Pandemic Influenza Preparedness and Response Policy: Combating H1N1
Policy & Research Forum
May 13, 2009
Featuring:
Paul Jarris, MD, MBA
Executive Director
Association of State and Territorial Health Officials
Robert Kadlec, MD, MTM&H, MA
Former Special Assistant to the President for Homeland Security and Senior Director for Biological Defense Policy
Jeffrey Levi, PhD
Executive Director, Trust for America's Health
Associate Professor, Department of Health Policy, The George Washington University School of Public Health and Health Services
Maj. Gen. Philip K. Russell, MD (USA, Ret)
Former Senior Advisor
Office of the Assistant Secretary for Public Health Emergency Preparedness
Department of Health and Human Services
Moderated by:
Frank Cilluffo
Director, HSPI
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On May 13, 2009, The George Washington University Homeland Security Policy Institute (HSPI) and GW’s School of Public Health and Health Services (SPHHS) co-hosted a Policy and Research Forum entitled, “Pandemic Preparedness and Response Policy: Combating H1N1.” The event featured Paul Jarris, MD, MBA, Executive Director of the Association of State and Territorial Health Officials (ASTHO); Robert Kadlec, MD, MTH&H, MA, former Special Assistant to the President for Homeland Security and Senior Director for Biological Defense Policy in the White House Homeland Security Council; Jeffrey Levi, PhD, Executive Director of Trust for America’s Health (TFAH), and Associate Professor in the Department of Health Policy, SPHHS; and Major General Philip Russell, MD (USA, Ret.), former Senior Advisor in the Office of the Assistant Secretary for Public Health Emergency Preparedness at the Department of Health and Human Services. The event was also webcast live.
Jarris led off the discussion by noting that in responding to the outbreak of H1N1, federal, state, and local governments have coordinated and “come together as one entity.” The communications efforts of the Centers for Disease Control (CDC) and the Department of Health and Human Services (HHS) played a crucial role in fostering public trust and confidence as information was conveyed by the experts—health professionals, with political figures in a background support role. Jarris underscored that even through we are only in the first weeks of what could be a months-long process as the virus evolves, there are lessons to be learned. These include the need to: challenge our pandemic planning assumptions; bolster our domestic surveillance system to enable national analysis; support vulnerable populations such as migrant workers; and fund overall public health infrastructure as we prepare for a possible resurgence of H1N1 in the fall, or for another pandemic in the future. “Without a workforce, we can’t do anything,” he stated, noting the importance of keeping critical infrastructure such as the banking system running.
Kadlec highlighted the need for the federal government to apply resources to preparing for a pandemic or biological attack notwithstanding the myriad of other important national security issues. Though not always well understood, public health is part of our national security infrastructure. When considering the economic costs, and consequences of a pandemic “superimposed” on unstable countries such as Iraq or Afghanistan, the national security threat to the United States and other nations is brought into clear relief. According to Kadlec, we have a unique window of opportunity to make strides in getting better prepared, such as by thinking in novel ways about vaccine distribution and other logistics that will determine the success of our strategy for dealing with pandemics.
Levi stated that while we are better prepared for pandemics than we were eight years ago, there are still improvements to be made: “we can’t fall into the trap of complacency because media is done covering it [H1N1].” Needed measures include updating national preparedness strategy and plans (most federal departments last did this in 2006); improving communications to the American public about real and apparent risk; and fostering surge capacity in our hospitals. He also cited the need to improve surveillance capacity, and questioned how well the surveillance efforts of the intelligence community meshed with those of the health (epidemiological) community in this case.
Russell wrapped up the panel by focusing on the importance of vaccines in combating pandemics. He noted the challenges of allocating a limited supply. Hewing to prioritization may be difficult as both public and private entities distribute vaccine. Russell also observed that only two licensed manufacturers of vaccine undertake this activity in the United States, though vaccine may be pre-purchased from elsewhere. However, ensuring the developing world also has access to vaccine is an important moral question with significant political consequences. Russell noted that new technology for vaccine development is on the horizon, but its implementation is still one or two decades out; unfortunately, that “technology will not be available until the next pandemic”.
In response to a question by Rebecca Katz, Assistant Research Professor at SPHHS, Kadlec assessed the World Health Organization’s response to the outbreak as effective, due to the processes put in place by the organization as well as its veteran leadership. However, WHO’s “Pandemic Stages” warning system may require re-design so as to better reflect the virulence of the virus as well as its spread.
A question from Amir Afkhami, Assistant Professor at both SPHHS and GW’s School of Medicine and Health Sciences (SMHS), sparked discussion, citing human behavior in the face of a pandemic as a “wildcard.” “Ultimately,” said HSPI Director Frank Cilluffo, “we are trying to induce behavioral changes in the pandemic context.” The panel agreed that decisionmakers need to integrate the study of human behavior as they craft policy, particularly for a sustained pandemic.
