Doctoral student’s work helps communities prepare for next flu pandemic

November 30, 2012
It’s that time of year again – time to start thinking about influenza (flu) and steps to guard against it. More than 40 states already are reporting cases of seasonal flu, and while experts don’t expect a pandemic this year, they say it is never too early to get plans in place.
Lisa Koonin

Lisa Koonin

A new paper co-authored by Lisa Koonin, MN, MPH, offers local and state public health officials guidance that reflects lessons learned from the response to the 2009 HINI pandemic virus. Koonin is a doctoral student in the health policy and management department’s executive leadership program at the Gillings School of Global Public Health at UNC-Chapel Hill and senior adviser in the Center for Disease Control and Prevention’s Influenza Coordination Unit, part of the CDC’s Office of Infectious Diseases.

Koonin’s paper, “Selecting Nonpharmaceutical Strategies to Minimize Influenza Spread: The 2009 Influenza A (H1N1) Pandemic and Beyond,” published in the November-December issue of Public Health Reports, provides a road map for making decisions about when and how to use nonpharmacologic approaches – strategies that can help control a flu pandemic before a well-matched vaccine becomes available.
The paper was informed by input from stakeholders who responded to the 2009 pandemic and further builds on recommendations published by the CDC in 2007 that provide guidance about strategies that could be used during an influenza pandemic. Koonin and other CDC scientists were co-authors of that guidance (PDF).
“There likely will be another pandemic of flu, but we can’t predict when it is going to come or how severe it will be,” said Koonin, who leads several pandemic influenza planning issues at CDC. “We do know that state and local public health authorities need a flexible decision-making process to be able to respond to and adjust prevention strategies as the virus emerges.”
That’s because public health authorities will need to make difficult decisions about how to protect the public early in the course of a pandemic, and often without a great deal of information about the emerging outbreak. Nonpharmacologic strategies are particularly critical during the earliest stages of a pandemic, Koonin says. Such strategies include the use of face masks and social distancing to separate sick people from those who are well (e.g., dismissing schools, canceling events).
“The complicating factor about flu is that about 30 percent of people could be ill and spreading the disease, but are not showing symptoms,” Koonin said. “The flu spreads very easily from person to person. That’s why, during a severe pandemic, we might need to be proactive and not let people cluster together in small spaces. We might need to protect children by sending them home from school so they don’t get exposed or spread the virus to others. These are hard things to do and can be disruptive, but they are actions that could help protect the public.”
In looking back at the 2009 H1N1 pandemic, Koonin said it was a challenge for public health officials to decide what to do — what was feasible and would be accepted. “This paper addresses the kinds of decisions that local and state public health authorities need to make, and it gives them questions to consider,” she said.
Of course, decision making during a pandemic is an ongoing process and must be highly responsive to conditions in a particular community or region. State and local public health officials will need to weigh pros and cons of implementing pandemic protective measures.
Other co-authors include Koonin’s CDC colleagues, Lisa C. Barrios, MS, DrPH (UNC 1996), Katrin S. Kohl, MD, MPH, and Martin Cetron, MD.
For up-to-date information about this flu season, visit


UNC Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or