PlanFlu, I.

The Pandemic Flu Plan (PlanFlu) went up at 9 am yesterday morning at http://pandemicflu.gov/. It is long (although padded with photos and wide margins) and I have yet to read it all. I will try to look more closely at some parts over the next few days or so, as the spirit moves me and time and space permit.

As a preliminary comment, I'd say it is very clearly written and presented. I give DHHS high marks on clarity, and mostly (as far as I can see), without overt spin. When I am able to view it in its entirety I may change my mind but right now it is a good effort at presentation. At the outset it ratifies what we an many others have said, that local communities will be on their own in the event of a pandemic:

If efforts to contain isolated outbreaks within the U.S. were unsuccessful and influenza spread quickly to affect many more communities either simultaneously or in quick succession—the hallmark of a pandemic—response assets at all levels of government and the private sector would be taxed severely. Communities would need to direct all their influenza response assets to their own needs and would have little to spare for the needs of others. Moreover, as the number of affected communities grows, their collective need would spread the response assets of states and the federal government ever thinner. In the extreme, until a vaccine against the pandemic virus would become available in sufficient quantity to have a significant impact on protecting public health, thousands of communities could be countering influenza simultaneously with little or no assistance from adjacent communities, the state, or the federal government. Preparedness planning for pandemic influenza response must take this prospect into account.

As we have noted here often in the last year, this is absolutely correct. In a pandemic there is no "outside" from which to get outside help. The necessary response will have to be at the community level. This was the idea behind the Flu Wiki (which appears to have influenced the government's website, although without acknowledgment). It is a fact that the Federal role will of necessity be limited to providing some limited supplies of antivirals, vaccines (if they exist) and guidance. I don't fault them for this division of labor. It is dictated by circumstance.

Where I do fault them is for their almost complete abrogation of prior leadership. Financially pressed state and local health departments and other infrastructure components needed a clear signal from CDC and DHHS that pandemic influenza was a looming threat and they should be devoting time and resources to preparing for it. In the absence of that leadership, which should have started years ago, local authorities continued to use their resources to address the urgent daily needs generated by a crumbling public health system.

Which is the other place I fault the administration. The public health system in the US has been going downhill since the eighties (thank you, President Reagan). Bush Senior pushed it along, Clinton did little to stop the decline and the current Administration is finishing it off (see "Grover gets his wish"). Even as Bush was announcing $7 billion in new money for the pandemic flu plan, the Republican leadership was busy planning to recoup the $7 billion by cutting Medicaid and Medicare. One hand giveth, the other hand taketh away.

Because this lack of leadership and active destruction of the public health system has left us unprepared, the burden of Bush's pandemic flu plan will fall on individuals and state and local municipalities:

Indeed, the plan stresses that if a pandemic begins, Americans should limit visits to doctors and hospitals unless absolutely necessary and hospitals should triage those seeking care so that suspected super-flu cases have limited contact with other patients, the plan says.

But critics battered Bush's plan for the federal government to stockpile enough of the anti-flu drugs Tamiflu and Relenza to treat 44 million people and make states buy another 31 million treatment courses, mostly with their own money, to cover the rest of the anticipated need.

"States are extremely nervous about what's going to be required of them," Sen. Patty Murray, D-Washington, told Leavitt.

And Sen. Arlen Specter, R-Pennsylvania, said he doesn't trust the administration's assessment of the nation's health care needs and demanded that Leavitt provide more information about its response to the evolving bird flu.

"Could we have acted sooner to avoid the situation we are in now, in effect running for cover?" he said. "We need a better way of finding out what the hell is going on." (CNN)

Maybe the Democrats should ask for another closed door Senate session, this time asking what we knew and when about the threat of pandemic influenza and why we were misled that other threats were more important.