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Editor’s Note: This is an expanded version of a story published earlier today (Nov 1, 2005).Nov 1, 2005 (CIDRAP News) – President George W. Bush today proposed $7.1 billion in spending to prepare for an influenza pandemic, including $5 billion for vaccines and drugs, as his administration released an outline of its preparedness strategy.”At this moment, there is no pandemic influenza in the United States or the world,” Bush said in a speech in Bethesda, Md., today. “But if history is our guide, there is reason to be concerned.”He explained the threat posed by the H5N1 avian flu virus, saying it is “still primarily an animal disease” but could spread around the world if it gained the ability to pass efficiently from person to person. “Our country has been given fair warning of this danger to our homeland—and time to prepare,” he said.Bush said his strategy has three main elements: detecting outbreaks anywhere in the world; stockpiling vaccines and antiviral drugs while improving the ability to make new vaccines for a pandemic virus; and improving general readiness at the federal, state, and local levels.The president called for the following spending measures:$1.2 billion to buy enough doses of the H5N1 vaccine now being tested to protect 20 million people. The government is already spending $162.5 million for this vaccine under existing contracts with Sanofi Pasteur and Chiron. Bush said the vaccine probably would not be a “perfect match” for a pandemic virus but would probably offer some protection.$2.8 billion to develop cell-culture technology for producing vaccines, with the aim of being able to make enough vaccine for all Americans within 6 months of the start of a pandemic.$1 billion for antiviral drugs, “so that we have enough on hand to help treat first responders and those on the front lines, as well as populations most at risk in the first stages of a pandemic.”$583 million for developing “effective pandemic emergency plans,” including $100 million for state plans.$251 million to help Asian countries control and monitor avian flu by training medical personnel, increasing surveillance and testing capabilities, and writing preparedness plans.Bush asked Congress to enact liability protection for vaccine makers, blaming concern over litigation for the fact that only one company now makes flu vaccine in the United States.The president also announced the launch of a new Web site, pandemicflu.gov, to help the country keep up on pandemic preparations and what individuals can do to protect themselves.The government is also storing critical medical supplies in the Strategic National Stockpile, since a pandemic is likely to trigger shortages of hospital beds, respirators, masks, and protective equipment, the president said.”To meet all our goals, I’m requesting $7.1 billion in emergency funding from the United States Congress,” the president said.The White House also released a 17-page version of its preparedness plan, with a promise that the full plan will be released tomorrow morning. The summary gives few specifics, but it does call for:Subsidizing state-based stockpiles of antiviral drugsPossible use of quarantines and restrictions on travel and the shipment of goodsPossible use of the military to maintain the nation’s infrastructure.The document says the government will “prioritize” the allocation of vaccines and antiviral drugs before and during a pandemic, but it doesn’t say which groups would have priority. Another section says the government aims to ensure that the country can produce enough vaccine to “vaccinate front-line personnel and at risk populations, including military personnel.”As another step to boost vaccine production capacity, the plan calls for expanding “the public health recommendations for domestic seasonal influenza vaccination.”To contain outbreaks, the document says the federal government, where appropriate, will use its authority to “limit non-essential movement of people, goods, and services into and out of areas where an outbreak occurs.” It adds that Washington will provide guidance to other levels of government on the use of quarantines, restrictions on gatherings, and other containment measures.The plan promises that the government will “determine the spectrum” of activities that the military and other arms of government could support during a pandemic. These could include activities in medicine, public health, and maintaining infrastructure.The document also says that individuals and families will play a critical role in coping with a pandemic. People will need to be prepared to heed restrictions on public gatherings, avoid nonessential travel, and keep enough supplies at home “to support essential needs of the household for several days if necessary.”The Infectious Diseases Society of America (IDSA) praised the administration’s plan while promising to scrutinize the details when they are released.”By strengthening global surveillance activities and reinvigorating the development of vaccines and antivirals, the president’s strategy will go a long way toward pandemic influenza preparedness,” said IDSA President Martin J. Blaser, MD. “This preparedness will yield important health benefits, even if the next pandemic does not appear for years. IDSA specifically supports the proposed investments for new cell-based vaccine technologies and incentives to lure new manufacturers into the vaccine and antimicrobial market, such as liability protections.”Michael T. Osterholm, PhD, MPH, a leading advocate of pandemic preparedness, expressed a mixed reaction to the plan as revealed so far. “I think it’s aggressive and provides a good start for addressing the vaccine and drug issues,” he said. “But I’m concerned that too many people are putting all their eggs in the drug basket in determining preparedness around that issue.” Osterholm is director of CIDRAP, publisher of this Web site.He said using antiviral drugs to fight a pandemic will involve difficult logistical problems, since the drugs must be taken within the first 2 days of illness or they won’t help.See also:Transcript of Bush speech http://georgewbush-whitehouse.archives.gov/news/releases/2005/11/20051101-1.htmlNov 1 IDSA press release
