UNCLASSIFIED
Worldwide: New 2009-H1N1 Influenza Virus Poses Potential
Threat to U.S. Forces
Defense Intelligence Agency
Defense Intelligence Assessment

excerpt from wikileaks.org.....

(U) Key Judgments

(U) NCMI assesses with high confidence a new H1N1 influenza virus (referred to by the media as "swine flu") poses a potential threat to U.S. forces overseas and within the United States. The virus can be acquired relatively easily through casual contact with infected persons. The full worldwide extent of the H1N1 outbreak, including the extent of the virus spread, the number of cases, and the number of related deaths, remains unknown because of the lack of specialized diagnostic capabilitiesin many countries.

(U) Based on clinical and epidemiological data from current cases, NCMI judges the 2009-H1N1 influenza virus may cause attack rates exceeding 10 percent per month in U.S. forces. Most cases will likely debilitate personnel for approximately 1 week, possibly longer. Military populations living in crowded or austere conditions where handwashing and personal hygiene are suboptimal are particularly vulnerable to person-to-person spread of H1N1 influenza virus if introduced. Attack rates in such populations may exceed 50 percent per month.

(U) NCMI judges a small percentage of healthy military-age adults may develop severe and potentially fatal illness, requiring hospitalization, intensive care, and weeks of recovery. If large outbreaks occur among deployed U.S. military personnel, they will likely strain and possibly overwhelm military medical capabilities, particularly at the intensive care level.

(U) NCMI further assesses with high confidence that detection of H1N1 outbreaks in local populations, including those near concentrations of U.S. forces, will be limited in developing countries with poor surveillance capabilities.

THE WHITE HOUSE

Office of the Press Secretary
____________________________________________________________________________
For Immediate Release August 24, 2009

President’s Council of Advisors on Science and Technology (PCAST)
releases report assessing H1N1 preparations

Administration’s H1N1 efforts to date praised
Additional recommendations made to improve monitoring and strengthen medical response

WASHINGTON – A Presidential advisory group of the nation’s leading scientists and engineers today released a new report assessing the Obama Administration’s preparations for this fall’s expected resurgence of 2009-H1N1 flu and outlining key steps officials can take in the coming weeks and months to minimize the disease’s impact on the nation.

The Federal Government’s preparations for 2009-H1N1 flu have been well-organized and are scientifically grounded, according to the report by the President’s Council of Advisors on Science and Technology (PCAST), which assembled a subcommittee of experts on influenza and public health for the purpose. (PCAST is an independent group of leading scientists from academia and industry administered by the Office of Science and Technology Policy in the Executive Office of the President.) But some aspects of those preparations could and should be improved or accelerated, the group concluded.

"As the nation prepares for what could be a challenging fall, it is crucial that our public health decisions are informed by the very best scientific and technological information," said John P. Holdren, Assistant to the President for Science and Technology and a co-chair of PCAST.

The report concludes that the 2009-H1N1 flu is unlikely to resemble the deadly flu pandemic of 1918-19. But in contrast to the benign version of swine flu that emerged in 1976, the report says the current strain "poses a serious health threat" to the nation. The issue is not that the virus is more deadly than other flu strains, but rather that it is likely to infect more people than usual because it is a new strain against which few people have immunity. This could mean that doctors’ offices and hospitals may get filled to capacity.

Among the group’s prime recommendations: accelerate the preparation of flu vaccine for distribution to high-risk individuals; clarify guidelines for the use of antiviral medicines; upgrade the current system for tracking the pandemic’s progress and making resource allocation decisions; accelerate the development of communication strategies—including Web-based social networking tools—to broadcast public health messages that can help mitigate the pandemic’s impact; and identify a White House point person with primary authority to coordinate key decisions across the government as the pandemic evolves. An overarching message of the new report is that through their behavior, individuals can have a potentially big impact on the flu season’s severity. Frequent hand-washing and staying home from school or work when sick will be crucial. The report recommends intensive public education campaigns to reinforce those key behaviors, and also calls for policy adjustments that can reduce economic and other incentives that might encourage people to risk infecting others. For example, workplaces could liberalize rules for absenteeism so employees don’t feel pressured to come to work when sick and school districts could arrange alternative means of distributing lunches to children who are sick but who normally depend on school meals for adequate nourishment.

Overall, the PCAST subcommittee concluded that it was "deeply impressed" by the H1N1-related efforts underway across the Federal Government, including the breadth of issues being anticipated and addressed, the depth of thinking, the overall level of energy being devoted, and the awareness of potential pitfalls.

"The Federal Government’s response has been truly impressive and we’ve all been pleased to see the high level of cooperation among the many departments and agencies that are gearing up for the expected fall resurgence of H1N1 flu," said Harold Varmus, a PCAST co-chair and President of Memorial Sloan-Kettering Cancer Center.

