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Antiviral Prioritization, Planning Antiviral Prioritization, Planning and Production Capacityand Production Capacity

June 28, 2007

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Federal Perspective on Antiviral Federal Perspective on Antiviral Federal Perspective on Antiviral Federal Perspective on Antiviral Federal Perspective on Antiviral Federal Perspective on Antiviral Federal Perspective on Antiviral Federal Perspective on Antiviral PrioritizationPrioritizationPrioritizationPrioritizationPrioritizationPrioritizationPrioritizationPrioritization during a Pandemicduring a Pandemicduring a Pandemicduring a Pandemicduring a Pandemicduring a Pandemicduring a Pandemicduring a Pandemic

Alicia M. Fry, MD MPHAlicia M. Fry, MD MPHInfluenza DivisionInfluenza Division

Centers for Disease Control & Prevention Centers for Disease Control & Prevention Atlanta, GAAtlanta, GA

ObjectivesObjectivesObjectivesObjectivesObjectivesObjectivesObjectivesObjectives

Antiviral agents in the SNSAntiviral agents in the SNS

Goals for the Federal SNS Goals for the Federal SNS

Guidance for antiviral use during a pandemicGuidance for antiviral use during a pandemic

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Antiviral MedicationsAntiviral MedicationsAntiviral MedicationsAntiviral MedicationsAntiviral MedicationsAntiviral MedicationsAntiviral MedicationsAntiviral Medications

2 Classes of drugs currently available2 Classes of drugs currently available

Adamantanes Adamantanes

Amantadine, RimantadineAmantadine, Rimantadine

Active only against influenza A virusesActive only against influenza A viruses

Neuraminidase inhibitors Neuraminidase inhibitors

Oseltamivir, Zanamivir, others Oseltamivir, Zanamivir, others

Active against influenza A and B virusesActive against influenza A and B viruses

Amantadine (1976)

Rimantadine (1993)

Resistant viruses emerge

rapidly during treatment

and spread easily

Inexpensive

Treatment of choice for

influenza A – until

recently

Adamantane DerivativesAdamantane DerivativesAdamantane DerivativesAdamantane Derivatives

4

Zanamivir: Relenza (1999)

Oseltamivir: Tamiflu (1999)

Resistance rare

Resistant viruses replicate

& transmit less effectively

Expensive

Neuraminidase InhibitorsNeuraminidase InhibitorsNeuraminidase InhibitorsNeuraminidase Inhibitors

Antiviral TreatmentAntiviral TreatmentAntiviral TreatmentAntiviral TreatmentAntiviral TreatmentAntiviral TreatmentAntiviral TreatmentAntiviral Treatment

Each of the 4 drugs is equally efficacious Each of the 4 drugs is equally efficacious against susceptible virusesagainst susceptible viruses

Decrease the duration and symptoms of Decrease the duration and symptoms of uncomplicated influenza by ~ 1uncomplicated influenza by ~ 1--2 days2 days

Decrease viral sheddingDecrease viral shedding

Early treatment with neuraminidase Early treatment with neuraminidase inhibitors may reduce some complicationsinhibitors may reduce some complications

Otitis media, lower respiratory tract Otitis media, lower respiratory tract complications, antibiotic usecomplications, antibiotic use

Hospitalizations by ~50% in pooled trials dataHospitalizations by ~50% in pooled trials data

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Antiviral prophylaxisAntiviral prophylaxisAntiviral prophylaxisAntiviral prophylaxisAntiviral prophylaxisAntiviral prophylaxisAntiviral prophylaxisAntiviral prophylaxis

4 approved drugs4 approved drugs

Varies by age Varies by age AmantadineAmantadine, Rimantadine: , Rimantadine: ≥≥1 year1 year

Oseltamivir: Oseltamivir: ≥≥1 years, Zanamivir 1 years, Zanamivir >>5yrs5yrs

Approximately 70Approximately 70--90% effective in 90% effective in preventing influenza illness preventing influenza illness

