ASTHO Roundtable Summaries

ASTHO - Got Into Some Very Interesting Discussions

ACM: Great find. 

I would have liked to have been a fly on the walls when the American State and Territorial Health Officials (ASTHO) roundtables were held.  It looks like some facinating discussions were held on issues including PAHPA, consistency of message, conflicts on school closing, the benefits of engaging the public in framing policy and whether families of critical workers should be given priorities.

I have set out some appetizers below.

http://www.astho.org...

Discussion Points and Issues
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Pandemic and All Hazards Preparedness Act (PAHPA)
?? New State and Local Public Health Preparedness Provisions: The Act has a number of provisions to strengthen state and local preparedness, including an increased focus on program performance assessment and provisions to enhance the public health workforce. The Act also contains new fiscal requirements such as matching and maintenance of effort. This will require close state participation in the implementation process to ensure that a fair and equitable system is put in place to document and report on these new fiscal requirements which will not over-burden states and become counterproductive.
?? Enhanced Federal Preparedness Infrastructure: The Act strengthens the federal public health preparedness infrastructure by creating the Office of the Assistant Secretary for Preparedness and Response and authorizing funds for federal health and medical surge capacity assets. The Act also establishes new federally managed systems for health volunteer deployment, disease surveillance, and countermeasures tracking. It is important that these new systems integrate with existing systems that are currently operating at the state and local level.
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Action Items
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Maintain a System to Support Consistency of Message and Coordinated Communications.   It was clearly recognized in all Roundtables that failure to maintain a level of consistency in communicating the rationale and basis for decisions and actions across geopolitical boundaries is a significant vulnerability that could result in the loss of public trust, thereby rapidly eroding effective community-based pandemic influenza protective measures.
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Reduce the Level of Professional Discord on the Topic of School Dismissal/Closure as an Effective Pandemic Influenza Countermeasure.   Throughout the proceedings of the three Regional Roundtables, the role of school dismissal/closure as one nonpharmaceutical intervention in a community mitigation strategy was clearly recognized. However, during the extensive discussions on this topic, it was very evident that many public health leaders and decision makers had a divergence of opinion and professional judgment as to when and under what conditions an order to dismiss or close schools would be issued. Some considered this a critical mitigation action and would be poised to issue such an order as soon as possible and appropriate as the Pandemic Severity Index escalates. Others believed that school dismissal/closure should be delayed as long as possible given the importance of functioning school systems to the stability and health of the community and the possible significant second and third order consequences that could occur. While no consensus was reached through the provocative discussions that took place, the Roundtable participants clearly recognized this issue as one of significant importance requiring immediate further attention.
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Engage the Public in Framing Policy. The impressive and effective use of structured public engagement events in the forging of the draft prioritization schema for both pandemic influenza antivirals and vaccination administration clearly illustrated how powerful and beneficial such an approach is in setting unprecedented public health policy. While public health officials have traditionally relied on the feedback and input of the general public to guide them in the establishment of policies, plans, practices, and procedures (e.g. through focus groups, satisfaction or opinion surveys, or through unsolicited ad hoc comments received), these traditional means may not be as reliable or as robust as compared to the data obtained through the public engagements recently conducted under the auspices of the Department of Health and Human Services (http://www.keystone.... and http://www.keystone.... ). As state and local public health officials face circumstances that require them to establish their own policies and priorities, many of which will be very challenging and complex with little precedent, the utility of public engagement exercises will become increasingly valuable to gauge public opinion and expectations.

