This afternoon the White House held a blogger conference call with John Brennan, Assistant to the President for Homeland Security, and Dr. Richard Besser, Director of Coordinating Office for Terrorism Preparedness and Emergency Response at the CDC, in concert with the H1N1 Flu Preparedness Summit. “…Secretaries Kathleen Sebelius (HHS), Janet Napolitano (DHS), and Arne Duncan (ED), along with Homeland Security Advisor John Brennan, hosted [the all day event] …with states to further prepare the nation for the possibility of a more severe outbreak of H1N1 flu in the fall…”
…. John Brennan, Assistant to the President for Homeland Security:…This summit today is a critically important opportunity for us to let the American people know that H1N1 is something that we’re going to be dealing with over the coming months. We went through the, the spring experience. We learned a lot from that, but there’s still a lot to be done. And so this preparedness summit is the, the opportunity for the government to work with state and local officials, public health officials, and the American public through flu, http://www.flu.gov to make sure that people understand what the status of this influenza is and what the government is doing to address it. As we talked in the summit today, this is a dynamic situation. There’s a lot that is unknown about the, the future of, progression, of the, the disease. And what we’re going to have to do is make sure that we’re able to adapt quickly to the evolving situation in the coming months. Which is a combination of making sure that we’re able to conduct the surveillance activities, as far as watching its progression in the southern hemisphere, carrying out those mitigation measures to minimize the impact, as well as to move forward with a vaccination program which is being pursued at this point and will be launched if a safe and effective vaccine can be found. And then, also, to make sure that we have regular communication with the, the American people. It’s one of the things that President Obama has said directly to me on many occasions – that the safety and health of the American people is foremost on his mind. And he wants to make sure that we’re doing everything possible to prepare for that. And so given that we have to do a lot within the coming months today’s summit brought together notable specialists throughout the fields that are related to following the influenza strain. And so what we’re trying to do is make sure that this is going to be a team effort as we go forward in the coming months. And with that I turn it over to Dr. Besser.
Dr. Richard Besser, Director of Coordinating Office for Terrorism Preparedness and Emergency Response at the CDC: Thanks very much. As we’ve been saying all spring, there’s, there’s a lot of uncertainty when there’s a new infectious disease. And we saw with H1N1 rapid spread after introduction in, in the United States. And what we were saying at that time is that we needed to track this virus as it spread through the southern hemisphere and plan for the fall because of uncertainty, because of our inability to predict what will take place in this country when, when, when the fall comes. This meeting today has been a tremendous opportunity to pull, pull together people from a variety of sectors. So we have public health here, we have governmental, we have folks from the Department of Education , Homeland Security – many different groups that have to work together to plan for what could take place in, in the fall. What we know now is that the virus is causing significant disease in the southern hemisphere. And that we need to be prepared for a variety of scenarios in, in this country – from a worst case to, to a, a milder case. And this effort today is really an attempt to encourage, inspire people across the country to step up and do that kind of intensive planning that will pay dividends in, in the fall. We know that every year seasonal flu will come. That’s a, a certainty. And so in addition to, to dealing with, with the, the arrival of H1N1 we need to be planning for seasonal flu on top of that. And as we’ve said repeatedly seasonal flu causes on average thirty-six thousand deaths per year. There’s shared responsibility, there’s things that we need to do in government, there are things that need to be in, in schools and across communities, and there are things that individuals need to do. We’re working hard on a vaccine, but at this point we don’t know yet that there will be a, a vaccine that will be ready to go. But we have to do the planning that would be required should a vaccine, a safe, effective, and recommended vaccine be available. We’re, we know there’s uncertainty but we are very confident that with collaboration and coordination and, and communication we can really reduce the impact of, of this virus on our communities. And with that I think we’re ready to open it for questions…
….Question: …Our basic question is, how can the Internet help President Obama and help the CDC and help the Department of Homeland Security in this preparedness effort? We’ve heard a lot of details about the illness and there’s a lot more facts we’d like to ascertain of course, but the real basic question is, how can we serve the country better?
