Pandemic Flu Plan Reviews

by DemFromCT

In lieu of having time to review the (391 page, 11 appendixes) plan, let me offer some thoughts from Effect Measure and the WaPo.

From Revere at EM:

The Pandemic Flu Plan (PlanFlu) went up at 9 am yesterday morning at http://pandemicflu.gov/. It is long (although padded with photos and wide margins) and I have yet to read it all. I will try to look more closely at some parts over the next few days or so, as the spirit moves me and time and space permit.

As a preliminary comment, I'd say it is very clearly written and presented. I give DHHS high marks on clarity, and mostly (as far as I can see), without overt spin. When I am able to view it in its entirety I may change my mind but right now it is a good effort at presentation. At the outset it ratifies what we an many others have said, that local communities will be on their own in the event of a pandemic:

If efforts to contain isolated outbreaks within the U.S. were unsuccessful and influenza spread quickly to affect many more communities either simultaneously or in quick succession—the hallmark of a pandemic—response assets at all levels of government and the private sector would be taxed severely. Communities would need to direct all their influenza response assets to their own needs and would have little to spare for the needs of others. Moreover, as the number of affected communities grows, their collective need would spread the response assets of states and the federal government ever thinner. In the extreme, until a vaccine against the pandemic virus would become available in sufficient quantity to have a significant impact on protecting public health, thousands of communities could be countering influenza simultaneously with little or no assistance from adjacent communities, the state, or the federal government. Preparedness planning for pandemic influenza response must take this prospect into account.

As we have noted here often in the last year, this is absolutely correct. In a pandemic there is no "outside" from which to get outside help. The necessary response will have to be at the community level. This was the idea behind the Flu Wiki (which appears to have influenced the government's website, although without acknowledgment). It is a fact that the Federal role will of necessity be limited to providing some limited supplies of antivirals, vaccines (if they exist) and guidance. I don't fault them for this division of labor. It is dictated by circumstance.

There's more, and the problem is the balance between pharma and government. From the WaPo:

George Conk, an expert in product liability at the Fordham University law school in New York, said the need for such protections has been overblown.

Conk pointed to recent research published in the New England Journal of Medicine that documented the very low rate of serious reactions to flu vaccines in the past two decades. The study found that only five deaths and 30 serious reactions were reported for every 10 million doses of flu vaccine given in 1990. More recently those numbers have shrunk to about 15 serious adverse reactions per 10 million doses.

Conk also took issue with proposed legislation supported by the Bush administration that would not only protect vaccine manufacturers but also block any judicial review of the actions of the secretary of health and human services and the attorney general should they declare a public health emergency to facilitate widespread use of a new vaccine.

"Do we really distrust our courts enough that these leaders should not be subject to judicial review?" Conk asked.

Alan Meisel, a professor of law and bioethics at the University of Pittsburgh, wondered whether it was even possible to rely on private industry to take on such a crucial part of the task of protecting the public in an emergency on the scale of a flu pandemic.

When the nation last faced a danger of this scale, he said -- referring to World War II-era concerns that Germany was developing an atomic bomb -- the government did not go to the private sector to see what liability protections and profit margins might be required to make a bomb for the United States.

"I thought the one purpose of government that was inarguable was to take measures for the common good where others could not possibly do so on their own," Meisel said, arguing for a sort of pandemic-flu Manhattan Project.

More to come on this. it's a start, but leaves much, including funding, undone.

Comments

[Sara]

Today the Governor of Minnesota announced the Minnesota Plan. Given that much of it is clearly influenced by Michael Osterholm (whom I respect) it is interesting. No Schools, No sports, Malls to close, virtually anyplace where people congregate to be closed up. Plans exist to distribute bacine to everyone in the Twin Cities within 48 hours -- for the whole state, 7 days. (Of course there is no vacine even given the plan.) Apparently the state has some sort of plan to produce generic Teriflu -- no plan as to how this is to be distributed. Much emphasis on how well our turkey indistry is protecting itself.

I see all sorts of things missing from the plan -- but at least there is one.

[DemFromCT]

thanks! You bet Osterholm and CIDRAP will influence MN; he's influenced the US plan as well.

MN's flu stuff is here.

[revere]

Dem: Just for clarification, if readers read on in my post over at Effect Measure they will find I am not as enthralled as the part quoted suggests, however.

[Bob]

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