With support from the Department of Health and Human Services, ASTHO should develop a tool kit and tutorial for state health officials on the precepts of public engagement as a means to more effectively inform decision making. The materials should outline effective methods for recruiting and engaging both the ?general citizen? public and the ?stakeholder? public, as well as proven methods for obtaining honest and reliable feedback from these groups. These products should also include template educational materials, presentations, and evaluation forms for adaptation and use by state and local officials.
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Evaluate the Importance, Necessity and Consequences of Assigning Priority Attention to Family Members of First Responders and Critical Infrastructure Essential Personnel Regarding Receipt of Antivirals and Vaccination.   A divergence of opinion surfaced regarding the merits of treating family members of first responders and critical infrastructure essential personnel as a priority category for the receipt of antivirals and vaccination, even if in limited supply. Some thought that this was a key feature in ensuring that those categories of personnel would report to duty, knowing that their families are being cared for, while others believed that such a policy would be very problematic for a variety of reasons and do not plan to consider them as a separate priority category. This situation could contribute to jurisdictional variation and inconsistency resulting in public confusion. With ASTHO?s support, the Department of Health and Human Services should convene a workgroup to examine this matter more closely and issue additional recommendations to bring about a more consistent approach to dealing with the issue of priority consideration of family members of first responders and essential employees of critical infrastructure facilities.
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Clarify the Conditions and Criteria that Would Govern the States? Discharge of Authority to Seize Privately Held Medical Countermeasures. A number of private sector companies are either in the process of, or are seriously contemplating purchasing antivirals for their employees as part of their company?s Continuity of Operations Plan. It has been stated that some companies have voiced serious reservation about doing so for fear that state and/or local governments would seize these assets during a pandemic and redirect their use as part of a jurisdiction-wide response effort. Anecdotes from the field also suggest that some companies may be making purchases without informing governmental public health agencies due to fears of potential seizure at the time of a pandemic. As well, some companies may be buying the antivirals and immediately dispensing them to their employees to personally manage so that no ?stockpile? is actually in existence to be seized. These ?work-arounds? are not conducive to effective and sound emergency planning or to healthy public and private relations. States possess the statutory authority and obligation to potentially seize and redirect critical life saving medical assets, as necessary and with good cause, in order to protect the health of the entire state during the time of a pandemic.

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

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by: Into The Woods @ Wed Jul 11, 2007 at 00:39:10 AM UTC

Refusal to purchase during the pre-pandemic period

the PPE, other supplies, medications, food, that states and counties and municipalities would need for even the first pandemic wave, (which would require education of the public so they would approve of these expenditures for panflu response - and an educated public would be motivated to prepare themselves) - these refusals to purchase and pre-position, while supply chains are fine, (supplies could have been increased to meet demand, and regional businesses could have been encouraged to improve homeland security and US jobs) - and simply have plans to seize what others have had the foresight to sacrifice other choices and buy-
are not "conducive to effective and sound emergency planning" nor to "healthy public and private relations"
- neither pre-  during, nor post-pandemic!

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by: crfullmoon @ Mon Jul 16, 2007 at 12:23:43 PM UTC

[ Parent ]

Seizures may be a wee bit more difficult than they think. n/t

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

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by: Into The Woods @ Mon Jul 16, 2007 at 22:34:11 PM UTC

[ Parent ]

makes a great excuse to not ask the public

for money for panflu supplies though - they'd have to explain so the public "got" what panflu year is about, to get enough money.
Officials don't seem to want that public awarenss.

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by: crfullmoon @ Wed Jul 18, 2007 at 21:47:07 PM UTC

[ Parent ]

And there's the rub

To get resources, you have to justify the need.
To justify the need, you have to be honest about the threat.
To be honest about the threat, you will probably scare people.

{Cue public officials running screaming down the hallways from fear of scaring the public.}

Or

To be honest about the threat and not scare people you have to tell them there is something they can do to protect themselves, which will raise expectations about what everyone (govt and individual) needs to do to prepare.

Raised expectations for either the government or the individual have gone out of favor of late.

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

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by: Into The Woods @ Wed Jul 18, 2007 at 22:10:18 PM UTC

[ Parent ]

States have the obligation to Honestly warn their public. n/t

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by: crfullmoon @ Mon Jul 16, 2007 at 12:24:51 PM UTC

[ Parent ]