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Questions for ASPR

by: SusanC

Tue Nov 06, 2007 at 08:44:38 AM EST


The office of HHS Assistant Secretary of Preparedness and Response (ASPR) is holding a meeting Pandemic and All-Hazards Preparedness Act (PAHPA) Implementation Discussion Meeting on Thursday Nov 8 (details on the ASPR site )


Here is the agenda

SusanC :: Questions for ASPR


To their credit, they are asking stakeholders to submit questions that they would like to see addressed ahead of time. 


Discussion Topic Question Submittal


Please take a moment to submit any questions you may have on the topics to be discussed to assist us with insuring your questions are addressed during the time provided for discussion. While opportunities will be provided during the discussion to ask questions, we are attempting to insure all questions are addressed during the related topical session.



I only found out about this meeting 2 days ago.  Seeing as I am in the middle of the mad rush trying to accomplish our goals for ReadyMoms.org grassroots community engagement exhibit at the APHA Expo with too few of us (between 2-4 people) and too little lead time (2 weeks!), I am writing up questions only just now.  I will post them at the ASPR site, but since these are issues of public interest, I am posting them here for public discussion as well.


Here's my first question.  I will most likely write up others in between talking to people at the booth (probably when I have to sit down cos my feet are killing me!!).  I hope this is not too late in the day for these questions to be included in the meeting.


At-risk individuals


The largest single group of at-risk individuals in the next pandemic will likely be children and their families.  A new grassroots initiative at the APHA Expo, ReadyMoms.org, expressed their concerns in the following statement:


We are parents concerned about the potential impact of the next pandemic on children, families, and communities.


We are especially concerned about the following:


  1. If a 1918-like pandemic happens today, communities will suffer 20 years of normal child deaths (aged 1-19) in the space of one season.

  2. The current H5N1 avian influenza virus is causing human infections with an overall case fatality rate (CFR) of 60%.

  3. This CFR rises to 75% for those aged 10-19.

  4. H5N1 has to become 30 times (NOT 30%) weaker to match the 2% CFR of the 1918 pandemic.

  5. A WHO working group report in 2006 tells us that "the present high lethality could be maintained during a pandemic" caused by H5N1.


We believe parents have a right to be given this information, and be supported to make the decisions that are best for their family.


We believe that failure to assist families to make informed choices will result in severe social disharmony as bereaved parents take their wrath against officials who have failed them.


We believe it is possible to protect our families with adequate implementation of the social distancing measures as specifically recommended by the CDC, especially early and proactive school closure.


We believe these same measures will also make it safe for essential workers to go to work.


We understand that implementation of these measures will require communities to make some tough choices between the cost to the economy and saving lives.


We believe that such choices cannot and should not be made FOR families and communities, only BY them.




Question


The question that I would like to see addressed, is how specifically is the ASPR office working to ensure the safety of children in the next pandemic. 


More importantly, to the extent that the 'right to information' is a fundamental human right clearly set out in the various international Human Rights Covenants to which the US is a signatory, and that the right to equal protection is enshrined in the US Constitution (Fourteenth Amendment), what is being done currently and in the near term, to ensure that all American parents are adequately informed, equally and without discrimination, of the risks so that they can be assisted to make the right decisions about preparedness for their families.


UPDATE 1  I have put up a poll, to be used as an unofficial PETITION, to show the level of support or concern (or otherwise) on this question.  It is on the frontpage, right column.


UPDATE 2  For a more in-depth exploration of this and related issues, read also the commentary written for the ReadyMoms exhibit posters, By Parents, for Families
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Questions for ASPR | 138 comments
Good question!
I have two children in the 10-19 year old range, and the current CFR numbers give me pause.  Pandemic Influenza was an issue I was basically ignoring until recently.  It seemed like a pretty distant and unlikely threat, considering the information I had.  I thought I was prepared with just a few days supplies on hand.  Now that I have more information, I realize that no matter what I do to prepare, if I'm the only one in my town taking it seriously, my more comprehensive preparations probably won't benefit me or my family very much.  My lone voice will not be enough to persuade the local education agency that early and proactive school closure is justified.  Until other parents get the facts, my voice will most likely go unheard by the people with the political sway to change things.

I have faith in my fellow citizens that once they hear the facts, they can be counted upon to make informed decisions without panic.  A little healthy fear, based on factual information, is a good thing.  It moves people to action.  Much like a person who sees a freight train bearing down on them will step off the tracks, people who see a pandemic coming will take necessary steps to preserve themselves and their families.

Millions for defense, but not one cent for tribute!

I agree
A little healthy fear, based on factual information, is a good thing.  It moves people to action.

It's like every other risk in life.  Take smoking.  How do you get people to stop?  People stop smoking only because they are scared. 

When we give out information about the hazards of cigarette smoking, we are NOT doing it to scare people, not in and of itself, but to WARN them of the consequences. 

Same for drunk driving.  How do you warn people against DUI without scaring them with the consequences?  Like death and injuries and loss of loved ones?  Like giving out figures on how many people (or especially how many YOUNG people) get killed every year from drunk driving!

If we accept that it is the responsibility of good governments to warn citizens of health hazards of smoking and drunk-driving, then it is also their responsibility to adequately educate and warn citizens of the hazards of NOT preparing for a pandemic.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
Statement and question:
I'm convinced that a pandemic would be devastating to the health and welfare of all our people.  I'm also convinced that it's a mistake not to inform them about the threat of a pandemic virus and the follow-on effects of empty grocery stores, power grid failure and all the other resulting hardships.  When I've told people that I'm worried about a pandemic and JIT inventories, sometimes their eyes widen and they seem to understand, but sometimes they dismiss it because "if it were that serious they would hear about it from the government."  Even those who react at the first warning may not follow up and prepare their families. 

I've tried to stay anonymous in my warnings, because I'm afraid that if I'm visible, too many people will come to my door looking for food after the pandemic starts.  We could do a lot to lessen the misery and deaths if government and local volunteers worked together, while we have the time.  The threat of pandemic is as real as HIV spreading through casual sex with multiple partners without the use of condoms; it's as real as knowing that diabetics can't eat a whole birthday cake; it's as real as knowing that milk and meat spoil without refrigeration.  Over time, we have learned those facts.  It will take a while for knowledge about pandemic virus to be absorbed (including how to avoid catching it), and to think through how their families will cope, will take even longer; then there's the planning and purchase of alternate foods, heat sources, cooking fuels, etc.

When will you start this education process and how will you encourage productive local efforts?

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

This took a long time to post,
so I thought it was locked, and we were supposed to send it to the hhs link.  So I did.

The hard thing was deciding which category to put it in.  I chose Education/Training.  I hope that works, because I mean educating the people, not the employees of HHS.  Maybe "Other" would have been better.  Situational Awareness wasn't right.  Grants??

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
it was locked for a while lol
cos I thought there was a mistake that needed to be rectified, specifically with regards to whether children are included in the definition of 'at-risk individual'.  Until I clarified that I wasn't sure whether the whole question/diary needed to be re-written, so I didn't want any more people to post until I got it sorted out!

It's sorted out now, definition found and posted.

Thank you for your patience.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
Definition of at-risk individuals
First of all, the PAHPA Progress Report November 2007 says,
HHS has been an active participant in the Special Needs Workgroup established by DHS to craft the first Federal definition of "special needs" ("at-risk") populations. This definition is incorporated in the draft National Response Framework (NRF, formerly the National Response Plan) and is also being used for implementation of PAHPA.

And from the draft NRF glossary, Special Needs Population is defined as:

A population whose members may have additional needs before, during, and after an incident in one or more of the following functional areas:  maintaining independence, communication, transportation, supervision, and medical care.  Individuals in need of additional response assistance may include those who have disabilities; who live in institutionalized settings; who are elderly; who are children; who are from diverse cultures, who have limited English proficiency, or who are non-English speaking; or who are transportation disadvantaged.




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
My question:
When will school superintendents and Boards of Education be receiving clear and direct guidance on the dangers and mitigation of pandemic influenza? 

Why have these entities heard almost nothing, so far, from either your office at HHS or from the Dept. of Education on this critically important subject? 

America's local school officials remain uneducated and uninformed.  A critical element of the Community Mitigation Guidance involves school closure, yet few school officials are either conversant with, or even aware of, the vital role that they and their schools will be expected to play during a pandemic. As a member of my local BOE, I can testify that this subject is not under discussion within this region.  Because energetic federal guidance is absent, state guidance is also woefully lacking.  When can we expect to see that change?

in CT, the superintendents have
a white paper on the topic. If this outline is followed...

SCHOOL DISTRICT PANDEMIC INFLUENZA
PLANNING GUIDELINES

CONNECTICUT ASSOCIATION OF PUBLIC
SCHOOL SUPERINTENDENTS
http://www.capss.org
MAY 2006

http://www.doe.state...

[ Parent ]
Thanks, Dem
I'm sure such a thing exists on paper, but my superintendent's dog ate his.  ;-)

He wasn't in the position in May, 2006, and I'm sure that document has been lost in a file somewhere.  There is, in reality, absolute silence on the issue.

There's a big upcoming state conference for BOE members next month.  Panflu is nowhere on the agenda. 

There's also a big NSBA annual national conference for BOE members upcoming too, to be held in Orlando.  We received a big, oversized, 15-page, glossy and very highly produced brochure listing the topics and speakers.  Panflu is also nowhere on that agenda.

Schools are the most organized and direct link our government has with our families and children.  They need to make use of this relationship for panflu awareness, education, and mitigation. They are not.  And, as it stands, superintendents, BOE's, and parents will be blindsided when panflu begins and their key role is suddenly "discovered."

[ Parent ]
good input so far, thank you
I started off this diary intending for it to include all different questions for ASPR, but it is becoming clear to me the issue of informing parents is probably THE most critical one, so I'm going to start a separate diary, in a minute, for y'all to post other questions, and let this one be used only for issues directly related to children's wellbeing in a pandemic, informing, involving and empowering parents.

I am also going to start a separate diary as a poll, for this question specifically.  It's almost ready to go, please take it to show your support/opinion!

I'm going to edit the top diary accordingly.

Again, thank you for your patience.  This is what happens when you have 2 days notice and many balls up in the air!!



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

UPDATE - no separate diary
After reconsidering how little time there is left etc, I decided it is best that we just post whatever we want to post here, and not worry about another diary for other questions. 

So please post your thoughts, ideas, questions, comments.  Also, it would probably help structure your comments or questions better if you have a look at the agenda here http://www.hhs.gov/a...

