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Jeffrey Levi

Jeffrey Levi

Posted April 30, 2009 | 10:43 AM (EST)

The Swine Flu Response


As the first swine flu cases were diagnosed in Mexico, health officials all over the United States leapt into action. This is the test that they are always preparing for.

As the disease spread, public health professionals have been actively tracking the cases, working to contain the disease by treating areas where the disease is most concentrated, dispensing antiviral medications from the Strategic National Stockpile, and letting the public know how to protect themselves and when to seek treatment.

The Administration has displayed strong, coordinated leadership, with the U.S. Centers for Disease Control, the U.S. Department of Health and Human Services, the U.S. Department of Homeland Security, and the White House conveying guidance and strategies based on the best expert advice for how to respond. State and local health departments are monitoring and responding to cases as they emerge.

We are fortunate that the country has taken many measures to prepare for a potential pandemic flu outbreak. In November 2005, then President Bush issued a National Strategy for Pandemic Influenza that called for plan that spanned every department of the federal government, every state, and the private sector. Congress provided nearly $7 billion to help prepare. Most of this funding went to stockpile existing antiviral medications and give scientists resources to research and develop vaccines and other pharmaceutical interventions.

Since then, due to the tireless work of public health professionals, the country has made significant strides in improving surveillance, coordination, communications, treatment capabilities, and vaccine manufacturing capacity. In addition, all 50 states and the District of Columbia have developed pandemic plans.

Overall, our ability to respond to a pandemic is light years ahead of where we were just a few short years ago.

But, our public health system has been under-funded for decades and there are many existing gaps that leave us vulnerable, particularly if the swine flu becomes more severe and lethal.

If large numbers of Americans start getting very sick and start flooding into hospitals and health care facilities, our system will really be in for a test. Our health system could be overrun in a very short period of time.

Figuring out how to plan for a massive influx of patients is one of the hardest parts of preparing for health emergencies, and it has yet to be adequately dealt with. "Surge capacity" management is one of our biggest weaknesses, particularly at a time when we have shortages of emergency and public health workers. That problem is getting worse as state and local governments are cutting budgets. An estimated 11,000 public health workers have been laid off in just the past year.

The problem of managing massive numbers of patients is even more complicated under the current health care system, where there is serious concern that people who are uninsured or underinsured may not seek treatment or may not have trouble accessing care. If people who are contagious do not seek treatment during the limited time period when antiviral medications might be effective, they are at serious risk. And they also risk spreading the disease to others.

During an infectious disease outbreak, ensuring that care is in place for all Americans is more vital than ever. Not only is the patient at risk, they risk further spreading the disease unless they receive proper care.

The swine flu is a clear demonstration of how public health issues are an integral part of our overall health care system -- and the importance of considering these issues as part of the health reform debates.

Congress should incorporate preparedness planning support into health care reimbursement streams, so hospitals and health facilities can actually meet the needs of all patients when emergencies arise. In particular, a "State of Emergency" health benefit would ensure that the uninsured and underinsured receive the care they need on a temporary basis during crisis. Hospitals and health providers shouldn't have to worry whether they'll be compensated for providing care to individuals in need in an emergency. And more importantly, no patient should have to worry that they'll be turned away when the need care.

We also need to ensure that the right medications will be available to people when they need them. The investment the country has made in buying antiviral medications for the Strategic National Stockpile is now paying off. However, even now, some states have more antiviral medications available than others, leaving some Americans unnecessarily vulnerable.

We also need to make sure we continue to replenish the Strategic National Stockpile, so if there are additional cases and waves of swine flu -- or even another new strain of flu develops, we will be able to treat people.

Vaccine development and production is also imperative. We need to give scientists the resources they need to develop a vaccine for this new swine flu, and once a vaccine is ready we need to be able to produce enough vaccine to cover all Americans. At the same time, scientists must continue development of bird flu and other flu vaccines.

The swine flu outbreak is a very real reminder of why we need a strong and stable public health system in the United States. This requires an ongoing and sustained investment in our federal, state, and local health departments. Unfortunately, in the past, we have not provided sufficient resources to this system. As we look to reform the health system in coming months, we also have the opportunity to build a reliable funding stream for public health as part of that system. Until we do, we are leaving Americans unnecessarily vulnerable to potential health threats, and our hospitals and health care providers at risk for emergency situations they do not have the capacity to handle.