prepared

You know the saying: “hindsight is the best foresight.” When it comes to handling public health disasters, we can only hope that prior failures and shortcomings of the system – the aftermath of Katrina, for example – will serve as a valuable lesson for the future.

What would happen if a contagious disease spread across the United States, or a deadly toxin were released into the population? Would the government and medical community be able to spring into action quickly and coherently, or would they be fumbling in the dark, leaving millions of people without immediate and proper care? Should we be worried about our nation’s readiness to deal with disasters swiftly and effectively?

The question is not superfluous.

“When it comes to pandemics, we are overdue. And, we are under-prepared,” Health and Human Services Secretary Michael Leavitt warned last year.

He went on to deliver a frightening prediction: if we were to have an outbreak today comparable to the 1918 influenza pandemic, 90 million Americans would get ill; 45 million would become sick enough to require serious medical treatment, and roughly two million would die.

An obvious frustration of preparing for possible disasters, Secretary Leavitt added, is that “anything we say in advance feels alarmist, but anything we do once a pandemic starts seems inadequate.”

The good news is that some inroads are made all the time by health officials and the government in bolstering our preparedness to handle public health disasters. For example, a survey released last fall by the National Association of County and City Health officials shows that 90% of the nation’s 2,800 local health departments have consolidated their disaster planning and ability to respond.

On the medication front, just this month, the Food and Drug Administration granted Fast Track designation – which expedites the development and review of drugs intended for the treatment of life-threatening conditions — to BioThrax, which would treat, in conjunction with antibiotics, the outbreak of anthrax infections. And 16 manufacturers from 10 countries are currently in the process of developing prototype pandemic influenza vaccines against the H5N1 variant of the deadly bird flu virus, while five are also developing vaccines against other virus strains

It is a small step considering plethora of possible toxins that could be unleashed, but it is a stride forward nevertheless.

Also this month, the administration released a new budget, which proposes, for the year starting in October 2008, $1.2 billion in new funds for pandemic preparedness, which includes $870 million to develop a pandemic vaccine.

Bioterrorism spending would increase by $143 million to $4.3 billion, including $154 million for the training of medical emergency response teams, as well as $135 million for the Strategic National Stockpile, the large quantity of perpetually rotated antibiotics, antidotes and other vital medications that Centers for Disease Control and Prevention maintains for predictable health threats.

That’s the good news. The not-so-good news is that while one hand giveth, the other one taketh away.

Public heath experts point out that while some disaster preparedness funding would get a boost, other essential programs would get the boot. Trust for America’s Health (TFAH), a non-profit health advocacy group, says the budget cuts of $185 million from the funds earmarked for improving state and local preparedness capabilities would plunge grass-roots first-response institutions 25% below 2005 levels.

“We are cutting core support for emergency disaster response,” said Richard Hamburg, TFAH’s director of government relations, “leaving the country at unnecessary levels of risk.”

At the end of the day, the question is whether our government and health system could step up to the plate in a harmonized and efficient manner.

“While we have taken steps in the right direction, our level of preparedness remains a work in progress,” Frank J. Ciluffo, director of Homeland Security Policy Institute at George Washington University told the Senate last year. “It is not yet where it needs to be.”