Feb 13, 2009 (CIDRAP News) – With money for pandemic influenza preparedness stripped from a huge economic stimulus bill that appears headed for final congressional approval, public health advocates say they have to look to the regular budgeting process for the next chance to get some pandemic funding.The House of Representatives had included $900 million in pandemic preparedness funds in its version of the massive stimulus package, but it appeared that all but $50 million was removed by the conference committee that ironed out differences between the House and Senate versions, said Richard Hamburg, government relations director for the nonpartisan, nonprofit group Trust for America’s Health (TFAH).The House passed the $787 billion compromise bill this afternoon by a vote of 246-183, with no Republican support, the New York Times reported. The story said the Senate was expected to approve the measure this evening.The $50 million left in the bill, listed as a Public Health and Social Services Emergency Fund, is for improving information technology security at the Department of Health and Human Services (HHS), Hamburg said. The sums removed included $420 million for pandemic flu and $430 million for biomedical advanced research and development, he reported.Now it’s back to the regular budget process for those seeking pandemic and other public health preparedness funds, leaders of public health groups say.”Hopefully in the president’s budget for 2010 there will again be funding and decisions about funding for preparedness,” said Robert (Bobby) Pestronk, executive director of the National Association of County and City Health Officials. The Obama administration is expected to propose its 2010 budget soon.Nothing left in pipelineHamburg said there is no more pandemic preparedness money in the pipeline for state and local public health. “The $600 million that was made available in December 2005, in the fiscal year 2006 emergency supplemental bill, the last of those dollars went out the door this past August,” he said.In addition to the cutoff of pandemic flu funding, public health agencies have seen their “all hazards” preparedness funding drop about 25% since 2005, Hamburg said.TFAH and its partners are advocating for another $350 million specifically for pandemic readiness and additional money for other public health emergencies, he said.Fiscal year 2009 budget legislation is still awaiting action, and it could include some pandemic money, but it would all be for federal activities, according to Hamburg.He said President Bush’s proposed 2009 budget included $507 million in one-time spending for pandemic vaccines and countermeasures, plus $312 million for annual recurring pandemic activities at HHS, but no funds for state and local activities. Hamburg expects that Congress may take up the labor and HHS funding bill, which includes that money, later this month.Some public health money survivedAlthough pandemic money was stripped from the stimulus package, still included is about $1 billion to support various other state and local public health activities, according to Pestronk.He said it appears that the sum includes $300 million for community vaccination programs and $50 million for healthcare-associated infections. Funds are also targeted for “evidence-based programs to address chronic disease and to support current and new workforce development for public health.” The vaccination funds are part of the Section 317 program, a Centers for Disease Control and Prevention immunization program mainly for uninsured and underinsured children, he said.”Overall it looks like there will be over $1 billion available,” Pestronk said. “I think that while the amounts initially talked about in the Senate committee and in the full House were greater, this is still a success for the public health community.”Story of the deleted $900 millionHamburg said the $900 million that was dropped from the stimulus package essentially represented the final installment of the $7.1 billion that President Bush proposed for pandemic preparedness back in 2005.In his proposed 2008 budget, Bush asked for a one-time appropriation of $870 million for vaccines, antivirals, and diagnostics, Hamburg explained. But that was cut from the final budget legislation. Then last August, Bush made a supplemental budget request that included the $870 million, which was for different purposes than the $507 million that was part of the 2009 budget proposal, he said.”So when the stimulus bill came up, our supporters in Congress saw an opportunity to take care of the $870 million request, with the assumption that the $507 million would be taken care of in the regular appropriations process,” Hamburg said.A Senate committee had approved the inclusion of $870 million in the stimulus bill, but that was removed before the full Senate voted on it. The House supported $900 million, but that was deleted by the House-Senate conference committee.Hamburg said a number of lawmakers felt that pandemic funding should be handled in the regular appropriations process, not in an economic stimulus measure.”Now we’ll need to take a look at opportunities starting with the fiscal year 2010 funding cycle and the [proposed] budget we’ll see in the next month or so,” he said.Dr. Paul Jarris, executive director of the Association of State and Territorial Health Officials, said yesterday, “We are extremely concerned about the diminishing funding for state and local preparedness as well as the removal of all funding for pandemic flu, and the decrease in funding for hospital preparedness. Along with the state budget cuts, this is a matter of losing the infrastructure created over the past several years.”Looking ahead, he said, “We will pursue everything we possibly can, but there are no guarantees. I wouldn’t’ say there are any promising leads we’re following right now. It seems that Congress is turning a blind eye to state and local health preparedness.”
