This is crossposted from the HHS Pandemic Flu Leadership Blog, where I'll be posting for two more weeks. The Pandemic Flu Leadership Summit agenda is here. I will be on the panel from 11:15-12:15. I will also be presenting a round table on pandemic flu and preparations at Yearly Kos (more to come on that).
Update [2007-6-10 8:13:41 by DemFromCT]:
While we're still in week 3, and looking at getting the job done there's an important piece of this we need to get out on the table, and very relevant for answering the question "What do I need to succeed in communicating the importance of preparing for a pandemic?" It's to take a look at the virus we know is out there, H5N1, and make sure it is central to our thinking.
The importance of the grassroots/netroots is highlighted today by Nedra Weinreich.
That’s where the grassroots approach comes in. A vibrant and engaged community of concerned citizens has developed over time in various places online, such as the Flu Wiki and the Pandemic Flu Information Forum. On their own, they have come together to share news and preparedness tips, and many participants have tasked themselves with educating their community leaders and neighbors.
This is a nasty, vicious killer of young people (90% of H5N1 deaths are less than 40 years old), and while we do not know that it is the next pandemic virus, no one can assure us that it is not. Mutations are a normal part of viral evolution, and the virus has changed since 1997 when it appeared, and 2003 when it reappeared, in Hong Kong. The next set of mutations can set off events we'd rather not think about, let alone experience. After all, the 1918 pandemic was bad enough with a 2.5% case fatality rate, but H5N1 has a 61% case fatality rate overall (80% in Indonesia). Those are staggering numbers to consider and comprehend.
Now, isn't that just an alarmist way of looking at current events? isn't it true that we don't know for a fact that H5N1 will be the next pandemic virus? Well, here's the thing. H5N1 is out there, and it is not going away because it's established itself in the bird and animal population (cats in Indonesia are not excluded from this virus, and there's speculation that they may have some undefined role in viral spread). Each human exposure is another chance for viral mutation. And we have an important precedent to look at, both from Hong Kong and Ontario. I am, of course, referring to SARS. And here, we have a blue ribbon review of what happened in Canada when SARS broke out, what was done, and what could have been done better.
The independent Commission to Investigate the Introduction and Spread of Severe Acute Respiratory Syndrome (SARS) was established by the Government of Ontario as an investigation under section 78 of the Health Protection and Promotion Act. Mr. Justice Archie Campbell of the Ontario Superior Court of Justice was appointed Commissioner.
The Commission investigated how the SARS virus came to the province, how the virus spread and how it was dealt with. Its final report was completed in December 2006 and made public on January 9, 2007. It was transmitted to the Minister of Health and long-Term Care on January 4, 2007.
Here's an excerpt:
SARS had Ontario’s health system on the edge of a complete breakdown. The wonder is not that the health system worked so badly during SARS, but that it worked at all. SARS also badly hurt Ontario’s international reputation, setting up an unfortunate link in the minds of many in other countries between Toronto and a mysterious deadly disease. Worst of all, SARS demonstrated how many earlier wake-up calls had been ignored, and how few of their warnings had been heeded...
We must remember SARS because it holds lessons we must learn to protect ourselves against future outbreaks, including a global influenza pandemic predicted by so many scientists. If we do not learn from SARS and we do not make the government fix the problems that remain, we will pay a terrible price in the next pandemic. (bolded mine).
There were some specifics from the report that need highlighting (vol 1, p.16):
Common problems and themes emerge from the stories of both [hospital] outbreaks. They reflect seven systemic problems that run like steel threads through all of SARS, through every hospital and every government agency.
• Preparation, planning
• Accountability: who’s in charge, who does what?
• Worker safety
• Systems: infection control, surveillance, independent safety inspections
• Resources: people, systems, money, laboratories, infrastructure
• Precautionary principle: action to reduce risk should not await scientific certainty
Here's more on the precautionary principle (page 10):
Perhaps the most important lesson of SARS is the importance of the precautionary principle. SARS demonstrated over and over the importance of the principle that we cannot wait for scientific certainty before we take reasonable steps to reduce risk. This principle should be adopted as a guiding principle throughout Ontario’s health, public health and worker safety systems.
H5N1 is a real threat. Robert Webster and Elena Govorkova , writing in the New England Journal of Medicine, said
Clearly, we must prepare for the possibility of an influenza pandemic. If H5N1 influenza achieves pandemic status in humans -- and we have no way to know whether it will -- the results could be catastrophic.
So, given what we know about the potential threat of H5N1 (which is considerable), and mindful of the precautionary principle, as well as the duty to inform, does it not make sense to prepare for worst case as well as mild case scenarios? It is in this context that discussion of how to stockpile (including suggestions of how long, and what, to stockpile, including medicines), and folding pandemic preparation into an all-hazards approach run into stormy weather. Planning for a worst case scenario ought to cover mild case scenarios and assist all-hazard preparation. Planning for a mild case scenario does no such thing. Mild scenarios do not consider loss of electricity, for one, or mass casualty events, nor do they consider the effect of illness on a vulnerable JIT economy. We will not be closing the schools for mild events (though they may close on their own when parents don't send their kids – and don't ever underestimate parents).
And while it is true that we can not predict the next pandemic, or whether H5N1 is the next pandemic virus, the precautionary principle suggests treating H5N1 as if it is. After all, that's why there's such interest in this topic in the first place. Let's acknowledge it and move forward with that in mind. After all, preparing for H5N1 prepares for any pandemic we get.