The SARS epidemic, the South Asian tsunami, Hurricane Katrina, and avian influenza all underline a growing need for preparedness planning that addresses multiple hazards and coordinates all levels of government and society, said a panel of public health experts today at the Pan American Health Organization (PAHO) in Washington, D.C.
"Whether it's a tsunami, a hurricane, or a pandemic, the systems we need all have to be there," said Dr. Cristina Beato, PAHO's new deputy director and former senior advisor in the U.S. Department of Health and Human Services (HHS). "I think you will see PAHO and others increasingly taking an all-hazards approach to preparedness."
"National preparedness is a mosaic comprised of several pieces and is the result of preparedness of each sector: the private sector, civil society, and all of the public sector, with its various sub sectors," said Dr. Carissa Etienne, assistant director of PAHO. "This is complex and is a challenge for each of us."
During the 2003 SARS epidemic, a high proportion of Canadian cases were among health-care workers and resulted from poor infection-control practices in hospitals. This pointed up a need for cooperation across government agencies, and particularly between health and labor authorities.
"We had assumed that hospitals knew more about infection control than we did," said Helle Tosine, deputy assistant minister in Ontario's Ministry of Labor. "That turned out not to be the case."
Following a review of the SARS experience, Ontario's Ministry of Labor established a "Health and Safety Partnership" with provincial health officials to bolster occupational health and safety practices in health-care settings. The program included an Internal Responsibility System that assigns health workers major responsibility for promoting and reporting threats to health and safety in the workplace.
Weaknesses in the U.S. response to Hurricane Katrina in 2005 spurred HHS to partner with local authorities to prepare better for a possible new hurricane during 2006. The effort included a study of the needs and requirements for evacuating and sheltering vulnerable groups, and included gathering details on the location of nursing home residents and displaced people and assessing weaknesses in local infrastructure caused by Katrina.
"This was probably the first time we've seen such a highly detailed, joint planning process involving both state and local agencies," said Dr. Sandy Bogucki, senior medical advisor in HHS's Office of Preparedness and Emergency Operations.
The U.S. Centers for Disease Control and Prevention (CDC), in its planning for a possible influenza pandemic, emphasizes the need for coordination between local and national authorities and for action at the community level.
"Community-based interventions are extremely important," said Francisco Averhoff, chief of the CDC's Quarantine and Border Health Services Branch, Division of Global Migration and Quarantine. "Nonpharmaceutical interventions, such as school and daycare closures and social distancing, can help delay transmission and outbreak peak. This gives us more time to get a pandemic vaccine and to distribute antivirals, and it allows the health-care infrastructure to deal with a more spread-out case load. It also decreases the total number of cases."