Feb 25, 2009 (CIDRAP News) – Americans who receive anthrax shots—mainly members of the military—are likely to get five injections into muscle tissue instead of six subcutaneous injections, as a result of action today by the federal Advisory Committee on Immunization Practices (ACIP).The ACIP voted unanimously to make the changes in the schedule and route of administration for BioThrax, also known as anthrax vaccine adsorbed, according to Tom Skinner, a spokesman for the Centers for Disease Control and Prevention (CDC). BioThrax is the only anthrax vaccine currently licensed in the United States.Also, in making its annual recommendations for influenza prevention and control, the ACIP did not add any new age or risk groups to those already targeted for annual flu immunizations, Skinner reported.The ACIP sets the government’s immunization guidelines, making recommendations that are routinely approved by the CDC director and health and human services secretary.Change in anthrax regimenThe ACIP endorsed an anthrax vaccination schedule of intramuscular injections at 0 and 4 weeks and 6, 12, and 18 months, replacing the old regimen of subcutaneous injections at 0, 2, and 4 weeks and 6, 12, and 18 months, according to Skinner. Annual booster shots are also recommended after the initial series.”Subcutaneous administration is allowable only when medically indicated such as in persons with coagulation disorders,” Skinner reported in a written statement.The revised schedule and administration route stem from a large, ongoing clinical trial to determine if the long series of shots and resulting side effects can be reduced. The immunizations are required for US military personnel deployed in high-risk areas, mainly the Middle East, and some service members have objected to the shots because of side effects.In interim trial results reported last October, volunteers who received either three or four intramuscular doses over 6 months had about the same antibody responses at 7 months as did volunteers who received the standard regimen, involving four subcutaneous doses in the first 6 months. In addition, those who received intramuscular doses had fewer side effects at the injection site than those who received subcutaneous doses.As a result of those findings, in December the Food and Drug Administration (FDA) approved the five-dose intramuscular injection schedule. Emergent BioSolutions, manufacturer of BioThrax, had asked the FDA to authorize the new schedule.Emergent has said it may ask for FDA clearance to shorten the immunization series further, depending on future findings from the ongoing clinical trial.Flu-shot recommendationsIn approving its annual recommendations for flu immunization, the ACIP did not expand the recommendations to any new segments of the population. A year ago, the committee recommended flu immunizations for school-age children, adding about 30 million people to the millions already targeted for flu vaccination.”No new age or risk groups are being recommended to receive annual influenza vaccination,” Skinner said.He said no information on current flu immunization coverage among school children was presented at the meeting, adding, “We won’t know that for some time.”In addition to school children, the CDC recommends flu shots for children from 6 to 59 months old, people aged 50 and older, those with certain chronic medical conditions, people in nursing homes, pregnant women, healthcare workers, and other close contacts and caregivers of those who run an increased risk of flu complications.In line with previous recommendations by the World Health Organization and FDA, the ACIP also voted today to change the influenza B strain in the flu vaccine for next winter but to keep the two influenza A strains used in this year’s vaccine, according to Skinner.See also: Dec 22, 2008, CIDRAP News story “FDA approves shortened anthrax-vaccine course”Oct 6, 2008, CIDRAP News story “Trial offers hope for shortening anthrax-shot series”Emergent BioSolutionshttp://www.emergentbiosolutions.com/Feb 27, 2008, CIDRAP News story on ACIP meetinghttp://www.cidrap.umn.edu/cidrap/content/influenza/general/news/feb2707acip.html
Croatian National Tourist Board, CNTB office in France together with the Zagreb Tourist Board, in the prestigious museum area “Carrousel du Louvre“In Paris she presented an exhibition of photographs about Croatia by the author Davor Rostuhar. Exhibition Croatia. Full of colors. / Croatia. Full color. was opened by the Prime Minister of the Republic of Croatia Andrej Plenković in the presence of Minister of Culture Nina Obuljen Koržinek, Minister of Tourism Gari Cappelli, Director of the Croatian Tourist Board Kristjan Staničić, Director of the Zagreb Tourist Board Martina Bienenfeld and Director of the CNTB Representation in France Danijela Mihalić Đurica. Along with many guests, the opening of the exhibition was attended by Jean-François Legaret, Mayor of the First District of the City of Paris. The photo exhibition, which includes displays of all Croatian regions and its natural beauties, will be open to visitors until November 20, 2018, and it is estimated that around 3 million visitors will see it. “We are proud of the strong friendship that connects our countries, as well as this cooperation with which we got the opportunity to promote Croatia in the heart of Paris because France is one of the most important emitting markets for Croatian tourism. The French recognize Croatia as a country of rich cultural and historical heritage and quality