Excerpt
Executive Office of the President President’s Council of Advisors on Science and Technology
August 7, 2009
About the President’s Council of Advisors on Science and Technology
The President’s Council of Advisors on Science and Technology (PCAST) is an advisory group of the nation’s leading scientists and engineers, appointed by the President to augment the science and technology advice available to him from inside the White House and from cabinet departments and other Federal agencies. PCAST is consulted about and often makes policy recommendations concerning the full range of issues where understandings from the domains of science, technology, and innovation bear potentially on the policy choices before the President. PCAST is administered by the White House Office of Science and Technology Policy (OSTP).
For more information about PCAST, see www.ostp.gov/cs/pcast.
EXECUTIVE OFFICE OF THE PRESIDENT - PRESIDENT’S COUNCIL OF ADVISORS ON SCIENCE AND TECHNOLOGY
WASHINGTON, D.C. 20502
August 7, 2009
President Barack Obama
The White House
Washington, DC 20502
Dear Mr. President:
We are pleased to transmit to you the report, U.S. Preparations For 2009-H1N1 Influenza, prepared by your Council of Advisors on Science and Technology (PCAST). This report examines the strategic issues raised by the likely resurgence this fall of the novel influenza virus called 2009-H1N1.
The report reviews the full range of response options for minimizing negative impacts from a fall 2009-H1N1 epidemic and provides an integrated set of recommendations about how to think about hard issues and key policy decisions regarding the epidemic. The nation’s response to the threat of a fall epidemic involves decisions by government on a wide range of issues --- medical, scientific, social, and financial. We have tried to assess these, keeping in mind your interest in having the best available scientific insights and perspectives to inform your thinking about the nation’s response to the continued spread of this new virus.
To provide a solid scientific basis for our recommendations, the Council assembled a PCAST Working Group of non-governmental experts, including one other member of PCAST, from a number of relevant fields (virology, public health, pediatrics, medicine, epidemiology, immunology, and others). On July 16-17, the Working Group met with government officials and others to discuss various aspects of the 2009-H1N1 pandemic, and then developed an in-depth report based on its own knowledge, the information provided during the meeting, and additional consultations with government, academic, and industry experts. The results of that report were presented to PCAST at its meeting on August 6-7, and the Council then approved an Executive Report of findings and recommendations for transmittal to you along with the in-depth Working Group report to PCAST.
The Working Group report discusses the complexities posed by influenza epidemics, and the uncertainties inherent in an epidemic that is still in progress. The report identifies the key decisions and actions to be taken, while recognizing that many decisions (for example, relating to use of vaccines and to school closures) cannot be resolved now but will need to be made rapidly as the epidemic unfolds. In these instances, the Working Group report instead offers guidance about how decisions should be made over the coming weeks and months.
PCAST hopes that its Executive Report and the full Working Group report help lay a foundation for the medical, scientific, social, and financial decisions you and others in the Federal Government must make this fall. We are grateful for the opportunity to serve you and the country in this way.
Sincerely,
John P. Holdren
Co-Chair
Eric Lander
Co-Chair
Harold Varmus
Co-Chair
The President’s Council of Advisors on Science and Technology Executive Report - U.S. Preparations for the 2009-H1N1 Influenza
In April 2009, a novel influenza A (H1N1) virus (2009-H1N1) appeared in Mexico, causing pneumonias and 59 deaths in Mexico City alone. The virus soon spread to the United States and to other continents. Within two months, the World Health organization (WHO) declared that the viral outbreak met the criteria of a level 6 pandemic. Although initial concerns of an extremely high fatality rate have receded, the expected resurgence of 2009-H1N1 in the Fall poses a serious health threat to the United States.
Since the initial report of the outbreak, the Federal Government, through various departments, agencies, and offices, has been actively studying the course of events, responding to them, and planning for a resurgence of the pandemic this fall. In late June, President Obama requested that his Council of Advisors on Science and Technology (PCAST) undertake an evaluation of the 2009-H1N1epidemic and the nation’s response to a probable recurrence.
In this Executive Report, PCAST assesses the emerging Federal response to a second wave, identifies critical questions and gaps in this response, and suggests additional opportunities for mitigation. PCAST’s observations, conclusions, and recommendations presented here are based on the analysis of its 2009-H1N1 Working Group, consisting of 3 PCAST members and a further 11 non-governmental experts in virology, public health, pediatrics, medicine, epidemiology, immunology, and other relevant scientific fields. The Working Group’s deliberations were informed by discussions with government officials and others on various aspects of the 2009-H1N1 pandemic.
2009-H1N1 in Historical Context
Based on the history of influenza pandemics over the past hundred years, PCAST places the current outbreak somewhere between the two extremes that have informed public opinion about influenza. On the one hand, the 2009-H1N1 virus does not thus far seem to show the virulence associated with the devastating pandemic of 1918-19; moreover, medical science now has many potent tools at our disposal to mitigate an influenza pandemic in ways that were not possible ninety years ago. On the other hand, the 2009-H1N1 virus is a serious threat to our nation and the world, unlike the “swine flu” episode in 1976 that led to the vaccination of over 40 million Americans in the absence of any spread of the virus beyond an initial four cases at a single Army base.
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The Current Situation and a Plausible Scenario
Indeed, the 2009-H1N1 influenza is already responsible for significant morbidity and mortality world-wide — from its appearance in the spring, its continued circulation in the U.S. this summer, and its spread through many countries in the Southern Hemisphere during their winter season.
While the precise impact of the fall resurgence of 2009-H1N1 influenza is impossible to predict, a plausible scenario is that the epidemic could:
- produce infection of 30–50% of the U.S. population this fall and winter, with symptoms in approximately 20–40% of the population (60–120 million people), more than half of whom would seek medical attention.
- lead to as many as 1.8 million U.S. hospital admissions during the epidemic, with up to 300,000 patients requiring care in intensive care units (ICUs). Importantly, these very ill patients could occupy 50–100 percent of all ICU beds in affected regions of the country at the peak of the epidemic and could place enormous stress on ICU units, which normally operate close to capacity.
- cause between 30,000 and 90,000 deaths in the United States, concentrated among children and young adults. In contrast, the 30,000–40,000 annual deaths typically associated with seasonal flu in the United States occur mainly among people over 65. As a result, 2009-H1N1 would lead to many more years of life lost.
- pose especially high risks for individuals with certain pre-existing conditions, including pregnant women and patients with neurological disorders or respiratory impairment, diabetes, or severe obesity and possibly for certain populations, such as Native Americans.
There is an important issue with respect to timing:
- The fall resurgence may well occur as early as September, with the beginning of the school term, and the peak infection may occur in mid-October.
- But significant availability of the 2009-H1N1 vaccine is currently projected to begin only in mid-October, with several additional weeks required until vaccinated individuals develop protective immunity.
This potential mismatch in timing could significantly diminish the usefulness of vaccination for mitigating the epidemic and could place many at risk of serious disease.
PCAST emphasizes that this is a planning scenario, not a prediction. But the scenario illustrates that an H1N1 resurgence could cause serious disruption of social and medical capacities in our country in the coming months.
The circumstances underscore the importance of:
- ensuring that the nation’s complex and distributed healthcare systems are prepared to deal with the potential surge in demand, especially with respect to critical care.
- ensuring that all feasible steps are taking to protect the most vulnerable populations.
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