Pandemic Preparedness: Moving Beyond Public Health

A pandemic is the global spread of an infectious disease. While Ebola didn’t meet the definition, it revealed how underprepared we were to manage the risks in places like hospitals and airports both operationally and politically.

When it comes to pandemics and other highly infectious disease threats, we have the will, the brainpower, the technology and the protocols. What we don’t have is the village.

Ebola revealed numerous preparedness gaps in identifying and handling potential Ebola patients, including:
  • How to protect a nurse when dealing with a disease that has no cure and no vaccine;
  • How to rapidly step up hospital staff training across the country;
  • What to do with lots of highly infectious medical waste;
  • Deciding whether to quarantine healthcare staff based on the work they do and where they have traveled; and
  • Communicating risk to the American public.

Holistic Cooperation Needed

While the U.S. health care system boasts well-trained health care workers, auxiliary and administrative staff, the organization of the United States’ public health system varies dramatically across federal, state and local levels. The federal government provides funding and support, but it delegates authority to the states to organize and deliver public health services. Ebola demanded responses from more than one geographical area and more than one agency, requiring collaboration and cooperation. And there were breakdowns.

What we need is a “whole community” approach that makes everyone aware of, prepared for, and involved in the next challenge--and that means corralling a lot of knowledge. For example, the people who handle the food, cups and utensils of infected individuals, and the hazmat teams and the airline screeners. We need to incorporate insight from transportation workers, academics and counselors who deal with the aftermath of disease. We do better when we gather all perspectives and listen hard.

Especially now, when we are confronting threats exacerbated by weather, like the Zika virus, we must bring local natural resources managers and climate change scientists aboard our bandwagon. We need veterinary schools talking to local public health departments, local governments feeding information to local PhDs, businesses and the travel industry—because disease is on the move.  

The Nigerian Strategy that Halted Ebola

We know the community approach works. Nigeria proved it two years ago during its fast and forceful response to Ebola. The Nigerian government focused on protecting their hospital workers by designating only two hospitals as Ebola treatment centers, they set up a special Ebola helpline similar to the US 1-800-222-1222 Poison Helpline. They used social media, such as Facebook and Twitter accounts just for Ebola, as well SMS text messaging to rapidly disseminate and receive messages from professionals and the general public.

Nigeria already had a whole-community plan on paper: standardized, evidence-based guidelines built on a platform on social mobilization. In addition to public health workers, Nigeria marshaled church leaders, the port authority and all branches of the military. Funeral service workers were taught how to handle infectious bodies. Community leaders—including celebrities and sport stars—were enlisted to spread awareness and information. Janitorial workers were told what disinfectants worked and shown how to use them. An insurance company paid for public service announcements on the radio and television.  

Nigeria’s first Ebola patient arrived at a busy international airport in Lagos, the largest city in Africa with 21 million inhabitants—a playbook for an epidemic. Yet the country’s highly coordinated management system contained the outbreak.    

Using Virtual Classrooms to Share Lessons

Technology is critical to preparedness. Today each of us can click on a website, download infectious disease guidelines and read them. And while we do, the clock ticks away. Why not assign key people to read the documents and teach everyone else in their hospital, school or organization. Better yet, we should tap videos to transfer knowledge. (My public health students at Penn State University test better on material they’ve seen in a video than material they’ve read.) Why haven’t we set up virtual classrooms on YouTube for each of these disease outbreaks?  

Advanced encryption systems allow video conferencing on cell phones so health care providers can consult on cases, all without violating HIPAA--the Health Insurance Portability and Accountability Act. We can program medical record systems to automatically flag patients who have traveled to areas with outbreaks. Indeed, the United States has an entire community of technology entrepreneurs who could and should be helping us build our community response.

Finally, good surveillance may mean that we share findings without waiting for them to appear in peer-reviewed journals.

Zika is today’s threat. Tomorrow there will be another. In every case, the difference between an outbreak and a pandemic will come down to how well and how quickly we mobilize a wide-reaching network.

We need a new default position. We need the village.
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