No interference with immune response to No interference with immune response to trivalent inactivated influenza vaccinetrivalent inactivated influenza vaccine

LAIV should not be given until 48 hours after LAIV should not be given until 48 hours after cessation of antiviralscessation of antivirals

Adamantane ResistanceAdamantane ResistanceAdamantane ResistanceAdamantane ResistanceAdamantane ResistanceAdamantane ResistanceAdamantane ResistanceAdamantane ResistanceMay develop in 2May develop in 2--5 days in 105 days in 10--30% of patients due 30% of patients due to a point mutationto a point mutation

Resistant viruses are crossResistant viruses are cross--resistantresistant

Transmissibility and Transmissibility and pathogenicitypathogenicity unchangedunchanged

Transmission seen in households & institutionsTransmission seen in households & institutions

Dramatic increase in U.S. H3N2 resistanceDramatic increase in U.S. H3N2 resistance

2% during 20032% during 2003--04; 11% during 200404; 11% during 2004--05; 96% during 05; 96% during 20052005--06; 85% during 200606; 85% during 2006--0707

H1N1 resistance in US: 4% during 2004H1N1 resistance in US: 4% during 2004--05, 3% 05, 3% during 2006during 2006--0707

H5N1 resistance variableH5N1 resistance variable

cladeclade 1:1: 100 %100 %

cladeclade 22--1:1: ~80%~80%

cladesclades 22--2 & 22 & 2--3:3: 0% 0%

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Neuraminidase Inhibitor Neuraminidase Inhibitor Neuraminidase Inhibitor Neuraminidase Inhibitor Neuraminidase Inhibitor Neuraminidase Inhibitor Neuraminidase Inhibitor Neuraminidase Inhibitor ResistanceResistanceResistanceResistanceResistanceResistanceResistanceResistanceOseltamivir resistance among H3N2 viruses tested Oseltamivir resistance among H3N2 viruses tested <1%<1%

18% in Japanese pediatric treatment study18% in Japanese pediatric treatment study

Often prescribed for >5 daysOften prescribed for >5 days

Reduced Reduced oseltamiviroseltamivir sensitivity among 1sensitivity among 1--2% of 2% of influenza B viruses in Japaninfluenza B viruses in Japan

H5N1 resistanceH5N1 resistance

‘‘MixedMixed’’ H5N1 virus population from 1 treated child showed H5N1 virus population from 1 treated child showed variable oseltamivir sensitivities variable oseltamivir sensitivities

2 of 8 Vietnamese children in recent report had H5N1 virus 2 of 8 Vietnamese children in recent report had H5N1 virus populations demonstrating resistance populations demonstrating resistance

2 Egyptian patients infected with H5N1 virus with reduced 2 Egyptian patients infected with H5N1 virus with reduced sensitivitysensitivity

HHS Goals for StockpilingHHS Goals for StockpilingHHS Goals for StockpilingHHS Goals for StockpilingHHS Goals for StockpilingHHS Goals for StockpilingHHS Goals for StockpilingHHS Goals for Stockpiling81 million courses procured by Federal and 81 million courses procured by Federal and State governmentsState governments

75 million courses to cover treating 25% of the 75 million courses to cover treating 25% of the populationpopulation

6 million to support initial efforts at containment6 million to support initial efforts at containment

SNS goal is 50 million courses: split 80% SNS goal is 50 million courses: split 80% oseltamivir, 20% zanamiviroseltamivir, 20% zanamivir

44 million for pro rata distribution to states from 44 million for pro rata distribution to states from SNS at first sign of a pandemicSNS at first sign of a pandemic

6 million to support containment efforts6 million to support containment efforts

States are expected to purchase remaining States are expected to purchase remaining 31 million, with 25% Federal funding31 million, with 25% Federal funding

