Considerations for Pandemic Influenza Planning: A State

Epidemiologist’s Perspective

Kathleen F. Gensheimer, MD, MPH

State Epidemiologist

Maine Department of Health and Human Services

Need For National Leadership

• Need for planning local/state/national/international– interdependent

• HHS plan provides broad outline possible actions

• Lacks specificity – “Where’s the beef?”

• Starting point for public discussions / stakeholder meetings

• Avoid “100 flowers blooming”: Limit inconsistency enhance coordination

Public Health Preparedness/ Bioemergencies A Never Ending Planning Process...A Never Ending Need

• Dynamic / continuous

• Dual use vs. stove pipe

• Seasonal influenza needs

October 2004: Pretraumatic Stress Syndrome

• No vaccine for general public: 55 million doses

• Conflicting messages: promote universal vaccination vs ACIP priority groups: Set back public health recommendations: Set back public health

• Where is the vaccine? (“Where’s Waldo?”)

2005-06Influenza Season

• Vaccine distribution issues

• Confusion seasonal vs avian vs pandemic flu

• Antivirals questions: resistance; stockpiles; treatment/prophylaxis recommendations

• “I still get sick from my flu shot!”

Avian Influenza Fears, 2005

• Can I eat turkey for Thanksgiving?

• Personal hoarding antiviral stockpiles

• What do I do about that migrating goose in my backyard?

• Is it safe to have baby chicks in kindergarten class?

• Where do I get my bird test?

• Where do I get my bird vaccine?

Risk Communication

• Controversial decisions/unworkable plans

• Outbreak of fear / panic

• Building trust prior to crisis / understanding government recommendations

• ““... Mad Cow disease bumped flu ... Mad Cow disease bumped flu shots from page one in the U.S. shots from page one in the U.S. Yet Mad Cow caused one cow’s Yet Mad Cow caused one cow’s death—while flu kills 36,000 death—while flu kills 36,000 annually ...”annually ...”

• ---Harvard Public Health Review, September 2004

Politics vs SciencePolitics vs Science New York TimesNew York Times, Week in Review,

October 24, 2004

• Mr. Thompson has warned the elderly to avoid waiting in long lines for shots (they could get sick) and directed top officials to tour the country in a ‘flu education’ tour.

Politics vs Religion

• Bush, Kerry Trade Blame Over Scarcity of Flu Shots

• --USA Today, October 19, 2004

• “Under his plan, you don’t have a prayer of getting a flu shot. …”

• ...Democrat John Kerry, West Palm Beach, Florida

Politics vs Sports

• 2004 Boston Red Sox World Series Champion

• 1918 “Curse of the Bambino”

Sustainability Preparedness Funding

• Funding for nonterrorism bioemergencies marginal

• Age old public health truism: Eliminate the program prior to elimination of the problem

• Public health: investment in the public’s health

Lack of Resources

• Public health professionals limited and burned out

• Lack public health laboratory support diagnostic tools

• Lack of HCWs / surge capacity

Pandemic Influenza Funding Opportunities 2006

• Large amounts of money: limited time to spend it

• Open-handed contractors– Bird Flu Summit, February 2006

• Lasting impact/infrastructure?

Public Health Powers vs Geographical Philosophical Differences

• Northern New England – – “Live Free or (AND!!) Die”

• Suspicious of government

• Alternative belief systems

• Importing drugs/crossing borders for biologics

Narrowing the Gap Between Public Health / Clinical / Hospital Community

• Prevention vs treatment

• Partners together as team

• Private vs public distribution / administration of vaccine

Integrated Coordinated ILI Surveillance System

• Public/medical community/politicians demand local data

• Information for “action”

• ILI indicative of SARS, anthrax, other respiratory outbreaks

• Year-round system needed: Influenza Coordinator

• Outpatient / inpatient / deaths / special populations / animals

Global PerspectiveGlobal Perspective

• International Coordination / Collaboration, Including North American Neighbors

Invest In The Future

• 38,000 deaths annually ILI– 5 anthrax deaths

– 0 smallpox deaths

• Smallpox vaccinations for all Americans

• Adequate supply routine influenza vaccine for all Americans

Translating Scientific Discourse into Public Health Practice

• “To him who devotes his life to science, nothing can give more happiness than increasing the number of discoveries, but his cup of joy is full when the results of his studies immediately find practical applications” --Louis Pasteur

Conclusions

• Release of national plan opportunity for dialogue government / public / medical community

• Challenges many: procedure vs reactive• Public / politicians recent interest in influenza

provide momentum to grapple with a significant public health threat

• Coordinated and continued funded planning effort at local / state / national level critical

• Security and development capacity for • vaccines/antivirals: positive impact seasonal

influenza control efforts

“. . .It’s conceivable, in fact, that in certain places microbial ‘perfect storms’ could occur

– convergences of all the factors – and unlike meteorological perfect storms, the

events would not be on the order of once-in-a-century, but frequent . . .”

“Microbial Threats To Health: Emergence, Detection, and Response”, Institute of Medicine, March 2003.