NATIONAL STRATEGYFOR INFLUENZA PANDEMIC -- NATIONAL STRATEGYFOR INFLUENZA PANDEMIC -- CONTENTS -- PREFACE∗ -- THE WHITE HOUSEWASHINGTON -- EXECUTIVE SUMMARY -- THE PANDEMIC THREAT -- U.S. Government Planning for a Pandemic -- Federal Government Response to a Pandemic -- International Efforts -- Transportation and Borders -- Protecting Human Health -- Protecting Animal Health -- Law Enforcement, Public Safety, and Security -- Institutions: Protecting Personnel and Ensuring Continuity of Operations -- U.S. GOVERNMENT PLANNINGFOR A PANDEMIC -- THE PANDEMIC THREAT -- THE NATIONAL STRATEGY FOR PANDEMIC INFLUENZA -- IMPLEMENTATION OF THE NATIONAL STRATEGY -- NECESSARY ENABLERS OF PANDEMIC PREPAREDNESS -- View Pandemic Preparedness as a National Security Issue -- Promote Connectivity -- Communicate Risk and Responsibility -- Support Multilateral Organizations -- Merge Preparedness for Natural and Deliberate Threats -- ADVANCING PANDEMIC PREPAREDNESS -- PLANNING ASSUMPTIONS -- Planning Assumptions for the Implementation Plan -- FEDERAL GOVERNMENT RESPONSETO A PANDEMIC -- COMMAND, CONTROL, AND COORDINATION OF THE FEDERALRESPONSE -- ROLES AND RESPONSIBILITIES -- The Federal Government -- Non-Federal Entities -- FEDERAL GOVERNMENT ACTIONS DURING A PANDEMIC -- World Health Organization Phases of a Pandemic -- Stages of the Federal Government Response -- SUMMARY OF FEDERAL GOVERNMENT ACTIONSDURING A PANDEMIC -- Stage 0: New Domestic Animal Outbreak in At-Risk Country (WHO Phase 1, -- Stage 1: Suspected Human Outbreak Overseas (WHO Phase 3) -- Stage 2: Confirmed Human Outbreak Overseas (WHO Phase 4 or 5) -- Stage 3: Widespread Human Outbreaks in Multiple Locations Overseas(WHO Phase 6) -- Stage 4: First Human Case in North America (WHO Phase 6) -- Stage 5: Spread throughout United States (WHO Phase 6).

Stage 6: Recovery and Preparation for Subsequent Waves (WHO Phase 6 or5) -- INTERNATIONAL EFFORTS -- INTRODUCTION -- KEY CONSIDERATIONS -- Limited International Capacity -- Key Elements of Effective International Response and Containment -- Surveillance to Limit Spread -- Development of Vaccines and Rapid Diagnostics -- Effective Public Communication -- Assistance to United States Citizens Traveling or Living Abroad -- Assistance to the United States -- ROLES AND RESPONSIBILITIES -- The Federal Government -- State, Local, and Tribal Entities -- The Private Sector and Critical Infrastructure Entities -- Individuals and Families -- International Partners -- ACTIONS AND EXPECTATIONS -- 4.1. Pillar One: Preparedness and Communication -- 4.1.1. Support the Development and Exercising of Avian and Pandemic ResponsePlans -- 4.1.2. Expand In-Country and Abroad, Medical, Veterinary, and Scientific Capacityto Respond to an Outbreak -- 4.1.3. Educate People in Priority Countries about High-risk Practices that Increasethe Likeli-hood of Virus Transmission from Animals and between Humans -- 4.1.4. Work to Ensure Clear, Effective, and Coordinated Risk Communication,Domestically and Internationally, before and during a Pandemic. This IncludesIdentifying Credible Spokespersons at all Levels of Government to EffectivelyCoordinate and Communicate Helpful, Informative, and Consistent Messages in aTimely Manner -- 4.1.5. Encourage Nations to Develop Production Capacity and Stockpiles to Supporttheir Response Needs, to Include Pooling of Efforts to Create Regional Capacity -- 4.1.6. Facilitate Appropriate Coordination of Efforts Across the VaccineManufacturing Sector -- 4.1.7. Develop Credible Countermeasure Distribution Mechanisms for Vaccine andAntiviral Agents Prior to and during a Pandemic.