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Antiviral Drugs in the SNSAntiviral Drugs in the SNSAntiviral Drugs in the SNSAntiviral Drugs in the SNSAntiviral Drugs in the SNSAntiviral Drugs in the SNSAntiviral Drugs in the SNSAntiviral Drugs in the SNS

5.1 million regimens on hand5.1 million regimens on hand

1.3 million regimens on order1.3 million regimens on order

Relenza (zanamivir)Relenza (zanamivir)Relenza (zanamivir)Relenza (zanamivir)Relenza (zanamivir)Relenza (zanamivir)Relenza (zanamivir)Relenza (zanamivir)

(inhalation system)(inhalation system)

27.8 million regimens on hand27.8 million regimens on hand

3.0 million regimens on order3.0 million regimens on order

Tamiflu (oseltamivir) Tamiflu (oseltamivir) Tamiflu (oseltamivir) Tamiflu (oseltamivir) Tamiflu (oseltamivir) Tamiflu (oseltamivir) Tamiflu (oseltamivir) Tamiflu (oseltamivir)

(capsules and suspension)(capsules and suspension)

Total 5 day treatment regimens* as of 06/01/2007Total 5 day treatment regimens* as of 06/01/2007

* Based on FDA approved treatment regimen

••In addition, 2.9 million regimens of rimantadine, In addition, 2.9 million regimens of rimantadine,

purchased in a season of influenza vaccine shortage, purchased in a season of influenza vaccine shortage,

are still held in the SNS.are still held in the SNS.

2005 HHS Pandemic Plan for 2005 HHS Pandemic Plan for 2005 HHS Pandemic Plan for 2005 HHS Pandemic Plan for 2005 HHS Pandemic Plan for 2005 HHS Pandemic Plan for 2005 HHS Pandemic Plan for 2005 HHS Pandemic Plan for Antiviral UseAntiviral UseAntiviral UseAntiviral UseAntiviral UseAntiviral UseAntiviral UseAntiviral UseNeuraminidase inhibitors preferred because Neuraminidase inhibitors preferred because of resistance issuesof resistance issues

The fall 2005 plan recommends the use of The fall 2005 plan recommends the use of oseltamivir or zanamivir for treatment, oseltamivir or zanamivir for treatment, administered ideally within 48 hours after administered ideally within 48 hours after onset of symptomsonset of symptoms

Treatment preferred over prophylaxis Treatment preferred over prophylaxis because of supply and distribution concernsbecause of supply and distribution concerns

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2005 HHS Pandemic Plan: Use 2005 HHS Pandemic Plan: Use 2005 HHS Pandemic Plan: Use 2005 HHS Pandemic Plan: Use 2005 HHS Pandemic Plan: Use 2005 HHS Pandemic Plan: Use 2005 HHS Pandemic Plan: Use 2005 HHS Pandemic Plan: Use of Antivirals for treatmentof Antivirals for treatmentof Antivirals for treatmentof Antivirals for treatmentof Antivirals for treatmentof Antivirals for treatmentof Antivirals for treatmentof Antivirals for treatmentUntil the SNS target is achieved NVAC Until the SNS target is achieved NVAC recommended priority groups for antiviral recommended priority groups for antiviral treatment should be used for guidancetreatment should be used for guidance

Once the SNS antiviral target is achieved the Once the SNS antiviral target is achieved the goal is to treat all ill personsgoal is to treat all ill persons

NVAC Antiviral Priority GroupsNVAC Antiviral Priority GroupsNVAC Antiviral Priority GroupsNVAC Antiviral Priority GroupsNVAC Antiviral Priority GroupsNVAC Antiviral Priority GroupsNVAC Antiviral Priority GroupsNVAC Antiviral Priority Groups1.1. Hospitalized patients with Hospitalized patients with

influenza: 7.5M coursesinfluenza: 7.5M courses

2.2. HCWsHCWs with direct patient with direct patient contact: 2.4M contact: 2.4M

3.3. Highest risk outpatients: Highest risk outpatients: 0.7 M 0.7 M

4.4. Pandemic health Pandemic health responders, public safety responders, public safety & government decision & government decision makers: 0.9 Mmakers: 0.9 M