"This virus has pulled us all together in common cause," said PCAST co-chair Eric Lander, who is also President and Director of the Broad Institute of Harvard and MIT. "The preparations are the best ever for an influenza pandemic."

"As the Council of Advisors on Science and Technology notes, influenza brings many challenges and agencies across the government will need to make many key decisions in the face of uncertainty about when and how the virus will play out. As we did in the spring, we can hope for the best, but we must prepare for the worst."

Administration officials leading the flu response efforts praised the report and welcomed the recommendations from the PCAST subcommittee.

"The PCAST H1N1 subcommittee report recommendations will enhance National preparedness and response to 2009-H1N1 flu, and be valuable for longer term, systematic pandemic policy coordination and planning. The President discussed this report at length with PCAST members and expressed sincere thanks for their expert contributions," said John Brennan, White House Homeland Security Advisor.

"The President has been clear from day one that he wants our H1N1 flu response to be guided by science. He also has made it clear that he believes that responding to the flu is a shared responsibility, one that requires the efforts of every American and cooperation between the private and public sectors," said Health and Human Services Secretary Kathleen Sebelius. "The Department of Health and Human Services, including the Centers for Disease Control and Prevention, National Institutes of Health, and Food and Drug Administration, has already made some important progress on the recommendations found in the PCAST subcommittee report and we plan to adopt others to ensure we are doing everything we can to keep Americans healthy and safe."

"As this PCAST report notes, it is not possible to predict how the 2009-H1N1 influenza virus or the upcoming influenza season will play out, but it is best that we plan and prepare for a resurgence of H1N1 flu," said Homeland Security Secretary Janet Napolitano. "HIN1 influenza has the potential to affect virtually every aspect of our lives, from our economy and national security to our education system. It may not be possible to stop influenza, but we can reduce the number of people who become severely ill by preparing well and acting effectively."

"Schools, child care facilities and institutions of higher learning will not only play a key role in helping to mitigate the transmission of the flu this fall but will also play a significant role in promoting critical public health information," said Secretary of Education Arne Duncan. "I am happy to report that we are well on our way to implementing many of the recommendations for schools found in this comprehensive report and have joined with our partners across government to roll out guidance for K-12 and Institutions of Higher Learning over the past two weeks."

"The President’s Council of Advisors on Science and Technology did an excellent job, working on a short timeline, of summarizing and assessing the U.S. preparations for 2009-H1N1 influenza," said CDC Director Tom Frieden. "Their subcommittee, which included individuals from across the public and private sectors, has provided valuable insights and recommendations, including strategies for strengthening our nation's ability to monitor the presence and impact of 2009-H1N1 influenza and strengthen our medical and non-medical response."

To see the PCAST Recommendations and Administration Progress, click here (pdf).

To see the full report, click here (pdf).

For more about PCAST, visit: http://www.ostp.gov/cs/pcast.

Special interests' on both sides in health fight
By DAVID ESPO (AP) -8/19/09 – 1 hour ago

WASHINGTON — As public pitchman, President Barack Obama accuses special interests of fighting to block his health care overhaul. "They run their ads. And let's face it, they scare people," he told one weekend audience. Yet Obama has spent months assembling a formidable lineup of special interests of his own, an essential element of a plan to remake the health care system and succeed where President Bill Clinton memorably failed. "We have the American Nurses Association, we have the American Medical Association on board," Obama told the weekend crowd in Grand Junction, Colo. "We have an agreement from drug companies to make prescription drugs more affordable for seniors. ... The AARP supports this policy." In the parlance of Washington, the organizations on both sides are special interests — the insurance industry and business groups strongly opposed to the direction health care legislation is taking in Congress, as well as the groups of doctors, nurses, drug makers and labor unions working to pass an overhaul despite any misgivings they may have. Part of the permanent landscape in the capital, they all lobby Congress and federal agencies on the issues they care most about. Many purchase political ads in campaign season or try to turn out their own memberships to vote for preferred candidates. They have enormous sums at stakes in the outcome of the struggle over Obama's proposed remaking of the health care system.

Take just two:

_ America's Health Insurance Plans has emerged as a leading opponent of the portion of Obama's plan that calls for the government to sell insurance in competition with private companies.

_ The Pharmaceutical Research and Manufacturers Association is unhappy about the same provision but has pledged to spend a staggering $150 million on television commercials in support of the administration's quest for legislation.

What's the difference?

"They're stakeholders when they're with you, and they're interest groups when they're against you," Mary Matalin, a Republican, said recently, a tongue-in-cheek explanation that hints at the unappealing aroma associated with the label "special interests." White House spokesman Robert Gibbs seemed to understand as much when he said the administration is benefiting from the help of "interest groups," avoiding the more unsavory term "special interests." "It'd be sort of odd to go to a town hall meeting and rail against interest groups that are supporting reform ... who have acknowledged that it's time for health care reform," he said. The president's criticism is aimed at "interest groups that are aligned to keep the status quo either because it benefits them or they have a vested interest."

