Wednesday, December 07, 2005

Getting ready for being not ready

You have to admit, US local health officials have a point:
The administration invited state and homeland security officials to Washington on Monday to get their feedback on pandemic planning, and to announce that it would visit every state in the country over the next 120 days to reinforce the work.

The state officials noted that demand for a vaccine during a pandemic would soar far beyond what the nation experiences each winter with regular flu, yet throughout the country, doctors report an inability to get their hands on the vaccine.

"We are not credible year after year when we cannot get our priority populations vaccinated," said Leigh Devlin, president of the Association of State and Territorial Health Officials.

Janet Olszewski, director of the Michigan Department of Community Health, said her state recently obtained 36,000 doses of flu vaccine, but had orders from doctors for 90,000.

"This is getting pretty frustrating for us quite honestly," Olszewski told a panel of the nation's top health officials. (AP via WaPo)
A federal panel that included Department of Health and Human Services Secretary Mike Leavitt heard this from state officials at a pandemic summit in Washington on Monday. The feds then urged each state to hold their own "summit."
During a daylong meeting of about 200 state and federal health and emergency planning officials, Leavitt said it was time to move "from ethereal plans to community action" that would include local policies for distributing lifesaving medicines, closing schools, restricting travel and giving accurate information to the public to head off panic. (LA Times)
Another good point. As many state officials noted, the federal "plan" is really a direction to the states that "they do it." Community action is exactly what is needed. Too bad CDC and DHHS didn't give the signal a long time ago.
Some state officials at the meeting were skeptical about added costs and shifting priorities. Dr. Susan Allan, Oregon's public health director, cautioned against what she called "the disease-of-the-month plan."

"I do have a concern about the focus on a single disease, when other diseases may pose an equally severe risk," she said. "I'm afraid that everybody will drop what they're doing on other [health issues] and a lot of good activity will be undercut."

Iowa health director Mary Mincer Hansen criticized a feature of Bush's plan that calls on the states to bear a substantial share of the cost for purchasing antiviral drugs. These medicines are not vaccines, but can help ease severe flu symptoms and, in some cases, prevent infection.

Calling on the states to buy antiviral drugs "is doing a disservice to us," Hansen said. "We need a national stockpile."
OK. Also good points, but not quite as good as their first one. As we have said here (ad nauseam), if a pandemic strain emerges there is no way to stop it, so the task is one of managing the consequences, which, as Leavitt correctly notes, is a task of community mobilization. This will be difficult, however, with the resources available. Some of this is the fault of the Bush administration and some of it is the fault of the states themselves.

The Bush administration and Congress defaulted on leadership and instituted a flawed "biodefense" agenda which badly skewed national and local public health priorities. But the states also went on a tax cutting binge and sucked the life out of local health departments and social services. Between the state and federal tax cutting pincers, we have been left with anemic and demoralized structures just at the time we need them most. Add to that the "me-too" nineties and the selfish right-wing Republican Congress/Bush Administration kill-government crowd and we are left in the current fix.

Meanwhile, the skepticism of state officials about federal ability to manage their end of a pandemic is understandable, given their performance after 9/11, in Iraq, after Katrina, etc. They have a track record much like the Chinese government, whom nobody believes either. To clinch it, all signs point to Leavitt, Frist, Lieberman and company instead using the concern over vaccine supplies to get liability protection for Big Pharma. (WaPo and posts here and here).