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President George W. Bush
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Welcome to "Ask the White House" -- an online interactive forum where you can submit questions to Administration officials and friends of the White House. Visit the "Ask the White House" archives to read other discussions with White House officials.

Paula Dobriansky
Under Secretary of State for Democracy and Global Affairs

August 23, 2007

Paula Dobriansky
Good afternoon. This is Paula Dobriansky. It is a pleasure to take questions directly from the general public - via the internet - regarding our international efforts to combat avian and pandemic influenza. I would like to open with a bit of information regarding the action taken by the President on Tuesday.

President Bush, along with Mexico’s president and Canada’s prime minister, unveiled the North American Plan for Avian and Pandemic Influenza at the North American Leaders Summit in Montebello, Canada. The Plan outlines a collaborative North American approach that recognizes that mitigating the effects of a pandemic requires coordinated action by all three countries. It describes how Canada, Mexico and the United States will work together to prepare for and manage outbreaks of highly pathogenic avian influenza and pandemic influenza.

The Plan complements existing national emergency management plans, and builds upon the core principles of the International Partnership on Avian and Pandemic Influenza, the standards and guidelines of the World Health Organization, and other international organizations and agreements.

It represents a significant accomplishment in the United States Government’s continuing efforts to work with national and multilateral partners worldwide to combat a growing challenge to animal and human health.

With that, I am happy to take your questions.

Daniel, from Great Barrington writes:
It seems that news coverage of avian flu has lessened in recent months. Does that mean that avian flu is less of a concern now than a year ago?

Paula Dobriansky
No. The threat of an influenza pandemic has not abated. However, ongoing U.S. efforts through the International Partnership on Avian and Pandemic Influenza, in coordination with United Nations organizations and other donors, are significantly improving the ability of many affected countries to detect and manage animal outbreaks. This in turn is reducing the risk of human cases and the likelihood the virus will mutate into a pandemic form.

But, there is no guarantee that these efforts will prevent a pandemic virus from emerging or sweeping the globe.

As the President stated we are working to address the threat of pandemic influenza, whether it results from the strain currently in birds in Asia or another influenza virus.

Pandemics are a naturally occurring phenomenon, like earthquakes and hurricanes. There have been 10 major influenza pandemics over the past 300 years and there will be another one. The highly pathogenic H5N1 virus is a candidate to become a pandemic, and we are working to prevent that, but the potential risks demand that we prepare for any pandemic, whether it is from H5N1 or a different virus.

Janice, from Illinois writes:
Has the H5N1 gone human to human??? If not, how close is it?

Paula Dobriansky
Most cases of H5N1 avian influenza infection in humans have resulted from direct contact with infected poultry, such as domesticated chicken, ducks, and turkeys. As of today, there have been no reported cases of sustained human-to-human transmission of avian flu, but there have been occasional instances of limited human-to-human transmission based on very close contact, such as from a sick child to her mother. But this is very rare. For an influenza pandemic to occur, avian influenza virus must mutate or change to be able to be passed easily from person to person. The current bird flu virus has many traits that make it more likely to undergo these changes, but that is not at all certain. Unfortunately, no one knows when this will happen or whether it will be the current avian influenza virus the world’s attention is focused on. As of now, there have been no reported cases of sustained, efficient, human-to-human transmission of avian flu.

Craig, from Castle Rock, Colorado writes:
If a pandemic breaks out, wouldn't we just close the borders and stop the planes from coming from where the disease is?

Paula Dobriansky
Also, a very good question. However, based on experience with other infectious diseases, the general scientific consensus is that complete or partial closure of the border would not prevent the arrival of a human pandemic. The U.S. Government is developing scalable, flexible border measures to slow the arrival of the pandemic while striving to maintain the flow of U.S. citizens, non-citizens, and cargo across the borders during a severe pandemic. Such measures might include:

- Screening for illness at ports of entry; - For those people exposed, implementing measures such as health guidance, quarantine, and isolation to limit potential onward spread; - Restrictions on the arrival of airplanes from affected regions; and - Redirection and consolidation of screening and other resources as necessary

Since we recognize preventing the arrival of pandemic influenza is impractical once it is widespread in other countries, our objective is to use a targeted approach at ports of entry to delay its introduction into the United States. We live in an interconnected world and the U.S. relies on international products and commerce to maintain many of the infrastructure sectors critical to our economy and national security such as petroleum, electricity, and water. We are seeking to strike a balance between delaying its onset, thus giving us more time to develop a vaccine and other countermeasures, and minimizing the consequences closing the borders would have throughout the country.

carla, from kansas writes:
Other than the White House website, what do you recommend as a good source for information about pandemic flu? And what's the difference between pandemic and avian flu? Thanks.