Dr. Besser: Thanks for, for that question….One of the, the critical factors in, in responding to a, a public health emergency is people getting information, information that they can use. And you know that one of the important ways people get information is through the Internet. For that information to be as, as useful as possible it has to be credible. And so it’s important that you have the opportunity to ask questions, that on your sites you’re linking to information that’s available. We announced today the http://www.flu.gov which is a one stop shopping for, for all of the guidance that the federal government is developing. You can also provide links to state health department web sites, local health department web sites, places people can go to answer those questions. And you can also serve as a place to send, to identify issues that we may not be addressing and, and push those back up to us so that we are able to get out information that people can use.
John Brennan: …Obviously the Internet is the medium of choice of many, many Americans, more and more every day. And particularly of younger generation, my children are on there constantly. And so it is a source of information. And as Rich was saying, what we’re trying to do is to make sure that we’re able to communicate, but it’s also critically important that accurate information gets out there. And there are a lot of questions that we don’t really have answers to at this point, but one of the things President Obama wants to do is to make sure we are in fact communicating even before we don’t have the answers to a lot of these questions. So we see the Internet and also the blogging community as a, a critical mechanism to make sure that we’re able to engage the American public….
….Question: …I have a question for each of you. For Dr. Besser, in listening to the panels this morning about school and the role of potential school closures it is clear that the education folks were very focused, properly, on the health of children. But, I wonder, in listening to the panels, if you feel that they have really gotten the message about the role that school closure plays in community spread and community mitigation, that is to say it isn’t just protecting the kids at the, closing schools can do, it’s also helping stop, or slow I should say, spread virus in the community. The question for John Brennan is about non-pharmaceutical intervention. Certainly anti-vira
ls and vaccine are a whole order of difficulty and discussion. But for flu.gov, what is the message to the public about non-pharmaceutical intervention? Is it two weeks of stockpiling? And, and it’s kind of buried on the site, so, yeah we want to link to credible appropriate sites, but what is the message for NPI [non-pharmaceutical intervention] to the public and how do we get that message out to the public?
Dr. Besser: Thanks for that question. School closure is potentially an important means of, of interrupting transmission. I think that’s what you were, you were referring to.
Question: Yes sir.
Dr. Besser: There are some studies that would indicate that, that early school closure can have an impact. However, what we saw in the spring is that for, for school closure to be effective it really has to lead to decreased interaction of those children in the community. And for that to, to take place there have to be within communities those systems and that planning ahead of time to make sure that children who were getting school breakfast and school lunch are able to get that. There have to be systems to insure that people can stay home with their child and not lose their jobs and, and, and those sorts of systems in place. The other thing is the, for school closure to, to have an impact you, you would want use it in a setting where you didn’t already have widespread disease throughout the community. And so having systems in place to be able to know what disease looks like in your community will be very effective. There’s a lot of interaction now between the Department of Education, Department of Homeland Security, Department of Health and Human Services around issues of school closure – working on developing effective guidance that can be used in the fall for, for planning and for, for implementation. And, you know, what we have seen is that different countries have taken different approaches to, to school closure. And this morning Dr. Layton [sp] from New York is, was, was sharing that they’re, they are studying the impact in New York City of school closure. What happened with the schools that closed versus those that didn’t. Did they see increased transmission in one versus the other? Can we get some evidence base to help inform the guidance?
John Brennan: …Obviously anti-virals play a very important role in our efforts to mitigate the, and minimize the impact of H1N1, as would a safe and effective vaccine, if one is able to be developed. But in addition, what we’re trying to do is, certainly with the past several months, and, and looking forward, is to emphasize those other countermeasures that are as important. The social distancing, the appropriate sanitary habits, washing hands, if somebody is sick staying home, making sure that you don’t in fact be a conveyor of, of this disease. I find your comment interesting, about that the, you know, the link is maybe hard to find on, on flu.gov. And that’s one of the things that we welcome is, if you think that there are ways that we can, in fact, sort of enhance the ability of individuals to go to flu.gov and to identify those issues that are most important. We welcome that because we’re looking at it from the inside here, from the White House, from CDC, other places. What we want is, be, comments like yours about what we should in fact be trying to do so that is as user friendly possible. Because, and you’re right to point out that there is a whole host of things that we need to be doing, not just that our, sort of, rooted in, sort of the anti-virals and vaccine, but day to day practices. That really is going to be in some respects as effective as the others….
