CQ WEEKLY – IN FOCUS
Feb. 4, 2012 – 12:59 p.m.
New Bird Flu Fear: Worker Shortage
By John Reichard, CQ Staff
When a scientific team in the Netherlands last year developed a strain of the H5N1 “bird flu” virus that may be highly transmissible from human to human, experts feared that terrorists or even Mother Nature could achieve the same results.
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The development put H5N1, which for several years had slipped off the radar screen, back into public view. During the George W. Bush administration, fear of the flu prompted the government to spend billions to improve and expand treatment supplies and to prepare state and federal “pandemic” plans.
The nation’s capacity to produce flu vaccines, meanwhile, has been ramped up because of the need to quickly churn out flu shots to address the H1N1 “swine flu” outbreak that spread throughout the United States and other countries in 2009 and 2010. Also, the government has invested heavily in cell-based methods of manufacture that have the potential to produce supplies more quickly than conventional egg-based methods, which require the availability of large numbers of fertilized chicken eggs.
But the country now lacks something it had a few years ago: enough people to administer the shots.
As with many other public health initiatives, planning for such a pandemic has been hampered by economic pressures on state and local governments, which backtracked on investments in the public health workforce. That could have devastating consequences, say those who have been closely involved in pandemic-planning efforts, including former HHS Secretary Michael O. Leavitt.
“The entire public health mechanism has atrophied,” said Leavitt, who otherwise sees readiness as much improved compared with a decade ago and even with 2009, when he left office.
“The Achilles’ heel in our preparation is the last quarter-mile: actually getting pills into people’s palms,” he said in an interview. “We have vaccine capacity now. We have stockpiles now. We have plans now. But the place where those plans will break down under current conditions in many communities is actually distributing pills to people or getting vaccines in arms.”
Jeff Levi, the executive director of Trust for America’s Health, which lobbies for public health funding, said the cuts represent about 20 percent of the public health workforce.
“When you’ve lost 40,000 jobs at state and local health departments over the last few years, you’ve got a diminished workforce,” he said.
“The very people who could manage the response, manage the distribution of things like vaccines or antivirals, who could be educating folks, who could be providing the emergency direct care — we have fewer of those than we’ve had before,” Levi said.
Levi said Congress has cut a Centers for Disease Control and Prevention grant program to state and local health departments by 30 percent since 2007.
“We’re not talking huge sums of money” to restore public health capacity, he added, putting the sum in the “hundreds of millions.” But, he said, he’s hearing informally that there “will not be any pleasant surprises” in Obama’s fiscal 2013 budget.
New Bird Flu Fear: Worker Shortage
One potential vehicle to plug the gaps is the reauthorization this year of a 2006 law designed to better prepare the nation for pandemics and other public health threats. But Levi is concerned that the renewal will cap CDC grants at 2011 levels.
Michael T. Osterholm, a member of the National Science Advisory Board on Biosecurity and an infectious-diseases expert, agreed that the workforce must be strengthened, but he also said that improving vaccines is crucial. “Until we have better vaccines, we’re going to be nibbling at the edges in terms of being better prepared for the next pandemic,” he said.
Vaccine technology now produces flu shots that work in only slightly more than half of healthy adults, which would leave many unprotected in a pandemic, he said. Lab work funded by the National Institutes of Health has produced potentially more effective vaccine candidates, including “universal” vaccines that could be readily available against many strains.
But he estimated the cost of licensing such a vaccine at a billion dollars and said it’s unclear which one should be developed. That money must be found, he said. “If you want to watch the world economic recovery go down a black hole quickly, just have a severe global pandemic for twelve months,” he said.
FOR FURTHER READING: The 2006 bioterrorism law is PL 109-417; 2006 Almanac, p. 13-3.