4.1.8. Ensure that there is Maximal Sharing of Scientific Information aboutInfluenza Viruses between Governments, Scientific Entities, and the Private Sector -- 4.2. Pillar Two: Surveillance and Detection -- 4.2.1. Work through the International Partnership on Avian and PandemicInfluenza, as Well as through other Political and Diplomatic Channels such as theUnited Nations and the Asia-Pacific Economic Cooperation Forum, to EnsureTransparency, Scientific Cooperation, and Rapid Reporting of Avian and HumanInfluenza Cases -- 4.2.2. Support the Development of the Proper Scientific and EpidemiologicExpertise in Affected Regions to Ensure Early Recognition of Changes in thePattern of Avian or Human Outbreaks -- 4.2.3. Support the Development and Sustainment of Sufficient U.S. and Host NationLaboratory Capacity and Diagnostic Reagents in Affected Regions andDomestically, to Provide Rapid Confirmation of Cases in Animals or Humans -- 4.2.4. Develop Mechanisms to Rapidly Share Information on Travelers Who May BeCarrying or May Have Been Exposed to a Pandemic Strain of Influenza, for thePurposes of Contact Tracing and Outbreak Investigation -- 4.2.5. Develop and Exercise Mechanisms to Provide Active and Passive Surveillanceduring an Outbreak, Both within and Beyond Our Borders -- 4.2.6. Expand and Enhance Mechanisms for Screening and Monitoring Animalsthat may Harbor Viruses with Pandemic Potential -- 4.2.7. Develop Screening and Monitoring Mechanisms and Agreements toAppropriately Control the Movement and Shipping of Potentially ContaminatedProducts to and from Affected Regions if Necessary, and to Protect UnaffectedPopulations -- 4.2.8. Share guidance with international partners on best practices to prevent thespread of influenza, including within hospitals and clinical settings. -- 4.3. Pillar Three: Response and Containment.

4.3.1. Work to Develop a Coalition of Strong Partners to Coordinate Actions toLimit the Spread of a Virus with Pandemic Potential Beyond the Location where itis First Recognized Abroad in Order to Protect U.S. Interests -- 4.3.2. Where Appropriate, Use Governmental Authorities to Limit Movement ofPeople, Goods, and Services into and out of Areas where an Outbreak Occurs -- 4.3.3. Activate Plans to Distribute Medical Countermeasures, Including NonmedicalEquipment and other Material, Internationally -- 4.3.4. Address Barriers to the Flow of Public Health, Medical, and VeterinaryPersonnel Across International Borders to Meet Local Shortfalls in Public Health,Medical, and Veterinary Capacity -- 4.3.5. Analyze the Potential Economic and Social Impact of a Pandemic on theStability and Security of the International Community and Identify Means toAddress It -- 4.3.6. Ensure that Timely, Clear, Coordinated Messages are Delivered to theAmerican Public from Trained Spokespersons at All Levels of Government andAssist the Governments of Affected Nations to Do the Same -- TRANSPORTATION AND BORDERS -- INTRODUCTION -- KEY CONSIDERATIONS -- Goals of Transportation and Border Measures -- Circumstances and Impacts of Complete Border Closure -- Alternatives to Complete Border Closure and Other Containment Options -- Complexity of Transportation Decisions in Emergencies -- Sustaining Critical Transportation Services -- Emergency Transportation Services -- Transportation and Border Preparedness -- ROLES AND RESPONSIBILITIES -- The Federal Government -- State, Local, and Tribal Entities -- The Private Sector and Critical Infrastructure Entities -- Individuals and Families -- International Partners -- ACTIONS AND EXPECTATIONS -- 5.1. Pillar One: Preparedness and Communication.

5.1.1. Develop Federal Implementation Plans to Support the National Strategy forPandemic Influenza, to Include All Components of the U.S. Government and toAddress the Full Range of Consequences of a Pandemic -- 5.1.2. Continue to Work with States, Localities, and Tribal Entities to Establish andExercise Pandemic Response Plans -- 5.1.3. Continue to Work with States, Localities, and Tribal Entities to IntegrateNon-health Sectors, Including the Private Sector and Critical InfrastructureEntities, in these Planning Efforts -- 5.1.4. Provide Guidance to the Private Sector and Critical Infrastructure Entities ontheir Role in the Pandemic Response, and Considerations Necessary to MaintainEssential Services and Operations Despite Significant and Sustained WorkerAbsenteeism -- 5.2. Pillar Two: Surveillance and Detection -- 5.2.1. Advance Mechanisms for "Real-time" Clinical Surveillance in Domestic AcuteCare Settings such as emergency departments, intensive care units, and laboratoriesto provide local, State, and Federal public health officials with continuousawareness of the profile of illness in communities, and leverage all Federal medicalCapabilities, Both Domestic and International, in Support of this Objective -- 5.2.2. Develop and Deploy Rapid Diagnostics with Greater Sensitivity andReproducibility to Allow Onsite Diagnosis of Pandemic Strains of Influenza atHome and Abroad, in Humans, to Facilitate Early Warning, Outbreak Control, andTargeting of Antiviral Therapy -- 5.2.3. Develop Mechanisms to Rapidly Share Information on Travelers who may beCarrying or may have been Exposed to a Pandemic Strain of Influenza, for thePurposes of Contact Tracing and Outbreak Investigation -- 5.2.4. Develop and Exercise Mechanisms to Provide Active and Passive Surveillanceduring an Outbreak, Both within and Beyond Our Borders.

5.2.5. Develop Screening and Monitoring Mechanisms and Agreements toAppropriately Control Travel and Shipping of Potentially Infected Products to andfrom Affected Regions if Necessary, and to Protect Unaffected Populations.