Wednesday, August 24, 2005

The Bird Flu Game: Who's on First?

One of a small handful of good flu reporters, Maryn McKenna of the Atlanta Journal Constitution and her colleague Jeff Nesmith, are reporting today that pandemic flu "plans" in the US call for the lead agency to be:

Drum roll . . .

The Department of Homeland Security.
The head of the Department of Homeland Security said Tuesday that his agency --- and not the federal health establishment --- would manage the nation's response if a deadly new strain of bird flu evolved into a human pandemic.

Public health officials expressed dismay at the assertion by Homeland Security Secretary Michael Chertoff.

"They don't have the infrastructure at Homeland Security, or the technical expertise, to handle" a pandemic, said Dr. Georges Benjamin, executive director of the American Public Health Association, who was Maryland's health officer during the 2001 anthrax attacks.
The Department of Health and Human Services, which includes the U.S. Public Health Service, the Centers for Disease Control and Prevention and other health agencies, has described itself as the "primary federal agency" in a national health emergency.

But at a meeting with reporters in Washington, Chertoff said his department expected to have overall responsibility for managing a national pandemic response.

Chertoff said the government would depend heavily on the health expertise within HHS, "but we would manage the incident ... to make sure that all of the other pieces that could flow from the pandemic would be properly addressed." (Atlanta Journal Constitution)
And I bet you thought it would be the Department of Health and Human Services where all the health expertise resides, didn't you. Not a chance. Those guys aren't even in the same room anymore, much less at the table. And CDC Director Gerberding has her nose so firmly fixed to GWB's behind, he can hardly ride his dirt bike anymore.

The Atlanta Journal notes that most public health and medical authorities they interviewed were dismayed by this news. But one prominent expert who has been concerned for years about the lack of preparedness in the US, Dr. Michael Osterholm, saw no problem. In our view, this is more a measure of Osterholm's complete exasperation with the total disorganization evident in the federal health establishment's response to the bird flu threat. His more relaxed view of this news, in essence, is a repudiation of CDC and DHHS's ability to handle a pandemic.

But who will really be in charge? DHHS still claims priority, based on Presidential directives. So does DHS. Again from the Atlanta Journal's excellent article:
HHS has been under pressure from Congress for months to finalize a response plan in case the deadly bird flu virus begins human-to-human transmission.

The plan --- in preparation at the CDC since 1993 --- was finalized at the beginning of this month and turned over to HHS Secretary Michael Leavitt, but it has not been made public.

A draft document released last August states, "HHS will be the primary federal agency responsible for public health and medical emergency planning, preparations, response and recovery."

The Department of Homeland Security asserts its authority to manage a pandemic response under a National Response Plan released in December that covers "incidents of national significance," including pandemics.

Both documents use similar language to assert their authority.

HHS said it would take charge when "the resources of state, local or tribal public health and/or medical authorities are overwhelmed and HHS assistance has been requested by the appropriate authorities."
Homeland Security would assume authority when "the resources of state and local authorities are overwhelmed and federal assistance has been requested by the appropriate state and local authorities."
To shore up their claims of legal authority, the two agencies cite a variety of presidential directives, executive orders and laws such as the Homeland Security Act and the Public Health Service Act.
Chertoff's claim of authority is based on a presidential directive issued Feb. 28, 2003.

The same presidential directive is cited in the plan under which HHS claims to be the federal agency primarily responsible for pandemic response.

The HHS plan also notes an executive order signed by Bush in April 2003 giving the secretary of health and human services sweeping quarantine authority, even including the right to order the arrest and detention of individuals to prevent the spread of diseases.

The order was amended in April to add to the list "influenza caused by novel or re-emergent influenza viruses that are causing or have the potential to cause a pandemic."

There is no mention of the Department of Homeland Security in that order.
This is a bunch of Keystone Cops, unable to get their act together for a real national security threat. So if the strong suit of Department of Homeland Security isn't public health, what is it? Maybe keeping public order? Which might be necessary when people figure out how thoroughly this administration blew preparing for a pandemic.

But they had better things to do. Terry Schiavo, Iraq. Social Security, Valerie Plame, smearing Cindy Sheehan, . . . And because George's Pat Robertson constituency doesn't believe in evolution, the fact that influenza A/H5N1 is a negative sense RNA virus that mutates readily is of no particular concern. Since it was Intelligently Designed, it will only kill Unbelievers and Infidels. A Smart Virus.