Conference sponsored by:

Center for Biosecurity of UPMC

Deutsche Bank

The Contingency Planning Exchange

Pandemic Influenza Preparedness: The View from the White House
Rajeev Venkayya, M.D., Senior Director for Biodefense, Homeland Security Council, The White House

Speaker biography

I am honored and feel privileged to be here among such a distinguished group of speakers, and I'm not sure that I can trump what they're going to say. But I thought that it would be helpful to give you a sense of the U.S. government's perspective on the pandemic threat--a scene-setter--if you will, to set the stage for the scientific, public health, and financial contingency discussions that are to follow.

I really want to applaud the organizers of this conference and those who are participating today. I think we've seen without a doubt, since the tsunami through Katrina, and last night, hours ago, in Rita, the private sector has stepped up to the plate. And we've seen phenomenal outpouring of support, both financially and in the response of relief efforts of the U.S. government here on our own soil. And I want to thank you for that.

I should note that many of the things that we're talking about today do not just relate to an influenza pandemic. The kinds of things we're talking about are the kinds of things that we need to do to prepare for unorthodox threats. Those being threats other than terrorism, other than hurricanes, other than things that would degrade your infrastructure explicitly, but would in fact leave your infrastructure intact and force you to deal with severe absenteeism, severe infrastructure degradation. The infrastructure necessary to support your organization isn't working because those people haven't shown up.

It's a very different kind of threat. Ultimately, perhaps, it's the same outcome. You can't do what you need to do to take care of your business, to take care of your employees, and to help your company. And we'll hear a lot more about that today.

Now, on to the threat, the H5N1 or bird flu threat, the pandemic threat that you've heard so much about, that you've seen on the cover of magazines, that you've seen talked about on PBS on Tuesday of this week, on ABC last week, is very real. This is something that we take very seriously.

There have been three pandemics in the past century alone, and by my recollection -- not that I was alive, but in reading books -- about every century for the past four or five has had about three pandemics. It just happens. This is the way the influenza biology works, and this is the way the immune systems of our species respond.

So it is not a matter of if, but it is a matter of when, as Director General Lee said a couple of weeks ago at the WHO. The president said that if left unchallenged, uninterrupted, this virus could lead to the first pandemic of the 21st Century, and I couldn't agree more. If it doesn't, that's okay, because something else will, and so everything we do today is relevant to the threat that we face tomorrow, a year from now, or 20 years from now.

I'm not going to go into all the details of what the U.S. government is doing, but I do want to give you a sense and some confidence that we take this seriously. Every department and agency within the U.S. government is fully engaged in pandemic influenza preparedness, as of this moment.

I can say that with confidence because we run these meetings -- and people much more senior than me run these meetings -- with leaders of the respective departments and agencies sitting around the table talking about the pandemic threat. You should walk away knowing that your government is fully engaged on this issue.

We began our preparations internationally. The threat lies in Asia and it is endemic, as Dr. O'Toole pointed out, in many bird species, an accelerating number of bird species. It was poultry at one time. It's now an incalculable number of species of birds, and it's not just birds. It's mammals. It's mixing in birds and pigs, leading to the genetic mutation that could be the one that leads to human-to-human sustained transmissibility.

In order to address this, we cannot just look inward. We have to look overseas. We have to do what we can to ensure that the mechanisms are in place in Asia and in European nations that may see this very soon, and even in our own nation, to know as soon as possible that something has gone awry. If we don't do that, if we don't put those mechanisms in place, we will risk being behind the eight ball by weeks or months. And as we found in SARS, that can have devastating consequences.

So what does it take to do that? Well, transparency is number one. We know from the SARS experience that there is a disincentive to sharing information about a communicable disease that lies within your borders, no big surprise. I think any world leader will tell you that if he or she were to announce something to the world that could impact trade commerce travel, the economy of his or her nation, that would not bode well to their future administration. It would not bode well for their economy.

And so it's no big surprise that countries that I don't need to name are reluctant to share information. Not all of them--there are a number of countries that have been fantastic about sharing information. But we must encourage all nations to share information.

