After the World Health Organization declared the H1N1 flu pandemic over last week, public health and hospital advocates evaluated the lessons they learned from the deadly outbreak to help them manage future public health disasters.
In a little more than a year's time, the deadly pandemic—the first the WHO had declared since 1968—spread to more than 200 countries and claimed more than 18,400 lives. At a virtual news conference on Aug. 10, WHO Director-General Margaret Chan said the H1N1 virus has “largely run its course,” and the world is now in a post-pandemic period. In this phase, localized outbreaks may show significant levels of transmission, which means the virus wasn't completely eradicated. Based on experience from previous pandemics, the WHO said it expects the H1N1 strain to take on the behavior of seasonal flu and continue to circulate for years.
In the U.S., HHS spent $5 billion on the H1N1 flu pandemic. That includes about $1.16 billion of existing funds for vaccine development, including clinical studies and manufacturing of the H1N1 bulk antigen (a molecule recognized by the immune system) and adjuvant (the agent used in a vaccine to enhance the recipient's immune response), according to HHS' Office of the Assistant Secretary for Preparedness and Response.
The figure also includes $3.9 billion that HHS put toward supplemental funding for vaccine production, distribution and administration; domestic and international surveillance; communications and community mitigation; laboratory support for virus detection; preparation of the H1N1 vaccine for use in vials and syringes; and the purchase of ancillary supplies to administer the vaccine. An additional $1.5 billion was provided to states and hospitals for preparedness activities and for vaccination campaign planning and implementation, the office said.
The human cost of the disease was much greater, and is more difficult to quantify. According to the Centers for Disease Control and Prevention, many people with the flu do not seek medical care and only a small number of those who do seek care are actually tested for the disease. The Atlanta-based agency estimates that between April 2009—when the virus was first detected in the U.S.—and April 2010, there were between 43 million and 83 million cases detected with a “midpoint” of 61 million people; between 195,000 and 403,000 H1N1-related hospitalizations, with a midpoint of 274,000 hospitalizations; and between 8,870 and 18,300 deaths with a midpoint of 12,470 lives lost.
As the nation's hospitals and public health infrastructure were tested by the pandemic, experts cited two reasons why the U.S. healthcare system didn't buckle under the pressure: emergency-preparedness funding from the Bush administration (April 6, 2009, p. 6) that formed a foundation to manage the outbreak and the fact that the strain did not become more severe.
Roslyne Schulman, director for policy development at the American Hospital Association, said the funding provided the “seed money” for hospitals to purchase supplies and equipment and also build relationships with state health departments. She also said the pandemic emphasized the importance of timely and science-based federal guidelines for hospitals.
The pandemic also showed that the nation's public health system can't “turn on a dime,” so additional funding, workforce development, and an engaged community—including state and local legal authorities—are needed to sustain a viable public health infrastructure, said Jack Herrmann, senior adviser for public health preparedness and response at the National Association of County and City Health Officials.
“The greatest lesson we learned was that the money that was put into—and has been—for the last nine years for both public health preparedness and the pandemic certainly paid off,” Herrmann said. “Was it without challenges? Certainly not,” he said, adding that, considering all of those who were vaccinated, “We believe that from a public health perspective, it was successful.”
