The H1N1 flu outbreak revealed the shortcomings in the nation's pandemic preparedness.
Sick patients jammed clinics and hospitals, pushing many to their capacity limits.
Manufacturers took a half of a year to make a vaccine because they're still relying on 1950s technology. Once the vaccine was finally ready, the government pressed already overburdened health care providers to help distribute the doses.
If this had been a more severe pandemic these problems wouldn't be merely frustrating, they could have had catastrophic consequences. Nicole Lurie, assistant secretary for preparedness and response at the Department of Health and Human Services, said her organization plans to review the government's strategies for dealing with public health threats.
"There are many, many things that we need to take a look at and to try to learn from," Lurie said.
Some public health advocates believe the lessons from this experience are a wakeup call. The Department of Health and Human Services' review is broad in scope and will include threats such as bioterrorism and natural disasters. But the H1N1 outbreak and frustrations over the slow rollout of vaccine have given a special urgency to the agency's task.
For the past 50 years, the U.S. has relied on an antiquated process that uses chicken eggs to grow flu viruses. The technique takes a minimum of six months when growing conditions are ideal. Problems slowed the process this fall, which is why it took so long to produce substantial quantities of vaccine.
Lurie will look at whether it's feasible to switch to new technologies anytime soon. But she said the bar for adopting a new production technique is extremely high.
"We are relying on some of the best manufacturers in the world, and even they're having challenges," Lurie said. "So imagine the challenges if we were to rely on a startup company, because large manufacturers haven't been interested in getting into the market?"
During the H1N1 outbreak, the government relied heavily on private health care providers to give vaccine to their patients. Lurie said that approach seemed like the best way to move doses quickly, because most Americans who get a flu shot are already used to getting it from their own doctor, nurse or pharmacy.
But the additional vaccine duties swamped many clinics and hospitals that were already stretched as they cared for flu patients. That slowed the flow of vaccine at times, stretching out vaccinations over weeks instead of days.
During the last swine flu pandemic in 1976, the government relied much more on mass vaccination clinics.
"There were major public clinics set up with people who were designated just to vaccinate people for days on end. There were really large assembly line-like approaches," said Mike Osterholm, director of the Center for Infectious Disease Research and Policy.
Osterholm helped organize some of Minnesota's mass clinics in 1976. He thinks the process was much more efficient at getting vaccine to people, but he said the same approach couldn't be taken now because it requires an army of health care workers -- an army that no longer exists.
"Today we have really a very limited capacity within our health care system and within our public health systems to vaccinate many, many thousands of people," Osterholm said.
Osterholm said more funding is key to any meaningful improvements in the nation's pandemic response. He said the public health system needs to be rebuilt.
Richard Hamburg, deputy director of the advocacy group Trust For America's Health, agrees. He said the H1N1 outbreak was a reminder that even a relatively mild pandemic can overwhelm the health care system. He said the U.S. got a wakeup call that it shouldn't ignore.
"I guess the good news is we have a little time at some point to sit back and look at the lessons learned, and do a lot of things more effectively next time," he said.
Hamburg said in spite of its faults, the U.S. pandemic response was actually much better than it would have been even five years ago. He said some of the credit should go to the Bush administration, for spending billions of dollars on improving the production capacity of the existing vaccine manufacturing system.