Far more than semantics is involved.

Eager to succeed where Clinton failed, Obama nailed down agreements with deep-pocketed drug makers and others. The effect was not only to secure allies who could pay for grass-roots and advertising campaigns but also to drive a wedge between Republicans and organizations that have supported them in the past. Despite the obvious turbulence surrounding Obama's proposals, there is evidence the strategy is working. GOP discomfort was obvious when Rep. John Boehner, the House Republican leader, accused the drug industry of trying to protect its own profits by "cutting a deal with the bully" on health care. It marked a turnabout from the days when congressional Republicans received two-thirds of the political contributions handed out by the pharmaceutical industry. Ken Johnson, a senior vice president at PhRMA, sought the high ground in response. "We have been working diligently for more than a year to advance bipartisan health care reform. We're proud of those efforts, and they are completely consistent with our core principles." The drug makers went first in making a deal with the White House, agreeing to pick up $80 billion in additional costs over the next decade to help defray the expenses of the legislation.

The American Hospital Association agreed to shoulder an additional $155 billion.

In exchange, both won assurances the White House would protect them against attempts in Congress to seek additional cuts in their projected Medicare and Medicaid payments. The American Medical Association's key issue was different. Doctors hope the legislation will allow them to avoid a looming 21 percent cut in payments under Medicare. The cost to the government for that would be about $230 billion over a decade. Obama also agreed to require individuals to purchase insurance, reversing a position he held during his campaign. "My thinking on the issue of mandates has evolved. And I think that that is typical of most people who study this problem deeper," he said. It was a bow to the special interests — some now with Obama, others not — that suddenly opened up the possibility of millions of new customers with insurance to help pay for their health care.

Copyright © 2009 The Associated Press. All rights reserved.

The PUBLIC OPTION
Greater than the New Deal

In the face of a government that relies on a laissez faire economy; the opportunity for a tax based, government run health insurance plan is the best approach to maintaining the pecuniary economy that health insurance providers thrive on. The Public Option would add a competitive nature to a health care system that is driven by profit and cares very little for the overall well being of those who finance its very existence. The current system allows for the provider to set the standards regardless of the current market trends. Those very same market trends are less forgiving to the consumer who have absolutely no say in the health care process. The multinational corporations that run the health care system are in the business of pecuniary outcomes. Co-ops and Check-offs are a small example of how big industries may streamline their competition in order to dictate the market trends that they survive on.

The Public Option serves both the provider and the consumer. The Public Option falls far short of the government privatization of the health care industry. The health care providers are able to continue to swim in the cesspool of the pecuniary world. The blessing for the poor consumer who can not compete with the profit margins and stock options, is the creation of competition in the pecuniary market. The Public Option, in theory, is similar to what the large corporations enact when they deem it necessary to take control of their respective markets, despite their earnest call for a laissez faire economy. Large companies will pool a percentage of yearly profits, in order to create a common board or trust. This board or trust creates a hegemony within the respective industry which allows for a despotic rule in the guidance of said industry. The Public Option would be a check off for every tax payer. The payoff will entail a health care system that is centered around the ideas of adequate public health for everyone, not just those who can afford it.

Pregnant women to get flu vaccine
16:28 GMT, Thursday, 13 August 2009 17:28 UK
bbc.co.uk

A swine flu vaccination campaign will be launched in the autumn, but only certain at risk groups, including pregnant women, will be given the jab.

Those with underlying health conditions up to the age of 65 have been identified as the first priority in the UK followed by pregnant women. Health and social care workers will also get the jab, meaning about 14m people will be immunised by December. The government has yet to decide whether everyone should be given it. There are contracts in place for 132m doses of the jab - enough for the whole population as people will require two shots. Nearly 55m doses should be available by the end of the year, compared to the 15m ordered annually for seasonal flu.


Sir Liam Donaldson: Government will concentrate on 'vulnerable' first

Chief Medical Officer Sir Liam Donaldson said the vaccine was going through similar safety testing as the seasonal flu vaccine. He added: "We have a real chance to save lives if we can get the vaccine in place. "We are putting up a real fight against this virus." The vaccine programme is due to roll out as follows if it is granted approval by European regulators in late September or early October as expected:

• In October, those aged six months to 65-years-old in conventional at-risk groups for normal seasonal flu, such as those with diabetes or heart disease, will be vaccinated.

• This will be followed by all pregnant women, subject to licensing arrangements and better information on when in the pregnancy the vaccine should be given.

• People living in households with patients with suppressed immune systems and those over 65 in conventional at-risk groups will then be eligible.

• Front-line health and social care workers will then be vaccinated.

