Considerations for Pandemic Influenza Planning: A State Epidemiologist

1
Considerations for Pandemic Influenza Planning A
State Epidemiologists Perspective

• Kathleen F. Gensheimer, MD, MPH
• State Epidemiologist
• Maine Department of Health and Human Services

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Need For National Leadership

• Need for planning local/state/national/internation
  al interdependent
• HHS plan provides broad outline possible actions
• Lacks specificity Wheres the beef?
• Starting point for public discussions /
  stakeholder meetings
• Avoid 100 flowers blooming Limit inconsistency
  enhance coordination

3
Public Health Preparedness/ Bioemergencies A
Never Ending Planning Process...A Never Ending
Need

• Dynamic / continuous
• Dual use vs. stove pipe
• Seasonal influenza needs

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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? (Wheres Waldo?)

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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!

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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?

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Risk Communication

• Controversial decisions/unworkable plans
• Outbreak of fear / panic
• Building trust prior to crisis / understanding
  government recommendations

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• ... Mad Cow disease bumped flu shots from page
  one in the U.S. Yet Mad Cow caused one cows
  deathwhile flu kills 36,000 annually ...
• ---Harvard Public Health Review, September 2004

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Politics vs Science New 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.

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Politics vs Religion

• Bush, Kerry Trade Blame Over Scarcity of Flu
  Shots
• --USA Today, October 19, 2004
• Under his plan, you dont have a prayer of
  getting a flu shot.
• ...Democrat John Kerry, West Palm Beach, Florida

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Politics vs Sports

• 2004 Boston Red Sox World Series Champion
• 1918 Curse of the Bambino

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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 publics health

13
Lack of Resources

• Public health professionals limited and burned
  out
• Lack public health laboratory support diagnostic
  tools
• Lack of HCWs / surge capacity

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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?

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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

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Narrowing the Gap Between Public Health /
Clinical / Hospital Community

• Prevention vs treatment
• Partners together as team
• Private vs public distribution / administration
  of vaccine

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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

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Global Perspective

• International Coordination / Collaboration,
  Including North American Neighbors

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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

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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

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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

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. . .Its 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.