November 08, 2005
The Massachusetts Pandemic Preparedness Plan Arrives
Everyone (except the rather large contingent who wish I would shut up about avian flu) will be excited to hear that The Commonwealth of Masachusetts Influenza Pandemic Preparedness Plan has arrived. This is ia welcome addition to the Commonealth of Massachusetts, Department of Public Health Influenza Web Site
Although some of you might be depending on me to read the whole damn thing, and summarize, I know that otherwise this could be a complete bore. In fact, you might just skip this entry, especially if you don't live in Massachusetts, although I'll bet that your state's plan is similar. Australia and New Zealand have done a better job.
In any case, because of time pressures, and flawed attention span, I've only taken a peek -- my preliminary impressions follow.
Complaint number one. The plan cannot be copied, except in it's entirety, for some reason. I had to download the whole document into Word Pad. Really.
The first twenty pages primarily deal with statistical gathering, documentation of flu cases, and testing to see if the virus is H5N1 or another "novel" [read killer] virus. Important, but the paper work requirements are odious and might go right out the window if medical facilities are overwhelmed, and providers are stricken themselves.
Then, on page 21, we get to the real meat -- Section 3: Vaccine Delivery begins with "Assumptions"
"1. There will be a minimum of 6-8 months between a novel virus alert and the availablity of vaccine. When the vaccine does become available it will be distributed in multiple shipments over time as it is manufactured. Vaccine shortages are likely to exist especially early during a pandemic."
The implication that we will have to wait just a little while until the vaccine begins to flow into our state, is, as far as I'm concerned, a mighty big "assumption". Most experts estimate that a vaccine will not be available until 2008-9. Every idea in Section 3 that follows assumption #1, depends upon the availabity of vaccine. We are not offered much information about what to do while we're waiting for two or three years and dying. Oh well. I think we have to throw out most of the plan after Assumption #1, if we're going to be realistic. There is acknowledgement that security might be important, should some vaccine emerge somewhere, because people might be tired of waiting and try to steal it.
Next are the "Challenges" listed in Section 4: Use of Antivirals in the Prophylaxis and Treatment of Influenza During a Pandemic.
"• Unknown how many doses of antiviral medication will be available during a pandemic" [We DO know that 2 milion doses of Tamiflu have been stockpiled by the feds, and that there are 300 million citizens in this country. We DO know that there are 14 countries ahead of us on the Roche waiting list for Tamiflu, yet to be manufactured. I'd say the citizens of Massachusetts, given their liberal leanings, should count on about thirteen doses, if that. Just enough for our Republican governor.]
"• Antivirals may be available in both the public and private sectors." [may is the operative word]
"• Oseltamivir, the antiviral drug shown to be effective against H5N1 strain of influenza is
made by a single manufacturer. Production occurs in a series of steps and takes 12 months
for raw material to the finished product. [Reach any conclusions here, folks?]
"• For treatment to be effective, it must be started within 48 hours of symptom onset." [I can't even get an appointment with the podiatrist within 48 hours, let alone the doctor and the pharmacist, both of whom, I assume, will be quite busy during a pandemic, or sick themselves]
Peter Sandman, a risk communication expert, in his excellent essay "The Flu Pandemic Preparedness Snowball" cautions:
". The focus on the pharmaceutical fix is excessively optimistic. It is keeping people from focusing enough on worst case scenarios.
. The focus on the pharmaceutical fix is excessively medical. It is keeping people from focusing enough on non-medical preparedness.
. The focus on the pharmaceutical fix is excessively governmental. It is keeping people from focusing enough on what civil society, the private sector, and individuals can do
. The focus on the pharmaceutical fix is excessively national. It is keeping people from focusing enough on local preparedness.
. The focus on the pharmaceutical fix is excessively first-world. It is keeping people from focusing enough on ways to help Africa, Asia, Latin America, and the Middle East prepare for a pandemic."
I guess the authors of the Massachusetts Plan didn't get a chance to read his article.
Photo note: A metaphorophoto of sorts, for your amusement, just in case you don't live in Massachusetts..
Posted by Dakota at November 8, 2005 10:13 PM