For the REALLY intrepid policy-addicts, I would recommend reading through the PAHPA progress report, available here http://www.hhs.gov/a...



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
a better link for the agenda (without the final dot)
http://www.hhs.gov/a...

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.
[ Parent ]
should we post questions "there" as well? i guess yes :-?
http://www.hhs.gov/a...

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.
[ Parent ]
Yes, I think posting questions there is a good idea. n/t

[ Parent ]
making a comment automatically gives them your email address?
Well, that's not going to make for honest forthcoming questions that might be viewed as too critical, right?
[ Parent ]
I think it was intended for attendees
although it doesn't say that others can't have input either!  ;-)



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
I don't know about you
I've never worried about being critical AND letting tptb know EXACTLY who I am.  In fact, I WANT them to know who I am, how else are they going to get back to me on anything?  In general, I mean, not specifically for this instance.  ;-)



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
Given I recently had a representative for Public Health Emergency
MA Response Region 4-A, who had never met me before, say, they would come to my house "if there was a pandemic" because I had questioned why they were having an event telling the public "72 hour kit" instead of the pandemicflu.gov "two weeks" recommendation which was in itself quite inadequate...so by implication, I must have more than two weeks of food in my house...and this PH emergency response official, who has contributed to why the public is saying to me, "we'd have heard something from officials; if this was really a threat",  thought it was "funny" to say they'd just come help themself to my food during panflu year.

I don't want any of the officals, who continue to refuse to form PPCCs, refuse to tell the public about pandemicflu.gov and no vaccine for firstwave; don't do anything credible to get the school families nor cemeteries ready for pandemic, "getting back to me" because they run short at home. (They, and my fellow citiens; whom tptb have willfully and systemically failed to warn to prepare.)

[ Parent ]
well, it's up to you
as usual, we can agree to disagree.  ;-)  I just wanted to make the general point (ie not specifically targeted to your situation or comment) that if we want DIALOGUE with government, and if we want them to carry out public engagement, then we better be prepared to let them know where to get back to you with an answer!

If we ask questions but do not allow those whom we question an opportunity to explain their position in any other format than in FINAL and formal policy announcements, then we would have missed a) all the many opportunities along the way to influence them with our continuing input, and b) the lessons that WE need to learn by listening to THEIR interim responses.

It takes 2 to carry out a dialogue.  And it cuts both ways.

Just my 2 cents, given in general and with respect.  ;-)



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
Dialogue? Didn't we try that already?
I think many of us have given government, in the persona of Sec'y Leavitt, ample opportunity to engage in a dialogue with us, and he chose not to do so.

It would have been very simple for him to address the concerns expressed to him on his blog, without having to know any more about how to get in touch with us than that, but he did not do so, even in the face of repeated pleas.

The response given to someone who was querying them (PH) about pandemic preps should be all the handwriting on the wall that some of us need to read. 

[ Parent ]
It seems there are 2 schools of thought.
One is to keep yelling at and making demands on tptb, believing perhaps that intimidation works.

The other is to acknowledge that tptb hasn't seen the light, got their heads buried in the sand, and flubbies try to effect change by being willing to negotiate with tptb.

Each has its own place.

Now if we substitute flubbies with parents, and tptb with adolescents, which way will work better?

Personal gratification aside, that is.

If one decides that tptb is beyond repair, then one should also stop wasting time with the internet ranting, and organizes protests in person. Otherwise more useless ranting will simply embolden tptb to do nothing. Tptb can use the IGNORE button.

Readymoms demonstrated this week that it is more productive to get around tptb than to yell at them.



You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
with all respect, Clawdia
I don't doubt that many did spend hours and days writing on the hhs blog with sincerity but ended up in frustration.  May I however suggest with respect that if you think everything that one person, Mike Leavitt, did or did not do on a blog alone is representative of all of government, then you have seriously underestimated the size and complexity of even just this one part (one Federal department) of one branch (executive) of government.

If you think writing on a blog was in any sense even remotely close to giving government "ample opportunity" to respond to citizens on a matter of again such enormous complexity as pandemic preparedness, then you have seriously underestimates the work needed to prepare the country, let alone the world, even IF all of government were already agreed on what you propose.

If I even for a moment believe that tptb has done enough, I would not have busted my a*** (pardon my language) this past weeks to get the Readymoms project going AND to go straight after that into another day of meetings (and several more next week).

If I even for a moment believe that writing on a blog is enough to create change in the world, then I need my head examined, for a reality check.

If I even for a moment believe that nothing is possible unless you succeed the first time, then I would have gone home ages ago.

If we all believe in such notions, then millions of kids will die who could have been saved, if only we were willing, each one of us, to take one step further, EVERY DAY, EVERY TIME. 

And one more after that, and another, after that, and so on ad infinitum. 

Unless we have the will, to do whatever it takes to match the size and complexity of this monster, we will have failed in our efforts. 



The 'opponent' is not the government, Clawdia, it is a virus.  We need to think that, for the benefit of our children, and for humanity.  With all respect, and as an appeal for all of us to give our best DESPITE the failings of others...



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
The opponent is not government
It is easy to blame the government or better tptb..."they" are the problem.  Who ever they are.  Susan and I frequently disagree on approach but regardless I respect that she is committed and takes action.  She puts herself out there.  What ACM, Ready mom, Susan and BB demonstrated is individuals count.  They make a difference and it is really not that difficult.  ACM made a comment this morning that was also instructive - she said that the state and federal people seemed to get it - it was the others that were more difficult.  I keep hearing "tell the people".  Yet when people here tried telling their neighbors it fell on deaf ears.  When my county sent a 17 page document to every resident with fairly straight information about the threat and prepping - not one neighbor, co-worker even mentioned it.  When asked most couldn't remember seeing it or saw it and said "oh yeah.  Yawn.  We have had public forums held by the county and other outreach. 

Those are not tptb but public you want told.  They are like the people that won't evacuate in a hurricane and then ask why they were rescued. 

In my view the best hope we have is tptb and the need to be as prepared to the max.  I want tabletop exercises until we do them in our sleep (hospitals, emergency workers, schools).  Hospitals prepped so health care workers aren't afraid to show up.  States, counties, cities, schools, colleges to know the drill and to be ready to act immediately. 

I want tptb to know they have the political support for doing the right thing.  That means speaking up...participating not just ranting. 

Are their ignorant, foolish, wrong-headed people in government - any government - sure.  They are like every other cross section of society including your/my family, church, neighborhood, work place.  It is called mankind but that is no excuse for abdicating your/our responsibility.

Susan, Readymom, BB, ACM - please use your lesson to demonstrate what individual action can do because unfortunately too many people believe they are simply victims of tptb/system/government.  Your lesson proves them wrong. 


[ Parent ]
learned helplessness, etc
Learned helplessness (a phenomenon that takes place even in cockroaches) can be reversed.  (One possibility being intentional optimism, but I don't know what else we can come up with.)

It's going to be tricky to do it before a pandemic, but here we are.

And there we go. :-)

Thanks for the challenge, ReadyMoms (BB included)!

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
Conceptual error
The error in all of this is the naive belief that government can do anything honestly, efficiently, or productively. An realistic look at recent history reveals the fallacy of that belief. All you will get, for all of your well-intentioned efforts, is a group of politicians or their appointed sycophants pandering for votes. You will not get honest information; you will not get protection "for the children"; you will get a group of people eager to take your money and give you naught but promises in return.
[ Parent ]
that is your opinion
and I respect that.  It isn't factually based, however, unless you can provide the facts.

I am not so naive as to believe that governments can or even WANT to do things honestly efficiently or productively.  I do believe however, that governments are powerful institutions that for all their flaws do have tremendous effects (both positive and negative) on our wellbeing.

Wherever the power lies, that will affect the wellbeing of the people, I personally am willing to enter, to negotiate, persuade, bargain, cajole, threaten, sweet-talk, or do whatever it takes.  As long as the door remains open. 

That is MY opinion.  My choice.  You can have yours.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
Not opinion, Dr. C. Fact.
It isn't factually based

On the contrary. My beliefs are always based on facts:

2007: California wildfires caused by the US Forest Service's mismanagement of resources.
2006: Crash of Comair 5191, caused by the Federal Aviation Administration's failure to require that all runway crossings be authorized only by specific air traffic control clearances.
2005: Hurricane Katrina ("You're doing a heck of a job, Brownie;" need we say more?).
2004: Hurricane Ivan: Existing proposals for using public transportation for evacuations were ignored by government officials and 600,000 persons were left behind.

How far back do you want to go?

Spend your time and efforts talking to government officials if you choose -- just don't ask them to steal money from me to implement your plans.

[ Parent ]
Do you think any thing works? Any thing?
Sure blaming any one else is easy, blaming the 'guvamint' is easier. But you allowed them to be voted into office. You could have done something.

Do you think anarchy is better?

Do you think the rest of the country (or even the world) can produce and deliver what you need but don't make in your backyard with no government at all?  Let's just say you have an extended family of a 1000, with you being the head honcho, and completely isolated in your own Shangrila. Do you think you would have produced more per capita in your little tribe than the rest of the U.S. of A.?

Do you want to go back to the stone age?

What? How many people want to follow you as leader?

You know, I am really tired of the whining.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
Straw man fallacy
anon.yyz,
Your message represents a straw man fallacy. I never claimed to favor anarchy. To put up that statement and then argue against it is worthless. My statemen was that some here have the "naive belief that government can do anything honestly, efficiently, or productively." Susan's reply was "I am not so naive as to believe that governments can or even WANT to do things honestly efficiently or productively." She is correct in that part of her belief.
[ Parent ]
Rhetorical questions on your blanket statements. Peace. n/t


You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.
[ Parent ]
it's your interpretation of facts
and the assumption that what happened in the past is what will happen in the future.

Our govt. has blown it a number of times, but if you go back to 1992-2000 when there was a professional emergency manager running FEMA, there's a better track record. And there's no reason to think it can't get better still. And that includes expecting people to take responsibility for themselves (which is very cost effective).

Should you count on government? No Way. OTOH, stealing money from you isn't on the table as a plan.  ;-P

[ Parent ]
RE: FEMA
To repeatedly claim that FEMA was better from 1992-2000 is of dubious value (by the way, James Witt was not confirmed until 1993). It was, and is, a wasteful entity operating with a $4 billion per year budget that takes money from wise citizens to subsidize the stupid choices of unwise citizens. Why should your money be used to encourage people to build in disaster-prone areas? Those who live in flood plains or hurricane-prone areas should pay the costs of their decisions through their own resources or privately-purchased insurance. FEMA should be abolished.
To your last point: Using the coercive power of government to take money from me in the form of taxes, to fund some feel-good project that you favor is, indeed, tantamount to stealing.

