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Source: http://hstoday.us/content/view/3856/149/
Public Health Planners Continue to See Problems With Fed Pandemic Plans
by Anthony L. Kimery
Tuesday, 17 June 2008
'There are many of us ? who continue to make our case against the current federal guidelines'
As the Department of Health and Human Services (HHS) continues to move forward with its pandemic preparedness and response guidelines, authorities at state and local levels, and in the private sector, are voicing not infrequently substantive objections to some of the guidance.
HSToday.us has heard from a number of public health sector authorities who have expressed reservations over HHS?s policies for using antivirals, for instance - a problem recently discussed in HSToday.us's ?Kimery Report.?
All officials who have made their concerns known to HSToday.us have criticized the federal policies put forward for using antivirals. They say it constitutes bad policy, bad judgment, and ?very bad medicine.?
?I have been deeply involved in this issue from a public health standpoint since early 2002 and have been witness to the policy debates that have led to the current HHS guidelines promulgated here in the US,? a state official said.
?There are many of us ? who continue to make our case against the current federal guidelines, and who will continue to do so for as long as it takes to fully educate the public as to other more thoughtful optional responses,? the state official noted.
Other areas of guidance for preparedness, like how respirators should be used, have been called into question. Authorities said proposed guidelines could lead to abrupt shortages of N-95 face masks. They say production and supply chain issues haven?t been adequately addressed.
Public health planners who work on seeing the big picture of preparedness for a catastrophic event like a global pandemic say the government still hasn?t gotten a handle on things like coping with continuity and security for multiple critical resources supply chains and quarantine issues.
One seasoned public health planner said, ?I think the reasoning may be flawed in certain areas, particularly the lack of attention to critical infrastructure, and lack of notation that poor/etrhnic minorities may need particular support from law enforcement, as their communities may be most vulnerable to social disorder."
This authority also believes, as do others HSToday.us has heard from, that the matter of quarantining hasn?t been adequately debated.
But ?the largest issue,? the veteran planner said, ?is we have yet to describe the common operating picture we need during a global catastrophic event. Death and illness will not themselves describe the impact. [We haven?t adequately addressed] the ability to keep oil flowing from the North Slope [to] ensure the west coast has gas, potassium from Guam ensures we have fertilizers, commercial flights from Asia ensure there are critical parts for Internet servers.The complexity of supply chains is far beyond the imagination of the public health planners, we almost need a futures market for information.?
Continuing, the planner said the ?bottomline [is] we need to take a stab at describing what combination of predictive date regarding orange juice availability, oil prices, food distribution, consumer confidence, body bag distribution, etc., will be needed by mayors, governors and CEOs to enable them to make strategic, protective decisions.
The planner stressed the need to:
* Stress the importance of non-health related components of a pandemic, particularly needs for security of assets;
* Convening a representative group of business, critical infrastructure owners, governors and their aides, security, and emergency managers be nominated to develop a COP for the nation/state/business; and
* Developing exercises that move beyond awareness building to testing decision-making.
?Two years after the announcement of federal funds for planning many of the original issues remain unresolved,? the planner said, noting that ?during workshops and meetings across the country it is common to hear questions (not solutions) about: How do we take care of children when schools are dismissed? Who will enforce quarantine and isolation orders? Who is in a position to assess the continuity of the food supply?
?Each of these are difficult issues, each fundamental to social and economic cohesion. The lack of solution to these issues is in contrast to the time and money spent assessing, re-assessing and refining the distribution plans for antivirals - an irony given that there is little evidence that the antivirals provide anything more than marginal community protection or mitigation.?
Continuing, this planner said ?the planning efforts around the nation remain focused in a healthcare context rather than social and economic cohesion. The consequences are that the potentially most harmful affects of a pandemic remain obscured.
?I am not aware of tabletops, let alone functional exercises that look at resolving the issues such as feeding children in the breakfast/lunch programs.?
Significant issues undoubtedly remain, and public health planners at the state, local, and private sector levels are beginning to more vocally express their concerns.
