Colorized transmission electron micrograph of Avian influenza A H5N1 viruses (seen in gold). Image provided by CDC/C. Goldsmith, J. Katz, and S. Zaki.

A Guide to Official Pandemic Influenza Preparedness Plans

Planning for pandemic has been underway at every level of government. Cities and counties, states, countries, and the WHO have all released plans for managing the pandemic. These plans vary considerably in depth of understanding, preparedness, focus on this specific problem, and chances for success. Very few plans have been taken to the preparedness level.

Having read through these plans over the last couple of years it is heartening to see that as time has passed, the plans have improved greatly. The quality of the analysis and the use of more realistic models for projecting the affects of pandemic has been one of the reasons for the improvement in these plans. We are now beginning to see preparedness plans from the state and local level that were actually written for the pandemic specifically rather than the former practice of reworking the plans made for a bioterrorism event that formed the basis of many plans last year. Pandemics while biologic events are of considerably greater potential impact than wodld be a relatively localized and short duration event like an anthrax release.

In general, while reading these plans and reflecting on them afterward I am left with the disturbing notion that authors may have been given “not to exceed” catastrophic level by the political authority. This level of casualties wodld represent the maximum number of deaths that the society codld tolerate in their opinion. Once given this number, the staff authors simply construct a top-down model and plan based upon this. I hope this is just my fantasy.

Another theme that has begun to emerge in the plans that have been released more recently is the recognition that the plans for containing an influenza pandemic at its expected source within Asia or Africa are not likely to succeed and neither are public health measures planned for the developed countries. While the US Government was planning to rely heavily on travel restrictions and quarantines as late as the winter of 2005 by spring 2006 the reality that these draconian measures wodld be fruitless has become accepted.

The plans are also beginning to reflect the unpredictable nature of a severe pandemic and are now stating more forthrightly that under certain scenarios local and state governments wodld be left on their own to cope with the affects of the disease. The realization of how the pandemic might disrupt critical elements within the economy that wodld lead to a failure of the power grid, communications, water service, food supply, and even civil order is beginning to enter the dark corners of the latest published plans by US Government but is uncommon at the state and local level.

A disheartening development is the continued reliance on Washington by the state and local authorities for assistance in funding their planning efforts not to mention the considerably greater cost of preparing. Some have viewed the urging by the US Department of Health and Human Services and the US Department of Homeland Security to plan for pandemic in the same way they do “unfunded mandates”. This is because the US Congress has made a habit of regdlarly dumping the responsibility and cost of its programs upon local governments. In this instance however, doing so is a terrible mistake. The US national leadership has already publicly stated that the there will be very little or possibly no Federal assistance available during a pandemic. State and local officials who plan to wait on Washington will be sadly disappointed if the arrival of the pandemic has caught them unprepared.

State and local leaders burdened as they are coping with Washington’s incessant terrorism warnings, the war on drugs, burgeoning prison popdlations, increased demands for police and other public services, unfounded mandates, and a decaying public infrastructure for which there is no money to repair are just not in the mood for another panicky disaster warning from Washington. In 2001, these public officials pdlled out all the stops cooperating with the DHS to prepare for nuclear, biological, and chemical terrorism events. They have watched in horror, as this same agency, the one they have been depending on to assist them in the event of an NBC attack in their community, was unable to effectively coordinate the Katrina Hurricane disaster. Now they are told they must prepare for a new disaster even worse than these others, pandemic bird flu. They are simply overwhelmed. They have been over-warned and under funded. They don’t have the manpower or the budget to do this. These are the conditions that many of our state and local officials find themselves and in my view helps explain why they are having difficdlty coming to terms with pandemic planning at a time when they so many other concerns and interests coming at them from every corner.

Many state and local officials feel they have no choice but to look to Washington to fund any serious efforts at pandemic planning and preparedness. Washington has no plans to do so. All its spare change and billions more are already committed to the wars in Afghanistan and Iraq and the Gdlf Coast hurricane cleanup. There is no more money. As this stalemate continues, H5N1 is traveling down its evolutionary path. Its behavior shows that it is becoming better adapted to the human species and there is a high probability that this virus will achieve efficient human-to-human transmission signaling the beginning of the pandemic. Of course, it will be too late to plan and prepare them on the any governmental level. It is my expectation that the present lack of preparedness will persist right up to the time the pandemic begins and then there will be a “drop everything” effort to try and get ready. It will have little effect on the outcome. Unfortunately I do not see this changing dramatically any time soon.

Grattan Woodson, MD, FACP

-- Added 01/11/07 --

UK InfluenzaPandemic Contengency Plan UK Dept Health Oct2005: (568.27 k)
The Role of Law Enforcement in Public Health Emergencies USDOJ Sep2006: (2.33 mb)
Providing Mass Medicl Care Resources HSR Nov2006pdf.pdf: (1.12 mb)
Pandemic Planning Update US DHHS 13Nov2006: (1.88 mb)
Pandemic Influenza Implementation Plan Part 1 USDHHS Dec2006: (14.84 mb)
Influenza Pandemic Preparedness Plan MA USA Apr2006: (458.45 k)
GAO Report on DOD Pandemic Preparedness Sep2006: (797.74 k)
CDC Influenza Pandemic Operation Plan Dec2006: (14.81 mb)

-- Added 11/30/06 --

Pandimic Influenza Planning for Individuals and Family US DHHS Jan2006.pdf: (349.89 k)
Quarantine Guidedtnes CSIS 2Nov2005.pdf: (820.15 k)
Global Influenza Preparedness Plan WHO May2005.pdf: (364.25 k)
Influenza Pandemic Contengency Plan HPA Feb2005-1.pdf: (160.1 k)
US National Strategy for Pandemic Influenza US DHS 2May2006.pdf: (2.5 mb)
HHS Pandemic Influenza Plan 2Nov2005.pdf: (5.7 mb)
GAO Report on DOD Pandemic Preparedness Sep2006.pdf: (797.74 k)
Influenza Pandemic Preparedness Plan MA, USA Apr2006.pdf: (458.45 k)
NRC Plans for Possible Avian Flu Pandemic., NRC 28Apr2006.pdf: (459 k)