[ Parent ]
It is how you look at the world
and your community. Every place in the US has it's natural disasters. There are tornados, earthquakes, mudslides, avalanches, blizzards, you name it. It is just how it is.
Heck Yellowstone could blow and the whole world be in a mess climate wise. There is no ultimate safe place to live.

I like to look at the world in that we are all in this together as opposed to just me and what is good for me alone.
I don't mind giving someone in need a helping hand from my taxes. It is a better use than what it is mostly being used for now but that is too political to get into here.

Life is not so short but that there is always time enough for courtesy. Ralph Waldo Emerson

[ Parent ]
A Modest Proposition
You should be allowed to quit paying taxes as soon as you stop using anything that taxes have paid for.

The real fallacy is that wise, 'self-made' individuals with no need for agencies such as FEMA, have not, do not and will not ever rely on the entire hard and soft infrastructure of society for which we all pay through our taxes, fees, surcharges, etc. (or for which prior generations paid.)

Fine, drive only on the roads for which you have paid the entire cost, use hospitals on which no public money has been spent for hard assets or education of medical staff, land in airports that required no government spending, hire only those employees educated entirely in private schools, put out your own fires, drink water only out of your own wells (protected from contamination solely by your own resources), and if your wisdom cannot protect you from the unexpected (or expected) natural disasters that plague all of humanity from time to time - hang on to your philosophy of YOYO.

Good luck with all that.

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 

[ Parent ]
It's called the underground economy,
as in a living in a hole in the ground.

Some one did that in the heart of NYC, literally.


You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
"Some one did that in the heart of NYC, literally"
Hmmmmm....I wonder if the city paid to make that hole in the ground? ;-)
[ Parent ]
OT: The Fire Department found him during routine inspection.
I saw it on the news within the last year.  He was a veteran. The cave was dug by himself and it was quite clean and tidy. He did odd jobs for a living.

I can't find the story but I found this:

http://en.wikipedia....


You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
Wow! That iss amazing...
And sad that vets have to live that way...
[ Parent ]
He also had a lot of books in his cave. n/t


You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.
[ Parent ]
And all too common
Veterans make up one in four homeless people in the United States, though they are only 11 percent of the general adult population, according to a report to be released Thursday.

http://www.msnbc.msn...

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 

[ Parent ]
LOL you ARE funny too! n/t




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
Another modest proposition
1. Read the United States Constitution, Article 1, Section 8.
2. Read the Tenth Amendment to the United States Constitution.
3. Tell us why you think ASPR should exist at the federal level.
[ Parent ]
Constitutional challenges
are expensive. Before we go there, perhaps we should look at what the office of the ASPR is doing lately, and see whether the following is objectionable:

http://www.newfluwik...


Dr. Tevi D. Troy, Deputy Secretary of HHS ...

[snip]

On Pandemics ...

pandemic might not happen for years or decades, some people are cynical, eg Health Minister of Australia (same quote as Leavitt on hhs blog) "anything we say before will seem exaggeration, anything after is not enough, etc."  We reject that view, need to err on the side of caution.  Our responsibility is towards the people.

That is clearly a change in policy from Leavitt (BTW, the Australian position came from the U.S. Deputy Secretary's speech). I support this rejection of Sec. Leavitt's YOYO position.  I think there are powerful forces behind Leavitt's YOYO position (as described in my various posts about the Ottawa Communique, and the Canadian business lobby with the CDC Foundation).

If your constitutional challenge is against the ASPR, not against the entire government, then I would question your motive. If your challenge is about all government, then I wasn't wrong to ask questions about anarchy, and I don't think such discussions belong to this forum. Now you may have deep pockets, but my uneducated thinking says you will lose. Usually the side who is losing the debate resorts to constitutional challenges.

Don't expect to raise money here to fight your cause.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
RE: Constitutional challenges
...perhaps we should look at what the office of the ASPR is doing lately, and see whether the following is objectionable.

The issue is the constitutionality of Congress' support of ASPR and that does not hinge on whether you find its doings "objectionable" or not. Many people thought the National Recovery Act of 1933 was a good thing and many businesses proudly displayed the Blue Eagle. SCOTUS, however, deemed that the National Recovery Act was unconstitutional, since it "infringed upon states' authority, unreasonably stretched the Commerce Clause, and gave legislative powers to the executive branch in violation of the Nondelegation doctrine." This comes back to the concept that "not every good idea makes for a good law."
I will challenge the constitutionality of any federal program which is not authorized under the enumerated powers sections of the Constitution. There are, indeed, roles given to the federal government (such as maintenance of an army & a navy, and printing currency).  However, the ends and means of ASPR are not included in those enumerated powers and are, therefore, left to states and to individuals under the provisions of the Tenth Amendment.
That pesky Constitution just keeps getting in the way, doesn't it?
[ Parent ]
Constituion examination is way too complex for me.
That pesky Constitution just keeps getting in the way, doesn't it?

No. The constitution should not be a day-to-day administrative hurdle, it should be applied as a last resort to protect fundamental rights.  Otherwise we will need more lawyers than workers, which then costs you taxes you don't want. Correlating constitution with a specific issue is way over my head as I am not a lawyer. Even lawyers have to seek constitutional experts for advice. All I am saying is I will fight for the pandemic preparation cause, not the bigger constitution cause. You are of course free to do what you think best. I have no time for bigger battles.

I do know one thing. I like the latest ASPR approach in seeking public input, and I think it would be a mistake for humanity to shut down the ASPR public hearing process for constitutional reasons, for what I see as only frivolous lawsuits.

As I said, if the constitutional issues are much wider, then the discussions need to be much wider and deeper - though this forum is the wrong place for it.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
and pray may I ask
just out of curiosity, how exactly is the ASPR office being given powers that infringe on the rights of states and individuals?

All I have been hearing, is that they are writing programs for Federal funding to be given to States, with certain conditions attached, but the ultimate decision is up to the States as to whether they WANT to make use of such Federal funds. 

States have perfect right to ignore such conditions.  All they need to do, is decide they don't want to be part of this process.  And pay for all of their pandemic preparedness out of their own taxes.

Is there any compulsion written into the PAHPA?  If yes, can you do us the honor of EDUCATING us about it?



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
RE: Constitutional challenges
Unless all of the people serving in the ASPR office are working for free, then federal tax dollars are being spent to pay their wages. Since there is no constitutional mandate for the federal government to fund ASPR, that action is unconstitutional. Remember, "The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people."
Beyond that, "writing programs for Federal funding to be given to States" is among the most malignant of schemes formulated by the denizens of federal bureaucracy. If the money is to be given to the states, why not let the states raise that money from their citizens as they see fit (and as their citizens authorize)? Why does the federal government need to be involved in it at all? Why pay some group of people to serve as money-sucking middlemen?
So many of the statements I see from others here are reminiscent of "It doesn't cost anything, it is free. We get it from the Federal Government."
[ Parent ]
There is a easier way.
Well, you are free to initiate a constitutional challenge, which may take 10 years.

Or

you have 3 shots at voting some one into office who shares your views.


You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
thank you, now I think I understand
what you are saying.

Correct me if I'm wrong, but it would appear that yours is a general objection to the principles behind the existence of almost all of the different Federal agencies.  Let's say Department of Labor, Department of Education, Department of Transport, etc etc, none of these are created by constitutional mandates according to your interpretation ie that nothing should be created within the Federal structure unless they were explicitly enumerated in the constitution, such as the maintenance of an army or the printing of currency.

If that is the case, may I respectfully suggest that such lofty issues as the constitutionality of the existence of Federal agencies in general, fall clearly into areas that go beyond the scope of this forum.  We here on this forum are rather limited, I'm afraid, in our scope of debate, out of necessity.  Even though the questions you raise are intriguing and do doubt highly educational, I would suggest that we limit our debates to areas that are immediately relevant to pandemic influenza.

Apologies if I misunderstood your position, and thanks for your input!



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
RE: your understanding
1. I would point out that it was you who brought the discussion of the United States Constitution into this thread, in your opening post through your invocation of the 14th Amendment. That invocation was spurious, however, since the 14th Amendment says, "No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws." The 14th Amendment has no applicability to the issue at hand although I am sure it looked impressive to the uninformed who read it in your OP.

2. The basic issue at hand appears to be one of principles. If I found a bag of money alongside the road, my first question would not be, "How can I spend this so as to advance my favorite cause?" It would, instead, be "What can I do to return this to its rightful owner?"
You want to make suggestions as to how the money should be spent. I want to return it to those from whom it was taken. We have different sets of principles. I believe mine are correct. You, evidently, believe yours are. I will leave you with yours.

[ Parent ]
...
yeah...  so...  alot of the govt-driven safety nets that exist today didn't in the last major pandemic.  and that is a key factor that makes us weaker today, than we were then - in the yoyo scenario, the safety-net folks have major issues.  if folks can be motivated to become resilient once again - as their ancestors were - the need for those safety nets decreases.  short term, and long.  motivating the public to become more resilient is win-win.
[ Parent ]
well, I'm no expert
not even a student, of such lofty matters.  All I know is that
  1. the office DOES exist,
  2. the money HAS BEEN appropriated,
  3. it is GOING TO BE spent on programs related to pandemic preparedness,
  4. RIGHT NOW they are asking our opinions as to HOW that should be spent,
  5. if we DON'T participate (which BTW was the original debate, not the constitutionality of the office), the money will STILL be spent.
If someone else wants to take down the ASPR office, I have no opinion one way or the other, cos I know zilch about that business.  And as anon.yyz said, it goes way beyond the contexts appropriate for this forum.

For as long as that office is responsible for pandemic preparedness, then we need to maintain the dialogue.  If the responsibility is moved to another agency, then we need to go THERE and get in the dialogue.  That's my opinion.  Yes, OPINION.  And the extent of our influence.




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
Constitutional Callenges
Constitutional Challenges related to issues of federal juristiction normally hinge on the question of "is an interstate commerce impact".  I believe this meets the interstate commerce test in several ways- therefore the federal government has an interest.
[ Parent ]
does the Federal government
have a national security interest?  What I mean is, is that national security interest part of the mandate for preparedness?