• By the middle of winter, the government hopes to have enough evidence to decide whether the campaign should be extended to healthy people.

Many people had expected children to be among the first wave of priority groups. But experts ruled this out because while they have been the worst hit in terms of the number of cases it is mainly those with underlying health conditions that have developed complications. Sir Liam said: "We have to protect the most vulnerable first."

Vaccine

A total of 300,000 doses of the vaccine will be delivered this month by the two manufacturers contracted by the government. But this will increase dramatically in the coming months, although the 54.6m prediction is still less than expected as one of the firms, Baxter, has had trouble developing enough virus to make the vaccine. It is envisaged those who are also eligible for the seasonal flu vaccine will get both jabs in one go. However, the UK health departments are still in discussions with the British Medical Association about how GPs will administer the programme. The announcement about the vaccine programme comes as the number of newly diagnosed with swine flu continues to fall. There was an estimated 25,000 new cases in England in the last week compared with 30,000 the previous one. In Scotland there were more than 3,000 cases and in Wales more than 1,600. Northern Ireland has seen less than 100 cases since the outbreak began. In total, 49 people across the UK have died with swine flu - nine in the past week. Sir Liam also announced plans to scale down the National Pandemic Flu Service for England, from around 1,600 call centre agents at its launch to between 200 and 600 from 23 August.

New cases are expected to continue falling over the summer with a surge in the autumn after children go back to school.

radiohead, fog

Novel H1N1 Vaccination Recommendations

July 30, 2009, 7:00 PM ET
Content source: Centers for Disease Control and Prevention

With the new H1N1 virus continuing to cause illness, hospitalizations and deaths in the US during the normally flu-free summer months and some uncertainty about what the upcoming flu season might bring, CDC's Advisory Committee on Immunization Practices has taken an important step in preparations for a voluntary novel H1N1 vaccination effort to counter a possibly severe upcoming flu season. On July 29, ACIP met to consider who should receive novel H1N1 vaccine when it becomes available.

Novel H1N1 Vaccine
Every flu season has the potential to cause a lot of illness, doctor’s visits, hospitalizations and deaths. CDC is concerned that the new H1N1 flu virus could result in a particularly severe flu season this year. Vaccines are the best tool we have to prevent influenza. CDC hopes that people will start to go out and get vaccinated against seasonal influenza as soon as vaccines become available at their doctor’s offices and in their communities (this may be as early as August for some). The seasonal flu vaccine is unlikely to provide protection against novel H1N1 influenza. However a novel H1N1 vaccine is currently in production and may be ready for the public in the fall. The novel H1N1 vaccine is not intended to replace the seasonal flu vaccine – it is intended to be used along-side seasonal flu vaccine.

CDC’s Advisory Committee on Immunization Practices (ACIP), a panel made up of medical and public health experts, met July 29, 2009, to make recommendations on who should receive the new H1N1 vaccine when it becomes available. While some issues are still unknown, such as how severe the virus will be during the fall and winter months, the ACIP considered several factors, including current disease patterns, populations most at-risk for severe illness based on current trends in illness, hospitalizations and deaths, how much vaccine is expected to be available, and the timing of vaccine availability.

The groups recommended to receive the novel H1N1 influenza vaccine include:

Pregnant women because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated;

Household contacts and caregivers for children younger than 6 months of age because younger infants are at higher risk of influenza-related complications and cannot be vaccinated. Vaccination of those in close contact with infants less than 6 months old might help protect infants by “cocooning” them from the virus;

Healthcare and emergency medical services personnel because infections among healthcare workers have been reported and this can be a potential source of infection for vulnerable patients. Also, increased absenteeism in this population could reduce healthcare system capacity;

All people from 6 months through 24 years of age

Children from 6 months through 18 years of age because we have seen many cases of novel H1N1 influenza in children and they are in close contact with each other in school and day care settings, which increases the likelihood of disease spread, and
Young adults 19 through 24 years of age because we have seen many cases of novel H1N1 influenza in these healthy young adults and they often live, work, and study in close proximity, and they are a frequently mobile population; and,
Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.

We do not expect that there will be a shortage of novel H1N1 vaccine, but flu vaccine availability and demand can be unpredictable and there is some possibility that initially, the vaccine will be available in limited quantities. So, the ACIP also made recommendations regarding which people within the groups listed above should be prioritized if the vaccine is initially available in extremely limited quantities. For more information see the CDC press release CDC Advisors Make Recommendations for Use of Vaccine Against Novel H1N1.

Once the demand for vaccine for the prioritized groups has been met at the local level, programs and providers should also begin vaccinating everyone from the ages of 25 through 64 years. Current studies indicate that the risk for infection among persons age 65 or older is less than the risk for younger age groups. However, once vaccine demand among younger age groups has been met, programs and providers should offer vaccination to people 65 or older.

Links to non-federal organizations are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the federal government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.