Public Health Preparedness

This commentary appeared on the Asia Healthcare Blog on May 10, 2013.

Chinese health officials announced recently that a new bird flu virus is bringing sickness and death to dozens of seemingly random victims in the eastern part of the country. Scientists have classified this new flu as subtype H7N9.

Like its cousin H5N1, this latest version of the avian flu virus successfully made the jump from birds to people. And like its predecessor it is especially deadly, according to the leader of an international investigation team from the World Health Organization (WHO). Authorities aren't certain how all its victims have been infected, but they have found no evidence, for now at least, that ongoing spread from person to person is occurring.

This commentary appeared on CNN on April 18, 2013.

A pair of deadly bomb blasts marked a violent and tragic finish to this year's Boston Marathon. But as shocking as the attack may have been, an act like this has been anticipated for some time. It was a surprise, because none of us awoke the morning of the Marathon anticipating the race would end this way. Yet a terrorist attack against a symbolic target or a heavily attended event was something for which authorities had long prepared.

Authorities have known for some time that a wide range of terrorist organizations, extremist groups and individuals — both foreign and domestic — seek to inflict harm on the United States. And this knowledge motivated federal, state and local agencies to devise protocols to enhance their response to mass casualty events. Although official after-action reports are still being compiled, it looks like Boston's first responders and hospitals delivered under difficult circumstances....

The remainder of this op-ed can be found at cnn.com.

Public health practitioners most often work behind the scenes to keep bad things from happening. They conduct inspections to ensure that restaurants are safe places for people to eat. They provide immunizations to prevent people from getting diseases. They help ensure safe water and sanitation. They educate people about healthy lifestyle choices regarding diet and exercise. They collect and analyze surveillance data to detect and monitor potential health problems.

But bad things do happen, and when they do, public health practitioners are also there. Disasters, including Superstorm Sandy on the Atlantic coast; tornadoes in Alabama and Missouri; earthquakes in Haiti, New Zealand, Chile, and northern Japan; the 2009 H1N1 influenza pandemic; and the post-9/11 anthrax attacks have taught us that public health is not just about prevention. It is also about preparedness, response, and recovery. Public health practitioners are the front line force for national health security, ensuring that communities are prepared for, protected from, and resilient in the face of, a full range of health threats or incidents with potentially negative health consequences.

This fall, advertisements for flu shots in U.S. drug stores have been competing for attention with Halloween, Thanksgiving, and, now, Christmas displays. Unfortunately, if this season's statistics follow those of previous years, these ads will fail to rally shoppers to action more often than not. What's needed, according to RAND research, is more proactive engagement by doctors and medical staff.

First a bit of background. Despite the convenience of "retail clinics" and the flu's astounding financial costs ($87 billion, according to a 2007 Lancet study), vaccination rates for influenza among adults have remained flat over the past two years at under 40%. Even during the 2009 H1N1 pandemic, more than half of all health care workers declined vaccinations, putting both themselves and their medically vulnerable patients at risk for transmission.

A month ago the second costliest-storm in U.S. history wreaked havoc on the East Coast. New York is seeking $42 billion in federal aid, and New Jersey is seeking nearly $37 billion. While the federal government has distinct capabilities that are essential for disaster response and recovery, including disaster aid, it is also uniquely positioned to sponsor the research required to develop new technologies, strategies, and tactics to better deal with large-scale disasters.

One objective of the National Health Security Strategy of the United States of America is to ensure that all systems that support national health security are based on the best available science, evaluation, and quality improvement methods. A first step is to understand how research funds are currently being spent.

"Have an emergency plan for your family.” "Expect to be on your own for three days." "Stock a disaster kit with water, food, basic medical supplies, and prescription drugs. Include extra clothes, a flashlight, and a battery-powered radio." "Be sure you know what your community's disaster plan is."

This is the kind of advice public health officials have been giving the public since 9/11. But the public isn't listening. Four years after Hurricane Katrina, only slightly more than half of those responding to a survey by the Federal Emergency Management Agency reported that they had any kind of emergency preparedness kit in their homes. Other national surveys report similarly dismal findings.

Given the recent spate of highly publicized disasters, why don't more Americans pay attention? As we argue in a recent issue of Disaster Medicine and Public Health Preparedness, the messages they are getting are largely based on unverified assumptions, not hard evidence. Equally concerning, these assumptions may inadvertently hinder preparedness. Here are five examples.

The movie "Contagion," released to coincide with the 10th anniversary of 9/11 and the anthrax attacks, gave moviegoers an opportunity to consider what would happen if a really nasty germ went viral. The movie graphically depicts the rapid spread of illness, death and panic that would ensue. In the film, the pandemic is ultimately brought to heel by the Centers for Disease Control and Prevention and public health science. It is worth considering the lessons the film taught.

Mother Nature can be as dangerous as a bioterrorist. Laurence Fishburne, who plays the CDC director, has one of the most important lines in the movie. When asked if the new virus could be a "weaponized version of bird flu," he snaps: "We don't need to 'weaponize' bird flu. The birds are doing that." At various points in history, Mother Nature cooked up the bubonic plague, smallpox and HIV. The Spanish flu pandemic of 1918-19, caused by an H1N1 influenza virus, killed nearly a million Americans, and some 50 million to 100 million people worldwide. Nobody knows what Mother Nature may throw at us next. That's why it's vital to sustain a strong public health system.