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The emergence of the H5N1 avian influenza virus (also known as "bird flu") has raised concerns that it or another virus might mutate into a virulent strain that could lead to an influenza pandemic. Experts predict that a severe pandemic could overwhelm the nation's health care system, requiring the rationing of limited resources. GAO was asked to provide information on the progress of the Department of Health and Human Services's (HHS) plans for responding to a pandemic, including analyzing how HHS plans to (1) use pharmaceutical interventions to treat infected individuals and protect the critical workforce and (2) use nonpharmaceutical interventions to slow the spread of disease. To conduct this work, GAO reviewed government documents and scientific literature, and interviewed HHS officials, state and local public health officials, and subject-matter experts on pandemic response.

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Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services 1. To improve the nation's preparedness for a pandemic, the Secretary of HHS should expeditiously finalize guidance to assist state and local jurisdictions to determine how to effectively use limited supplies of antivirals and pre-pandemic vaccine in a pandemic, including prioritizing target groups for pre-pandemic vaccine.
Closed - Implemented
GAO recommended that the Department of Health and Human Services (HHS) finalize its guidance on how antivirals would be used during a pandemic. In December 2008, HHS released guidance clarifying the use of antivirals during a pandemic, incorporating the recognition of factors in addition to reducing morbidity and mortality such as protecting those critical workers needed to keep society functioning, including health care and law enforcement personnel, and a greater production capacity. For example, HHS's guidance recommends providing antivirals for prophylaxis use among those at high-risk for exposure, such as health care and emergency service workers with the goal of reducing health impacts and minimizing societal disruption. GAO also recommended that HHS determine how to effectively use pre-pandemic vaccine. Pre-pandemic vaccine includes advanced stockpiles of vaccine against an anticipated pandemic-causing strain of the influenza; this recommendation included prioritizing target groups for the vaccine, while also considering factors such as reducing morbidity and mortality as well as keeping society functioning. If the pandemic-causing strain is caused by the strain used to develop the pre-pandemic vaccine, then the pre-pandemic vaccine could become a pandemic vaccine. In July 2008, HHS, along with the Department of Homeland Security, issued guidance on allocating and targeting the use of pandemic influenza vaccine, which could include pre-pandemic vaccine should the influenza strain used to develop pre-pandemic vaccine match the pandemic-causing strain. For example, during a severe pandemic, inpatient and outpatient health care providers would be targeted for receiving vaccine as would emergency services personnel, such as those with law enforcement and fire services.

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