….Question: …One of the biggest issues that’s come across this spring with our, our, I guess first few weeks of this outbreak has been that this virus apparently is age selecting for younger ages versus senior citizens, more or less. Do, do we have any details on some of the healthy children that have, have died of this? Are, are there follow ups being, going on and, you know, if there are, what do we expect, some of those facts? And, also as far as the Native American community goes, there was a speaker that was on quite a bit today, very, very interesting, what is the U.S. government doing to help, you know, our, our Native Americans? And to a larger extent, since the CDC and HHS have really been world leaders in pandemic preparedness, there was also a comment today about what we are doing and what we’re going to be helping other countries with and would, could anyone comment on that?
Dr. Besser: Sure. Thanks, thanks for those questions. The first question about, about age distribution of, of, of disease is, is very interesting. One of the things that we’ve seen in, in looking at population immunity is that older Americans appear to have some increased levels of antibodies, protective factors, that, that may be due to exposure to seasonal flu over their long lifetime or exposure to, to vaccines over their lifetime. And that may, that may relate to why we’re seeing less disease in, in that age group. Regarding the, the cause of, of death, in the children and other populations, that is an area of very active work because we want to learn as much as we can about risk factors for severe disease and, and mortality. That could drive vaccine recommendations for, for the fall. There’s work going on not just in this country but also in many countries of the southern hemisphere as this virus spreads in those areas. Regarding work with the, the tribes, CDC has administered for many years the Public Health Emergency Preparedness Cooperative Agreement which gives close to a billion dollars a year to state health departments for preparedness efforts. Within that cooperative agreement there’s a requirement that the states work with local health departments, but also with tribes that are within their states. Secretary Sebelius this morning mentioned that there are, are funds coming out for public health emergency response. And in that grant guidance which will be available tomorrow on grant.gov, there’s also language that calls on states to work with tribes. So, it’s very important that as part of preparing this all parts of our states and communities are, are prepared and taking action….
….Question: …This comes from a recent study that was published in Health Affairs looking at messaging. Finding no surprise, CDC was prompt and, and, and accurate with updates and getting information out relatively quickly. States, a little bit less so, but pretty good, but when it got down to the local public health level, not so great. And we know, and I say this with respect at my public health colleagues in Connecticut where I am, and elsewhere, there’s some variability at the local level in regard to what people are used to and can do. Whether it’s being used to talking to bloggers, whether it’s, you know, just coordinating and getting the message out on their own local web sites. I’m wondering whether there’s any grant money or help from the federal government in making sure that things get down to the local level and not simply stop at state level. Difficult question and you don’t have a lot of time to answer, but I, I just worry that things kind of stop and get a little bit more diffusive by the time it gets down to the local level.
Dr. Besser: That’s a, that’s a good question. With, within the, the funding that comes to states for preparedness there are requirements of local concurrence and so a significant number of those dollars do get down to the local level. And with these response dollars that will be the case as well. I, I, I’m familiar with that study and, and I think that there are a couple points. One is, it’s important that people have a credible place to go for, for information and, I’m, I’m not sure that I, I’ve seen the, the analysis of where people go for information to see how many go to their local health department versus their state versus a site like flu dot, flu.gov. What you’ll see in a lot of the sites is that it’s the same i
nformation that’s cross linking which is what you’d like to see. So that there’s, there’s standard guidance.
Dr. Besser: But I think that we can learn from that, that it’s important that individuals know where to get credible information and that if they’re not able to get that at the local health department that they have another source where they can acquire that. There are over three thousand local health departments and it may be more efficient and effective to have a really strong state web site with, with links to where people can get local information, and maybe it could be a call line or other source, than having over three thousand different sites that have to be kept up to date with, with current information.
Question: Yes sir, I just want to make sure that the locals do go to the state or they do go to flu.gov and that they’re updated more than, you know, once every couple months which unfortunately is the case sometimes.
Dr. Besser: Well and, and we know that, that a lot of local health departments are really hurting right now as resources are cut back. We’re in touch with local health departments…[and] the organization which represents city and county health, health departments to understand the, the situation for, for them….
Now you may know a little bit more.