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
The Commerce Clause
I think the purpose of this agency has a close and substantial relationship with protecting the national economy from burdens and obstructions.  This being the case, congress cannot and should not be denied the power to excercise its authority to pursue, and fund, these purposes.

I think it is worth discussing this further because a philosophy that would limit the role of congress to that it held in 1918 will not serve us well in preparing for, responding and recovering from a 21st Century pandemic and its impact on a 21st Century national and global economy.

And the standards you suggest are not the standards that have been applied by the courts, not even back in 1918.  Even the standards that are applied have rarely been used to limit congress's powers in anywhere near the ways you adocate.

You imply that anything not expressly enumerated is beyond the power of congress.  I have always thought of this as the crystal ball test of Constitutional construction. It seems to say that if they did not foresee it and include it in the text of the constitution, it is outside the authority of the federal government.  Since I don't think the drafters of the Constitution had a crystal ball and since they chose to omit the key word expressly it is pretty well settled that implied powers were included in the constitutional grant of power to the congress.

The crsytal ball test is really only useful as a method of obstructionism.

There are limits to federal powers and real debates about how the legal standards that define those limits should be applied. But that's not what you are suggesting.  You are suggesting adoption of new (or very old) standards that would freeze the constitution sometime back in history.  The biggest problem with that is that frozen things get brittle and are apt to break. 

If people are intersted in learning more about the U.S. Constitution, Article 1, Section 8, you might want to start with a key historical case.  While subsequently limited in some ways,  National Labor Relations Board v. Jones & Laughlin Steel Corporation is still good law. 
http://caselaw.lp.fi...

http://en.wikipedia....

The men (and women) in black robes still apply (and occasionally even extend) its principles. 

http://en.wikipedia....

The constitution contains within it the capacity to change with the times.  It is this ability of the principles inside the constitution to accomodate new developments in the world outside, including evolution of the national and international economy, that allows it to keep its effectiveness. 

You might even call it resilient.

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 

[ Parent ]
Commerce Clause
It has a broad application (does the impact go beyond a states lines or juristiction.  Pandemic spread or inability to to cope with the outbrak would have an impact beyond a single states boundries. This impact could include national economic impact, flow of goods and services across state lines, maintence of power and other infastructure across state lines, national security and even possibly the spread of disease beyond state boundries.
[ Parent ]
fact or opinion?
Events are never so simple as can be represented by a single-item cause and effect relationship.  Even wildfires are caused by a combination of many events, including the mere EXISTENCE of trees!

My little pandemic 'gridlock' graphic is a case in point.  Katrina was another - can one truly say that the disaster was ONLY caused by whatever political problems you are highlighting?  I don't doubt that these problems exist, and I find them distasteful just like everyone else (or maybe I can't speak for everyone else), but that is not the question, is it?

The question at least for me is, what do we DO about certain problems that plague us?  Everyone of us have to make up our own minds and make some choices, including in this instance whether to 'engage' with government. 

The question also is, do we make our choices based on our opinions, and express them as such?  ie as CHOICES that are dependent on individual OPINIONS?  Or do we make our choices AND THEN portray them as universal truths or 'facts', having ignored the fact that such 'truth' was a result of having made some determination ie choice in the first place?

Spend your time and efforts talking to government officials if you choose -- just don't ask them to steal money from me to implement your plans.

MY plans?  ;-)  I am very flattered that you even think that I (or anyone of similar background) can possibly have such influence!  But let's hypothetically assume that I can, and I succeed in persuading them to 'take money from you' (although I have no such intention and certainly don't know how to do that even if I want to!) to carry out 'my' plans, doesn't that prove somehow that engaging with the government WORKS?

With all respect, you can't have it both ways.  Either you think engaging with government is a waste of time cos they won't listen to whoever is in there only for the public good, in which case I am doomed to fail and you don't need to worry about your money being stolen, or you think I actually DO have the ability to influence government, in which case, well, I'd like to think that it proves it IS worthwhile engaging with them!! 

;-D



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
False dichotomy
Even wildfires are caused by a combination of many events, including the mere EXISTENCE of trees!

Right. I am sure that is why FEMA felt the need to stage a phony news conference on October 23rd, with FEMA employees posing as reports asking questions of FEMA Deputy Administrator Harvey Johnson.
But let's hypothetically assume that I can, and I succeed in persuading them to 'take money from you' (although I have no such intention and certainly don't know how to do that even if I want to!)

You demonstrate a hard-to-believe naiveté regarding how taxation is used to fund the operations of US Federal agencies ... unless you are saying you will personally donate the money needed to fund the plan you are advocating.
With all respect, you can't have it both ways.  Either you think engaging with government is a waste of time cos they won't listen to whoever is in there only for the public good, in which case I am doomed to fail and you don't need to worry about your money being stolen, or you think I actually DO have the ability to influence government, in which case, well, I'd like to think that it proves it IS worthwhile engaging with them!!

That is a false dichotomy. The chance that you will be successful (in getting a government agency to pander to your plan) does not imply anything "worthwhile." What you may succeed in doing is extending the role of the federal government as a nanny. That is the antithesis of worthwhile.
[ Parent ]
with all respect
I'm not sure you understand the situation.  The ASPR office already HAS the money appropriated to carry out their responsibilities of the PAHPA act.  What is happening is they are asking people's OPINION as to how they should go about writing the programs for which the money will be spent.

If I'm not in there telling them what they need to do, the money will still be spent, but in ways that may not be consistent with what people on this forum think.  Which was why I went, and why I put up this diary to collect opinions.  I don't ever say I represent anyone's opinions in such meetings, but what I do tell them is "here are the concerns that I'm hearing, and you can read them yourself on the forum."  It's all in the open.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
I understand perfectly
My opinion is: Close the ASPR office and return the money to the taxpayers. To create an agency that has no idea about how to spend its money is the ultimate proof of its non-necessity. Imagine someone in a private corporation saying, "Hey, let's establish a new department. I don't know what they'll do but they can ask around after we hire them and come up with ... well ... something."
It is ludicrous.
[ Parent ]
LOL, THAT is funny!
My opinion is: Close the ASPR office and return the money to the taxpayers.

I would have to be VERY deluded to believe I have such powers of influence.

Since there's no way I can get them to CLOSE it, the next best thing I or anyone can do, is to make d****d sure they do the best with the money that they already got. 

The best is never enough, of course.  But the issue under discussion here is whether one should engage with government and how much influence one has.  If YOU or anyone has the ability to influence government to the extent of getting them to CLOSE the ASPR office, then I'd say "Good for you!"

;-D



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
Wow, that's the biggest double-bind
I've seen for a while!

To create an agency that has no idea about how to spend its money is the ultimate proof of its non-necessity. Imagine someone in a private corporation saying, "Hey, let's establish a new department. I don't know what they'll do but they can ask around after we hire them and come up with ... well ... something."
It is ludicrous.

If an agency does not do anything to consult the public, we accuse them of lack of transparency and accountability or worse.  If they consult the public, we accuse them of having no clue what they are doing.

IMHO, the truth is somewhere in between.  They have ideas of what they think needs to be done, and they are sharing those ideas and asking for comments and additional ideas to be incorporated, before final decisions are made.  THAT is accountability and transparency at its best. 

This of course is only my OPINION.  The consultation is the FACT.  Their intention and whether or not they WILL actually incorporate stakeholder ideas remain to be ascertained.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
I like public consultation, televised if possible.
I think it beats back room deals with special interest groups making all the decisions.

Please don't shut down the debate. We need many view points.


You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
Can I ask a factual question -
You mention that the ASPR office:

- DOES exist,

-  the money HAS BEEN appropriated

-  it is GOING TO BE spent on programs related to pandemic preparedness

How much money has been appropriated, specifically, to the ASPR office and for what timeframe? 

[ Parent ]
well, I don't know about the total
but in the PAHPA itself, there are sections on appropriations.

The text of the PAHPA can be found from THOMAS by searching under the 109th congress and "pandemic".  There is no direct link, and the search items expire after a certain time, so it's a bit of a pain trying to find it.  But for the benefit of everyone, I've turned the text into a pdf file which you can download from here.

In that pdf file, if you search 'appropriated' you will see 17 results some of which describe the various amounts appropriated within this particular bill. 

My understanding is, in addition to that, there was a supplemental bill but it will take a fair amount of time to hunt down the amount again!  If you have the time to figure out exactly how much, please let us know!  thanks!



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
also in the bill
have a look at the various clauses for matching funds and for withholding of funds from 2009 for non-compliance.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
to give an idea
not just on level of funding, but what is going on with regards to state pandemic plans as required by the Act:

under SECTION 201 IMPROVING STATE AND LOCAL PUBLIC HEALTH SECURITY

(a) In General- To enhance the security of the United States with respect to public health emergencies, the Secretary shall award cooperative agreements to eligible entities to enable such entities to conduct the activities described in subsection (d).
(b) Eligible Entities- To be eligible to receive an award under subsection (a), an entity shall--

  1. (A) be a State;
    (B) be a political subdivision determined by the Secretary to be eligible for an award
    under this section (based on criteria described in subsection (i)(4)); or
    (C) be a consortium of entities described in subparagraph (A); and
  2. prepare and submit to the Secretary an application at such time, and in such manner, and containing such information as the Secretary may require, including--
      (A) an All-Hazards Public Health Emergency Preparedness and Response Plan which shall include--
    1. a description of the activities such entity will carry out under the agreement to meet the goals identified under section 2802;
    2. a pandemic influenza plan consistent with the requirements of paragraphs (2) and (5) of subsection (g);
    3. preparedness and response strategies and capabilities that take into account the medical and public health needs of at-risk individuals in the event of a public health emergency;
    4. a description of the mechanism the entity will implement to utilize the Emergency Management Assistance Compact or other mutual aid agreements for medical and public health mutual aid; and
    5. a description of how the entity will include the State Unit on Aging in public health emergency preparedness;