5.5. Increased risk Increased risk outpatients: 22.4M outpatients: 22.4M

6.6. Outbreak response (PEP Outbreak response (PEP in nursing homes): 2M in nursing homes): 2M

7.7. Prophylaxis of Prophylaxis of HCWsHCWs in in ER, ICU, EMS: 4.8M ER, ICU, EMS: 4.8M

8.8. Pandemic societal Pandemic societal responders & other responders & other HCWsHCWs: 2.7M : 2.7M

9.9. Other outpatients: 47.3M Other outpatients: 47.3M

10.10. Prophylaxis for highest Prophylaxis for highest risk outpatients: 10Mrisk outpatients: 10M

11.11. Prophylaxis for other Prophylaxis for other HCWsHCWs w/patient contact: w/patient contact: 32M32M

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HHS Pandemic Plan: Use of HHS Pandemic Plan: Use of HHS Pandemic Plan: Use of HHS Pandemic Plan: Use of HHS Pandemic Plan: Use of HHS Pandemic Plan: Use of HHS Pandemic Plan: Use of HHS Pandemic Plan: Use of antivirals for containment of antivirals for containment of antivirals for containment of antivirals for containment of antivirals for containment of antivirals for containment of antivirals for containment of antivirals for containment of disease clustersdisease clustersdisease clustersdisease clustersdisease clustersdisease clustersdisease clustersdisease clusters

In special circumstances, state and local In special circumstances, state and local health departments could consider health departments could consider ““targeted targeted antiviral prophylaxisantiviral prophylaxis”” as a communityas a community--based based measure for containing small clusters of measure for containing small clusters of infection with novel strains of influenza.infection with novel strains of influenza.

HHS Pandemic Plan: Use of HHS Pandemic Plan: Use of HHS Pandemic Plan: Use of HHS Pandemic Plan: Use of HHS Pandemic Plan: Use of HHS Pandemic Plan: Use of HHS Pandemic Plan: Use of HHS Pandemic Plan: Use of antivirals for containment of antivirals for containment of antivirals for containment of antivirals for containment of antivirals for containment of antivirals for containment of antivirals for containment of antivirals for containment of disease clustersdisease clustersdisease clustersdisease clustersdisease clustersdisease clustersdisease clustersdisease clustersIncludes case finding, case treatment, Includes case finding, case treatment, identification of close contacts and post identification of close contacts and post exposure prophylaxis exposure prophylaxis

This measure could be implemented in This measure could be implemented in small, wellsmall, well--defined settings such as the defined settings such as the initial introduction of a virus with pandemic initial introduction of a virus with pandemic potential into a small communitypotential into a small community

However, once a pandemic is underway, However, once a pandemic is underway, such a strategy may such a strategy may not not represent an represent an efficient use of limited antiviral supplies efficient use of limited antiviral supplies

10

Use of Antiviral AgentsUse of Antiviral AgentsUse of Antiviral AgentsUse of Antiviral AgentsUse of Antiviral AgentsUse of Antiviral AgentsUse of Antiviral AgentsUse of Antiviral Agents

Amount of antiviral agents available to local Amount of antiviral agents available to local health departments will influence priorities health departments will influence priorities for usefor use

Current federal stockpileCurrent federal stockpile

Current state stockpiles (including private sector, Current state stockpiles (including private sector, if applicable)if applicable)

As production capacity of oseltamivir As production capacity of oseltamivir increases and supply increases, additional increases and supply increases, additional uses of antiviral agents can be considered. uses of antiviral agents can be considered.

