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Public Health Preparedness Summit

February 16, 2010

Atlanta, GA

Thank you, Tom. I also want to thank NACCHO for hosting this important conference and for inviting me to speak here today. Public health is a top priority for this administration. So is strengthening our partnerships across government. So I’m glad I could come talk with you about how we can work together to keep Americans healthy and safe.

Before I get to our H1N1 response and some of the lessons we’ve learned, I want to acknowledge a couple members of our terrific public health team who are here today. Many of you knew Tom Frieden from his trailblazing work as New York City Health Commissioner. Since then, many of you have gotten to know him as one of the key leaders of our H1N1 response. We’re very fortunate to have him as our CDC director.

You’re also going to hear later today from Dr. Nicki Lurie, our terrific Assistant Secretary for Preparedness and Response. Like Tom, she plays a key role in almost all our public health activities. And over the last year, those efforts have greatly benefited from her extraordinary experience, not just in the federal government, but in the private sector, academia, and state government. So we’re very lucky to have her, too.

And last, I want to mention one member of our team who isn’t here today. A few weeks ago, we lost one of our own, Diane Caves, in the Haiti earthquake. Diane joined CDC’s Office of Public Health Preparedness and Response in 2007, and I’m told she immediately impressed her colleagues with her deep caring and adventurous spirit. So no one was surprised when she volunteered to go to Haiti to strengthen our HIV/AIDS programs there. She was working on those programs when the earthquake hit. Our thoughts and prayers are with Diane’s family and with all families who have lost loved ones in the earthquake.

Like so many of you here today, Diane’s passion was building safer, healthier communities. And that job has never been more challenging than it is today. We face a wider range of public health threats than ever before in our history. It could be a dirty bomb set off in a subway car, or a contaminated food outbreak that originates outside our borders. Or we could face a new strain of flu that targets our children, like the novel H1N1 virus. America’s families are counting on us to prepare for all of these threats – and to be as prepared as possible even when we face a new threat that we haven’t seen before.

Because you’re on the front lines of response, you know better than anyone that these health emergencies can test our entire public health system. How well we respond depends on the strength and numbers of our health workforce. It depends on the effectiveness and reliability of our countermeasures. Our response depends on how diligently we plan and practice in local communities, and on whether we have enough hospital beds and working emergency rooms. Can we execute a national response strategy on the local level and inform the national strategy with the best local data? And we know that no response can work unless we’re also able to reach the public to educate them about the threat – and how to prevent it.

The 2009-10 H1N1 flu was one of those crises that put every aspect of our public health system to the test. I was sworn in as Secretary just as we were recognizing the first wave of the disease. Less than an hour after I became Secretary, I was taken to the White House Situation Room to get briefed.

I’ve been involved in the H1N1 response from my first day on the job. And what’s been striking about this flu is that like so many public health crises, it hasn’t evolved the way we planned. We had planned for a pandemic that was more deadly and emerged far away from our shores. The flu that presented was less lethal – thank heavens – and already present in several states. This confirmed the wisdom of our flexible, “all hazards” approach to public health preparation. The most dangerous public health threat is often the one you’re least prepared for, so we tried to be prepared for everything.

When the H1N1 flu hit in April, these preparations paid off. One of the first steps we took after identifying the flu was to release 11 million antiviral doses, 13.5 million surgical masks, and more than 25 million respirators from our Strategic National Stockpile. Having these countermeasures on hand allowed us to ensure that commercial shortages didn’t slow our response.

Another example of preparation paying off is our Hospital Preparedness Program. Since 2002, we’ve sent more than $3 billion to state, local, and territorial public health departments, which have been invested in strengthening our medical surge capacity. Because of this investment, many of our hospitals had actually conducted pandemic flu exercises before H1N1 hit, so they knew what to do when their emergency rooms and ICU beds started filling up.

Steps like these allowed our public health response to hit the ground running. Working with partners in government, industry, and around the world, we rapidly characterized the virus, developed a candidate vaccine, made sure it was safe, and began production. By acting quickly, we made the first doses of the vaccine available in October, less than six months after the flu was identified.

At the same time, we launched an unprecedented multimedia communications campaign, first to educate Americans about how to recognize the flu and how to prevent it from spreading and then to encourage them to get vaccinated. We taught an entire generation of kids how to sneeze and built an incredibly powerful one-stop web site called that served as a resource for millions of people.

All these successes had one thing in common: they were made possible by our unified public health response. In some cases, that meant partnerships between agencies within our own department, for example when the CDC, NIH, FDA and others worked to develop a safe vaccine. In other cases, it meant partnership with other departments in the federal government, like when we worked with the Education Department to develop a school closing plan that balanced health risks with the value of time in the classroom.

Most often, it meant partnership with state, local, tribal and territorial public health officials like all of you. In any public health emergency, you are both our eyes and ears on the ground and our first line of defense. That was certainly true with the H1N1 flu. And what we also saw with H1N1 was that these partnerships pay off. When we spoke with one voice, our message was clearer. When we responded together, our efforts were more effective. One good example was our vaccine locator tool on, which used information you collected about clinics in your neighborhoods to make it incredibly easy for any family to find the nearest vaccine site.

Another example were the ASTHO and NACCHO liaisons we embedded in our CDC Emergency Operations Center. Having these liaisons made it incredibly easy to share information and ideas. It helped us get feedback on whether the flu was stressing local health departments and allowed us to identify innovative approaches in local communities that we could then spread throughout the country. We also got invaluable input from our vaccine implementation steering committee, which brought state, local, territorial, and community organizations together to assist our CDC vaccine task force. Being able to incorporate these field perspectives was a huge advantage.

