Flu plan burdens public health agencies

HHS Pandemic Influenza Plan

The strategy President Bush unveiled last week to fight a flu pandemic includes a massive data collection effort to distribute avian flu drugs but little money for state and local governments to carry it out.

The Department of Health and Human Services asked all state and local health departments to develop pandemic plans and collect data about the distribution of drugs. But public health officials view the data collection effort as a daunting task for their underfunded departments.

Dr. Rex Archer, health director of Kansas City, Mo., and president of the National Association of County and City Health Officials, said state and local governments will struggle to meet the collection requirements unless the federal government significantly increases funding.

Archer said the 396-page pandemic plan, under development for a decade, "will not be worth the paper it is written on" without sufficient funding for states.

When Bush announced his flu strategy last week, he added an extra $100 million for state and local health departments.

However, Archer said this does not meet the shortfall in the 2006 HHS budget for public health preparedness. "They took away $130 million, and now they are only giving back $100 million," he said.

The administration, in its proposed 2006 HHS budget, slashed funding for public health preparedness by $129 million, from $926 million in 2005, to $797 million.

Archer said state and local public health departments will be hard-pressed to meet the tracking requirements while dealing with a pandemic. In the most severe case, a pandemic could result in about 90 million sick people, 45 million outpatient visits, 9.9 million hospitalizations and 1.9 million deaths out of a U.S. population of 295 million, according to the HHS plan.

Nationally, the data-collection effort will be massive, based on HHS estimates of the number of antiviral medications and vaccines the department plans to distribute. The plan anticipates that the United States will stockpile 20 million doses of vaccine and enough antiviral medications to treat 25 percent of the population, or more than 70 million people.

Mike Williams, director of the division of communicable disease control and emergency preparedness at the St. Louis County health departments, said managing the data collection for receiving and distributing antiviral medicine, such as Tamiflu, produced by Roche Pharmaceuticals, and vaccines from Chiron or Sanofi Pasteur poses a new challenge for public health departments.

Besides inventory control data, HHS wants state and local public health departments to collect data on adverse events following administration of antiviral drugs and track patients who do not respond to the flu drugs. In addition, HHS wants health departments to track vaccines by doses administered and submit at least minimal information, such as the date of administration, the age of the recipient, and the recipient's state, county and ZIP code.

Williams said the sheer size of this data collection poses a new challenge for health departments, especially without federal funding identified in the pandemic plan to support such an effort.

But Williams added that "this is not an impossible task." He said he is convinced he can do it, but would like funding to support the effort.

Dr. C. Mack Sewell, state epidemiologist at New Mexico's Department of Health, said the data collection requirement is a tall order, which New Mexico cannot meet at this time. Sewell said he doubts that many state and local health departments are ready to meet the data-collection mandate.

James Farrell, director of immunization at the Virginia Department of Health, said the state has the data elements HHS requires to track flu vaccines and drugs in a number of different systems. The department needs to collate the information, and Farrell no idea at this time of the data collection effort will impose additional costs.