An interagency working group is working on An interagency working group is working on an update on antiviral guidance, including an update on antiviral guidance, including use for prophylaxisuse for prophylaxis

SummarySummarySummarySummarySummarySummarySummarySummarySummarySummarySummarySummary• Neuraminidase inhibitors are the

preferred agents during a pandemic

• Current HHS antiviral goals are to provide treatment to ALL ill persons during a pandemic persons

• Until federal and state stockpile targets are achieved, prioritization of antiviral agents may be necessary (NVAC prioritization guidelines)

• Discussions regarding use of antivirals for prophylaxis are underway

•• Neuraminidase inhibitors are the Neuraminidase inhibitors are the preferred agents during a pandemicpreferred agents during a pandemic

•• Current HHS antiviral goals are to provide Current HHS antiviral goals are to provide treatment to ALL ill persons during a treatment to ALL ill persons during a pandemic personspandemic persons

•• Until federal and state stockpile targets Until federal and state stockpile targets are achieved, prioritization of antiviral are achieved, prioritization of antiviral agents may be necessary (NVAC agents may be necessary (NVAC prioritization guidelines)prioritization guidelines)

•• Discussions regarding use of antivirals for Discussions regarding use of antivirals for prophylaxis are underwayprophylaxis are underway

11

AcknowledgementsAcknowledgementsAcknowledgementsAcknowledgementsAcknowledgementsAcknowledgementsAcknowledgementsAcknowledgements

Influenza Division, NCIRD, CDCInfluenza Division, NCIRD, CDCInfluenza Division, NCIRD, CDCInfluenza Division, NCIRD, CDCInfluenza Division, NCIRD, CDCInfluenza Division, NCIRD, CDCInfluenza Division, NCIRD, CDCInfluenza Division, NCIRD, CDC

DSNS, COTPER, CDCDSNS, COTPER, CDCDSNS, COTPER, CDCDSNS, COTPER, CDCDSNS, COTPER, CDCDSNS, COTPER, CDCDSNS, COTPER, CDCDSNS, COTPER, CDC

Interagency antiviral working group Interagency antiviral working group Interagency antiviral working group Interagency antiviral working group Interagency antiviral working group Interagency antiviral working group Interagency antiviral working group Interagency antiviral working group

Production and Distribution Capacity for Treatment and Prophylaxis Before and During a Pandemic

Mike McGuireVice President, Anti-InfectivesMarketing

12

Update of government pandemic stockpiling

• Roche has

– Received orders or letters of intent from the governments of more than

80 countries ,

– Accounting for firm orders of ~215 million treatment courses

0

10

20

30

40

50

60

70

80

90

100

110

2004 2005 2006 2007

num

ber o

f Tam

iflu

trea

tmen

ts in

Mio

Q4

Q1

Q3

Q1

Q2

Published targeted levels of stockpiles > 5%in % of total population based on treatment

0%

10%

20%

30%

40%

50%

60%

Greece

Brazil Ita

ly

Cypru

s

Taiwan

Czech

Repub

lic

Sweden

German

y

Canad

a

Denm

ark

Japan

Algeria

Hong

Kong

Portugal

SpainMalta

United K

ingdomIre

land

United

Sta

tes

Slovenia

Finlan

d

BelgiumMac

au

Norway

Austria

New Z

ealand

Netherla

nds

Singapore

Qatar

Iceland

Switzerla

nd

Kuwait

Luxembo

urg

Australi

a

France

% c

over

age

base

d on

trea

tmen

t

Sources: Media / National pandemic plans (as of April 1, 2007)

13

Manufacturing Tamiflu

• Threat of pandemic was a “call-to-action” for rapid capacity expansion

• Tamiflu production is a complex, multi-step process

• Current manufacturing network involves 19 partner companies

• By end-2006, Roche increased production 15-fold versus the levels of production in 2004

• In addition, agreements with 4 third-party manufacturers (China, India, South Africa)

