New Report Shows Lessons Learned From the H1N1 Swine Flu Outbreak

Trust for America’s Health (TFAH), the Center for Biosecurity, and the Robert Wood Johnson Foundation (RWJF) issued a new report called “Pandemic Flu: Lessons From the Frontlines”. The report found that the initial response to the H1N1 Swine flu outbreak “showed strong coordination and communication and an ability to adapt to changing circumstances from U.S. officials”. But, the report also shows how the US core public health capacity would be severely overwhelmed if a more severe outbreak was much more widespread.

The Pandemic Flu: Lessons from the Frontlines report reviews 10 early lessons learned from the response to the H1N1 (swine) flu outbreak, 10 ongoing core vulnerabilities in U.S. pandemic flu preparedness, and case studies of challenges communities around the country faced when responding to the outbreak. The 10 early lessons learned from the 2009 H1N1 outbreak in the report were that:

1. Investments in pandemic planning and stockpiling antiviral medications paid off;
2. Public health departments did not have enough resources to carry out plans;
3. Response plans must be adaptable and science-driven;
4. Providing clear, straightforward information to the public was essential for allaying fears and building trust;
5. School closings have major ramifications for students, parents and employers;
6. Sick leave and policies for limiting mass gatherings were also problematic;
7. Even with a mild outbreak, the health care delivery system was overwhelmed;
8. Communication between the public health system and health providers was not well coordinated;
9. WHO pandemic alert phases caused confusion; and
10. International coordination was more complicated than expected.

The report also identified some surprises encountered during the H1N1 Swine Flu outbreak, including that much of the world’s pandemic planning had revolved around the potential threat of the H5N1 (bird) flu virus, which had been circulating in Asia and elsewhere for nearly a decade. It also reveals that planners anticipated there would be six weeks of lead time between the time a novel flu virus was identified and its spread to the United States.

In addition, according to the analysis in Pandemic Flu: Lessons from the Frontlines, there are a number of systemic gaps in the nation’s ability to respond to a pandemic flu outbreak. To further strengthen U.S. preparedness, the following 10 core areas must be addressed:

1. Maintaining the Strategic National Stockpile– making sure enough antiviral medications, vaccinations, and equipment are available to protect Americans, which includes replenishing the stockpile when medications and supplies are used;
2. Vaccine development and production– enhancing the biomedical research and development abilities of the United States to rapidly develop and produce a vaccine;
3. Vaccinating all Americans — ensuring that all Americans would be able to be inoculated in a short period of time;
4. Planning and Coordination — improving coordination among federal, state, and local governments and the private sector preparedness and planning activities on an ongoing basis, including taking into account how the nature of flu threats change over time;
5. School closings, sick leave, and community mitigation strategies — improving strategies to limit the spread of disease ensuring all working Americans have sick leave benefits and that communities are prepared to limit public gatherings and close schools as necessary;
6. Global coordination — building trust, technologies, and policies internationally to encourage science-based, consistent decision making across borders during an outbreak;
7. Resources — providing enough funding for the on-the-ground response, which is currently under funded and overextended;
8. Workforce — stopping layoffs at state and local health departments and recruiting the next generation of public health professionals;
9. Surge capacity — improving the ability for health providers to manage a massive influx of patients; and
10. Caring for the uninsured and underinsured — ensuring that all Americans will receive care during an emergency, which limits the spread of the contagious disease to others, and making sure hospitals and health care providers are compensated for providing care.

The full analysis is available on TFAH’s Web site at The report was supported by a grant from RWJF.

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

The Center for Biosecurity is an independent, non-profit organization of the University of Pittsburgh Medical Center. Their mission is to strengthen national security by reducing the risks posed by biological attacks, epidemics, and other destabilizing events and to improve the nation’s resilience in the face of such incidents.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. Helping Americans lead healthier lives and get the care they need — the Foundation expects to make a difference in our lifetime. For more information, visit

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