    (B) an assurance that the entity will report to the Secretary on an annual basis (or more frequently as determined by the Secretary) on the evidence-based benchmarks and objective standards established by the Secretary to evaluate the preparedness and response capabilities of such entity under subsection (g);
    (C) an assurance that the entity will conduct, on at least an annual basis, an exercise or drill that meets any criteria established by the Secretary to test the preparedness and response capabilities of such entity, and that the entity will report back to the Secretary within the application of the following year on the strengths and weaknesses identified through such exercise or drill, and corrective actions taken to address material weaknesses;
    (D) an assurance that the entity will provide to the Secretary the data described under section 319D(d)(3) as determined feasible by the Secretary;
    (E) an assurance that the entity will conduct activities to inform and educate the hospitals within the jurisdiction of such entity on the role of such hospitals in the plan required under subparagraph (A);
    (F) an assurance that the entity, with respect to the plan described under subparagraph (A), has developed and will implement an accountability system to ensure that such entity make satisfactory annual improvement and describe such system in the plan under subparagraph (A);
    (G) a description of the means by which to obtain public comment and input on the plan described in subparagraph (A) and on the implementation of such plan, that shall include an advisory committee or other similar mechanism for obtaining comment from the public and from other State, local, and tribal stakeholders; and
    (H) as relevant, a description of the process used by the entity to consult with local departments of public health to reach consensus, approval, or concurrence on the relative distribution of amounts received under this section.
(c) Limitation- Beginning in fiscal year 2009, the Secretary may not award a cooperative agreement to a State unless such State is a participant in the Emergency System for Advance Registration of Volunteer Health Professionals described in section 319I.

then further down in the bill:

`(2) CRITERIA FOR PANDEMIC INFLUENZA PLANS-
`(A) IN GENERAL- Not later than 180 days after the date of enactment of the Pandemic and All-Hazards Preparedness Act, the Secretary shall develop and disseminate to the chief executive officer of each State criteria for an effective
State plan for responding to pandemic influenza.

also withholding of funds:

`(5) WITHHOLDING OF AMOUNTS FROM ENTITIES THAT FAIL TO ACHIEVE BENCHMARKS OR SUBMIT INFLUENZA PLAN- Beginning with fiscal year 2009, and in each succeeding fiscal year, the Secretary shall--
`(A) withhold from each entity that has failed substantially to meet the benchmarks and performance measures described in paragraph (1) for the immediately preceding fiscal year (beginning with fiscal year 2008), pursuant to the process
developed under paragraph (4), the amount described in paragraph (6); and
`(B) withhold from each entity that has failed to submit to the Secretary a plan for responding to pandemic influenza that meets the criteria developed under paragraph (2), the amount described in paragraph (6).



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
note on appropriations
Tracking federal funding for avian and pandemic flu preparedness is difficult for several reasons. First, funds designated specifically for pandemic flu do not reflect the sum of all relevant activities. For example, programs to improve health surveillance in general, or to streamline federal coordination during disasters, are important for pandemic preparedness. Also, the President has called on all federal agencies to develop continuity plans specifically for a flu pandemic, activities that are typically funded through general administrative accounts.

Second, certain activities (e.g., the expansion of flu vaccine production capacity) address preparedness for both seasonal and pandemic flu, and may not be designated as pandemic spending, despite their relevance.

Finally, federal agencies may not prepare budget information, such as the presentation of base funding or annual increases, in a consistent fashion. This report provides information on appropriations, primarily to HHS, that the Congress has specifically designated for influenza preparedness, including efforts to expand seasonal flu vaccine production capacity and related activities.

Amounts are discussed in subsequent sections of the report, and are presented in Tables 1 and 2 at the end. Pandemic flu funding for HHS has generally been provided in the Public Health and Social Services Emergency Fund (PHSSEF), an account intended for one-time or short- term activities.

http://fpc.state.gov...

and this is the CBO estimates by fiscal year, in millions of dollars:

http://www.cbo.gov/f...

Spending Under S. 3678 2006-11

Estimated Authorization Level

1,811

1,649

1,673

1,707

1,742

1,756

Estimated Outlays

1,760

1,942

1,674

1,653

1,669

1,710

[ Parent ]
thank you
I saw that page before, I was trying to find it again!



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
to clarify, for Pixie and others
even though the CBO said it's difficult to estimate, those estimates are the appropriations DIRECTLY related to the Pandemic and All Hazards Act, and do not include other money funded through other appropriations.  At least that is my understanding.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
I realize that there is a very large
complicated pot of funding available for the PAHA.  I was more wondering what the new office of ASPR had at it's direct disposal/command (i.e. how well they are funded).  Just curious if they could find themselves in a situation similar to that of the Surgeon General's office.
[ Parent ]
I suspect they are pretty well funded
because the appropriations to carry out the functions of the ASPR office are directly within the bill itself, and quite well defined.  Of course, the Secy of HHS always has some discretion as to what budget to present, but I suspect he would have to answer some pretty tough questions if the ASPR office is not adequately funded to serve their functions, as per the Act.  Remember, this Bill had strong bipartisan support, and as did Vanderwagen for his confirmation.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
Appropriations
Note these numbers are for Fiscal Year (FY) 06 and 07 depending on which report you are looking at - we are now in FY08.  Further funds may be allocated through different programs and offices (other than ASPR)in addition to other agencies.  There was $625million allocated in the 08 supplimental this was money that was allocated previously and remains available until expended or resended - normal appropriation funds expire at the end of the fiscal year.

Lastly, the $625m is available for a range of things specified or with some discretion of the Secretary. 

[ Parent ]
thank you, yes, I understand
I was giving those figures for Pixie just for reference.  The PAHPA contains in various places references to further funding for subsequent years as appropriate.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
the piece I supplied is estimatyes through 2011
but also helpful is this from TFAH:

http://www.newfluwik...

[ Parent ]
when you say plan
I'm not sure that I DO have a PLAN to suggest, and I DIDN'T suggest any plan in yesterday's meeting (which I will write up later today, have to gather my thoughts and notes).  But what I did was to convey to them the issues that they have overlooked (or ignored) and put them on the record.  Like the need to tell the public about the pandemic risk.

Risk communication etc, is ALREADY included in the various programs, ie the funding is already there.  The issue is whether and how they write their BENCHMARKS, standards or criteria that states need to meet in order to continue to get funding.  Those benchmarks can be written any number of ways, but they will have powerful effects on what states and local officials actually DO.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
to clarify
with the pandemic preparedness funding that states have been getting, the past few years, they only needed to 'self-declare' compliance.  From next year, there will be benchmarks, measurable items that if they don't meet, they will have their funding withheld.

It's in the PAHPA legislation.

At the APHA Expo, I talked to someone at the CDC.  The CDC has cooperative agreements with states which is the principal mechanism (so far) for state funding for panflu planning.  The CDC website only show the guidance for up to FY06, and I have been looking for the FY07 one for a while.  I asked this question, and it transpired that the guidance which should have come out in the summer to coincide with the budget cycles, was delayed to make sure that the PAHPA provisions were included.  That is now finalized and will be out in the next couple of weeks, at least that's what I've been told.

Now, the CDC could have gone ahead with as scheduled and put out guidance without incorporating PAHPA, but to the extent they did, it moves forward by 1 budget year the speed with which states are required to comply with whatever the ASPR requires of them.  Since the Act was only passed in December, this is only the first cut of what is going to come out of ASPR.  The rest of it is being worked on, and gathering stakeholders opinions before they are finalized, was the main purpose of yesterday's meeting.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
what type of benchmarks?
I used to write benchmarks all the time when I was a teacher.  We couldn't write things like:  "The teacher will teach long division" but rather, "Students will demonstrate 95% accuracy in using long division".

So what types of benchmarks are we hoping for states to write?

"States will provide pandemic flu education to inform citizens of the need to prepare through a series of radio and TV and print ads"

versus

"75% of a state's citizens, when called randomly on the phone for an interview, will be aware of the term flu pandemic, its possible severity (as specified earlier), the likelihood of no vaccine for several months, and will understand the need to be  prepared (as specified earlier)"

That kind of thing?

GetPandemicReady.org - non commerical website with practical ways for families to prepare.

[ Parent ]
I like "measureable"
http://www.newfluwik...

Fear, uncertainty and doubt is no longer enough.


You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
benchmarks
I don't know the details.  As I said, I'm waiting for the CDC guidance to come out, as is everyone else involved in state pandemic planning, as I understand.

Your analogy is correct in principle.  I just don't have the details yet.  The details will be extremely important, in determining what will get done.  But, this is a work in progress, so personally I don't expect too much out of this year's guidance yet.  It is the first cut, the rest is all in the stuff talked about yesterday.

Look at the agenda, it tells you the scope of what was covered.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
Certitude or Certainty?
Not opinion, Dr. C. Fact.
It isn't factually based
On the contrary. My beliefs are always based on facts: ... 

Goodness. Now that's certitude for you. 

But even if you have managed to rigorously cleanse your belief setting system of all but what you see as facts, it is good to remember what Oliver Wendell Holmes, Jr. had to say:

Certitude is not the test of certainty. We have been cocksure of many things that were not so.


ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 
[ Parent ]
It is not all or nothing. It is some where in between.
Yes they are trying to get our votes and some times may be often times don't deliver on vague promises - because the masses let them. If people do nothing about it, we deserve what we get.


You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.
[ Parent ]
The Role of Govt
There are things that individuals and non-governmental organizations can do more effectively and efficiently than government.

There are things that government can do more effectively and efficiently than individuals or private organizations.

Failure to acknowledge either of these truths results in a discussion that is fundamentally flawed from the get-go.

If you look around you at almost any time of day and look past what you take for granted, you can almost always see something that we, working together through our government, have achieved that makes our life better. 

That does not mean there is not graft, malfeasance or just plain idiocy operating in both realms (which is evidence that all-too human individuals are active in both realms.) It means that in many instances where there is a national, long-range interest that can serve the common good, very often government is the best (and sometimes only) instrument to meet that need. To deny this is to deny or ignore history.

How well government performs its tasks often has more to do with who is running government and how well the citizenry keeps tabs on the government's performance.  We all too often get the government we deserve.

The scope and complexity of pandemic preparedness efforts necessitate a whole country (whole world) approach that asks from each realm (private and governmental) the best it can offer.  We are asking for that best effort from both realms.  We can afford nothing less, so we should not, cannot, give up on either. 



ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 

[ Parent ]
my child, and my child's generation, count
not that I like to get personal, but yes: the next pandemic will be personal.

I'd like to thank all of us here and beyond for doing what we can and, at least at times, more than what we thought was possible.

Back to jester mode. ;-)

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

needs of infants
I had three people come to me today, thanking me (us) for the ReadyMoms.booth and our work, and specifically asking us if we had considered the needs of infants, especially with regards to feeding.

I know from reading the guidelines for businesses and COOP plans, that some people are being "briefed" to expect supply chain interruptions of at least 6 to 8 weeks during a pandemic, for instance.

I realize no one knows for sure what a pandemic will bring.

