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44th National Immunization Conference

Atlanta, GA
April 19, 2010

I’m glad to be here at the 44th National Immunization Conference – with the people who are on the front lines of the fight against the H1N1 flu pandemic as well as the fight to protect Americans through immunization year in and year out. You should be proud of how aggressively and effectively you all fought, and I wanted to take this opportunity to remind you how far we’ve come.

You remember what began April 21, 2009—almost one year ago. The Centers for Disease Control and Prevention announced they had identified a flu strain we’d never seen before in California and Texas. When preliminary lab results revealed similar viruses in Mexico, public officials and scientists realized we had a serious outbreak on our hands.

The President made it clear from the beginning that the security of the American people was his top priority. He directed the entire federal government to mount a comprehensive response to what was then a new health threat and which would become a pandemic. On April 28—minutes after I was sworn in as HHS Secretary—I was rushed into the White House Situation Room to get a briefing on the growing number of H1N1 cases.

The Department of Health and Human Services didn’t waste any time. We mobilized the world’s top scientists at CDC, the Food and Drug Administration, the National Institutes of Health, and the Biomedical Advance Research and Development Authority, and began working closely with outside groups and other federal agencies.

But soon the H1N1 virus turned up in the New York City schools. Cases were evident around the world, and eventually in the Southern Hemisphere. The World Health Organization declared a global pandemic. Well before our country’s traditional winter flu season began, many people—particularly children—had already gotten sick, and some were dying, from flu.

It was time to get the entire country involved.

The people in this room really stepped up to the plate. You made a rapid assessment of both the needs of, and the capacity in, your states and communities. You developed thorough vaccination plans designed to meet those needs. You set up clinics, and as vaccine began to arrive you worked hard to ensure those clinics had flu mist and shots and ran smoothly. You got the word out to families with children, people with chronic diseases, expectant mothers, and others in the high-risk populations—they needed to get vaccinated first.

You enrolled three times as many health care providers to vaccinate people against the H1N1 flu than we have providing vaccinations in the Vaccines for Children network. That meant we could get vaccine into communities faster, and knew that people could be protected sooner.

Less than six months later, we’ve administered about 90 million doses of vaccine, and we’ve protected approximately 80 million people from H1N1 flu. Combined with the more than 100 million people who got a seasonal flu vaccine, we’ve had unprecedented levels of immunization during the 2009-2010 flu season.

And what’s more, when you see someone in the grocery store coughing into their sleeve, a parent who keeps a child home when he’s sick, or someone at work disinfecting her keyboard, you can take a little of the credit for that, too.

On behalf of all of us at the Department of Health and Human Services: thank you. Facing a dangerous and unpredictable situation, and with state budgets under enormous pressures, you came through and made a truly incredible difference.

We learned a lot from this experience. In a few minutes, Dr. Schuchat will really dive into the lessons of our H1N1 response, but I just want to hit a couple of points very quickly.

First, it’s very important to plan and prepare. Thanks to our preparations, we were able to issue a public health emergency within days of the initial cases. Among other things, that declaration enabled us to distribute a portion of the federal antiviral drug stockpile to states and territories right away.

We reached out to other governments with our infectious disease experts, to build lab capacity and help with surveillance, but also so we could learn from them in places where the disease had progressed further.

Here at home, we made sure our vaccine safety and tracking system was state-of-the-art. We worked with states to set up an extensive new vaccine distribution system. We diversified our manufacturing base, signing up not one, but five companies that were already producing seasonal flu vaccine to make the new H1N1 vaccine.

Point two: we need to trust in the science. We ran more clinical trials on the H1N1 vaccine because we knew we had to have the public’s confidence if they were going to want to get vaccinated. We did not distribute vaccine until we knew it was safe and an excellent match to the virus.

We directed states to follow the Advisory Committee on Immunization Practices’ recommendations and target people in high-risk groups first, which directed our efforts and resources to the most vulnerable, and helped protect everyone else.

We made a commitment to tell the American people what we knew, when we knew it. We launched an aggressive communication strategy to get the word out to the American people—primarily about vaccination, since this is the single safest and most effective way to protect public health—but also about “what you can do to keep flu from spreading: cough in your sleeve; keep surfaces clean; stay home when you’re sick.”

