Map of life expectancy at birth from Global Education Project.

Wednesday, November 02, 2005

Boy Scout Motto, Part II

Okay, it's fine to keep working on developing new vaccine manufacturing technology so that we might one day be able to turn around the manufacture of adequate vaccine supplies in time to meaningfully reduce the impact of an influenza pandemic -- one day being 2010 or later. It's largely feckless to stockpile tamiflu and try to buy some of the current, experimental H5N1 vaccine. $251 million to help other countries detect and contain outbreaks is a good idea, but not nearly enough. That's the president's pandemic flu plan, except for one more item: $644 million to ensure that all levels of government are prepared for an outbreak. That sounds good. What does it mean?

According to the NYWT:

According to a draft . . . obtained recently by the New York Times, the nation is woefully ill prepared for a flu pandemic. Were one to occur, it says, hospitals would be overwhelmed, riots would engulf vaccination clinics, and even power and food would be in short supply. The draft does not specify how troops would be used and who would be in charge under various circumstances. . . .Administration officials have said that such operational decisions will be made in the coming months through cooperation among cabinet secretaries.

In other words, there is no plan. Like Seinfeld, the plan is about nothing.

I've written about this before, but I'll remind you. The existing infectious disease emergency plan for the U.S. consists of something called the National Strategic Stockpile. Obviously, it doesn't have any bird flu vaccine or Tamiflu in it now, but presumably the idea is to buy some. When an outbreak occurs, materiel from the stockpile can theoretically be delivered anywhere in the country within 24 hours. Then what happens?

It is the responsibility of local boards of health to actually dispense it. Every city, town and hamlet is supposed to have a plan in place to set up dispensing sites, capable of processing 5,000 people per day. They are supposed to have enough sites to process their entire population in two days, and then on day three go out and do the shut-ins and riff raff. Processing includes a medical evaluation to triage people for whom vaccine (or whatever) is counterindicated, and identify people who may already be infected and ship them off to the hospital. Your local board of health -- which spends all of its time normally inspecting restaurants to make sure they aren't storing cleaning supplies on a shelf above one where food is stored -- is supposed to have all of this ready to go by the time the stuff shows up from the stockpile, including communicating to the public where to go and what to do, in all of the languages spoken in the area of course. Now, if all 10,000 people happen to show up on Day One, instead of half of them waiting till Day Two like they're supposed to; and if the people don't happen to distribute themselves evenly among the various sites but too many of them show up at one place; and if somebody happens to think that his kids should go to the front of the line even though somebody else disagrees; and if there turns out not to be enough parking at the local middle school for 3,000 cars and the people who get there first can't get out because they're blocked in, whereas half of the staff that's supposed to do the processing can't get in; and it actually takes longer than one day to process 5,000 people (hmm, do you think it might?) and there aren't any toilets and there's nothing to eat and there isn't any water and some people who show up indeed do have the flu but the ambulances can't even get in or out and it wouldn't matter if they could because the hospital has people lying in the parking lot . . .

That's the plan. Fortunately, there is a very good chance that your town hasn't done squat, because nobody is really making them do anything anyway and most of them haven't gotten a dime to spend on it. Who knows, some of them may even have figured out that it's completely nuts.

So now we're going to spend $644 million to actually figure something out. Eventually.

No comments: