- The Washington Times - Saturday, July 25, 2009

Skimpy supplies of flu vaccine and public panic are not the only concerns among officials charged with managing a potential pandemic. Some vital caregivers could be no-shows.

Sixteen percent of public health workers - about one in six - said they would not report to work during a pandemic flu emergency regardless of its severity, according to a survey released Friday by researchers at the Johns Hopkins University’s Bloomberg School of Public Health in Baltimore.

“Employee response is a critical component of preparedness planning, yet it is often overlooked,” said lead author Dr. Daniel Barnett, an assistant professor of environmental health science at the campus.

“By ‘public health workers,’ we are referring to any and all workers in a local public health department. These would include types of local public health department employees ranging from clinical workers - doctors, nurses - to administrators, to clerical and support staff.”

Other recent research revealed even more reluctance. A survey of close to 200,000 union health workers conducted by the AFL-CIO in April found that 42 percent said they would most likely stay home should a pandemic strike; one-third would go to work, and 24 percent were unsure what they would do.

Hospitals and other health facilities “are far from ready” to provide protection for workers, the survey said.

Dr. Barnett said intensely personal perceptions could keep uneasy workers at home.

His findings are based on responses of 1,835 public health workers in three states, gauging their willingness to go to work during a large scale threat, plus their thoughts on the nature of the emergency - and their own role as first responders.

Dr. Barnett found some pronounced, emotionally driven motivations. A sense of public calling still matters.

Workers who felt citizens were in danger, had confidence in their own abilities and felt they could have a “meaningful impact” on the threat were 31 times more likely to respond to work in an emergency than those who felt the threat was low or that their own role had no impact.

Even workers who did not think the threat was critical but still strongly believed in their value were 18 times more likely to say they would respond compared with those in the “low threat/low efficacy” group.

“We found belief in the importance of ones work was strongly associated with a willingness to report to work in an emergency,” said co-author Dr. Ran Balicer, an epidemiologist at the Ben-Gurion University of the Negev in Israel.

The researchers said that emergency preparedness training for public health workers should clarify what’s expected of them and emphasize why their response is vital during an “all hands on deck” scenario such as pandemic flu.

Trying to “artificially ‘minimize’ employees’ perceptions of the threat posed by an influenza pandemic is not an advisable approach,” Dr. Barnett said.

Public health departments, in turn, should “squarely address” the workers’ concerns about their own safety and give them and their families priority access to antiviral medications.

The Centers for Disease Control and Prevention is close to recommending that all health care workers receive a seasonal flu vaccine along with the H1N1 vaccine when it becomes available.

“I want to make a special reminder to health care workers: This year in particular, we want to keep health care workers healthy, at work, able to care for sick patients, and we don’t want them to be spreading influenza to their patients,” said Dr. Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases.

Congress already has heard about the “critical” need to protect workers during a pandemic flu outbreak.

“Our frontline health care workers are the foundation upon which our health care system is built,” Jordan Barab, acting assistant secretary in the Occupational Safety and Health Administration (OSHA), told the House Education and Labor Committee on May 7. “If they are not able to work due to illness, or unwilling to work due to fears for their health, individual patients and the countrys entire health care structure will suffer.”

The committee said in a follow-up report that even though “OSHA has issued guidance and even has some specific standards relevant to pandemic flu, the agency does not have a mandatory standard that comprehensively addresses the workplace hazards posed by airborne transmissible diseases.”

Pandemics are not the only threat to the public health work force. The number of workers already is dwindling and close to “crisis,” according to the Association of Schools of Public Health.

Some 250,000 additional public health workers will be needed by 2020, the group said, adding that almost a quarter of the current work force - 110,000 workers - will become eligible to retire during the next presidential term.

The CDC, meanwhile, is closely tracking the H1N1virus. The federal agency announced Friday that close to 44,000 case of swine flu have been confirmed in the United States, resulting in 302 deaths. The government already has bought 195 million doses of the H1N1 vaccine for vaccination campaign this fall, according to Dr. Robin Robinson of the Department of Health and Human Services.

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