But I would like the government to brief the American public about the same thing, if there is a credible threat.  Infants in particular are vulnerable to interruptions in their food supply.  Mothers could be encouraged to prepare for this now, by choosing to breastfeed or by being sure to have a backup method of feeding in ample supply.

GetPandemicReady.org - non commerical website with practical ways for families to prepare.

And breastfeeding mothers need regular food and drink or their milk will fail.
Again, preparation is key. 

How many mothers have a non-electric way to puree foods for babies?  Imagine having to pre-chew the baby's food or find suitable rocks for pounding it.  (A sharp knife and cutting board would help, but can it be made into a fine enough texture?)  Without stockpiling a cooking method and fuel along with the food and water-processing supplies, parents will have nothing to feed their babies.  If the food can be cooked to softness, a food mill or mortar and pestle would work, but uncooked food, or no food, and babies will starve first.

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
It's actually not as bleak as that
although having the parents know it may be a problem. The idea that babies *need* pureed food is a myth. Mine never had any (unless you count the occasional jar of commercial babyfood for convenience). This wrong idea goes with feeding babies solid food very early, when all they can cope with is puree. If one follows the WHO (and other) guidelines and gives them nothing but breastmilk for the first 6 months, one can start them on finger foods and/or foods just mashed with a fork, and they're fine. Breastmilk is ideally the main food for the first year anyway - solid food is more for play :-) -  and in extremis if it's the only food for the first year, no harm is likely to be done (exception: some of those fully-breastfed-for-a-whole-year babies would become iron deficient, a few seriously, so the ultimate prepper might want to stock baby iron drops). Breastmilk is truly wonderful stuff.

Mothers need food and drink to make it, yes, but the milk supply is also not as delicate as many people think; it takes serious famine to stop it, at least when there's a baby breastfeeding for all its nutrition. Water is more important than food: breastfeeding mothers need far more than other adults, of course.

I'd actually be more worried about the babies getting formula that might be made with less-than-clean water, if there are problems with the water supply and/or power.

[ Parent ]
...
When will the public be given realistic numbers?  Not the happy-talk, not the numbers from 1918 - the numbers for what we are likely to face when H5N1 goes H2H?  Not the 30% AR in some table tops, but a more realistic 40-50% AR.

There are alot of responsible people around the world, but 3 days or 2 weeks is too easy for them to bargain away with the food they have on hand (we could stretch what we have on hand).  Many, perhaps most, are doing nothing - because all they've heard is happy talk, regarding the event we would prefer to face -- not the event we are likely to face.  And really - two weeks - so everyone will have to go shopping at the upslope of the first, wave - is that really what the govt wants?

When will the public be engaged by its govt in a manner that befits the seriousness of what we face, where we are in preparing for it, and what individuals and families need to be doing NOW?  Plans have been posted online - certainly - but ask John Doe on the street if they've seen the latest NRF, and what they think about the CMG - huh?

There is not enough money in the govt to cover programs to feed and care for all the people in the country in an MCE of this magnitude; the only way is for individuals and families get ready.  Most that I talk to are thoroughly unaware - the best I get are 1918 numbers.  And no one is looking at an event that stretches out 3-4 waves over 18 months, or closer to 36 if we employ NPI/CMG and flatten the waves to salvage our healthcare systems.  No one is addressing the break down in our infrastructure that we are likely to face.  No one is translating what a single wave impact would look like at 40% AR and 80% CFR.

Unless individuals and families are engaged months before it kicks off - in a manner that befits the seriousness of the event - very few will remain to complain.  The people of our country need our government to engage; and those people need to be given time to prepare - they need to know about it BEFORE it happens.

The govt owns the airwaves - no one needs to buy airtime.  The govt chooses to filter its message through sound bites - it is a choice.

perhaps more succinctly..
When will the govt treat the citizens of our country as a provider would a patient, and provide accurate information such that the patient can make an informed decision on changes needed to face a serious health problem?
[ Parent ]
THAT is a great quote
that I can use, thank you!

When will the govt treat the citizens of our country as a provider would a patient, and provide accurate information such that the patient can make an informed decision on changes needed to face a serious health problem?




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
3 Times as Bad As 1918 = 6.3% Average CFR for U.S.
c3jmp: I could not agree with you more about the need to warn the public about realistic possiblities, except to add - just for perspective - that the the 'worst case' they are currently willing to share with the public is their version of severe (1918-like) with a Case Fatality Rate of 2.1%  http://www.pandemicf...

So you could reduce the current cummulative case fatality rate of H5N1 by a factor of 10 and still be more than 3 times as bad as what the government is telling the public is the worst case.

And those that say you should not plan for (or warn the public about) worst case scenarios that have little or no chance of actually coming true, I would offer that even a 10-fold reduction in CFR is a pretty moderate (or even optomistic) assumption given the concerns stated by the World Health Organization Working Group that

One especially important question that was discussed is whether the H5N1 virus is likely to retain its present high lethality should it acquire an ability to spread easily from person to person, and thus start a pandemic. Should the virus improve its transmissibility by acquiring, through a reassortment event, internal human genes, then the lethality of the virus would most likely be reduced. However, should the virus improve its transmissibility through adaptation as a wholly avian virus, then the present high lethality could be maintained during a pandemic.
http://www.who.int/c...

(I would note, that while this would seem to be a highly controversial statement - I don't remember seeing anything in the way of scientific critique that said it just wasn't so.)

I think it is safe to say that all or most of the impact magnifiers you discuss would begin to have major effect well before we got to a pandemic severity of triple that of 1918.

It is also safe to say that when you are working with national averages (which is where they got the 2.1% from 1918), you will find communities that had (will have) both lower and higher CFR in their community.  So especially if you are only willing to plan for the past, your range for 'worst case' should probably not be limited to a national average. 

It is especially critical that when discussing the resources to be allocated for ensuring our capabiity for effective NPI that we remember that effective NPI could reduce fatality rates by 50-75%. 

In the US, even using a 30% attack rate, each 1% of CFR is another 900,000 people who would die (and 450,000 to 675,000 that might be saved by effective personal and community mitigation.)

And if age-based fatality remained the same, the vast majority of those will be children and young adults.

________
The quote above comes from this document:
Influenza research at the human and animal interface
Report of a WHO working group
Geneva, Switzerland, 21-22 September 2006

http://www.who.int/c...

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 

[ Parent ]
...
I agree - and I fully recall the discussion on degrees of bad.  My point was to contrast the very possible numbers with the 1918 scenario the everyone I talk to that doesn't dismiss the risks out of hand considers worst case (because the govt would tell them if it were worse).  Most folks I talk to don't sit up and listen with 1918-like numbers; they haven't put any serious consideration into the potential impacts because if it could be that bad - their govt would tell them -- and they're not.  My point is the stark difference between what most people believe the danger to be, and what the danger is.  That stark difference may well kill people that could survive if they know to prep now. 

Unless our govt has deemed its citizens incapable of making decisions for themselves - that may be the case.  I've seen nothing presented to the public (outside of documents online) that approaches anything beyond a palliative treatment for the public.  And it's only palliative on the front-end - when there is the greatest opportunity to make a difference.

Until the govt engages its people in a very up-front manner, most people are going to flip the page, mute the tv, switch channels, or surf elsewhere - they've heard the bird flu stuff before.  I thought the govt was headed that way with, and following the HHS Leadership blog - and I've waited - and I've seen nothing of any substance, to convince anyone in my country that they should do anything different before the next pandemic. 

Folks here have spent months working the numbers on different scenarios -- the public, however, has a much smaller level of interest, and very nearly no attention span on-topic.  And while planners may very clearly recognize the difference in impact by soft-balling the numbers - the public doesn't care - because they've been given no reason to care.

It'll be a much smaller country.

[ Parent ]
if it could be that bad - their govt would tell them
Unless our govt has deemed its citizens incapable of making decisions for themselves - that may be the case.

If pandemic flu could be cured with a new deodorant, we'd hear never heat the end of it - because no one knows how to shop like we do.  Shoppiness is next to godliness.

But making decisions for our country's long-term common good is something we don't seem to have a big hankering to engage in right now, and its a burden others would just as soon take off of our little hands to make sure we don't go messin' it up for them.

Could we handle it if they leveled with us?  If I've been watching too much TV, at times I have my doubts.  But when I make that question more local - could the people I know personally handle it if the government leveled with them?  Then the answer is easy - yes. And I think that's true pretty much everywhere you'd go.

But no matter what the answer to that question is, the real question is do we all stand a better chance of 'handling' the pandemic in the future if the government levels with us now?  On this there should be no argument.  Yes - and it would save lives.

And if they don't, and we can't, then I think as your last line is intended to convey - our post-pandemic country will be smaller in more ways than population.

 

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 

[ Parent ]
ESF - 8
Did Pandemic Flu Year Victim identification/mortuary services response ever rate its own Emergency Support Function # creation or it is still lumped under 8 ?

Does the fact that "all-hazard mce" plans (which seem to be all they will try to implement at local and state level if pandemic year starts next week- and I don't think local funeral homes have been consulted during local planning; what do you think?) are totally inadequate to the scope and infrastructure disruptions of a Panflu mass casualty Year from high cfr virus plus normal death rate plus  collateral deaths from infrastructure collapses "remain a topic no one wants to address at any level of government"?

Funding could have been tied to community mass mortuary drills (and true "all"-stakeholder PPCCs) rather than just flu vaccination drills; given that local mortuary response will be needed immediately, and for months, with diminishing staff, long before there is any effective vaccine handed out in quantity-
how long do you think it will take for the public to figure that out, despite all the, "we practiced handing out vaccine to the whole town if there was a pandemic" articles the press keeps running?

Do you think it is ethical and useful to have local and regional officals trying to sign up community volunteers for the MRC who have not even been told we are in a pandemic alert from H5N1, nor that the pandemicflu.gov site even exists? (Do you know there are MRC members who have never heard of pandemicflu.gov? They are telling people they need "72 hour kits" because "that's how long it will take for govt help to arrive".)

How ethical and helpful is it to not purchase pandemic supplies, and not tell the public that state and local officials haven't bought enough for their communities, because they either think they can,(MA state legislator) "make the feds take more responsibility", or (Selectman) "it's not a Town problem; it's a Health Dept problem and he says he has a Plan", or (ph/emergency officials) fear, "if we bought supplies, they'd just get comandeered away from us"?