Shikimic acid Epoxide

AzideSmallvessels

Dangerous: toxic and potentially explosive

Drying

Final step

Chemicalplant Filtration

FINAL STEP

Filtration

CHEMICAL CONVERSION

ANISE

E-COLI

•Extraction•Concentration•Purification

•Modification•Removal of biomass

•Extraction of acid

ANISE

E.COLI

1st step

3rd step

Chemical plant Drying

2nd step

Recap: The making of Tamiflu

Active ingredient

14

Recap: The making of Tamiflu

Active ingredient

Tamiflu Supply Chain: September 2005 (baseline)

external production partners

Roche

Shikimic acid

Epoxide Azide EncapsulationActiveingredient

15

Production Capacity for Tamiflu 1999-2007

5.5 18 2755

190

0

50

100

150

200

250

300

350

400

450

'99 - '02 2003 2004 2005 2006 2007

Millions of treatmentcourses

External partners help boost capacity further to meet increased demands for pandemic stockpiles

Volumes actually PRODUCED per year

Tamiflu supply chain today

EPX

external production partners

Roche

Shikimic acid

Epoxide Azide EncapsulationActiveingredient

16

TamifluTailoring manufacturing output to actual demand

Production well in excess of current order book

Tamiflu Planned approach going forward

• Adapt Tamiflu supply chain output in accordance with demand

• Maintain a buffer stock of intermediates and final active ingredient (oseltamivir)

• Gearing up of production will be triggered by one of two events1. Roche inventories of final active ingredient (oseltamivir) or key

intermediates drop below target levels2. WHO declares pandemic has evolved to phase 4 (human to

human transmission)*

*this could support wave two of a pandemic

17

A responsible approach

• Governments worldwide purchase pandemic supplies of Tamiflu at a significantly reduced price

• Roche has demonstrated the ability to produce more than 400 million packs of Tamiflu annually

• Agreements to manufacture supplies for local pandemic use have been granted to companies for China, India and Africa

• BUT… capacity now outstrips demand of government and corporate orders

We Innovate Healthcare

18

Case Study: Business-Public Health Partnership in Georgia

James W. Buehler, MDCenter for Public Health Preparedness & Research

Rollins School of Public HealthEmory University

Image sources: www.cdc.gov, www.wikipedia.org, www.georgia.gov

• Context: Cities Readiness Initiative– Anthrax bioterrorism scenario– How do you administer antibiotic prophylaxis

to 5 million people in metro Atlanta in <48 hours?

• Partnership issues relevant to pan flu & other hazards

19

Business Executives for National Security(BENS) www.bens.org

• Not-for-profit, non-partisan• National organization, local/regional

chapters• Business Force: Business collaboration

with state and local gov’ts for preparedness

Initial Efforts of Partnership

• July 2005, SNS dispensing exercise– GA Division of Public Health & local PH Districts– 2 sites in metro Atlanta

• Company facility• School

– BENS & business members supported• Planning, design, and after-action review• Mobilized 1,200 business volunteers

– Clinic managers (1 site) & staff– Mock patients– Exercise evaluators

Image: www.sph.emory.edu

20

Background

• NBGH previously identified unmet potential of business & PH partnerships

• Were there insights to be gained from studying the partnership in GA?– Expansion in GA– Business & PH leaders in other states

• Case-study investigation funded by the Alfred P. Sloan Foundation

• Could we identify useful insights from the partners’ experience?– Expansion in GA– Business & PH leaders in other states

Image source: www.keystone.org via www.pandemicflu.gov

21

Study Questions

• Motivation• Enablers• Challenges• Impact on emergency preparedness• Reasonable expectations• Future issues

Case Study• Interviews with 26 participants

– Government• Public health: local, state, federal• Public safety & homeland security

– Business• BENS staff• Business members

– Academia

22

Business

"We're a part of the community and should be a part of the solution"

[ We have a ] “fear of failure and a clear understanding of the limits of government"

Public Health

“If we can’t find a way to solve this [ mass dispensing ], people are going to die.”

