Pandemic Influenza Preparation

What is it?
An influenza pandemic is caused when the influenza ("flu") virus mutates to produce a strain so different from previous strains that there is no natural immunity to it, and the disease becomes widespread. Each year there is a worldwide flu season that ordinarily causes about 37,000 deaths in the U.S. Flu pandemics occur about three times each Century. In the 1918-1919 pandemic, up to 40 million people worldwide died, including 48,000 members of the U.S. military. (Planners preparing for a future pandemic use the 1918 pandemic as an example of a worst case scenario.) In the 1957-1958 pandemic, about one million people worldwide died, and in the 1968-1969 pandemic, up to four million people died.

Since 2004 an avian flu ("bird flu") virus (H5N1) has circulated among birds in Asia, Africa, and the Middle East. Birds have also infected humans and other animals. The avian flu has been spread among people, but no sign of the efficient human to human transmission necessary for a pandemic has been found. About 50 percent of humans infected by the avian flu have died. Many experts are concerned that this strain of avian flu could bring about the next pandemic, but no one is certain that it will happen. There is no pandemic at this time but the world is statistically overdue for one.

The World Health Organization estimates that between 20 and 50 percent of the world's population may be affected by a pandemic. The Centers for Disease Control and Prevention estimates that in the most severe period of a pandemic, over three to four months, the U.S. could have 200 million cases, causing 800,000 hospitalizations and 300,000 deaths. During past pandemics, a second wave occurring weeks to months after the first has been more severe. It may be six to nine months before a vaccine for a pandemic virus strain becomes available.

What has the Army done?
The Army Operations Center (AOC) conducted an Avian Influenza Response Table Top Exercise (TTX) from October 2-13, 2006. The Army developed a pandemic plan. In accordance with Department of Defense (DoD) Directive 6200.3, public health emergency officers (PHEOs) have been appointed at Army installations, Army Materiel Command, depots, arsenals and plants. The PHEO capability is significant in reducing the effects of pandemic influenza (PI). The PHEOs coordinate with elements on the installations and in the communities to mitigate the PI threat. The U.S. Army Center for Health Promotion and Preventive Medicine has established a website with information on how Soldiers and Family members can protect themselves and others during flu season.

Army medical treatment facilities hold prescribed amounts of DoD-funded Tamiflu (oseltamivir) antiviral treatments. The DoD also maintains other stocks of Tamiflu and Relenza (zanamivir) treatments at strategic storage sites. The effectiveness of antivirals against a pandemic strain is unknown, but oseltamivir-resistant H5N1 has already been isolated. The Office of the Secretary of Defense has a quantity of H5N1 vaccine in both bottled and bulk form awaiting Food and Drug Administration approval. This vaccine would provide partial protection at best.

What continued efforts does Army have planned for the future?

The AOC will incorporate lessons learned from the October 2006 Avian Influenza Response TTX in future planning and operations. The Army initiated service-level PI planning in July 2007, and planners continue participating in PI conferences and exercises in coordination with the Joint staff, other services, component commands, combatant commands, and other stakeholders. The Army PI plan was validated by United States Northern Command (USNORTHCOM), the DoD global synchronizer for PI planning, in May 2008 and was approved by the Vice Chief of Staff, Army on September 5, 2008.

Other Army elements are developing supporting plans. The Army and other Service installations will prepare installation level plans guided by a common format and coverage. The Army will continue to encourage Soldiers, their Families, and Army Civilians to follow individual and Family guidelines during flu season, including getting annual flu shots, cough and hand washing etiquette, and staying home when ill.

Why is this important to the Army?
The Army's response to an influenza pandemic will focus on preserving mission assurance and combat readiness; saving lives, reducing suffering, and slowing the spread of infection; and, as directed and within capabilities, supporting the broader federal response to an influenza pandemic.

During a pandemic, mass casualties and fear of illness impacts all sectors of society. High rates of absenteeism could generate civil unrest, requiring Army action at a time when the Army's own readiness might be degraded.

The first line of military support in most states will be their National Guard forces (majority Army) on state active duty or Title 32 status. Availability of these forces for Title 10 activation is questionable. Planning for integration of NG responses with USNORTHCOM is underway and some tasks contained in the DoD Implementation Plan for PI address NG preparation.