eno-gastronomy, and we are additionally pleased with the growth of French interest, except for the favorite Dubrovnik and Split, for destinations and regions such as Zagreb, Istria, Kvarner and Slavonia”, said the director of the CNTB, Kristjan Staničić.By the way, this is the first time in history that a Croatian exhibition is held as part of the most visited museum in the world, the famous Louvre, where many visitors will have the opportunity to see a total of 26 beautiful and large format photos of Croatia. At the opening ceremony, many guests had the opportunity to taste Croatian products, and the gathered guests were entertained by the musical group “Kings of the Street”. In order for the experience to be complete, and for interested visitors to be able to get all the necessary information about the entire Croatian tourist offer during the exhibition, in an attractive space Carrousel du Louvrea a “Croatian corner” was also set up. “This unique opportunity to present our country and the capital in Paris is extremely important because about three million visitors, not only from France but also from all over the world, will see at least a part of the beauties of Zagreb and Croatia. With this exhibition, we place emphasis on culture, which, according to the UNWTO, is one of the main motivators of all travel. Recently, two million overnight stays were recorded in Zagreb, even a month earlier than last year, and with the exhibition of photographs by Davor Rostuhar, I believe that we will attract new visitors and thus continue the positive tourist growth that the Croatian capital, as the most important cultural destination, achieves from month to month.” said Martina Bienenfeld, director of the Zagreb Tourist Board.Author of the exhibited photographs, Davor Rostuhar / Photo: CNTBAuthor of exhibited photographs, Davor Rostuhar, emphasizes that photography has great power. “We imagine and remember photographically. One good photo of Croatia is enough for people from all over the world to remember it and to imagine our country in this way, and to decide to visit Croatia, perhaps because of it. I am glad that the Croatian National Tourist Board and the Zagreb Tourist Board recognized the quality of my photos and decided to promote Croatia through them in this prestigious area through which people from all over the world pass! This exhibition partly includes photographs taken in the project “National Geographic – Croatia from the air”, which was created for seven years and achieved great success in Croatia and in the world, but was also expanded and enriched with other Croatian motifs that were not taken from the air. This exhibition is therefore a kind of cross-section of my previous opus of photographs of Croatia”, said Rostuhar.During the first nine months, more than 556.000 arrivals and more than 2 million overnight stays were made from the French market, which is an increase of 8 percent in arrivals and 5 percent in overnight stays compared to the same period last year. Positive trends in tourist traffic are a consequence of the promotional activities carried out, as well as the expansion of the production of existing tour operators, ie the opening of Croatia as a new destination with French travel organizers. See more about Davor Rastuhar’s project, Croatia from the air HERE
The suggestion of the Community to join the requests of the Association of Travel Agencies of the Croatian Chamber of Commerce is to enable 100% full capacity of all types of tourist transport. They explain that these are known and closed groups in which all passengers are registered, unlike public transport. “All calculations are based on 80% occupancy, it is not profitable to work below that, and we will ensure compliance with all other epidemiological measures because the protection of the health of our guests is our first priority., concludes Bencun. The HGK Adventure Tourism Association has proposed to the competent ministry that the measures for the active and adventure tourism segment be reduced from 11 May. “We had a problem with the prices in the national parks that were raised in order to manage visitors last year, this year it will be unbearable to work under these conditions. There are other mechanisms for managing visitors, it cannot be a condition that only richer guests have the right to see our natural beauties. Not to mention that, unfortunately, we will not have the problem of overloading the number of visitors this yeari”, said Bencun. With regard to national parks, nature parks and other natural attractions, the Community has recommended, inter alia, an urgent reduction in ticket prices and the return of advances to agencies for paid tickets that will not be used. They outlined a number of measures that can be implemented so that cycling, hiking, horseback riding and other tourist services of active and adventure tourism, which are determined by the Law of the Adventure Tourism Association of the Croatian Chamber of Commerce, can be performed as safely as possible. They point out that they are satisfied with the current cooperation with the relevant Ministry of Tourism and epidemiologists and their respect for the proposals of the profession. “These are specific activities in which the profession is used to paying attention to the safety of clients, and as most programs are implemented in a nature that allows the prescribed social distance, we believe that almost all activities can be carried out without major difficulties., said the president of the community Iva Bencun.