“Public health…can’t do it alone, [ we ] need to reach out.”

“Complex logistics—that’s what businesses do.”

Motivation

Initial Challenge—Culture Gap• Stereotypes & Limited

– Familiarity – Contacts– Precedent for collaboration

• History shaped by – Regulation – Contract & procurement rules

• Differences in – Management styles

• Business: Centralized authority, standardized procedures• PH: Decentralized authority, local flexibility

– Accountability• Business: Shareholders (value efficiency)• PH: Political process

Image source: www.usa.gov

23

What made it easier to work together?

• BENS focus on:– Volunteer service

• Not part of post-9/11 vendor avalanche

– Engagement of • Senior gov’t and business leaders• Multiple gov’t preparedness agencies• Multiple area businesses

– Business model• Identify priority tasks• Mesh partners’ assets• Ambitious, feasible, measurable projects

• PH & BENS: Willingness to develop new relationship & commitment to stick with it

Concerns as work began…• Legal issues

– Confidentiality of proprietary information• Potential access via “open record” laws

– Liability—Limits of “Good Samaritan”laws

• Protect individual responding to crisis• What about: business and pre-event

exercises?

• Frustration with delays– Government’s “flavor of the month”

• Logistic– Mock patient recruitment: half empty or

half full

Image source: www.georgia.gov

24

Evidence of Benefit• Working relationships & trust established

– “We’re on each other’s speed dials.”– "We're learning to think like them and they're learning

to think like us.”• SNS dispensing

– Substantial engagement of private resources & expertise– Successful test of collaborative model for dispensing &

commitment to expand– "Are we better prepared? Absolutely, but we're not

ready. We're halfway through the first quarter.“• Georgia’s response to Katrina

– Easier for businesses to offer services– Easier for government to ask for help

• Expansion to pandemic influenza planning• Commitment to expansion & CDC support

Image source: www.usa.gov

Key Lessons

• BENS was strategic in its outreach to government.• Mass dispensing is a clear example of the potential

value of government-business collaboration.• Business leaders and government officials were willing

to entertain a new type of relationship with one another.• Partners recognized & addressed challenges to

collaboration (ongoing).• Business model resonated with business and public

health participants.• The concept of community continuity bridges

principles of business continuity and public health.

25

Future Issues• Importance and limits of volunteerism• Managing & funding growth• Ongoing differences in perspective & styles• Timing

– “Relationship building cannot be rushed”– “You need to make a start”

• Legal issues: liability, confidentiality • Respecting roles

– Government responsibilities & public expectations– Potential collaboration with multiple business organizations

• Maintain value proposition: “If we are not creating value for other members, the team will not survive. If we can to that, we can sustain our effort."

• Communication with media & public

Next Step: Community Continuity Atlanta Partnership

(CCAP)

• CDC support for expansion to involve POD exercise with 5-6 metro Atlanta public health districts

• Business-PH-Academic partnership• POD model

– Core PH IC and health team– Staffing by business volunteers

• Small pre-trained group• Just-in-time training

• PH updating POD operations plan• BENS developing business guidance• Hands-On Atlanta recruiting volunteers for mock patients• Potential applicability to pandemic flu dispensing• Evaluation planning

26

AcknowledgementsProject advisory group

Metro Atlanta Region, Business Executives for National Security:Conrad "Connie" Busch, Jr., APRJohn H. H. Turner, IIIAnthony Begando

Division of Public Health, GA Dept. of Human ResourcesJ. Patrick O'Neal, MDCalita Richards, PharmD, MPHLee Smith

Study teamJames Buehler MD, Ellen Whitney MPH, Ruth Berkelman MD Full report at BioMed Central Public Healthhttp://www.biomedcentral.com/1471-2458/6/285

FundingAlfred P. Sloan Foundation O. Wayne Rollins FoundationCDC

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