As the first H1N1 or so-called swine flu cases were diagnosed in Mexico, health officials all over the United States leapt into action. This is the test that they have been preparing for.
As the disease spread, public health professionals have been actively tracking the cases, working around the clock to analyze lab specimens, offering treatment to those with confirmed cases, dispensing antiviral medications from the Strategic National Stockpile (SNS), and letting the public know how to protect themselves and when to seek treatment.
The Obama administration has displayed strong, coordinated leadership, with the U.S. Centers for Disease Control (CDC), Department of Health and Human Services (HHS), Department of Homeland Security, and the White House conveying guidance and strategies based on the best expert advice for how to respond. State and local health departments are monitoring and responding to cases as they emerge.
There also have been some surprises.
All of our pandemic planning to date has focused on the potential threat of the H5N1 virus, the so-called bird flu that has circulated in Asia for the past 10 years. In fact, HHS has procured 12.2 million courses of H5N1 pre-pandemic influenza vaccine to help meet the first wave of a bird flu pandemic. However, this pre-pandemic vaccine is not effective against the H1N1 flu virus that is currently causing so much concern. As we struggle to contain the H1N1 outbreak, this should serve as a reminder of just how unpredictable the flu virus can be. It reinforces the need to invest in research and development so that we can respond and adapt to any flu virus mutations.
The fact that the H1N1 flu outbreak struck in late April, at the end of the seasonal flu season, is surprising and offers both reason for hope and concern. Science has shown that flu bugs don’t do well in warm weather, so Mother Nature may help to limit this outbreak. At the same time, we can’t let down our guard, because the virus could return in the fall — and be more virulent. All the more reason the government must fund the expedited research and development of an effective vaccine.
We also don’t yet understand why deaths from the H1N1 flu appear to be so much higher in Mexico than in other countries with confirmed cases. Is it possible that a more deadly strain of H1N1 is circulating in Mexico? Or is it the case that the same virus is circulating across North America and we simply have not been able to detect all of the cases? If the number of people infected with H1N1 is exponentially larger, the deaths in Mexico, although tragic, are not as alarming. Our inability to answer this question just yet is an argument in favor of enhancing global disease detection. Currently, CDC’s Global Disease Detection (GDD) Program receives $33.7 million in funding. If the funding were increased to $55 million, four additional regional detection centers could be established to improve global disease outbreak detection and control.
We are fortunate that the country has taken many measures to prepare for a potential pandemic flu outbreak. In November 2005, then President Bush issued a National Strategy for Pandemic Influenza that called for a plan that spanned every department of the federal government, every state, and the private sector. Congress provided nearly $7 billion to help prepare. Most of this funding went to stockpile existing antiviral medications and give scientists resources to research and develop vaccines and other pharmaceutical interventions.
Trust for America’s Health (TFAH) has conducted a series of analyses on U.S. preparedness for pandemic flu and other health emergencies. Thanks to the tireless work of public health professionals, the country has made significant strides in improving surveillance, coordination, communications, treatment capabilities, and vaccine manufacturing capacity.
At the federal level:
- HHS has reached its goal of stockpiling enough pandemic influenza antivirals to cover 44 million people. It has completed the purchase of 50 million courses of antiviral drugs for the federal portion of the antiviral stockpile goal. As of February 8, 2008, the Strategic National Stockpile contained 39.4 million regimens of Oseltamavir capsules, with 409,000 on order; and 9.9 million regimens of Zanamivir with zero regimens on order.
- HHS has purchased medical supplies for the Strategic National Stockpile, including 104 million N95 respirators, 51.6 million surgical masks, 20 million syringes for pre-pandemic vaccine, and 4,000 ventilators.
- By 2011, U.S.-based vaccine production capacity is expected to be at a point at which it can generate enough pandemic influenza vaccine for every American within six months of the time that the pandemic virus is identified.
At the state level:
- All 50 states and Washington, D.C., have a pandemic flu preparedness plan.
