Sunday, October 4, 2009

Influenza is a public health threat that arrives in the community every fall. The emergence this year, however, of the novel H1N1 virus — also called swine flu — raises concerns about the potential for a widespread outbreak and possible spread of a more virulent strain than previously seen.

In order to prepare for and respond effectively, we must have an adequate public health system. This system must be able to: (1) recognize when influenza enters the community and track its spread, (2) prevent it when possible and mitigate its spread, (3) treat the victims of the disease and (4) strengthen the resilience of our communities to withstand the social and economic effects on the community through education and planning.

There are a few ways we can strengthen this system. First, our nation’s current disease surveillance and reporting capability relies on a fragmented web of clinicians, laboratories and health facilities that look and test for influenza and other diseases. The system works, but it is not as efficient as it should be considering the speed by which today’s contagious diseases spread through communities. We must correct the chronic underfunding of the nation’s public health system by providing adequate and sustainable funding to address the growing demand placed on federal, state and local public health agencies.

Second, vaccines are the mainstay of our fight against vaccine-preventable diseases. Recent efforts by the federal government to ensure production of a vaccine for H1N1 influenza are admirable. Yet, having a vaccine and getting the shots into arms are two different issues. The recent recession and the loss of critical public health infrastructure at the state and local level severely challenge the ability to get people vaccinated during this outbreak.

Third, we need to ensure adequate access to antiviral agents and other therapies through the medical care system, and we need a more robust capacity within our medical care system to handle emergencies.

Finally, building a resilient community requires planning and a comprehensive approach at all levels of society from government to businesses to families and individuals. This approach enables a community to withstand the ravages of a pandemic and hasten the community’s return to normal.

Operationalizing our response to a swine flu outbreak requires a coordinated effort across all levels of society. The federal government sets the national tone for successful emergency response and provides the latest information, guidance, research and advice. In the face of H1N1, the federal government has successfully led preparedness efforts by creating a national plan, working quickly to get a vaccine ready and collaborating with state and local health departments to plan for this event.

State governments must also do their part. Every state has a pandemic influenza plan. States also need to ensure the public understands these plans and what is expected of them. Soon, state officials will begin to order initial supplies of the H1N1 vaccine, will implement their distribution strategy and will need to keep people informed about how to get the vaccine. States also play a key role in collaborating with federal agencies to ensure that they are able to monitor the spread of viruses in their state, to share samples and to help convey important guidance to residents.

Local health agencies also have a role to play in ensuring we are prepared. Like the fire department or police department, communities’ health departments is a first line of defense in an emergency situation and they are usually the first to know that influenza or other health threats are occurring in the community. They also manage much of the community response, which is of particular importance when social distancing strategies or disease containment strategies are used such as closing schools or canceling local events. Along with our health care providers, local health agencies are where most of us will turn for health information in an outbreak situation and they must be prepared to offer guidance.

Other sectors in our communities must also be involved. Businesses need to have a plan in place to ensure employees are able to stay home when they are sick, encourage hand washing and other prevention methods, and ensure the business can continue to serve its core function. Schools, likely to play a central role in a prevention strategy due to the rapid spread of H1N1 among youths, must also plan effectively to follow federal recommendations and keep students healthy. Other community organizations should reflect the comprehensive prevention approach and do what they can to help communicate information and help the people they serve.

Our last line of defense is each and every one of us. We have both an individual and collective responsibility to keep ourselves healthy and help prevent the spread of flu. We should follow the guidance from health authorities: get vaccinated against both seasonal and H1N1 flu, wash our hands often with soap and water, and avoid close contact with those who are sick. If we become ill, it also means helping our family, friends, co-workers and community stay healthy by staying home from work, avoiding public places, covering our mouth and nose when we cough or sneeze, and practicing good hand hygiene.

We’ve come a long way in being prepared for public health emergencies such as an H1N1 flu outbreak, but we have more work to do.

Dr. Georges C. Benjamin is executive director of the American Public Health Association.

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