Senator Susan Collins (R-ME)on pandemic flu and the stimulus:
"Everybody in the room is concerned about a pandemic flu, but does it belong in this bill? Should we have 870 million dollars in this bill? No, we should not."
Well, that's an interesting statement, when you think about it. Everyone in the room (and that would be mostly Senators) was properly concerned about the possibility of a pandemic. That part is crystal clear (and thank you, Senator Collins, for saying so.)
As to whether it's appropriate to put the money in a safety net/stimulus bill, that's the debate that's ongoing. A case can be made that money spent on science, health and education — and that includes public health — is a great investment in jobs and infrastructure. Unfortunately, more people believe that on the House side than the Senate side, as Collins articulates, and so the 870 million was removed from the Senate bill, for now (900 million still sits in the House bill - details here.)
Interestingly, at the beginning of the week I spent two days with scientists and public health officials from all over the world who are experts on the topic of pandemic and seasonal flu. And guess what? Everyone in the room, from the White House to WHO, was concerned about a pandemic flu. There was some consternation at the meeting about Tom Daschle withdrawing (both nature and scientists abhor a vacuum.) And there was a good deal of concern about the fate of public health funding in this stimulus bill. Ultimately, the meeting was about science and policy.
The science meetings were sponsored by IDSA (the Infectious Disease Society of America), who have been involved in pandemic influenza preparedness since at least 2005. Back then, Dr. Andew Pavia (the chief of the Division of Pediatric Infectious Diseases at the University of Utah Health Sciences Center and Primary Children's Hospital) was also chair of IDSA's Pandemic Task Force (after a stint on the public policy committee, he's back on the Task Force.) In testimony to Congress (.pdf) *, Dr. Pavia noted the fragility of our nation’s vaccine supply, and the importance of bolstering R&D, which is where most of the pandemic dollars in the stimulus would go. In addition, a need for antiviral R&D, stockpiling and distribution plans was identified in 2005.
I caught up with Dr. Pavia at the meetings and asked his opinion of how far we've come, and where we need to go. His opinion was that there's a "mixed scorecard". While the vaccine picture has certainly improved, with high-tech solutions for mass production on the horizon, and research into adjuvants and other antigen-stretching techniques (making vaccine more efficacious, and allowing more vaccine to be made with the same hard-to-produce antigen) has come a long ways, the "under-exploited" state stockpiling of anti-virals was notable (see Trust For America's Health 2008 Ready or Not? report.) The Biomedical Advanced Research and Development Authority (BARDA), for example, still gets year-to-year funding, and many states cannot afford the purchase of anti-virals. The resistance developing in some flu viruses (see part I of this series) just complicates things even more.
Dr. Pavia reminded me that IDSA suggested in 2005 and affirmed in 2007 that health care workers really need to get their flu shots, not just to set an example but to keep their patients healthy. In 2007, "the current rate for this group is about 40%, the ISDA report says," which is disgraceful.
Dr Keiji Fukuda from the World Health Organization emphasized that the pandemic threat from H5N1 has not diminished, even as reported human cases have declined since 2006. Unfortunately, new cases continue to be reported from China, Egypt and Vietnam, where the virus is endemic in wild birds [Establishment of zoonotic infection is less known as hard fact than we would like, particularly on the issue of poultry vs wild bird reservoirs, and where disease comes from when humans catch it in individual countries affected also remains unclear].
Researchers from all over the world presented data on the surveillance of flu viruses, and also discussed how work done on pandemic flu and H5N1 spills over into seasonal flu and other infectious disease control.
We've been having ongoing discussions here about public health infrastructure and what that means (this meeting and others like it are part of that infrastructure). Every scientist and public official I spoke to emphasized that infrastructure can't be created overnight, or turned off and on with a switch. Public health infrastructure also means jobs.
That brings us back to Sen. Collins' remarks, and the difference between the House and Senate versions of the recovery, stimulus and safety net bill.
Jeff Levi, PhD, executive director of TFAH, said in the statement, "This is an unprecedented one-time investment in public health." In 2008, a TFAH expert panel reported that the country faces annual $20 billion shortfalls in critical public health program funding across state, local, and federal levels.
The National Association of County and City Health Officials (NACCHO) said in a Jan 15 statement that federal support for effective public health programs has eroded steadily over several years. "This (House) bill would reverse that course and set the stage for an emphasis on wellness in forthcoming discussions of reform of the nation's health system," the group said.
On Jan 27 TFAH released a statement applauding the Senate Appropriations Committee for including $16 billion for public health in its version of the stimulus bill. "This funding is desperately needed to revitalize and modernize the country's ailing public health system, and we'll be putting more Americans to work in programs that will directly improve the health of communities where they live," Levi said.
I don't think anyone cares if money for health and safety (including R&D) is removed from this bill and passed in some other bill. But keeping the focus on public health infrastructure, much of which gets back to the states, is essential to keeping our citizens healthy. And accepting that these funds are essential is part of the on-going debate as to where and how we best spend our limited resources. Senator Collins didn't challenge the need, just the vehicle to get there. That, at least, is a start. But just as with education, dollars spent here not only create jobs, they keep jobs at state level while promoting the public good. It's a twofer that should be emphasized while we debate these and subsequent bills.
*IDSA represents nearly 8,000 infectious disease (ID) experts, many of whom administer the flu vaccine to patients, treat life-threatening complications of influenza, conduct vaccine and antiviral research, and implement influenza surveillance activities and other important influenza public health programs at the local, state, and federal levels. Let me be very clear from the onset: Although we are speaking on the same panel as our industry colleagues, our testimony is provided strictly for the good of public health and the patients whom we treat. IDSA is not here on behalf of the pharmaceutical or biotechnology industries nor is our advocacy financed in any way by industry.
From page 2, Infectious Diseases Society of America’s Statement by Andrew T. Pavia, MD, Concerning Pandemic Influenza Before the Committee on Energy and Commerce Subcommittee on Health United States House of Representatives