (199). Instead, a set of policies, directed from the Health and Human Services, director of CDC should have held meetings with Governors on how to allocate protective equipment to hospitals, institutions, and the general public. From the Governor’s office, elected officials should meet with local officials to define who gets equipment first, immunocompromised, etc. Setting clear procedures would allow for the allocation of scarce resources to be prioritized adequately.
At the onset of the H1N1 outbreak, the challenge of overwhelming hospitals, which already operated between “96.5 and 98% of maximum capacity on any given day,” was a challenge of logistics (199). As the SNS had plentiful supplies of medications and protective equipment, the one vital tool that was in short supply was mechanical ventilators for pulmonary-challenged patients. To combat this issue, it was a matter of establishing pandemic preparedness at the onset of the outbreak.
Officials were battling between a wait approach to determine whether protective measures were needed before another surge, which was characterized as the start of a new academic year and common flu across the Northern Hemisphere. For policymakers to combat a surge, analyzing state populations and outlining scenarios for all state officials to establish across their districts, country, state, etc. A plan arriving from an elected official with advice from medical advisors coincides with the supply of ventilators and other medical reserves as a certain amount of resources could have been hypothetically distributed per 100k people/capita if forecasts of the virus were aligned.
To establish guidelines and methodologies to tackle pandemics, international and national guidelines should be established. The former encompasses joint agreements between foreign leaders for discussions and plans of cooperation. While the latter defines setting mitigations across states of the nation. For example, in early 2009, the U.S. CDC had a website for pandemic influenza, which contained information on all U.S. state and federal territories. However, a lack of cooperation and collaboration led to “marked failures of incident management efforts for an event of national significance” since the established pandemic template varied for each state (201). Instead, the President's medical advisor should meet with state governors, and establish plans for their state and those plans carry down to majors, etc. Having a clear agenda with the safety of the people at the forefront is optimal for pandemic preparedness.
References
Hunting, Katherine, et al. “The 2009 H1N1 Influenza Pandemic: When You Make Mistakes, Don't Miss the Lessons.” Essential Case Studies in Public Health: Putting Public Health Into Practice, Jones & Bartlett Learning, Sudbury, Massachusetts, 2012, pp. 195–201.
World Health Organization, “Weekly Virological Update on 05 August 2010.” The World Health Organization, 5 August 2010.