Because this was clearly a young person’s pandemic, we made sure to include partners that appealed to kids—Elmo, Facebook, and a hip-hop doctor—on

We saw how smart it was to depend on you.

State and local public health departments came up with great ways to make it convenient to get vaccinated. There were the drive-through clinics and partnerships with pharmacies.

There were the schools that turned gyms into vaccine clinics. A recent CDC study found that one of every three children across the country who got the H1N1 flu vaccine, received it at school.

Businesses worked overtime to ensure that employees had the flexibility to stay home when they—or their kids—were sick, and to ensure that the workplace was a flu-free zone. Some held their own vaccination clinics as well.

Hospitals across the country pitched in and made use of all available space. And we’re grateful to those of you who insisted doctors, nurses and other health care workers get vaccinated.

Doctors, nurses, pharmacists and others juggled the need to administer separate doses of vaccine—one for the seasonal flu, one for H1N1, and additional doses for children nine and under.

Here was a lesson that came through loud and clear: Some of our most valuable resources for keeping people healthy in this country are our business, community, and government leaders, as well as our school systems – in addition to the dedicated health providers who are already on the ground keeping people well.

It’s a lesson that applies to much more than flu.

The best, most recent example is the huge step forward we took with health insurance reform.

Many of our friends and neighbors still have questions about this law. That’s understandable. Given the complexity and enormity of our health care system, it would be surprising if they didn’t. And it didn’t help that they were bombarded by nearly two hundred million dollars in ads over the last year, many of which were intentionally misleading.

In reality, the new Affordable Care Act will give Americans with insurance more security and stability. It will give Americans without insurance better insurance options. It will bring down costs for families, businesses, and government.

It makes a huge investment in public health.

This year, plans will cover recommended preventive care and immunizations, without any cost-sharing.

People with Medicaid will get free preventive services. Beginning January 1 next year, Medicare beneficiaries will not have to pay out of pocket for annual wellness visits, preventive care, and screenings.

There are tax credits for small businesses so they can afford to cover their employees and incentives for employers to promote wellness in the workplace.

The law puts new resources into state and local health departments for the public health workforce and for evidence-based programs to help Americans approaching retirement age stay healthy and get the right treatment when they need it.

And it sets up a trust fund dedicated to prevention and public health. It contains new funding for the Childhood Obesity Demonstration Project that was authorized last year as part of the Children’s Health Insurance Program. It makes new funds available for communities to build bike paths and parks to help them fight chronic disease as part of new Community Transformation Grants.

The new law also makes a big investment in health communication …

The law imposes new food labeling requirements for chain restaurants so customers will know how many calories they’re eating. This is a page from Dr. Frieden’s playbook when he was New York City’s Health Commissioner. With kids getting most of their calories outside the home, I’d say this change is long overdue.

And it provides resources to educate people of all ages about nutrition, oral health, regular exercise, smoking cessation—to name just a few of the things they need to do to stay healthy—so they can make informed decisions about their own health.

What’s going to make these 2010 reforms—and ultimately, public health in this country—even more effective is that we are building on significant improvements we made to health care in 2009.

This is a story that a lot of people overlooked.

The Recovery Act was also one of the biggest investments in public health in American history. Under the Recovery Act, we funded proven, local health and wellness strategies to help give families more healthy choices in their neighborhoods. As you all know, the Recovery Act provided 300 million dollars to support the section 317 immunization program.

It also expanded Community Health Centers, which now provide high-quality primary care to 19 million Americans a year. We invested in the National Health Service Corps to strengthen our primary care workforce, especially in underserved areas. And we made a historic investment in health information technology, which helps patients fill out fewer forms and doctors deliver better care.

Another example was the Children’s Health Insurance Program Act which, along with the Recovery Act, was one of the first bills President Obama signed last year. Thanks to this program, by the end of 2009, we had enrolled 2.6 million kids in CHIP and Medicaid—kids who were eligible for these programs, but, at the time, didn’t have insurance.