Public Health Planners Continue to See Problems With Fed Pandemic Plans
by Anthony L. Kimery
Tuesday, 17 June 2008
'There are many of us ? who continue to make our case against the current federal guidelines'
As the Department of Health and Human Services (HHS) continues to move forward with its pandemic preparedness and response guidelines, authorities at state and local levels, and in the private sector, are voicing not infrequently substantive objections to some of the guidance.
HSToday.us has heard from a number of public health sector authorities who have expressed reservations over HHS?s policies for using antivirals, for instance - a problem recently discussed in HSToday.us's ?Kimery Report.?
All officials who have made their concerns known to HSToday.us have criticized the federal policies put forward for using antivirals. They say it constitutes bad policy, bad judgment, and ?very bad medicine.?
?I have been deeply involved in this issue from a public health standpoint since early 2002 and have been witness to the policy debates that have led to the current HHS guidelines promulgated here in the US,? a state official said.
?There are many of us ? who continue to make our case against the current federal guidelines, and who will continue to do so for as long as it takes to fully educate the public as to other more thoughtful optional responses,? the state official noted.
Other areas of guidance for preparedness, like how respirators should be used, have been called into question. Authorities said proposed guidelines could lead to abrupt shortages of N-95 face masks. They say production and supply chain issues haven?t been adequately addressed.
Public health planners who work on seeing the big picture of preparedness for a catastrophic event like a global pandemic say the government still hasn?t gotten a handle on things like coping with continuity and security for multiple critical resources supply chains and quarantine issues.
One seasoned public health planner said, ?I think the reasoning may be flawed in certain areas, particularly the lack of attention to critical infrastructure, and lack of notation that poor/etrhnic minorities may need particular support from law enforcement, as their communities may be most vulnerable to social disorder."
This authority also believes, as do others HSToday.us has heard from, that the matter of quarantining hasn?t been adequately debated.
But ?the largest issue,? the veteran planner said, ?is we have yet to describe the common operating picture we need during a global catastrophic event. Death and illness will not themselves describe the impact. [We haven?t adequately addressed] the ability to keep oil flowing from the North Slope [to] ensure the west coast has gas, potassium from Guam ensures we have fertilizers, commercial flights from Asia ensure there are critical parts for Internet servers.The complexity of supply chains is far beyond the imagination of the public health planners, we almost need a futures market for information.?
Continuing, the planner said the ?bottomline [is] we need to take a stab at describing what combination of predictive date regarding orange juice availability, oil prices, food distribution, consumer confidence, body bag distribution, etc., will be needed by mayors, governors and CEOs to enable them to make strategic, protective decisions.
The planner stressed the need to:
* Stress the importance of non-health related components of a pandemic, particularly needs for security of assets;
* Convening a representative group of business, critical infrastructure owners, governors and their aides, security, and emergency managers be nominated to develop a COP for the nation/state/business; and
* Developing exercises that move beyond awareness building to testing decision-making.
?Two years after the announcement of federal funds for planning many of the original issues remain unresolved,? the planner said, noting that ?during workshops and meetings across the country it is common to hear questions (not solutions) about: How do we take care of children when schools are dismissed? Who will enforce quarantine and isolation orders? Who is in a position to assess the continuity of the food supply?
?Each of these are difficult issues, each fundamental to social and economic cohesion. The lack of solution to these issues is in contrast to the time and money spent assessing, re-assessing and refining the distribution plans for antivirals - an irony given that there is little evidence that the antivirals provide anything more than marginal community protection or mitigation.?
Continuing, this planner said ?the planning efforts around the nation remain focused in a healthcare context rather than social and economic cohesion. The consequences are that the potentially most harmful affects of a pandemic remain obscured.
?I am not aware of tabletops, let alone functional exercises that look at resolving the issues such as feeding children in the breakfast/lunch programs.?
Significant issues undoubtedly remain, and public health planners at the state, local, and private sector levels are beginning to more vocally express their concerns.
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