Avian Flu--Who is in charge

Wednesday, October 05, 2005
One of the troubling issues about national planning for a pandemic flu is the bureaucratic issue of who is in charge. On August 26, the Department of Health and Human Services issued its draft pandemic flu response plan. Unforunately, for those in public health who normally take our technical guidance from CDC via state departments of health, Secretary Chertoff of Homeland Security issued this assertion two days earlier. The Palm Beach Post summarized some Public Health comments in its article on the release.

Considering the increasing number of avian flu cases being reported, it is a bit disconcerting to see this bureauractic infighting between two major federal departments. I can speak only to Washington state where the state, and my county has developed a pandemic flu response plan. The County plan was exercised along with county hospitals, clinics, and other first responders in late June. Based on some planning programs available on the CDC website such as Flusurge we have been able to predict hospital visits, ICU requirements, and ventilator requirements. The County Health Officer, who in Washington State has broad ranging powers including quarantine orders, has worked with the county emergency management office to develop or response.

I dont believe any local emergency planner--at least in Washington State--expects significant federal response--especially for rural areas. The CDC has what is called the Strategic National Stockpile for deployment in 12 hours on approval of a Governor's request by the Feds, but the contents of that stockpile do not consist of the things most directly needed for a pandemic flu outbreak.

I would personally hope that federal response is mobilized for the first reported cases in the US and the effort is focused on those geographic areas to contain the virus. That is about the only meaningful public health response given the lack of vaccine and antivirals for treatment. More and more many health officers are not considering quarantine as an option for both legal and practical reasons. Guidelines have been developed for vaccination and treatment priorities but the system is likely to be overwhelmed if a pandemic situation arises within the next year--these items are likely to be in very short supply. And the nation overall is short some 20 thousand ventilators.

These are some of the larger issues we are looking at from a Public Health standpoint--and regretably not knowing who the lead federal agency is is not comforting to us in public health. And most regretably, the media have not elevated this situation to national prominence being apparently more willing to wallow in Abu Graib and Katrina.


Rick Ballard said...


How do you raise public awareness without causing unwarranted anxiety?

I'm deeply unimpressed with the language used in the response plan - unless it's intended to be a soporific. It does not reflect the potential serious consequences of a disease that killed 57 of the 112 people who contracted it (per the WHO stats).

I can sort of understand the HSA grab for the lead - if we were talkong about a bioterror incident. I really don't see other than a supplementary role for HSA in the event of a pandemic. In the event of a crossover occurring this thing would be worlwide in under two weeks if I understand the propable transmission vectors correctly. I've been infected on a number of long flights by lesser bugs.

I know that Public Health Agencies have the authority to close public schools - do they have the same authority wrt private schools, pre-schools and day care centers?

Here's a cheering link to a BBC story that makes a connection to the 1918 pandemic.

RogerA said...

Rick--depends state by state on public health officer's authority. As an aside, I dont think we as Americans realize just how fragmented political authority is and the true nature of our federal system--what applies in Washington state doesnt necessarily apply in any other state; and even in Wa state, what applies in Grant County doesnt necessarily apply in King county.

Long prelude to answer your question about authority--In MOST cases, public health officers probably have more far reaching power than many officials, and yes, at least in WA state, the Public Health Officer can restrict any public gathering, schools, movies or churches.

Which, interestinly enough created the problem in Canada with SARS--Churches refused to obey the public health quarantine order using a freedom of religion argument.

MaxedOutMama said...

I'm so thankful to have found you!

I have been trying to write up something telling people what they needed to ask of their local authorities. You are a great resource.