APHA offers plan for boosting pandemic preparedness

Feb 23, 2007 (CIDRAP News) – The nation's largest public health group, the American Public Health Association (APHA), yesterday released recommendations aimed at strengthening existing federal strategies for pandemic preparedness and encouraging local officials and businesses to play key roles.

At the top of its list are more resources for an overburdened public health workforce, which will play a key role in responding to a pandemic flu outbreak. Other recommendations in the APHA's 16-page report range from expanding surge capacity in hospitals and public health labs to providing emergency medical coverage for people who are uninsured.

Preparing for an influenza pandemic isn't just the job of the public health sector, said Georges C. Benjamin, MD, the APHA executive director, in a press release yesterday. "The general public must be equipped with the proper resources to prepare themselves in the event of a flu pandemic," he said. "The better we prepare now, the better our chances will be for protecting the health of Americans during an emergency."

Jeffrey Levi, PhD, executive director of Trust for America's Health (TFAH), a nonprofit public health advocacy group, lauded the APHA's report, particularly its call for Congress to enact measures, such as scholarship and loan incentives, to bolster the public health workforce. "This is an excellent report that covers some of the critical pandemic preparation issues and places them appropriately in larger context," he told CIDRAP News.

Though isolation of flu patients and quarantine of exposed people are likely to play a limited role in the early stages of a pandemic, policymakers need to shore up laws and policies on isolation and quarantine, including who has authority to issue quarantine orders, the APHA report says. "These decisions should be made on the basis of scientific risk and use the least restrictive alternative."

The US Department of Health and Human Services (HHS), along with state and local officials, should develop national standards for sheltering in place, and the public should be urged to prepare to shelter at home for at least 2 weeks, according to the report.

HHS and the US Department of Education should take the lead in developing national criteria for school closings in a pandemic and should make school districts aware of them, the report says.

The APHA questions a component of the HHS antiviral stockpiling plan that encourages states to purchase antiviral medication with a 25% federal subsidy. According to a USA Today report on the antiviral subsidy program, written after the Aug 1, 2006, signup deadline, at least 43 states indicated they wanted to participate, though some said their ability to buy the drugs was uncertain. "The level of protection Americans receive should not be determined by where they live and the current fiscal position of their states," the report says.

Funding for national stockpiles of medical and lab supplies is inadequate, the document says. Besides items such as ventilators, syringes, and gloves, the medical stockpile should include equipment and medications needed to treat people who have chronic illnesses such as HIV and diabetes.

In addition, the Food and Drug Administration should consider relaxing its limit on the amount of medicine that can be dispensed per prescription so that people with serious health problems can store enough medication to get them through an isolation or quarantine order during a pandemic, the APHA contends.

Echoing the concerns of other health advocacy groups, such as TFAH, the APHA calls on Congress and HHS to establish an emergency Medicaid designation to encourage uninsured people to seek treatment more quickly if they have influenza symptoms. Other measures the APHA says would help ensure patients' access to medical care during a pandemic include improving medical surge capacity—not only for flu patients, but also for those with other medical conditions.

The APHA report places a strong emphasis on pandemic-related business and occupational health concerns. It urges businesses to consider paid sick-leave policies that encourage employees to stay home when they or their family members are contagious during a pandemic.

Also, the group recommends including several other business-related provisions in the national pandemic plan, such as:

  • Setting guidelines about work-related influenza exposure for use in workers' compensation cases
  • Providing financial support for employers who face extremely high costs for worker protection
  • Requiring employers to develop pandemic preparedness plans
  • Mandating employee training in prevention and exposure control
  • Recommending that workers in high-risk occupations wear respirators rather than surgical masks

Like other groups, such as the Infectious Diseases Society of America, the APHA critiques current federal emergency response plans for designating the Department of Homeland Security as the lead agency in a flu pandemic, leaving HHS responsible only for "very traditional public health and medical issues."

"Responding to a pandemic flu is much different than responding to a terrorist attack or hurricane," the report says. "Therefore, public health officials—the Department of Health and Human Services—should have the formal authority to take the lead in the federal response to pandemic flu."

See also:

Feb 22 APHA press release

APHA report: "Prescription for Pandemic Flu"
http://www.apha.org/advocacy/policy/APHA+Prescription+for+Pandemic+Flu.htm

Feb 1 CIDRAP News story "HHS ties pandemic mitigation advice to severity"

Jan 25 CIDRAP News story "IDSA urges requiring flu shots for healthcare workers"

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