National Environmental
Health Association Position Regarding


Avian and Pandemic Flu

Adopted April 28, 2006


Discussion

As HHS Secretary Leavitt is quick to point out, pandemics are a part of life.  They happen.  Some ten pandemics have developed over the last 300 years; three within the last century. Pandemics occur largely because flu viruses easily mutate due to the fact that they lack a self-correcting mechanism to guard against mutations. If the virus mutates in a significant way and becomes unlike anything that people have seen before, a pandemic may very well take flight because the human population will not have any immunity to the virus. And as Secretary Leavitt has been quick to point out, this very scenario has played out many times over the course of human history.

 

At the moment, there is worldwide concern that the H5N1 virus may be evolving in the direction of becoming a pandemic flu virus.  Accordingly, nations throughout the world are mobilizing to deal with what could be a serious pandemic.  As a part of these mobilization efforts, nations are purchasing and stockpiling anti-viral medications just as they are developing plans for the mass vaccination of its citizens.  The United States and every state within the United States is following a similar course of action.

 

While in the long term, developing a vaccine and administering it to the population at large would seem to be the appropriate public health strategy, there are significant problems with this strategy in the short term.  Not the least of these problems is the simple fact that with current vaccine producing technology, it could take as long as six to eight months after the pandemic virus appears before a vaccine could even be produced.  Moreover, early trials of H5N1-type vaccines are indicating that in order to produce an acceptable immune response, at least two doses of the vaccine will be necessary.  On top of that, each dose would have to be three to six times the standard dose that is administered in flu vaccines today. 

 

And even at these high doses, information from the H5N1 vaccine trials are indicating that immunity is only conferred on about half of all who took the vaccine. 

 

This is all troubling because it indicates that a vaccine will not be available until well after a pandemic begins (and well after the first pandemic wave goes through – which is generally regarded to be the worst). Moreover, when vaccines finally do become available, they will be available in only very limited amounts.  

 

If a serious pandemic flu were to develop and if in fact, the vaccine crisis suggested by this discussion actually plays out as described, that will mean that our best strategy for protecting people and our economy will be the adherence to basic public health principles and practices. To limit the spread of the disease, there will have to be a heavy reliance on promoting cough etiquette, frequent hand washing, social distancing, regular disinfection in the workplace, self isolation (as in working from home), curtailment of meetings, and so forth. In order for this strategy to be effective, the public health community as a whole (inclusive of environmental health professionals) is going to have to all join together to promote and communicate these public health messages to our communities.

 

Recommendations

 

1.   Environmental Health professionals need to help get the word out on appropriate public health messages.

 

        In view of the conditions that we can anticipate throughout at least the first part of a serious pandemic, NEHA strongly recommends that all environmental health professionals understand that they are likely to be involved in general public health efforts to promote public health messages about appropriate public health practices during a pandemic.

 

2.   Environmental Health Professionals need to accept that in a serious pandemic, they may have to perform tasks that have little to do with traditional environmental health work.

 

        NEHA also urges environmental health professionals to consider themselves to be a part of the public health team. The response to a serious pandemic will largely be local event. Local public health departments are going to have to rely on all of its employees to do whatever it must do to protect the public health of its community. As such, environmental health employees may find that they are being given assignments that bear little resemblance to the typical environmental health work that they have been trained to do.

 

Moreover, it is expected that in a serious pandemic, workplace absenteeism could be as high as 25% and even more. If a local public health department has to carry the burden of a major response role and its workforce is significantly impaired, we can expect that health departments will quickly adopt an “all hands on deck” approach to its work. Accordingly, environmental health professionals may well find themselves involved in tasks ranging from traffic control in mass vaccination clinics, to community surveillance work to actually distributing medicines themselves.  We as a profession need to embrace such assignments understanding that in the big picture we are all public health professionals doing what we have to do to protect the communities that we serve.

 

3.   Environmental Health Professionals need to help make the point that mass vaccination centers will only come into play much later during a serious pandemic.

 

        The overwhelming emphasis in public pronouncements, state pandemic flu plans and the like is on getting a mass vaccination program in place to defend against a serious pandemic flu.  As important as this is and as the above discussion points out, a considerable part of the overall effort that will be undertaken in community after community all around the country, should a pandemic erupt, is going to be centered on getting the public to adopt basic public health practices.  It is the opinion of NEHA that this has not been emphasized enough and in fact, a false sense of security is being promoted with all the talk about vaccination centers.  Accordingly, NEHA urges its members as they participate in pandemic flu planning activities to emphasize the importance of engaging in basic public health practices.  This will of necessity become the front-line defense for any response to a pandemic flu for the better part of the duration of the pandemic.

 

4.   Environmental Health Professionals need to take this issue seriously and prepare for the worst.

 

Finally, it is the position of NEHA that this is an issue that needs to be taken very seriously.  A pandemic flu deriving from the current H5N1 virus racing around the world may never develop.  However, if a pandemic does develop and if it resembles the deadly pandemic of 1918, the consequences to our society could be extraordinary.  In fact, many commentators worry beyond the health impact itself to some degree of social disorder and economic impact. Such social breakdown could be unleashed by a public that is unprepared for mass illness and fatalities and by a public health system that is similarly unprepared for the sheer magnitude of the pressure it could be under. As Secretary Leavitt often notes, “we are overdue and under prepared”.

 

Consequently, NEHA urges its members and the environmental health profession to take this issue seriously.  NEHA also urges its members to avail themselves of whatever training is available in the general area of pandemic flu and emergency response.  A well-prepared workforce is going to have a significant impact on how serious a pandemic flu or for that matter; any emergency situation will ultimately prove to be. 

 

5.   NEHA encourages environmental health professionals to in turn encourage their health departments to train both for preparedness and for willingness to respond.

 

        According to a recent (March 2005 – July 2005) survey of three prototypical health departments in Maryland,  (published in the April 2006 journal BMC Public Health), 42% of health department employees said that they would not respond in the event of a flu pandemic. The less important the employee felt his or her role would be, the higher the percentage became. Presumably, if environmental health employees feel that their role would be minimal or perhaps even inappropriate, environmental health employees would also be less inclined to report for work.

 

The study’s co-author (Dr. Daniel Barnett, an instructor at the Johns Hopkins University Center for Public Health Preparedness) noted that the public should be concerned about these results, as the system cannot function during a pandemic if many key workers don’t show up. The author also assumes that these findings would apply throughout the country.

 

The co-author further recommends that “health departments can and should develop clear and coordinated response plans and raise the prevailing level of flu knowledge among staff. NEHA would offer that the more knowledgeable the staff, the more willing they might be to participate in whatever response the health department would be conducting.

 

 

 

 

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