- As of September 2008, states had purchased 22 million courses of antivirals. (The goal is for states to purchase 31 million courses).
- All 50 states and D.C. have adequate plans to receive and distribute emergency vaccines, antidotes, pharmaceuticals, and medical supplies from the SNS, based on a review by CDC.
- All 50 states and D.C. have increased or maintained rates for vaccinating adults ages 65 and older for seasonal flu, which is a key indicator for showing how well states could vaccinate people in an emergency.
Overall, our ability to respond to a pandemic is light-years ahead of where we were just a few short years ago.
But our public health system has been underfunded for decades, and there are many existing gaps that leave us vulnerable, particularly if the H1N1 flu becomes more severe and lethal.
As Congress holds hearings on the U.S. response to the H1N1 outbreak and considers the administration’s request for an additional $1.5 billion in emergency funds to address the current H1N1 outbreak, there are several key areas that policymakers must address to ensure that the United States is truly prepared to handle a widespread pandemic flu, and that may require more than the $1.5 billion the administration has requested.
If large numbers of Americans were to get very sick and start flooding into hospitals and health care facilities, our system will really be in for a test. Our health system could be overrun in a very short period of time.
Figuring out how to plan for a massive influx of patients is one of the hardest parts of preparing for health emergencies, and it has yet to be adequately dealt with. “Surge capacity” management is one of our biggest weaknesses, particularly at a time when we have shortages of emergency and public health workers. That problem is getting worse as state and local governments are cutting budgets. An estimated 11,000 public health workers have been laid off in just the past year.
Treating The Uninsured
The problem of managing massive numbers of patients is even more complicated under the current health care system, where there is serious concern that people who are uninsured or underinsured might not seek treatment or might have trouble accessing care. And the current recession has driven up the number of uninsured people. If people who are contagious do not seek treatment during the limited time period when antiviral medications might be effective, they are at serious risk. And they also risk spreading the disease to others.
During an infectious disease outbreak, ensuring that care is in place for all Americans is more vital than ever. Not only are patients at risk, but they risk further spreading the disease unless they receive proper care.
The H1N1 flu is a clear demonstration of how public health issues are an integral part of our overall health care system – and the importance of considering these issues as part of the health reform debate.
Paying For Pandemic And Public Health Emergency Preparedness
Congress should incorporate support for preparedness planning into health care reimbursement streams, so hospitals and health facilities can actually meet the needs of all patients when emergencies arise. In addition, a “State of Emergency” health benefit would ensure that the uninsured and underinsured receive the care they need on a temporary basis during a crisis. Hospitals and health care providers shouldn’t have to worry whether they’ll be compensated for providing care to people in need in an emergency. And, more importantly, no patient should have to worry that they’ll be turned away when they need care.
Replenishing The Strategic National Stockpile
We also need to ensure that the right medications will be available to people when they need them. The investment the country has made in buying antiviral medications for the Strategic National Stockpile is now paying off. However, even now, some states have more antiviral medications available than others, leaving some Americans unnecessarily vulnerable.
In addition, we need to make sure we continue to replenish the Strategic National Stockpile, so if there are additional cases and waves of H1N1 flu — or even if another new strain of flu develops — we will be able to treat people.
Strengthening Vaccine R&D
Vaccine development and production is also imperative. We need to give scientists the resources they need to develop a vaccine for this new H1N1 flu virus, and once a vaccine is ready, we need to be able to produce enough vaccine to cover all Americans. At the same time, scientists must continue development of bird flu and other flu vaccines.
The H1N1 flu outbreak is a very real reminder of why we need a strong and stable public health system in the United States. This requires an ongoing and sustained investment in our federal, state, and local health departments. Unfortunately, in the past we have not provided sufficient resources to this system. As we look to reform the health system in coming months, we also have the opportunity to build a reliable funding stream for public health as part of that system. Until we do, we are leaving Americans unnecessarily vulnerable to potential health threats, and our hospitals and health care providers at risk for emergency situations they do not have the capacity to handle.