U.S. pandemic preparation and response are mostly local affairs, which experts say is not good

Published 3 February 2006

The U.S. government may talk about a nation-wide plan to combat a pandemic, but when it comes down to it most of what will be done — or not done — when a pandemic hits will be locally determined

All politics is local,” former Massachusetts representative “Tip” O’Neill famously said. Apparently not only politics, but also pandemic preparation and you chances of surviving one. Yes, your chance of surviving a flu pandemic may well depend on where you happen to live. The United States has a federal pandemic plan, but in an emergency it will be the local response that matters the most, says Jeffrey Levi, senior policy adviser at the Trust for America’s Health. “The basic day-to-day, where the rubber hits the road for pandemic preparedness is being left to state and local governments,” he says. The Centers for Disease Control and Prevention (CDC) encourages states to create distribution plans for drugs and vaccines and policies on quarantine and isolation, but details on executing those plans are left to state and local health officials. “In the context of a pandemic, we cannot afford to have state-by-state variation,” Levi says. “We have a national interest in making sure that everyone is equally prepared and that we are using consistent strategies.”

Levi spoke at a flu summit in Washington, D.C. which was sponsored by the CDC, the Infectious Diseases Society of America, and other groups and agencies concerned about pandemic flu. Experts warn that a bird flu epidemic that has spread from Asia into Europe could spark a human flu pandemic that could be as severe as the 1918 “Spanish” flu, which killed up to 100 million people worldwide.

To prepare for a pandemic in the United States the U.S. government has stockpiled 4.3 million courses of Tamiflu and plans to acquire enough to treat seventy-five million people. A vaccine is being tested, and others are in development. Congress has so far allocated $3.8 billion for readiness. Stockpiles, however, should include more than vaccines and anti-virals, says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “Today we have a just-in-time delivery system for masks, syringes, for IV bags,” he says. “Most people don’t realize that 80 percent of the drugs we use in this country come from offshore. Right now, the two manufacturers of N95 masks in this country are operating on 100 percent capacity. They have no surge capacity. We will run out quickly of all these things. And at that time, we’ll be dealing with the equivalent of a 1918 health care system.”

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