Swine Flu: The Need for a Strong Public Health System
Posted April 27, 2009
The automated voice on my answering machine at first sounded like a telemarketing call. Yet as my finger moved to the 'delete' button, I stopped. "THIS IS A TEST OF THE DISASTER HEALTHCARE VOLUNTEERS NOTIFICATION SYSTEM," the mechanical voice intoned. "This test has been initiated in conjunction with recent Public Health and medical activities in response to the Swine Flu."
"This is a big deal," I thought to myself. "They're preparing to mobilize."
As a practicing physician in San Francisco, I registered many years ago with the California Disaster Healthcare Volunteer (DHV) system. The last time I was contacted as a healthcare volunteer was more than a month after Hurricane Katrina. By the time the Federal government finally got around to putting out the call for volunteers, I was already on-site in New Orleans with a team of NRDC experts performing an environmental assessment and planning environmental monitoring in consultation with local officials and community representatives. The Feds moved too slowly to mobilize the public health response to Katrina; it seems that they are avoiding that mistake this time.
But is it necessary to create all this fuss? An emergency declaration after only a couple dozen cases of influenza seems like it might be overkill.
As I went to the DHV website to confirm my contact information and willingness to be deployed, I thought: "better to act too soon rather than too late."
We live in a time when scientists predict an unusual array of health crises.
- We are way overdue for an outbreak of pandemic influenza; outbreaks historically occur every 25-30 years, yet the last major outbreak was in 1918 (with the most recent pandemic in 1968, from the "Hong Kong, China" flu); antigenic shift in the virus leading to a virulent and infective strain to which most people are not immune is only a matter of time. The swine H1N1 strain could fit that bill -- we'll see.
- Worldwide jet travel means that someone incubating a disease can get on a plane anywhere in the world, shedding virus as they go, and become ill in their destination country where they can spread the illness further.
- World trade in goods including food and livestock also increases the odds of spreading disease from infected populations to naïve ones.
- Poverty and overcrowding in many parts of the world mean that disease can spread rapidly, either person-to-person, or because of vectors such as mosquitoes.
- Climate change is also projected to shift disease patterns by making some areas warmer and wetter; although this may not be as important for influenza, it's a big deal for other infectious diseases such as Dengue ("Breakbone") fever, malaria, cryptosporidium, and even salmonella.
In my opinion, we're already seeing many of these health crises beginning to emerge, and the Swine Flu cases so far are playing this script out exactly as predicted.
So what's the solution, other than staying home with your head under your pillow?
The solution is to have a U.S. public health system that is well-funded, well-run, and up to the job of protecting people. Unfortunately, over the past decade, the budgets for the U.S. public health system have been cut, so the government's ability to rapidly detect health threats, and quickly mobilize to respond, has been hampered. During the eight years of the Bush Administration, the federal government quietly eliminated or crippled more than a dozen essential monitoring programs. Budget cuts, restructuring, program termination, and removal of industry reporting requirements undermined or eliminated the information that alerts us to problems in our air, water, food, or communities. Programs that directly track human health were slashed, creating gaps in our information about infectious disease outbreaks, chemical exposures in people, and chronic disease. We predicted trouble in a report called "Deepest Cuts: Repairing Health Monitoring Programs Slashed Under the Bush Administration" released in December. Swine flu is a wake-up call: we have one of the best public health systems in the world, but it has been mismanaged and starved for resources for years.
Fortunately, the current administration seems to be aware of the problem. For example, the EPA has already moved to restore some monitoring requirements for toxic chemical hazards. This influenza outbreak reminds us of the need to focus on rebuilding the CDC. After all, CDC experts are at the forefront of the fight to protect us all from new and emerging health threats. So I'm hoping that Congress and the Administration act to increase the funding stream to CDC, so that they can build an even stronger health tracking network, and can prepare to respond rapidly and strongly to the crises of the 21st century, including emerging infectious diseases, and the health threats from climate change. It's not too late to get back on track.
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