Larissa May, Assistant Professor at SMHS, asked the panelists to comment on the matter of logistics, in light of recent experience with H1N1. In reply, Jarris highlighted the need to “further clarify our thinking” so that clinicians dealing with patients receive practicable guidance.
Concluding the event, Cilluffo emphasized the “convergence point between health and security,” observing that “today’s issues require that we come together as an integrated whole as part of our planning and responses.”
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The HSPI Policy & Research Forum series is designed to spotlight cutting-edge policy solutions and innovative strategies to some of the most pressing national and international concerns. The Forum features leading officials, practitioners and thinkers in a systematic way designed to better highlight their work and promote a dialogue on effective solutions to current issues.
Related publication:
The H1N1 Influenza A Virus: A Test Case for a Global Response
School of Public Health & Health Services and the Homeland Security Policy Institute
May 2009
Paul E. Jarris, MD, MBA, was appointed Executive Director of the Association of State andTerritorial Health Officials (ASTHO) effective June 19, 2006. Prior to his appointment as executive director, Dr. Jarris served on the ASTHO Executive Committee from 2003 to 2006. Dr. Jarris served as State Health Official of the Vermont Department of Health from March 2003 to May 2006. In that capacity he oversaw a department of 850 employees, 12 district offices, and a $250 million budget serving the public health, mental health and substance abuse needs of all Vermonters. During his tenure, Dr. Jarris implemented The Vermont Blueprint for Health: The Chronic Care Initiative. Dr. Jarris graduated from the University of Vermont and received his MD degree from the University of Pennsylvania School of Medicine in 1984. He interned at Duke-Watts Family Medicine Residency Program in Durham, NC and completed his residency at the Swedish Family Practice Residency Program in Seattle, Washington in 1987. Throughout his career, Dr. Jarris has maintained an active clinical family practice, including work in federally qualified health centers and a shelter for homeless adolescent youth. He is certified by the American Board of Family Medicine and the American Board of Medical Management.
Robert Kadlec, MD, MTM&H, MA, was the Special Assistant to the President for Homeland Security and Senior Director for Biological Defense Policy in the White House Homeland Security Council. Prior to his appointment, he was the director for Biodefense and Public Health at PRTM Management Consultants. Previously, he served as staff director for the Senate Subcommittee on Bioterrorism and Public Health, where he oversaw the drafting of the Pandemic and All-Hazards Preparedness Act (PL 109-417). The law, signed by President Bush on December 19, 2006, improves the functioning of Project BioShield of 2004 and reauthorizes the Bioterrorism Preparedness Act of 2002. Before that, he served as director for BioDefense Preparedness and Response at the White House Homeland Security Council from February 2002 until March 2005, where he was responsible for coordinating medical issues pertaining to the threat of bioterrorism with the National Security Council and the Federal Interagency. He also served in senior advisory roles in the Office of the Secretary of Defense for Policy and the Central Intelligence Agency. Dr. Kadlec holds an M.D. and an M.T.M.&H. (tropical medicine and hygiene) from the Uniformed Services University of the Health Sciences; an M.A. in national security studies from Georgetown University; and a B.S. from the United States Air Force Academy. He is board certified in Aerospace and Preventive Medicine. He is a graduate of the Air War College.
Jeffrey Levi, PhD, is Executive Director of Trust for America's Health, where he leads the organization's advocacy efforts on behalf of a modernized public health system. Dr. Levi oversees TFAH's work on a range of public health policy issues, including its annual reports assessing the nation's public health preparedness, investment in public health infrastructure, and response to chronic diseases such as obesity. Dr. Levi is also an Associate Professor at The George Washington University's Department of Health Policy, where his research has focused on HIV/AIDS, Medicaid, and integrating public health with the healthcare delivery system. He has also served as an associate editor of the American Journal of Public Health, and Deputy Director of the White House Office of National AIDS Policy. Dr. Levi received a BA from Oberlin College, an MA from Cornell University, and a PhD from The George Washington University.
Major General Philip K. Russell, (USA, Ret.), MD, served in the U.S. Army Medical Corps from 1959 to 1990, pursuing a career in infectious disease and tropical medicine research. Following his training in internal medicine, he assumed a succession of research assignments at the Walter Reed Army Institute of Research and overseas laboratories in Pakistan, Thailand, and Vietnam. He conducted laboratory and clinical research on a variety of viral and parasitic infectious diseases, including dengue, malaria, hepatitis, and respiratory viruses. As commander of the U.S. Army Medical Research and Development Command, he spearheaded a major effort to increase the capability of the armed forces to defend against biological agents. Russell has served on numerous advisory boards of national and international agencies, including the Centers for Disease Control, the Institute of Medicine, the International Vaccine Institute, and the Albert B. Sabin Vaccine Institute. Following the anthrax attacks in 2001, Russell led a Department of Health and Human Services effort to develop and stockpile vaccines and other medical countermeasures against bioterrorism agents.