Paula Dobriansky
In response to your first question – Numerous departments or agencies throughout the U.S. Government are coordinating to maintain up-to-date information on pandemic flu and avian influenza at has pages on Federal Planning, State & Local Planning, Individual Planning, Workplace Planning, School Planning, Health Care Planning, and Community Planning, as well as active links to other sources of information. For those traveling abroad there is additional information at the State Department web site.

Your second question is a very good one – and a source of confusion for many people. The current “bird flu” virus getting attention is an avian influenza-meaning it is primarily a disease among birds. Were that, or another virus, to change into a form that readily infected and spread among humans and for which we had little immunity, a pandemic influenza would likely result.

Ray, from St. Paul, Minnesota writes:
How well prepared is the Federal government to ensure that emergency Federal employees (e.g. FEMA emergency workers, FAA Controllers, FBI agents, etc.) are given priority for treatment in a pandemic outbreak for the proper continuity of government outside Washington, D.C?

Paula Dobriansky
The Departments of Homeland Security and Health and Human Services are addressing this issue and I should defer to those agencies for details. However, let me say that the U.S. Government is in the process of developing recommendations on who should be priority recipients for vaccines during a pandemic. The prioritization scheme being developed is based on consideration of who will be at greatest risk from influenza, will be essential to the pandemic response, will be most likely to spread influenza to others, and who has jobs that are critical to maintaining the infrastructure of communities and sustaining American society through the pandemic.

It's worth emphasizing that vaccines and antiviral drugs are not the only ways to protect workforces and assure continuity of critical services. Community mitigation strategies to reduce close contact where influenza can be transmitted and other measures to reduce the likelihood of spread are equally important interventions. These are described in the Community Mitigation guidance (which can be found at Federal agencies are also including these measures in their continuity of operations planning.

Mary, from Valley, NE writes:
What part of the current plan of the National Strategy for Pandemic Influenza do you feel least comfortable about? What is our weakest link?

Paula Dobriansky
There are many challenging issues that we are continuing to address. The world has never attempted to mitigate the effects of an influenza pandemic in advance of an outbreak. We are working very hard on many critical issues that, frankly, will in some cases take many years.

One aspect, on the international front, I would suggest continues to need focus is disease detection and biosurveillance. We are working with our international partners, including the UN Food and Agriculture Organization, the World Health Organization, and many others to improve detection of avian influenza virus around the world. We are making progress as animal outbreaks appear to be more quickly identified and addressed. However, in some resource poor countries, building this capacity will take time.

Another area of concern domestically and internationally is enhancing vaccine supply. Vaccine production capacity is a critical problem, not only in the United States but around the world. Even with the current investments in expanded capacity, global vaccine production will remain well below demand during a pandemic. The U.S. Government is committed to working with the pharmaceutical industry, our international partners, and WHO to work to address this gap.

The U.S. is also working with our neighbors in Canada and Mexico to strengthen the ability of communities along our shared border to better mitigate the affects of a pandemic. The time required to produce a vaccine may exceed the duration of the first wave of a pandemic. We have developed guidance on how communities can mitigate the effect of a pandemic until sufficient vaccine supplies are available. We are sharing this guidance with our international partners to coordinate our approaches. Such interventions include staying home if someone or someone in their household is ill; dismissing students from school or otherwise keeping children home; and reducing close contacts in the community and at work (social distancing). Implementing a community mitigation strategy may significantly reduce illness and death, but implementation will not be easy. It will require the cooperation of governments at all levels, many local institutions, and individuals.

Paula Dobriansky
It was a pleasure interacting online with you today. In closing, I would like to urge everyone to take the threat of avian influenza and human pandemic seriously and to do your part in preparing yourself, your family, your business, and your communities for the very real possibility of a pandemic. You can get information about how to prepare yourself, and learn more about what the government is doing to prepare, at

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