Feds outline state pandemic planning gains and gaps

Jan 16, 2009 (CIDRAP News) – The US Department of Health and Human Services (HHS) yesterday released an assessment of progress states have made toward planning for an influenza pandemic. The report found that many scored well in areas such as protecting citizens and administering mass vaccinations, but showed major gaps in such areas as sustaining state operations, developing community mitigation plans, and maintaining key infrastructure.

States were required to submit their pandemic plans to the federal government 3 months after HHS issued a pandemic planning guide for states last March. Both the state pandemic planning guidance and the assessment requirement were spelled out in the in the Bush administration's national pandemic influenza strategy plan, released by the White House's Homeland Security Council in May 2006.

The 31-page document, "Assessment of States' Operating Plans to Combat Pandemic Influenza," is available on the HHS Web site (see link below).

William Raub, PhD, science advisor to HHS Secretary Mike Leavitt, said in an HHS press release yesterday that states and territories have accomplished a great amount over a short time, but much more work is needed. "The results of this assessment provide a broad-brush picture of strengths and weaknesses across various aspects of pandemic preparedness," he said.

HHS's overall assessment seems to mirror the findings of an Oct 16 report from the National Governors Association, which also found progress but expressed concerns about several planning gaps.

Yesterday's report, the second part of a two-stage assessment, was the first time that federal officials have made their state-specific findings public. The first stage, which spanned Aug 2006 to Jan 2007, was shared only with states.

The review of 56 states and territories was conducted by 12 federal departments and two White House offices and covers 28 operating objectives that fall under three strategic goals: ensuring continuity of state government and agency operation, protecting citizens, and maintaining critical infrastructure and key assets.

Continuity of state agencies and government
Evaluators found that 54 states and territories were inadequately prepared to sustain state agencies and support and protect workers and that the other 2 had many major gaps. They wrote that states that had a statewide plan or one agency that directed the planning had a better understanding of what was needed to keep state government and its workforce operating during a pandemic.

They emphasized that traditional continuation-of-operations plans do not contain all of the elements needed to support government operations during a pandemic.

The states fared better on sustaining public health operations during a pandemic: 33 of 56 states or territories had no or few major gaps. Those that scored low in this area focused mainly on external health services and prophylaxis and didn't adequately address internal public health operational continuity and protection of its workforce. Low-scoring states also lacked personnel training and exercises.

In reviewing states' plans to sustain transportation systems, federal officials found that states have made substantial advances in communicating with neighboring jurisdictions and other state and federal agencies, as well as being ready to issue public service announcements and public safety campaigns.

They found, however, that many states haven't formulated cleaning and sanitizing methods for transportation systems, cargo, and facilities. Some had no actionable plans for keeping goods and people moving. In all, 12 states and territories had no transportation-preparedness gaps, 11 had few major gaps, 8 had many major gaps, and 25 had inadequately prepared.

Protecting citizens
Forty-nine states and territories had no or few gaps in ensuring surveillance and laboratory capacity during each stage of a pandemic, but evaluators reported that many seem to struggle with some specific tasks such as planning for electronic death reporting and surge laboratory capacity.

Port-of-entry concerns apply to only 16 states and territories: those with a US Quarantine Station. Only one of those 16—Washington state—was found to have no major gaps in this area.

Federal officials said many of the port-of-entry states and territories are still in the draft stage of pandemic planning and getting guidance from and working out reimbursement issues with federal personnel, such as the Centers for Disease Control and Prevention (CDC). However, the evaluators pointed out that many states seem to be having a difficult time arranging separate quarantine facilities for detaining potentially exposed passengers.

Regarding community mitigation measures, states vary widely in their ability to implement plans, the authors found. Though most have identified legal authorities needed to implement interventions such as closing schools or canceling large gatherings. Most states have not engaged with businesses, school districts, tribal agencies and other partners to discuss community mitigation planning.

States seem to be lagging behind in community mitigation planning when compared with other aspects of pandemic planning, the group said. "The federal government should support their efforts in this area, as it may be the single most important aspect of readiness in terms of reducing morbidity and mortality during a pandemic," they wrote.

In general, states received high marks for planning for antiviral drug distribution and ensuring mass vaccination capacity. However, some states are struggling with other tasks surrounding vaccination, including collaborating with state and local health departments, transitioning from planning to implementation, and having a stand-alone pandemic influenza vaccination plan.

States seem to have misunderstood the objective that directs them to mitigate the influenza pandemic impact on workers in the state to mean just state workers, the report said. Only three had no or few major gaps. Better communication between state pandemic planners and their agencies might have avoided this problem, they said.

Sustaining critical infrastructure and resources
States still face steep challenges in supporting and sustaining key infrastructure during a pandemic, though the authors said they are encouraged by progress many have made. The review process unveiled some notable efforts and best practices, including a dedicated critical infrastructure pandemic plan, a public-private partnership plan for preserving critical infrastructure, and inclusion of critical infrastructure concerns in health department pandemic plans.

HHS said in its press release that the critical infrastructure panning merits significant attention. "Even the best plans can fail if managers cannot accommodate the significant absenteeism and disruptions in supporting services and supplies that an influenza pandemic is almost certain to produce," the agency said.

See also:

Jan 15 HHS press release

HHS state assessment report

Mar 14, 2008, CIDRAP News story "HHS issues pandemic planning guide for states"

Oct 16, 2008, CIDRAP News story "Governors group identified states' pandemic-preparedness gaps"

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