Pandemic Preparedness

Comments by Health and Human Services Secretary Mike Leavitt to the American Medical Association:

“Any community that fails to plan and to prepare and to exercise, with the expectation that somehow the federal government will come to their rescue, will be tragically wrong. Not because we lack the will, not because we lack the wallet, but because we lack the way. This is a uniquely local disaster. It is a global local disaster. We can deliver antivirals in large shipping packs to airports, but there’s got to be a [local] means of distribution…it is putting pills in the palms of hands at the right moment that defines victory.”

“Traditional, good public-health measures will be an absolute essential. Those are skills that, in many respects, we have forgotten how to use, given the fact that we have always had a pill or a shot for everything. Good, basic public-health measures of social distancing, hand-washing and [food] preparation [are things] we need to begin to teach….”

“There’s a big difference [between] having a plan and being prepared. The difference is exercising [i.e., actually practicing with simulation exercises.] … A nation prepared is when everyone has an exercise plan. I’m talking about every federal agency, every state, every tribe, every city, every county, every business, every school, every college, every hospital, every clinic, every medical office, every church, every household. This is something we can teach those who will listen….”

“There will be schools that need to be closed all across America…but you don’t want [the Federal government] deciding whether your neighborhood school closes or not. What you want is a principal that has got a plan and an understanding of when you close and when you don’t.”

I’ve been saving this post since March 13 of this year, when I recorded most of Health and Human Services Secretary Mike Leavitt’s speech and Q&A session at the American Medical Association’s conference. (Hooray for C-SPAN!) Leavitt’s talk was about bird flu, and as you might hope when the head of HHS talks to a bunch of doctors, both the speech and the Q&A were frank and hard-hitting. I found it a fascinating window into a bunch of medical professionals talking about scary stuff.

HHS is taking the possibility of a pandemic very seriously. Leavitt obviously doesn’t want to be the Michael Brown to a pandemic’s Katrina. But instead of trying to get his message to every American, Leavitt seems to be focusing on getting medical professionals, emergency responders and responsible bureaucrats up to speed. It’s a good strategy, but I’ll bet the principal at the high school where my wife works doesn’t have a pandemic flu plan yet.

I finally got some time over the last few days to transcribe the relevant bits from the recording, and I did so because this speech hasn’t shown up in the list of official speeches on the HHS website.  My transcript is below the fold. Bolded emphasis, and bracketed comments, are both mine. Wanna find out what the medical community is really hearing about a flu pandemic? Read below.

[Leavitt began by discussing bird flu and pandemics generally, and listing the checklists and other measures HHS has done so far.] “…we’ve also released Flu Surge, a spreadsheet-based model that will help hospital administrators and public health officials estimate the surge demand that would come for a hospital-based service during a pandemic. These and other tools will be very helpful to you as you begin to plan. You can find the tools available on a website called pandemicflu.gov. Later today, I’m going to be releasing a report entitled Pandemic Planning Update, which will detail the steps that we’ve been taking, and the actions that we’ve been taking to prepare for a pandemic.

“Now, I want to emphasize again that there’s a big difference in having a plan and being prepared. The difference is exercising. Now, if you’re in a hospital, or in a clinic or in a small practice, I would like to suggest that a good thing for you to do, that would be very helpful not just for you but for our entire community, would be for you to get the checklist, and begin appointing someon responsible in your clinical setting to begin thinking through how we would deal with a pandemic. …Now we do have and are building stockpiles of antiviral drugs that’ll be important as a part of pandemic influenza. I recently announced the purchase of additional antiviral drugs that could be used in the event that we had such an incident. We intend over the next year and a half to complete a stockpile that will be up to 25% of our population. That’s the recommended amount because that’s what would typically be affected in a pandemic.

“Because the virus has continued to drift, as all viruses, do, we will continue to monitor the virus’ evolution. For example, since the H5N1 vaccine was first developed, we have seen the virus drift; and last week, I authorized the development of another seed virus, ah, vaccine rather, to begin to focus on the virus version that is now circulating in Asia, Europe and Africa. It is different than the one we first saw. We will continue to do so as this unfolds.

