The Flu Factor

The threat of pandemic flu raises some of the toughest challenges of our times.

Avian flu raises complex questions for federal organizations, challenges state and local governments and calls for public leadership to prompt significant changes in private behavior among corporations and the populace.

Washington certainly has recognized the threat. Last November, the White House issued a National Strategy for Pandemic Influenza, and on May 3 it followed up with an implementation plan ordering more than 300 actions by federal departments and agencies. It also has proposed to spend $7.1 billion, mainly to stockpile antiviral medicines. Congress has held two dozen hearings on the topic.

The implementation strategy encourages agencies to develop their own plans for coping with the potential absenteeism of 40 percent of their workers. During a June 15 panel discussion of avian flu at Washington's National Press Club, just a few people in our audience of 125 federal officials raised their hands when I asked if they thought their agencies were prepared.

At the center of concern for government should be the capacity of the nation's public health system. Long neglected, it would be quickly overwhelmed by the flu-as it was on the Gulf Coast by Hurricane Katrina.

Our panel on the public health system brought together people with different perspectives: Dr. Nancy Cox, chief of the Influenza Branch of the National Center for Infectious Diseases at the Centers for Disease Control and Prevention; Dr. Gregg A. Pane, director of the District of Columbia Department of Health; Michael Bopp, staff director and chief counsel to the Senate Committee on Homeland Security and Governmental Affairs; and David Heyman, a bioterrorism expert who leads the homeland security program at the Center for Strategic and International Studies.

As Heyman observed, in the 20th century, medicine shifted emphasis from treatment to prevention with the development of antibiotic, antiviral and other drugs. Pane added that health funding now flows through narrow silos not conducive to community-based public health response. Prevention can't address a fast-moving flu or other catastrophe. So emphasis must shift to preparedness and response, including nonmedical steps such as quarantines or social distancing of the kind Zack Phillips writes about in this issue's cover story.

Bopp, whose committee has just completed an extensive investigation of government's response to Hurricane Katrina, and Pane agreed there's a long way to go before emergency response roles and hierarchies are sorted out. Even at the federal level, it remains unclear who's in charge in an emergency, and intergovernmental roles pose an even larger challenge.

Phillips' article argues, and our panelists agreed, that engaging the public in personal and institutional preparedness is essential. Here, too, much work remains to be done: A recent Associated Press-Ipsos poll finds that only one in 10 Americans has done anything to plan for an influenza outbreak, and companies in essential industries lag as well. As if these concerns were not enough, Cox agreed that tough questions of equity and international relations would attend the response to a pandemic. In a nutshell, which nations, and which population groups, would be first in line for vaccine that would be in very short supply?

The broad-ranging panel discussion resides as a Webcast on

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