So how do you do that? Well, you can't do it by focusing on the health sector. This is not accomplished by individuals who lead the agriculture sector, the health sector in these countries talking with each other and being encouraged by multilateral organizations to do the right thing.

Those efforts are critical, but they're not enough. It is critically important that heads of state, ministers of state are engaged on this issue -- presidents, prime minister, their deputies must be talking about this. I'm also happy to report to you that that's happening. We've seen a dramatic shift in the volume of discussions and the altitude of discussions that have been happening on this issue.

As you know, the president is fully engaged. He announced the international partnership with the United Nations, just several blocks away from here, a week ago. He also mentioned in his public remarks with Putin as well as the Thai Prime Minister. He is very engaged on this issue, as are others that are running your government.

We need to put money behind that. We need to put resources behind that, as do other nations, and we've done that. We've begun to do that -- $25 million in the avian influenza supplemental has gone to helping Asian nations to enhance transparency, enhance surveillance capabilities, enhance diagnostic capabilities to protect animal workers. To educate the public, to work on risk communication, to do the whole host of things in addition to preparedness and response planning necessary to get on this quickly.

All of this is at the heart of the containment strategy. What does containment mean?

Containment means that if you have a threat that resides in Asia, that's naturally occurring, that is communicable, that is going to be very, very difficult to stop or slow if it gets out of control, you put everything in place that you can to give you additional time.

To prepare domestically, to put your vaccine in place, to put antivirals in place. So that when the pandemic comes -- and I think many of us think it's unlikely we'll be able to contain this overseas -- our containment will actually be slowing the outbreak, that we will be better prepared than we were when we first recognized sustained human-to-human transmission.

The final thing that I'll say in addition to resources is that we need to have a group of nations that work together. The WHO is remarkable in this regard. The WHO does an amazing amount with limited resources and I think we can all be very proud of the work that it does and you'll hear more from Dr. Stohr later. But it's important for nations to stand behind WHO.

So the initial partnership in avian influenza, avian and pandemic influenza, the president announced last week at the UN, is designed to support WHO efforts, FAL OIE efforts on the animal health side, so that donor efforts are coordinated.

If we're putting money into this, they should be coordinated. We should have a common set of goals and objectives that all donor nations are working toward in Asia, and I think we'll accomplish that with the partnership.

There are 10 core principles that if you want to be in the club you have to sign up to, and those are principles that encourage transparency, cooperation, sample sharing with the WHO, and so on. That's critical on the international front, and I'm happy to tell you that that is going quite well. We've seen a phenomenal outpouring of interest and support from nations and a long list of nations that have signed up explicitly.

Let me touch on domestic issues, and then I'm going to want to talk about the business considerations here.

Domestically it's important to have planning in place, as Dr. O'Toole has pointed out. The Department of Health and Human Services (DHHS) and state and local entities have worked on pandemic planning. They're continuing to work on pandemic planning. You will hear much more on U.S. government pandemic planning in the coming weeks, I can assure you.

There's been a lot of discussion around countermeasures, as they like to call these in the biodefense arena. Things that you can do to prevent or mitigate disease, usually delivery of disease, in this case naturally occurring [disease].

Vaccine and antivirals are what we talk a lot about. There are a couple of antivirals that we know, in the laboratory, have shown activity. In humans, in clinical influenza, they have some effectiveness and in the setting of not having a lot, I think we're hoping that if we do face a virus that can be transmitted between humans that there will be some effectiveness of this drug, of those drugs, against this virus. But we don't know that. But it's all we've got, and so we're stockpiling it, and we've laid out a goal of 20 million courses of antivirals to be available to the American population.

Now the strategy on how to use antivirals is complicated. I mean, we've worked out an approach that we think is very sound.

But the reality is that, if you want to use antivirals to protect the American population, to slow the spread or contain an outbreak, you need a lot of antivirals. You need to be able to give a pair a day to every individual who is at risk for as long as the pandemic threat is there, the influenza threat is there. Which could be weeks, and most people may never get influenza or be exposed to it.

And the result of that calculation is a tremendous amount of antiviral that far exceeds the capacity of the manufacturing sector. This is a real challenge that we're all facing. Nevertheless, we have set a goal, and we will meet it.

