Groups question nation's preparedness for public health crises

BY CINDY BORGMEYER

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The United States is not prepared to respond effectively to a major public health threat such as a biological, chemical or radiological/nuclear terrorist attack. A growing number of stakeholders recently voiced this concern.

The House Committee on Government Reform convened a hearing Feb. 12 to review the public health system's ability to manage a contagious disease pandemic. Rep. Thomas Davis, R-Va., chair of the committee, set the stage in his opening statement at the hearing: "This year's flu season has raised the urgent question of whether our country is prepared to deal with a pandemic, be it a naturally occurring pandemic or one that results from a bioterrorist attack."

The experience with the 2003 - 2004 flu season "has challenged our public health system's capabilities and provides us with a chance to evaluate existing procedures and safeguards," said Davis.

"This hearing will help recognize if any deficiencies in coordination, communication and capacity exist and will facilitate discussion on how to work toward improvements necessary for more effective preparedness. In order to be adequately prepared, we should always be expecting the unexpected," Davis said.

In her testimony to the committee, CDC Director Julie Gerberding, M.D., M.P.H., focused chiefly on shortfalls in the vaccine supply. She noted, "Unprecedented media attention helped to increase consumer demand for vaccine late in the influenza season."

She told committee members HHS was finishing work on a multipronged pandemic flu preparedness and response plan. The plan will include approaches to achieve these steps:

Enhance surveillance.
Target research to improve the annual flu vaccine and promote use of new vaccine production technology.
Provide better production surge capacity.
Improve coordination among public and private partners.

More details about the committee hearing, including witness testimony, can be accessed at http://reform.house.gov/GovReform/Hearings/EventSingle.aspx?EventID=739.

Coordination is key

Jonathan Temte, M.D., Ph.D.
"What happened nationally this past November and December with the influenza vaccine is a case in point. There was not great coordination, there was panic, there were runs on vaccine, there was a mismatch of information."

According to FP Jonathan Temte, M.D., Ph.D., of Madison, Wis., public-private coordination is key. Temte is associate professor of family medicine at the University of Wisconsin, Madison, and serves on the CDC's working group on pandemic influenza. He also has spoken about bioterrorism at the AAFP Scientific Assembly.

There's a critical tie between pandemic diseases and bioterrorism, Temte said in a recent interview.

"What happened nationally this past November and December with the influenza vaccine is a case in point," he said. "There was not great coordination, there was panic, there were runs on vaccine, there was a mismatch of information. Sometimes I think the public had more worrisome information than was being supplied to physicians. And this was a fairly minor event and very predictable.

"If we can't do a better job with that, how are we supposed to be doing a flawless, seamless job with something worse -- a SARS (severe acute respiratory syndrome) epidemic or pandemic influenza or some bioterrorism event?"

It's a concern echoed by Shelley Hearne, Dr.P.H., executive director of the nonprofit group Trust for America's Health. Hearne also testified at the Feb. 12 House committee hearing, telling legislators the nation's public health system "is being stretched to the breaking point."

"In fact, even as it is given new responsibilities in the war on terrorism, America's public health system is still struggling to carry out its peacetime mission," she said.

States poorly prepared

A December 2003 report by Trust for America's Health looked at the ability of states to deal with a bioterrorism attack or another public health emergency, finding that most of them remain poorly prepared.

In the report, Ready or Not? Protecting the Public's Health in the Age of Bioterrorism, only about 25 percent of states scored above the halfway mark, attaining six or seven of 10 possible readiness indicators. Those readiness indicators fell within one of three general categories: funding, public health infrastructure and so-called double-duty indicators reflecting how recent federal bioterrorism funding has affected traditional public health functions.

Although the report said most states have made progress in expanding their health emergency communications networks, upgrading public health labs and developing bioterrorism response plans, much work remains to be done. In particular, the report deemed states' readiness for other health emergencies, such as a serious infectious disease outbreak, to be inadequate.

An overview and links to the report and related resources, including state-specific preparedness information, are available at http://healthyamericans.org/state/bioterror/.

The nation's mayors recently chimed in on the topic of preparedness funding. A report released Jan. 22 by the U.S. Conference of Mayors stated 76 percent of U.S. cities remain empty-handed when it comes to disaster preparedness funds.

"Homeland security money went to the states by Federal Express but came to cities by Pony Express," said James Garner, mayor of Hampstead, N.Y., and president of the conference. "This report is a national call for improving the system."

Second Mayors' Report to the Nation: Tracking Federal Homeland Security Funds Sent to the 50 State Governments is available at http://usmayors.org/72ndWinterMeeting/homelandreport_012204.pdf. Go to http://www.aafp.org/pdf.xml for help using PDF files.

To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.

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