Last year’s Pandemic thankfully was less deadly than originally forecast. The way it was handled has lessons to teach us about how to defend the homeland against naturally occurring health threats and man-made bioterror attacks.

In April of 2009 the United States first became exposed to what would ultimately become the latest Pandemic Influenza outbreak. It began with initial reports of citizens arriving back from trips to Mexico with a novel disease that was referred to at the time as Swine Flu. The swine flu had been circulating for the previous few months in parts of Mexico and was known to have infected humans; we were now seeing cases in the United States. The swine flu began spreading between family members and even to third parties who came into contact with infected people. The numbers of infected persons began to rise, the disease began to spread and with reports of similar infections from around the globe we faced the prospect of a pandemic.

In June of 2009 the WHO declared that the new disease, caused by the now re-named Swine-Origin H1N1 Influenza Virus (SOIV), officially was a pandemic. It met the all the criteria for a pandemic and this entirely novel virus was now active across the globe. In the eight years preceding the 2009 outbreak the NCCIA and a host of eminent researchers had expressed concerns about a pandemic episode.

The outbreaks of Bird Flu around the globe and the reported death rate of > 60% conjured images of the Great Influenza of 1918 and gave cause for concern to all who had studied that episode. Certainly, any repeat of a 1918-like outbreak was going to create a critical incident without immediate historical precedent. The work of the NCCIA with the National Governors Association and the conduct of pandemic preparedness exercises with all of the U.S. states and territories had demonstrated without doubt the extent to which an outbreak would test every facet of the national capability to withstand an entirely novel public health threat to the American population.

In March 2010 the CDC estimated that SOIV H1N1 had caused disease in 59 million Americans, hospitalized 265,000 and killed 12,000. A new disease strikes the U.S. it kills 12,000 it hospitalizes over a quarter of a million and it infects 1/6 of the population.

The NCCIA is currently studying what worked well in the effort to contain the disease and which successes appear to be random – due to the lower lethality of the disease than originally feared. The federal government relied on private doctors, nurses, hospitals as well as state and local public health agencies to do much of the actual work with individuals who were potentially or actually exposed to the disease. Much of the federal effort went into funding vaccine development. The plan was for widespread vaccination, something that was possible only with private sector cooperation. The federal government does not manufacture drugs so it turned to pharmaceutical companies. They were unable to meet the timetable that the federal government imposed. By the time the vaccine was in widespread use, the virus was proving to be less lethal than originally forecast. Fortunately, nature spared the nation a massive death toll.

In the future we cannot rely on good fortune. We are studying the response to the pandemic to learn how to be better prepared to deal with public health emergencies of all sorts in the future.