Key action: HHS will validate and fully implement Right Size tools in all state public health labs to ensure efficiency in specimen processing and reduce bottlenecks of testing for improved surveillance systems. Key action: HHS will improve laboratory identification of novel influenza viruses by supporting development of innovative detection tools and methods, as well as distributing diagnostic reagents using the IRR. Key action: HHS will leverage trends in personal health monitoring, including possibilities of at-home diagnosis and treatment, to prevent and control further spread of disease during a pandemic. Key action: HHS will develop and implement systems to track effectiveness of pandemic influenza vaccines, alone or in combination with seasonal influenza vaccines. Key action: HHS will double the number of domestic sentinel sites used for annual VE determination and coordinate data and processes for VE determination with international VE processes to improve the alignment of VE data. HHS will also implement an annual process for VE determination by vaccine manufacturers to inform vaccine development and optimization. Key action: HHS will work closely with partners in agriculture to improve surveillance of influenza viruses in birds, swine, and other animals, and will improve tools and processes for monitoring workers engaged in responding to influenza outbreaks in animals. Leveraging progress in Surveillance, Epidemiology, and Laboratory Activities, and applying lessons learned from other recent responses to novel influenza virus infections, yield areas for improvements for the U.S. response to pandemic influenza. Over the next decade, the goal of HHS will be to sustain momentum and continue to improve upon its surveillance, epidemiology, and laboratory activities domestically and globally. 17