“But there’s little question in my mind, despite the fact that we will have some capacity for vaccines, and we’re building as rapidly as possible more capacity — it’s our aspiration to get to 300 million courses in a 6-month period of time — that despite that capacity, during the first wave of a pandemic, we will be without a vaccine. It takes that long for us to identify the vaccine, to be able to begin manufacture, making certain it’s safe, and then getting it into the hands of physicians and practitioners. So traditional, good public-health measures will be an absolute essential. Those are skills that, in many respects, we have forgotten how to use, given the fact that we have always had a pill or shot for everything. Good, basic public-health measures of social distancing, hand-washing and preparation is something we need to begin to teach and to assist.

“A nation prepared is when everyone has an exercise plan. I’m talking about every federal agency, every state, every tribe, every city, every county, every business, every school, every college, every hospital, every clinic, every medical office, every church, every household. This is something we can teach those who will listen, and that is [it is] a time for personal preparedness. It’s a good idea for people to have a couple of weeks of food, not just for a pandemic but for any medical or community emergency. It’s a good idea for people to have water…. Personal preparedness is a very solid ethic that makes a community safer and healthier…..”

[Question and Answer Session]

[In response to an audience question from Arvind Goyal, president of the American Association of Public Health Physicians, Leavitt said this:] “…My biggest concerns are surge capacity and distribution of vaccines and antivirals. We are building large and significant stockpiles of antivirals, but it isn’t having them that defines victory; it’s putting pills in the palms of hands at the right moment that defines victory. As we begin to exercise ourselves, it becomes clear that distribution is the key.

“Now I have been going to these state summits, and an important part of what I’ve told them is this: any community that fails to plan and to prepare and to exercise, with the expectation that somehow the federal government will come to their rescue, will be tragically wrong. Not because we lack the will, not because we lack the wallet, but because we lack the way. This is a uniquely local disaster. It is a global local disaster. We can deliver antivirals in large shipping packs to airports, but there’s got to be a means of distribution. Now I will tell you we are now working with the states to develop a very rapid distribution where we can use existing assets, existing distribution, the people that deliver to you [physicians] every day….

“Our optimism, and our aspiration, I should say, is to have the capacity to develop 300 million courses of a vaccine in a 6-month period. Now much of that 6-month period would be in the development of it, the testing of it, and the manufacturing of it. That doesn’t leave very much time for the distribution of it, which would fall upon all of you. So again, I would say that it is our responsibility to assure that there’s coordination going on, but that ultimately the job of distribution is going to have to be planned in local health departments and with state governments and local practitioners — or it won’t work.”

[This was a question from another audience member:] “…Barry points out in his book that Philadelphia was so hard hit because previously, before the flu hit, they had a massive rally to sell war bonds, and 30% of the city’s population was at the rally. Public health officials had urged the mayor and the governor to cancel the rally because of the likelihood of spreading disease. In all of the planning that I have seen from your office, I haven’t seen anything about canceling or preventing public gatherings of this sort. Is there such a plan?”

[Leavitt’s response:] “The answer is that is clearly part of good pandemic preparedness. Social distancing and the public health measures I’ve spoken of are right at the heart of that. What you will see at some point in the very near future is a series of guidance we will provide on the levels of social distancing. I told you about my little home town [Leavitt earlier suggested that everyone Google ‘Spanish Flu 1918’ and the name of your home town, to see just how many stories are pulled up]. And this was true in almost every town across America, when people began to see what was happening, they created proclamations. In my hometown, they canceled church, they canceled school, they canceled the college, they turned the college into a hospital…. But that kind of guidance is in place now and more will be coming….

“Here’s the last thing I want to mention on this — those [decisions to close] need to be exercised by local governments. There will be schools that need to be closed all across America at different times, but you don’t wan the Secretary of Health and Human Services, or for that matter the Secretary of Education, deciding whether your neighborhood school closes or not. What you want is a principal that has got a plan and an understanding of when you close and when you don’t. Because life still has to go on in a pandemic; people still have to work, people still have to have food…. That is why it is so important that we have local preparedness.”