Whatever economic or political "panic" is feared at the top by "telling the public" will not "be worse than" an 80% to 100% cfr panflu year; North America has been depopulated before, after 1491 when strange people, pigs, and chickens, and, their viruses, arrived.
1918-1919 was bad and they had farms, food, home nursing and burial skills, (and 1/3 the population, and no one who couldn't live without our modern system).
They had no warning, no education; what use all the money and time and plans on paper, if it is thought waiting until after pandemic year start will be "just-in-time" for procuring supplies, public education, "lowering of expectations" and training replacements to do what needs to be done during pandemic year?

Trying to keep people ignorant, "so they'll show up to work" is planning to fail; that won't save society from a killer virus and infrastructure collapse.
Why not tell the public; so they, their schools, churches, farmers, utility and other essential workers can be proactive; try to be part of the mitigation solution, not part of the mass mortuary problem, now- while supply chains still function?

I recently asked
my EM if he had spoken to the funeral director, who mind you is a located 2 houses down from the fire dept., about fatality plans.  The EM said "no, but I know who he is"

Ha! Another great statement

[ Parent ]
Only two houses down?
We know at whose house the funeral director will be telling callers to drop the bodies, before he drops, himself.
[ Parent ]
The moms had done a great job, and the grouchies are coming out of the woodwork :-( n/t


You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.
UPDATE - at lunch break
I posted 2 questions (sent in by 3 x 5 cards), don't know if they will respond to them this afternoon, but I thought I'd let you guys know.

1.  we are repeatedly told that individual families and community preparedness and resilience is important.  When I do a search of the PAHPA report, the search return no results for family/families, child/children, public except in relation to public health, one result for individual except for the section on at risk individuals.  How serious is ASPR and this administration in actually delivering on this rhetoric?

2.  hspd 21, the future 'mechanism for up to date and specific pH threat information' to be relayed to relevant PH officials is to be established by DHS in coordination with AG, HHS, DNI, and ONLY in ways that are consistent with the requirements of the Information Sharing Environment.  In a fast developing public health threat such as a pandemic, how well is this security-based mechanism matched to the need for rapid up-to-date situational awareness at all levels, and how well will the public respond to information that is perceived as having been 'filtered' by a security apparatus?



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

PAHPA progress report
is here  http://www.hhs.gov/a...



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
Official rejection of Sec. Leavitt's YOYO message.
This to me is the BIGGEST DEAL for a long time for pandemic individual preparation cause.

Why are the loudest mouths in flublogia against HHS Blog suddenly so quiet?

Isn't it time to energize, if not rejoice?

May be that's why some want to shut down ASPR. Just may be.


You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

well, let's not speculate
and ascribe motives that may not exist or are beyond our powers to ascertain.

I would suggest that we just stay with the facts, and get on with the work.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
If YOYO has been rejected, does that mean the Feds will have help to give,
to communities from shore to shore?  What am I missing here?  I thought it was good that Sec. Leavitt said we all have to face up to the absence of help from outside, and therefore we had better wake up and make plans and get supplies or we'll be in deep trouble after the pandemic starts. 

"The truth does not change according to our ability to stomach it."  Flannery O'Connor
[ Parent ]
The insidiousness of the YOYO message
is that no matter what you do, it will not be enough. It is a 'plausibility deniability' statement together with the other part which is a warning to any one working in government not to scare the public (inform without alarm etc.).

The end result after years is no one tells the public, and if TSHTF the 'deniability' part was already in the original YOYO message. If it is not enough, it wasn't supposed to be ever enough.

Only the craftiest spin doctors could come up with such messaging.


You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
I agree, Jane
The most common objection of officials to meaningful local community education and preparation is that the state will take care of it.  The most common objection of state officials to practical preparation is that the feds will and should take care of it.  Leavitt's was familiar with this refrain, and his YOYO comments, as we paraphrase them, were meant to address this roadblock. He needs to get credit for attempting to get ahead of a problem, before most of us even ran into it.  I too thought that it was a positive and honest effort on his part, since there is no way the federal government can be everywhere, on a merely logistical basis. State and local entities needed to be reminded of that (and they were who he was specifically adressing those commments to in an effort to get them to prepare).

I don't know how it works for those who live in Canada or the UK, and I wonder whether they have the same sort of problems we have here with an local/regional officials  tending to want to kick the problem upstairs to the national level from the provincial/territorial or county level in Canada, or whether the Brits have that type of problem with county or borough officials in pushing the responsibliity for problems up a level. Maybe it's only an American problem, and it works smoothly everywhere else, but I doubt it.  I'll bet there's a struggle over funding and responsiblity, local/regional/national, on these issues in other places as well. 

[ Parent ]
Canada doesn't talk about preps at all.
The message has been consistently "we have lots of anti-virals, we have lots of vaccine capacity". Provincial governments have been muzzled into a deal of One Voice messaging by the Feds on the week end the Karo news broke. The lack of leadership is appalling. I am counting on the North American Pandemic Plan/Security Prosperity Partnership to get U.S. pandemic policies duplicated by Canada.

As for Sec Leavitt 'message', the YOYO is always accompanied by the "not alarmist" comment, which results in no one at any level of government daring to talk about preparation.

The latest rejection, my bad, is not the YOYO part, but the "alarmist" part or officially sanctioned cynicism that the public will be alarmed if you talk about preps so don't risk your career by telling the people.

The positive message should be, citizens should be told to prep, it can be done - not don't scare the sh*t out of citizens.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
Who is doing the muzzling?
When Canadian Federal Health Minister Tony Clement announced the influenza.gc.ca website, at a press conference, to be the one stop source of all pandemic and influenza information, he was heckled for several minutes by several people in the back for "fear mongering". Those weren't polite questions, but screaming and yelling. I think the Minister was ambushed, and learned how powerful the forces are.

Those hecklers may be journalists, but they may also be owned by special interest lobbies.  Such behavior certainly doesn't meet the standard of professional journalism.

You don't get into a Ministerial press conference without a Press pass, and no, security didn't remove them. They persisted and prevailed.



You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
See, I always thought that this comment:
Everything they say before a pandemic starts sounds alarmist. However, once a pandemic starts-no matter how much has been done, preparation will seem inadequate.

Was meant to encourage local and state entities not to let the accusations of being "alarmist" stop them. 

I took it as encouragement to soldier on, regardless of the perceptions.  PH can't win, but they have got to just do the right thing anyway, in other words. 

I still don't read it any other way.

[ Parent ]
Yes, Pixie, that's how I took it, too,
an exhortation to be bold! 

"The truth does not change according to our ability to stomach it."  Flannery O'Connor
[ Parent ]
agree completely n/t

[ Parent ]
do you agree
as in that is what you think, that people should speak boldly?  Or do you mean that you always thought that was what Leavitt meant? 

This is getting very confusing.  lol



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
that's what Leavitt meant
it was crystal clear in the context of the 50 state summits he attended.
[ Parent ]
Beauty is in the eye of the beholder.
The meaning of communication is in the mind of the recipient. 

The speaker may mean one thing. The audience may read a different signal or guidance. If the intent was to be bold about pandemic publicity, or the need for individual to prepare, then hardly any one got his intended message, out of 50 states (tour). Given how careful and official that "alarmist" line was, likely written by experts and vetted umpteenth times, it was at least a colossal failure, as measured in bold action at the state level.

In terms of no alarm or no panic, it was a colossal success.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
Public Health Education vs. Marketing.
This explains the origin of pandemic muzzling policy of Canadian, U.S. and likely other governments participating in the Ottawa Communique.

http://www.newfluwik...

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
well, not for the first time
I disagree with you, both in your assessment of failure (not utter, simce much has been done at fed and state levels), just not sufficient (the audience was not the general population, don't forget).
[ Parent ]
Good to have different view points. Thanks. n/t


You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.
[ Parent ]
glad you're posting again ;-)
and it is good to get different points of view!
[ Parent ]
that is really weird ;-)
Am I the only one who took it the other way round?

I always thought it was a way for Leavitt, to be semi-apologetic, to justify not speaking loudly about pandemics, and to cover his backside, to say whatever we do, you people will say it is not enough.

In any case, I have never heard him speak as clearly as Troy yesterday, saying "we need to err on the side of caution, our responsibility it to the people".

Troy was using the quote as an example of people who are cynical about the pandemic threat, FYI.  I wrote down what he said almost verbatim, here.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
I change the quote just a bit
and say it to myself as I push large containers of wheat around the basement:

"Everything you buy before a pandemic seems alarmist. However, once a pandemic starts-no matter how much has been purchased from Emergency Essentials, preparation will seem inadequate."

It's encouragement.  I promise.  ;-)

[ Parent ]
It's the audience's fault.
If the audience is mom public, they will hear a different meaning, especially when you changed say to buy. They will be scared by the first half of the sentence, but then throws in the towel after hearing the second half of the sentence. (No matter what you do, you are just as dead. Why not enjoy life for as long as you can and pretend the problem will never be here.)

The audience however was to State officials, and during the HHS blog, to some other officials (not mom the public on TV). 

The message official heard was:

If you say any thing, YOU risk looking alarmist.

No matter how much YOU do, you will still look like doing an inadequate job. i.e. you are in a no win thankless damned-if-you-do damned-if-you-don't situation, why bother.

The keyword that triggers reaction from officials is "seem".  It means LOOKING BAD.

The actual result in the field is exactly as expected. No one dared speak up - at the risk of HIMSELF/HERSELF SEEMING ALARMIST.

May be you are the only official feeling encouraged to speak up. 

Well, if you substitute as you just did "say" with "buy", you are right about encouragement - for the official to personally prepare for the family, but still not to tell the public. LOL.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
here's another thought
a general one.

If someone makes or quotes a statement, which can then be dissected in so many different and conflicting ways, what does that tell us at least about this person's communication skills?

And if there was lots of tinfoil, what might one conclude about the intended message?

There is no clear answer.  Draw what conclusions you will...



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
Accusing CDC of "Inflame but Not Inform".
http://newfluwiki2.c...

The spot seemed more than a tad alarmist as per the article.

You see, it is the powerful economic forces that are intimidating officials. It doesn't matter who is in charge of the HHS or the CDC. If you don't think this happens. Take a look at this - the Canadian story was more blatant. I saw it on TV.

http://www.newfluwik...

That explains how the Inform but Not Inflame guidance from HHS. Ironically, even when the CDC tried ever so slightly treading on thin-ice to Inform but Not Inflame as in this article, they were attacked for being alarmist, practically saying that the CDC fabricated the threat.

