HHS advisor fields online pandemic preparedness queries

Feb 19, 2008 (CIDRAP News) – FluWiki, an online resource and community forum, has its finger on the pulse of pandemic influenza planning issues and avian flu news, but today it featured something unusual: a dialogue with a top federal science advisor who's directly involved in the government's pandemic preparations.

William Raub, PhD, science advisor to Health and Human Services (HHS) Secretary Mike Leavitt, fielded six multipart questions from the FluWiki community, covering issues such as vaccine prioritization, food and medication stockpiling, the federal government's role in pandemic planning, and how HHS plans to publicize the role of community mitigation measures.

Greg Dworkin, MD, one of the editors at FluWiki, in January urged participants to compile a list of questions and offered to forward them to HHS. Dworkin told CIDRAP News that the online "interview" with Raub was an outgrowth of the HHS Leadership Blog and Summit, events held last May and June that were designed to encourage public engagement in pandemic planning efforts.

Raub has participated in the HHS Leadership Blog and Summit, and Dworkin said HHS has wanted to monitor the concerns of the online community of flu watchers.

Dworkin said he was impressed by the level of detail in Raub's responses. "From our perspective, the two-way dialogue and the involvement of the community in posing the questions were important," he said. "Dr Raub took the assignment very seriously, which we greatly appreciate."

Sharing responsibility
One of the themes that emerged from the dialogue is that federal officials strongly believe that pandemic planning should be a shared responsibility. Leavitt has often warned against total reliance on the federal government in the event of a pandemic.

Raub wrote, "To the extent that potential partners refuse to apply their talents and assets unless the federal government foots the bill, they are abdicating their responsibility and thereby placing their communities at higher risk than need be."

However, he also wrote that citizens can expect the federal government to play a prominent role in pandemic planning, focusing on areas that it is uniquely positioned to manage, such as vaccine and antiviral stockpiling, providing financial and technical assistance to states, and boosting domestic vaccine development and production.

FluWiki members asked Raub if funeral directors and other mass-casualty personnel, as well as their families, would be considered a priority in the federal vaccine allocation plan. He responded that a federal working group is evaluating public comments it received, which included concerns about mass-casualty workers, and that the group will release an updated plan within the next several months.

Responding to questions about vaccine development, Raub wrote that most experts believe that a viable pandemic vaccine using DNA or other emerging technologies is more than 5 years away, but that HHS is currently reviewing contract proposals for advanced development of a DNA vaccine.

He pointed out that six HHS-funded companies are developing cell-culture vaccines and said work is on schedule toward the government's goal of achieving by 2011 the industrial capability to produce 600 million doses of vaccine within 6 months after a pandemic flu strain is identified.

Antiviral stockpiling
When questioned about the government's stance on antiviral stockpiling by individuals, Raub wrote that HHS has concerns about misuse of the drugs and the possibility of greater use leading to antiviral resistance. However, he said an experiment with antibiotic medical kits for bioterrorism events produced promising results and that HHS would assess the design and feasibility of a similar antiviral medical kit.

On another antiviral topic, the FluWiki community asked if federal efforts to induce states to build their own antiviral stockpiles by purchasing the drugs with federal subsidies amount to an "unfunded mandate."

"States . . . can provide antiviral drugs for their citizens at 30 cents on the dollar," Raub wrote. "Some see the offer as being 30% empty. I see it as 70% full."

Another query dealt with how local groups can promote community mitigation plans without clear messages from the government about the importance of measures such as school closures. Raub responded that the challenge in engaging the public is more difficult than it was 2 years ago, because the public's' interest in avian flu seems to have diminished.

"The Web site Pandemicflu.gov will remain the lynchpin of our messaging machinery. But we recognize that we need multiple modalities to promulgate and reinforce preparedness messages," Raub responded. He added that HHS values the input from FluWiki's online community.

HHS pleased with results
Stephanie Marshall, HHS director of pandemic communications, said HHS is pleased with the question-and-answer discussion between Raub and the FluWiki community, and that she believes this is the first time HHS has participated in this type of online discussion.

"It's an opportunity to reach a very interested and engaged audience and it's something we're considering doing more of in the future," she told CIDRAP News.

Dworkin said FluWiki's goal has always been to "put the 'public' back into public health, by helping to close the gap between the often invisible public health folks and the communities who under-appreciate what they do." Online forums can also help messages filter down from the federal level to families and individuals, as well as offer important feedback on the practical aspects of pandemic planning, he said.

Blogs and online forums offer two-way communication improvements to fill the gap, but the efforts require work from both sides to be successful, Dworkin commented. "We have a long way to go, but it is a worthy long-term goal," he said.

See also:

Flu Wiki Q & A with William Raub, PhD

Apr 17, 2007, CIDRAP News story "Pandemic planners urged to tap grass roots"

Jun 14, 2007, CIDRAP News story "HHS hears community leaders' ideas on pandemic readiness"

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