Public health systems will always have to address preparedness for contingencies well beyond the well publicized H1N1 (swine flu), H5N1 (avian flu), and SARS (Severe Acute Respiratory Syndrome) outbreaks – three somewhat similar diseases that in recent years have led to improved and more thorough pandemic-influenza planning efforts both within the United States and overseas.  U.S. health officials have therefore become very attuned to threats from such historic diseases as smallpox, plague, anthrax, and a host of others more exotic and/or not quite as well known.

The Association of State and Territorial Health Officials (ASTHO) is one healthcare association that has become increasingly concerned over the capacity of the nation’s health system, both public and private, for preparing and planning for various pandemic threats.  A pandemic influenza plan may not be enough, though.  Pandemic planning may, in fact, have to assume more of an all-hazards cast – which would be a definite capacity challenge.  Policy approaches are variously emphasizing one end or the other of the local-state-federal government spectrum, ranging from the federal-centric to the individual household, or YOYO (“You’re on your own”), to any and all points in between.

ASTHO represents state health officials at the center of the public health enterprise – i.e., between the federal government and local communities. “Our partners are horizontal across the country and vertical across all levels of the public and private sectors.  Our goal is to strengthen a permanent and robust public health system by changing our focus from deficits and problem areas to our collective strengths as a public health system – federal, state, and local.  This will change how we function in public health and strengthen our relationships with each other.” So said Paul E. Jarris, M.D., MBA, ASTHO executive director.  “And these [efforts],” he adds, “will require sustaining current relationships and brokering new ones to create a comprehensive approach to public health preparedness and response.”

Keeping these issues and concerns in mind, DomPrep asked the DomPrep40 to consider a number of issues related to pandemic preparedness and response.  To that end, Dr. Jarris and his ASTHO staff drafted the following DomPrep40 survey.

Key Findings:  The DomPrep40 is in a three-way split over which level of government has or should have the primary responsibility for pandemic flu planning and response.  Nonetheless, they are virtually unanimous in their belief that the state and local levels of government lack the resources needed to respond to emerging infections.

These findings are an indication of a possible fault line in current pandemic planning assumptions that may have to be addressed in the very near future.

Here are the full survey results

Over three quarters favor federal funding, going beyond preparedness for specific pandemic threats to cover all hazards.

A mixed result.  No consensus emerges as to whether the federal, state, or local government should have primary responsibility for pandemic flu planning and response.

The table below represents the DomPrep40 responses to additional questions asked in the survey.   Several conclusions, based on the answers indicated in the table, become evident, including the following: (1) a conclusive majority believes that the H1N1 vaccine campaign affords some valuable lessons learned for future seasonal-flu vaccination efforts; (2) seven out of ten believe that the federal government should provide more detailed guidance for state pandemic planning and response; and (3) the DomPrep40 holds, almost unanimously, that states and localities lack the resources needed to mount an effective response to an emerging infection.

A near-even split.  No agreement was reached on whether the Strategic National Stockpile should cover all needs required for an effective pandemic influenza response or only those not met by the private sector.

Just under two-thirds believe that clarification of responsibilities between public health and emergency management is the most important issue needing improvement.  Somewhat over one-fourth say that communications (and/or the occasional lack thereof) is the most important issue.

The DomPrep40 has not reached a solid consensus on what level of government should have the lead in pandemic planning and response.  This absence of agreement among such a distinguished group of homeland security professionals suggests that all levels need to come together to reconsider the topic and the strategy – particularly in view of the group’s near-unanimous agreement that state and local governments lack at least some of the resources needed for and effective response.

How does the DomPrep40’s thinking compare with your own current understanding?   In Part 2 of this Pandemic Preparedness and Response survey, all DomPrep members will now have a chance to weigh in and to agree or disagree.  Take The Survey Now!

Paul E. Jarris

Dr. Paul E. Jarris, ASTHO (Association of State and Territorial Health Officials) Executive Director.

John F. Morton

John F. Morton is the Strategic Advisor for DomPrep. He is also the Homeland Security Team Lead for the Project on National Security Reform (PNSR). A member of the DomPrep team since its founding, he has served as managing editor for writer assignments and interviewer for scores of DomPrep audio interviews.

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