The agencies tasked with handling a public emergency are lacking key capacities, according to a National Security Council report
I'm glad the new Hollywood blockbuster Contagion will be scaring moviegoers around the world this fall. The truth is, we probably should be scared. Pandemic emergencies are a very real threat in our ever more globalized society. Unfortunately, both the Obama administration and Congress are set to cut funding to investigate and track new infectious diseases. They seem to think that sudden pandemics are works of fiction.
The government's top security experts know otherwise. The National Security Council (NSC) recently released a low-profile but extraordinarily important report: Promoting Global Health Security: Guidance and Principles for U.S. Government Departments and Agencies to Strengthen International Health Regulation Core Capacities Internationally. While lacking a decent title, this paper is the first NSC document to acknowledge that the U.S. apparatus responsible for handling international public health emergencies is split among many agencies and lacking key capacities. If you want to view the paper, you'll have to wait: The interagency group that created the document is still deciding where it will be posted.
Hollywood blockbusters are not normally a recommended form of educational material, but Contagion and the NSC report make similar points:
1. We are badly prepared for inevitable future outbreaks. Dramatic soundtracks aside, there are good scientific and security reasons to fear novel viruses like H5N1 and an uncoordinated, fragmented and ineffectual response. A 2010 study examining the initial response of health care institutions to H1N1 found that more than half of hospitals neglected important infection prevention measures. The New England Journal of Medicine reports that one month after the release of the H1N1 vaccine only seven percent of high-priority adults had been vaccinated. According to the same study, nine months following the pandemic, 54 percent of survey respondents said that the federal government was doing a poor or very poor job of providing the country with adequate vaccine supplies. Our health systems don't have a great track record for responding to public health crises, and with the rise of drug resistance in many disease strains, the lack of proper containment and response efforts could pose a significant security threat.
2. Better coordination is urgently needed: Improving coordination among the many agencies responsible for responding to a pandemic emergency will be crucial for the effective response. For example, even seemingly straightforward goals such as maintaining one trained field epidemiologist for every 200,000 people is vastly complicated by the fact that this responsibility is spread across six different programs in three different U.S. agencies. Nothing tests coordination capacity like a health security scare; let's make sure we pass next time.
3. Cutting funding could cost lives: The NSC report has excellent suggestions for improving coordination. But guess what? They can't do it with less funding. The already extremely cheap Centers for Disease Control program to investigate and track novel disease outbreaks (just $37.8 million in 2010) was cut (PDF) by almost $10 million in the Administration's pre-debt crisis 2012 budget proposal. Currently just $1 million per year is budgeted for the program's crucial Operations Center, which sends experts to investigate novel diseases -- the kind that translate so well to the silver screen. By comparison, Contagion cost $60 million.
It remains to be seen if the popular interest in pandemics stirred up by Contagion will have a lasting impact on public health preparedness. In the meantime don't forget to wash your hands.
Image: Warner Bros.