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Local Infection Controls Are Key to Pandemic Flu Strategy

By Michael J. Klag

November 10, 2005

We have long needed a coherent, national strategy for dealing with a global epidemic of deadly flu. The new plan announced by President Bush is good, but it has a serious Achilles heel.

The national pandemic flu strategy, devised by the Department of Health and Human Services, is desperately needed because our country has failed in dealing with even the run-of-the-mill, seasonal flu epidemics. Witness the shortages of flu vaccine over the last several years.

Our lack of preparation for a pandemic that could kill millions in the United States alone has been a serious threat to the nation for years. Flu pandemics erupt about once every three decades, and we are overdue for another.

The previous pandemic, which occurred in 1968, was relatively mild, but we cannot know which strain of flu virus will cause the next pandemic. The greatest threat now - the H5N1 virus that causes avian flu - has not acquired the ability to spread easily from one person to another, though it has killed about half of the people it has infected. Even a much less aggressive strain that can be transmitted person-to-person could set off a pandemic that would sicken tens of millions of people.

The HHS plan is a good one. It relies on developing surveillance systems to detect influenza infections, increasing our stockpiles of antiviral medications and flu vaccines, distributing medications and vaccines effectively and fostering international collaboration. It also emphasizes much-needed technological improvement to our vaccine development and manufacturing infrastructure. So far, so good.

But one of the most critical components of a flu strategy - infection control activities at the local level - is not adequately supported. Of the $7.1 billion in the proposed plan, only $100 million goes to local health departments for planning and program development, an average of $2 million for each state. By the time this amount trickles down to the community level, it will have little impact.

The local community is where the rubber meets the road in any pandemic. Local health officials will have to manage the outbreaks, develop policies for quarantines and how to handle infected people, administer antiviral medications to those with infections and vaccinate others not yet infected. Local health agencies will also be responsible for coordinating responses to the pandemic, improving their ability to identify virus subtypes, and informing the public about what to do.

In the last half of the 20th century, we in the United States took our public health infrastructure for granted and systematically underfunded it. Now is not the time to make the same mistake.

A $7.1 billion investment is a huge one, no doubt. Compared to the economic impact and loss of human life if we do not manage a pandemic effectively, however, it is a drop in the bucket. The work to be done by local and state agencies needs to be defined and realistically funded. Rather than spend effort in reslicing the pie, we need to make an already big pie even bigger.

Pandemic flu is a threat to our national security, and our government is now responding with appropriate urgency. We just need to make sure the front-line troops have the resources they need to save lives.

Michael J. Klag, M.D., is dean of the Johns Hopkins Bloomberg School of Public Health.

Article originally published in the November 10, 2005 edition of the Baltimore Sun. 

2005, reprinted with permission of the Baltimore Sun.