I am challenging the federal government, states, and local community organizations to find and enroll every one of the five million CHIP and Medicaid-eligible children out there who are currently uninsured. I recently visited a hospital in Cincinnati that took me up on my challenge. If children come into the emergency room without an insurance card, the hospital checks to see if they are covered by CHIP or Medicaid.

I hope that all of you will take me up on this challenge, too.

All of this adds up to a stronger, more effective health care system moving forward. We’re making a very conscious effort to improve not only access and affordability, but also evidence-based practices and community health. After all, if you live in a neighborhood food desert, or you don’t have a safe place outside for kids to go and play, all the talk about nutritional guidelines and the importance of physical activity doesn’t mean much.

So we’re taking a pragmatic approach when it comes to implementing health insurance reform—making it easier for seniors to get medicines, easier for families and young adults to get coverage, and easier for small businesses to cover their workers right away.

And we are working to lay the foundation for 2014, when the biggest elements of this new law kick in. That’s when the health insurance exchanges become operational, and tax credits become available for individuals and families to buy insurance.

We’re also looking to apply practical lessons to flu seasons moving forward.

One of the “teachable” moments from this past flu season was on the communications front. We wanted to make sure the American people knew what we knew when we knew it, but we raised expectations too high. When vaccine manufacturers provided estimates of future production, we reported that. And when vaccine grew more slowly than anticipated, we had to revise the projections downward.

Though we firmly believe states need to manage vaccine distribution—they’re closer to the ground and know where it’s needed—we also discovered weak links in some states’ vaccine distribution systems. We will use this information in the future to highlight and accelerate best practices so we can get vaccine to people as quickly as possible.

We need to do a better job of engaging two groups in particular.

(1) Minority communities. Too many people in these communities still don’t believe that vaccines are safe, or even that they work. But with so many African Americans, Hispanics, American Indians, and others experiencing rising rates of chronic disease, not getting vaccinated is many times more dangerous than even the perceived threat of the vaccine. In fact, a virus like the flu could be fatal. So we need your help in coming up with creative ways to increase their vaccination rates.

(2) Physicians. We shouldn’t have to convince health providers that vaccines are safe and that they work. But, despite the fact that we had more health providers than ever getting vaccinated last year, there was still a sizable number who did not. We need providers on the front lines. We need to make sure that the vulnerable people they work with aren’t at greater risk. You are the experts that the rest of us look to when we need good advice about health. So we are asking for your help in encouraging your patients and the people you work with to protect themselves and the people around them. Tell them to get vaccinated.

Finally, this flu season has made us even more committed to ensuring that vaccine production—and all of our medical countermeasures—are state-of-the-art.

Our experience with the ups and downs of the vaccine manufacturing process has made clear the need to enhance our country’s influenza vaccine manufacturing capability.

The Department of Health and Human Services has been working this since 2005 and 2006, when it awarded the first six contracts for cell-based flu vaccines. That preparation and the move beyond the egg-based technology we’ve been using for decades will serve the country well.

President Obama has set aside nearly a half-billion dollars in the 2011 budget to upgrade manufacturing of vaccine and other countermeasures. Dr. Nicole Lurie, our Assistant Secretary for Preparedness and Response, is going to talk more about this later in the conference.

Everything we did to fight the 2009 H1N1 influenza pandemic was done with an eye toward the future. And what a difference a year makes.

At this time last year, we had no idea that we would be confronted with a brand new strain of flu. We didn’t know that it would spread easily—not primarily affecting seniors, like seasonal flu—but primarily among kids and young adults.

Today, we are looking back on the most ambitious immunization campaign ever. We’ve learned important lessons about managing a pandemic and communicating with the public, and about how much we depend on partners who are working on the front lines. Those of you who worked hard to get kids back in for a second dose of H1N1 will be glad to know that next year, the H1N1 strain will be included with the seasonal flu vaccine, so vaccination will be a lot simpler this time around.

We have never been in a stronger position to create new and better vaccines, or—thanks to the lessons learned with the flu and the opportunities we’ve created with health insurance reform, the Recovery Act, and other programs—to make more of a difference in public health.

So again, thank you—we couldn’t have done it without you.