The United States is currently experiencing the worst influenza epidemic in a decade. Places like Boston and New York have declared influenza emergencies. Experts tell us this is a “bad” flu season. Actually it isn’t, and things could be a lot worse. The dirty little secret is that the United States isn’t even close to being prepared for a serious influenza epidemic, and we can and should be doing more right now to prepare.
After 9/11, the U.S. government got serious for a while about public health preparedness. I was part of a group of researchers around the country who were funded to study how all levels of government (local, state and federal) should work together to prepare for all types of public health emergencies but, especially, bioterrorism and pandemic influenza. We made significant progress. We worked with local and state governments to develop pandemic influenza plans. We piloted tests to evaluate the preparedness of health departments to respond to emergencies 24/7. We crafted plans to help different sectors of government like public health, emergency management and law enforcement work together. We developed strategies for improving, managing and deploying the strategic national stockpile for vaccines and antiviral medications.
Then the recession occurred and most of this progress came to a screeching halt. Policymakers focused on fiscal austerity decided that public health preparedness wasn’t a serious enough threat to warrant continued funding. Grants to the Centers for Disease Control and Prevention to fund research on bioterrorism and epidemics were cut. State and local health departments were left holding the bag with staff that they could no longer pay for and initiatives that were no longer funded. Preparation for pandemic influenza and novel infectious disease outbreaks were put on the back burner as low-probability events.
The result is that the United States is simply not prepared to respond to a deadly influenza pandemic. Imagine a flu season like the one we are having where the fatality rate is much higher and where no vaccine is available. What would we do? Movies like “Contagion” highlight just how grim the situation could become, and they are based in part on plausible scenarios.
We have a group of policymakers that can’t even balance the federal budget. How would we expect them to perform in an emergency situation where hundreds of thousands, if not millions, of people are dying? We should all be grateful that so far we haven’t had to face another influenza pandemic like the one in 1918 where more than 50 million people worldwide died. Just because we haven’t faced this scenario recently doesn’t mean it can’t occur. In every century in recorded history, there has been at least one major pandemic that has resulted in a significant loss of human life, and many of those pandemics have involved influenza.
It is clear that our existing infection-control efforts and vaccine campaigns are unable to significantly slow the spread of the influenza. We shouldn’t wait for the movie “Contagion” to play out in real life before we decide to get serious about preparing to respond to novel infectious disease epidemics. Influenza has always represented a serious threat to public health. We need to be ready to respond not only to a “bad” influenza season but also to a catastrophic one. That requires bipartisan support for sustained investment in local, state and federal public health preparedness that is viewed as a priority even in tough economic times.
David J. Dausey, Ph.D., is a professor, researcher, epidemiologist and internationally known public health scholar. He is chairman of the Public Health Department at Mercyhurst University in Erie, Pa., and founding director of the Mercyhurst Institute for Public Health.