I always think the hush-hush pandemic policy is not because of who is in government, at least in Canada, the Liberals (~ Democrats) were in government to set up the Public Health Agency of Canada after SARS which is mostly PR to downplay the pandemic threat (many at the WHO at first thought SARS was the pandemic flu), and PHAC lobbied other governments that Canada really understood the problem of SARS therefore pandemic is not a health care problem but a economic problem, the result of which is the Ottawa Communique of 2005. When the Conservatives (~ Republicans) took over, the exact same policy continued.

To me, it is not a matter of which party is in government. It is the economic interests that drove the hush-hush policy.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
Pixie, Can you please help me reconcile this?
Some seem to think Sec Leavitt can do no wrong. This "seem alarmist" message must be encouraging officials to tell people to prep. I would really want to believe that. I can't.

http://www.singtomeo...

Monotreme Posted: Tue Nov 13, 2007 8:51 pm

The CDC needs to tell Lake County. Instead, at every meeting and press conference, they have understated the threat. They have soothed those who questioned their plans. They've done every thing they possibly could to make sure anyone who tries to warn an unsuspecting populace about the possibility of a severe pandemic and how to prepare for it is considered a nut.

Thanks CDC.

So Pixie, help me here. Why is the CDC so consistent in understating the threat, and yet Sec Leavitt is encouraging (in your view) officials to tell people to prep. Last I heard the CDC is part of the HHS.

See my post here for the other story written by J. Peder Zane: "Must we be very afraid"

http://newfluwiki2.c...

Why is it that both pandemic flu deniers and flublogia attack the CDC and yet support Sec Leavitt's "not inflame" policy?

Sec Leavitt warns officials not to look alarmist.

Mr. Zane enforces that warning by beating up the CDC which could also be personified in the form of Dr. Gerberding.

(Similar to the Canadian method - heckling the Minister of Health as a fear monger.)

So poor Dr. Gerberding (I am no fan, see my Public Health Education vs. Marketing diary), you are damned-if-you-do and damned-if-you-don't. You got both sides wielding a big stick. You will take the fall, no matter what i.e. the second part of the Sec. Leavitt "seem inadequate" message.

To me that says that perhaps Mr. Zane works for the same ultimate masters as Sec. Leavitt, may be unbeknown to each other - yeah I know it is speculation. Help me find a better explanation.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
Bump: Question for Pixie is in the parent n/t


You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.
[ Parent ]
U got mail ;-)
yes, one of these days, we are likely to resort to courier pigeons. 



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
I would suggest
and that is for everyone, not just you - that if you disagree, just disagree.  It isn't always productive to prolong a discussion unless more fruitful outcomes might arise out of it.  Particularly since it is a matter of opinion and not verification of facts.

thank you!



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
It is a veiled threat to underlings, a directive, a doublespeak.
The message to the public health manager is "if you say anything, YOU personally run the risk of being labeled THE ALARMIST - no matter what you say you LOOK (the "seem") alarmist. (No one working in government wants to look bad.)  There is no upside for you.  In any case, no matter how much you do, when pandemic hits, it will still LOOK inadequate. So why bother taking it on the chin.

So if you are a bureaucrat, you are encouraged to not put your career at risk in speaking out.

Mind you, many still worked hard to prepare, but can't talk about it.

The behavior of the entire health care or public health community is living proof that the "messaging" worked to shut every body up.

If there was a sincere desire to tell bureaucrats to TELL, the message doesn't have to be so twisted.  It can be very simple to encourage.

"The public needs to prepare".  "It can be done".  "We shall overcome". etc etc.


You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
well, I just plain disagree ;-)
If I look at Leavitt's message, in totality, beyond YOYO, there was NOTHING ELSE.

When someone, as the Secy of Health, goes and tells people about pandemics, and the ONLY message is YOYO, what does that tell us about this person?

I don't know about you, but I was always more impressed with his ability to cover his backside than anything else.  Sure he did some good work too, but mostly as far as I can see, it was done with great reluctance, kicking and screaming.  Just look at how he evaded simple questions on the HHS blog, and when the heat got intense, put his deputy up front to take the fire.

THAT was not the act of a leader who takes responsibility for his actions.

But, as they say, that is all water under the bridge.  ASPR Vanderwagen is made of very different material, as far as I can tell, and I am a lot more optimistic about what will come out of his office, than I have ever been about Leavitt and co, to be honest.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
No, it is not a rejection of YOYO.
It has to do with rejection of the message that government preparing ahead of time will be seen as alarmist.

THAT was the essence of the message that was quoted by Leavitt, here on this blog,

When preparing the public for a pandemic, leaders struggle with a constant dilemma. Everything they say before a pandemic starts sounds alarmist. However, once a pandemic starts-no matter how much has been done, preparation will seem inadequate.

THIS is what is being rejected.  In its place, we are told that they will "err on the side of caution", and that their responsibilities are "towards the people".



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
Should have said Rejection of "Alarmist" message and official cynicism. n/t


You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.
[ Parent ]
Exactly!
The label "alarmist" should be confronted frankly.  It's part of the lesson DHHS should be giving.  It is not alarmist when the consequences are severe. 

People calling it alarmist should be shown how bad it can be:
  {"You think this [closing schools] [wearing masks to work] [staggering work hours] is bad?  Just think about the 40% absentee rate and what that will do to grocery stocks, the power grid, hospital care, etc."}
and maybe given legal documents to sign saying they've been warned and know they are responsible for doing X and Y for themselves-no lawsuits allowed. 

Actually, everyone needs the frank and merciless message, sooner rather than later.  Maybe put the waiver in income tax papers sent to all households?

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
Media reports of mass vax clinics
are unfortunately not giving the public a "frank and merciless message," but rather the idea that PH will have everything under control come panflu. It's irresponsible for them to even imply that is true when they know it is not.

Osterholm's logic about the difficulty of obtaining necessary supplies during a wave, and of the practical difficulties people may have of resupplying between waves, has gone unheard.  I know we can tell people to get rice & beans to make it through, but nobody's addressing the fact that most likely a considerable quantity of rice will no longer be appearing on the shelf if it is the Asian grown variety and one is shopping for it between waves. What is available on those store shelves will likely be exhorbitantly expensive at least short-term, hitting people with the least means the hardest.

The consequences are potentially severe, in so many ways.  Frankness about those possibilities is only fair.  Yesterday I spent the day in crowds of people, all of them clueless for the most part about what might be ahead. The lack of fairness of this struck me. There was such a mighty public health effort to make the country aware of AIDS early on, and to try to mitigate its affects.  There is, in contrast, such silence on this issue. The AIDS educational effort wasn't able to get started immediatly either for political reasons, but it did eventually get going.  When it did, a stark but truthful message was delivered. Perhaps we can at least hope for that. I'd just like to see the same things that our officials discuss in their meetings discussed with the people. No editing for palatability or political correctness.  Just the factual information, as it is, and what conjectures they have. 

[ Parent ]
THAT will have to happen
I'd just like to see the same things that our officials discuss in their meetings discussed with the people.

when the benchmarks that include risk communication etc become more explicit.  We will see how well that works.

Remember, government is not a homogeneous entity.  Also, what we would like to see, is never as easy to achieve when you are sitting in the hotseat.  Having said that, there are signs of movement.

There are strategies that I am beginning to get a glimpse of.  I'm not certain of where they are going with these yet, but I suspect these will have more powerful effects.

Such as the compulsion, written into the PAHPA, for all state pandemic plans to take into account the needs of at-risk individuals, and the fact that ASPR/HHS is classifying all children AND THEIR FAMILIES into this category.  This creates powerful leverage, to compel states to implement early school closure as well as individual and family preparedness, as part of preparing for such 'at-risk' populations.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
But Sec Leavitt never "confronted" the "alarmist" label. He created it.
He reinforced, almost condoned, that YOU the public health professional will be called "alarmist" if you speak up.

The unsaid message is "say nothing", you might not want the label of being an "alarmist". Definitely a career limiting move to speak up.

The result was NO ONE IN OFFICIAL CAPACITY DARED SPEAK UP, as has been evident for the last two years.

Then add the One Voice Public Health Marketing, the result we see was disastrous, but from HHS standpoint it was a huge success.  THERE IS NO ALARM.  THERE IS NO PANIC.

Oh, there is also no individual preparation, but then "it is not my department".



You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
Stating reality
Sec. Leavitt simply was stating reality as he saw it.  That being:

This is too big for government (especially at that time) and everyone would be on their own.  The problems too big, and the calvary too small.

and:

What ever is said concerning a pandemic will appear alarmist to most of those hearing it, and what ever is done will appear to be too little after a pandemic.  Again, the problem is too big.  Folk's mind have a difficult time getting grasping the threat, so they reject it as alarmist.  Afterward...well, nothing will seem to be enough to meet the challenge.

The problem is too big.

(Hint: Sometimes reading too much into a statement is a mistake.  Sometimes you have to take it at face value.)

Stating reality.
Sometimes reading too much into a statement is a mistake.  Sometimes you have to take it at face value.

Agreed to the hint in general, but not this time.

We are actually not able to read deep as we don't know the inside workings of the HHS. But because the obfuscation is so pervasive among all countries involved in the Ottawa Communique, even without reading deep the signs are obvious to all who follow the pandemic issue. Just go back to read the HHS Blog and you won't be able to miss them. Even when urged by a vast majority of bloggers, the HHS chose to be evasive on the issue. They were clearly unwilling to tell the public in clear simple terms the need for preparation.

Sec Leavitt also used carefully chosen words such as

  inform but not inflame

(I don't want to spend more time digging the stuff up so the words may not be exact.)

So it wasn't a matter of one or two statements. It has been a pattern of communicating mixed messages.  There was NEVER a straight talk (show me one if you know of it).

Sec. Leavitt also was signatory to the Ottawa Communique 2005 that pretty much made "not alarmist" a higher priority than informing.

That is the reality. No official dare tell people in simple straight talk to prepare.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
all I can say
is that to give credit where credit is due, right now, ASPR appears to be open to input.

It's early days yet, but I'd much rather we look forwards not backwards.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
Credit where it is due.
I am even willing to consider the possibility a new openness is emerging in the HHS that manifests itself in the latest round of public consultation and new messages from the ASPR, as a new directive from Sec Leavitt.

We shall see.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
HHS is a huge entity
with the authorities from the PAHPA, Leavitt may not have to be very involved, for ASPR to work.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...
[ Parent ]
Questions for ASPR | 138 comments
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