This combination of preparation and partnership has allowed us to have a successful response to the H1N1 flu so far. Today, we have filled, finished, and released more than 155 million doses of the H1N1 vaccine and more than 70 million Americans have been vaccinated.

But I want to stress that the H1N1 flu is still circulating and is still a dangerous disease. The one thing we know for certain about the flu is that it’s unpredictable. The level of H1N1 disease has declined over the past couple of months, but there’s no guarantee that trend will continue. So we need to continue to watch for an uptick in disease. And we need to continue to encourage Americans to get vaccinated, especially health care workers and those who are at high risk of complications. Like the cross country racers competing in Vancouver, we need to lean into the finish line and make sure we finish the job.

We’ll continue to work with you to keep Americans safe this flu season. But as we monitor this dangerous disease and the seasonal flu, we must also always look ahead to the next public health crisis. And that means taking a hard look at our H1N1 flu response for lessons that will allow us to do our jobs better next time, when the threat could be more dangerous or unexpected, and when we may have even less time to respond.

Our department is currently conducting a rigorous review of our flu response to identify lessons that can be applied to future threats. But we already have a few insights that I can share this afternoon. For example, we’ve learned about the importance of partnerships outside the public health community. There was a very interesting survey recently of parents who had gotten their children vaccinated against H1N1. Almost one out of every three parents said that at least one of their children had gotten vaccinated at school. So one of the things we’re going to change is we’re going to look for new ways to work with outside partners to further public health goals, whether it’s with our public school system or universities or businesses.

We also saw new benefits from our partnership with state and local health officials. Thanks to your hard work, we were able to sign up three times as many health care providers to vaccinate people against the H1N1 flu as we had in our routine childhood vaccine network. That gave us the most robust distribution system ever put in place to deliver vaccines to target populations identified by our local partners. In particular, we made huge strides in reaching out to obstetricians to help protect pregnant women from H1N1. We need to build on these successes as we battle both seasonal flu and the next public health crisis.

As successful as these efforts were, we also know that many of you were doubling your efforts at the same time that budget cuts were slashing your resources. Thanks to your hard work and dedication, we’ve still managed to respond quickly and effectively, but H1N1 confirmed that continuing to reduce our state and local public health infrastructure, is a formula for disaster.

Perhaps the biggest lesson we learned was about the limits of our vaccine technology. This fall, our efforts to rapidly produce vaccine and get it out to communities ran up against a hard fact: we were fighting the 2009 H1N1 flu with vaccine technology from the 1950s. We could hurry to develop a vaccine candidate, verify its safety, and clear production facilities, but there was nothing we could do to make the vaccine grow faster in eggs.

We worked to squeeze every last bit of efficiency and dependability out of a safe, but outdated technology. It was like an old car we had tuned up but still couldn’t accelerate the way we needed it to. And the conclusion is clear: if we want to avoid these problems in the future, we needed to continue to make long-term investments in developing countermeasures that are safe and effective, but can be produced faster and more reliably.

That’s why I’ve asked Dr. Lurie and her office to lead a comprehensive review of our public health countermeasures enterprise that will be completed by the end of this quarter. We’re going to look at how our policies affect every step of countermeasure development and production from the laboratory to the distribution point, and ask: how can we do better? And then we’re going to take those answers and put them into action.

The ultimate goal of this review is to have a modernized countermeasure production process where we have more promising discoveries, more advanced development, more robust manufacturing, better stockpiling, and more advanced distribution practices. In other words, we want to create a system that can respond to any threat as quickly as possible. The kind of system that is so dependable and comprehensive that it deters potential bioterrorism attacks and makes our enemies say, “It’s not worth the effort.” And when it comes to the next pandemic from Mother Nature, we want to be able to develop, produce, and deliver a vaccine within weeks—not months.

As part of this review, we need to hear from you. Your input and partnership have been incredibly important at every step of our H1N1 response. Now, we want to know what insights you have when you look back. What worked well? What can we do better? What are some of the innovative approaches you used to respond effectively to H1N1 in your communities that you think could work in the rest of the country?

This review is not just about flu. The partnerships we’ve built and the lessons we’ve learned in the last ten months will be useful in any public health emergency, whether it’s a naturally occurring pandemic, an outbreak from contaminated meat, or an anthrax attack. One of our major goals as a department is to always be guided by the best science possible. And that means we need to be constantly studying our response, identifying key lessons, and incorporating these new findings into our plans.

In a few months, the seemingly endless 2009-2010 flu season will come to a close. And I can imagine how much you all want to get back to your “regular” work. We know that public health is a full-time job. As we meet today, viruses are mutating. Terrorists may be planning. Many of you will face new natural disasters in your communities in 2010. The threats we face are always evolving, so our defenses must evolve, too. There is an old saying in sports that most victories are won on the practice field. That’s also true in public health. No amount of hard work at the height of an emergency can make up for months of inadequate planning. Shortcuts in preparation quickly lead to shortfalls in results when a crisis hits.

That’s why we ask ourselves every day: how can we make our public health defense even stronger? It’s also why I’m so grateful for all the incredible work that you’ve continued to do, at a time when many of you are being asked to do more with fewer resources. Today, I can pledge to you that this administration and this department will continue to do everything we can to support our state and local public health partners and to strengthen those partnerships to minimize gaps or overlaps.

We can’t predict when or how the next public health emergency will hit. But by building on the success of our H1N1 response and applying the lessons we learned, we can be even more prepared next time. So thank you for inviting me here today. Thank you for your partnership. And I look forward to working with in the months to come to keep Americans safe and healthy.