We've also set a goal on the vaccine front. We have seen success in the laboratory and in clinical trials with the human vaccine against H5N1. We have a vaccine that shows an immune response that we anticipate will show protectiveness in humans and that is in the process of undergoing additional testing, dose-sparing or dose-stretching evaluation to see if we can squeeze more out of it.

Somebody called it the "Hamburger Helper" approach. You've got a certain amount of vaccine, but it goes three times as far because you could administer it with something else.

We're also investing in surveillance to provide real-time visibility and awareness of what's happening in hospitals around this country. If you think a pandemic is underway or if you hear that there's an outbreak, if you hear a plane has arrived that might have somebody on it, you need to know instantaneously what's happening in the emergency departments and intensive care units around that town. And we think real-time surveillance capability is a critical element of that.

The final thing I'll say is that we're investing in diagnostics. When you have a limited, constrained resource such as antivirals, it is very important that those go to the people who actually need them. Which means that every sniffle, until we have unlimited antivirals, every sniffle can't get that drug. It's not a prudent use of your constrained resource. And so diagnostics can help you to understand whether somebody truly requires that treatment and we're investing there.

Let me lastly turn to business considerations. I'm not the expert on this. I can tell you, though, in watching the response to the two naturally occurring events that are ongoing, that a couple of lessons jump out to me.

I've talked about infrastructure degradation, and I just want to highlight for you that this is not like Katrina, in that it doesn't come and go in a matter of days, then allow you to pick up the pieces over weeks. This occurs over weeks. It's a slow roll. This is something that would begin overseas. We'll watch it in slow or relatively fast motion arrive on our shores, and you won't have to deal with this threat for quite some time to come.

Even if a single employee of yours is not infected, there's a pretty good chance, if it's a real pandemic, that somebody they know will be and that they may have to care for that person. There is a good chance that the infrastructure necessary to support your people coming back and forth from work, supporting your IT infrastructure, that those folks may have the same considerations and not be able to deliver. So, realize that the threat may be a couple of degrees removed, but the ultimate outcome is no different.

I think it's critically important that companies have clear communication strategies for their employees. Your employees will not only turn to their local public health officials in this event and the federal government, they'll turn to you to give them guidance, and you will need to know who the information sources are immediately. And I would say that you need to know what those information sources are yesterday.

If you have an outbreak of infectious disease domestically, my recommendation is that you go to the CDC website to get instantaneous information that's updated on a very regular basis on what to do with your employees or what guidance to give them. If it's an international outbreak, go to the CDC. Also go to the Department of State and you'll see, again, rapidly updated information.

You should run to put your contingency planning through its paces to know exactly where you're going to get that information, because you're going to be turned to. And you need your Blackberrys, if your Blackberrys are working in this environment, to put out information, push out information within hours, not days.

The last thing I'll say is that I think it's important for the private sector to not only think about protecting its interest, for every company to not only think about preserving its continuity, but also to think about protecting its employees. And finally, to think about protecting its community. I think that every company of any size in a community ought to be part of that community's plan.

True preparedness is not just about, as we've learned, the national government being prepared. It's not just about state governments being prepared or local governments being prepared. Guess what? It's about every individual, rich or poor, being prepared. You don't have to be rich to be prepared in your household.

But, it's also critical for companies to be prepared, and I think as we've seen with Katrina, we're going to turn to the private sector to help in any way they can. And so to the extent that you can integrate yourself so that we're not guessing and that you're not in there with a surprised look on some government official's face when you show up on their doorstep, I think integrating yourself into their preparedness planning early is critically important.

So, with that, I just want to close by saying that this is a very complicated issue for the private sector, and I've only touched on a couple of issues, assuming that my distinguished colleagues will speak longer on these issues.

I think there needs to be an effort to model the impact on the private sector. There are many entities that have taken a stab at this. I think there needs to be a concerted effort, and I would propose that individuals in the private sector look at doing this on your behalf, and look at the unique considerations that you're going to face with an infectious disease of this type.

We know that UPMC has done this kind of thing. We already know where this is going. But I think you need to nail, for yourselves, the explicit, specific things that impact your entities. That would be my recommendation and admonition.

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