Oct 16, 2008 (CIDRAP News) – State pandemic preparedness has improved over the past few years, but gaps remain, particularly in areas that don't relate directly to healthcare such as continuing government operations, maintaining essential services, and coordinating with the private sector, according to a recent report from the National Governors Association (NGA).
The 18-page report, posted on the NGA's Web site, details what the group learned from participants during nine regional pandemic preparedness workshops that involved all 50 states, the District of Columbia, and four of five US territories. According to the NGA report, which was released in mid September, the workshops focused on areas that are common to all states: healthcare, commerce, education, and public safety.
In 2006 the NGA released a pandemic primer for states, and in March the US Department of Health and Human Services published a comprehensive pandemic planning guide for states.
The authors of the NGA report said their analysis of the workshop proceedings includes a major caveat. "Accurately assessing state preparedness for a pandemic outbreak is a moving target. There currently is no baseline, nor any agreed metric, against which state pandemic preparedness can reasonably be measured," they wrote.
Also, the authors of the NGA report said that states have lost some of their pandemic planning momentum for two reasons: States have already achieved some pandemic planning successes, which they said is encouraging. But at the same time the spread of H5N1 avian influenza seems to have slowed in animals and humans, which has led to waning interest in the issue.
Chris Logan, program director for the NGA's Homeland Security and Technology Division, said in a Sep 15 press release that though this issue has largely fallen off the public's radar, states recognize that successfully managing a pandemic outbreak requires a sustained effort. "The conclusions of this report serve a vital national service: they demonstrate both the extent of our readiness as well as the gaps in our current preparedness," he said.
The pandemic challenges that states seem most aware of involve the healthcare sector, the authors reported. One area that represents a strength and weakness is how states have focused on antiviral drug stockpiling.
The NGA said that though many states have robust stockpiles, the effort has come at the expense of other preparedness components such as planning for surge capacity. However, the group reported that other states have voiced concerns about over-reliance on the drugs, and that financial constraints are forcing others to limit their supplies.
Gaps threaten commerce flow
On the topic of commerce, the NGA said communities and states with international borders face unique challenges, because a pandemic would hamper the flow of supplies and workers. The authors reported that states acknowledged they were unprepared if a concurrent event such as a hurricane or earthquake were to strike during a pandemic.
State officials said they worried most about small and medium businesses, which not only have fewer resources to prepare and respond to a pandemic, but would be hit hard by worker illnesses because the firms' operations are less automated.
Most states aren't prepared to manage the economic impacts of a pandemic because they haven't estimated them, the report said. However, some states and territories, such as California, Maine, New Hampshire, Puerto Rico, and the Virgin Islands, have outlined how travel restrictions and reduced tourism could affect their economies.
Maintaining food supplies was another gap identified. "No state reported having agreements with private sector food distribution and retail system to ensure the reliability of the food supply, nor has any state developed or deployed any type of monitoring system that would provide state officials with situational awareness," the report's authors wrote.
Issues affect public safety
States felt public safety would be less impacted than other areas in a pandemic setting. Law enforcement agencies generally have well-defined structures that are helpful in emergencies, and many have strong relationships with other community groups such as volunteer and faith-based organizations.
State officials predicted that community mitigation measures during a pandemic could stall some judicial system activities, and that some are already considering suspending jury trials during pandemic emergencies.
Challenges for schools
Educational systems will likely be severely affected by a pandemic, but the NGA authors pointed out that schools are well suited to manage a range of problems. "Schools serve as a strong source of cohesion, and of information, for the communities they serve, and public agencies have a long history of working through schools to send messages to the public," the authors wrote.
One major gap, however, is a lack of situational awareness that administrators need before recommending closing or reopening schools. "The lack of federal and, in some cases, state coordination of school policy is likely to exacerbate those challenges," they wrote.
Solutions for states
The NGA authors made several recommendations based on the workshop findings. For example, they advised states to:
- Develop and test policies that encourage government and private workers to perform their duties, both in traditional and alternate settings
- Craft human resource policies that allow workers to stay home and care for sick family members
- Establish strategies of closing and reopening schools
- Address challenges of colleges and universities, particularly dorm living that could facilitate the spread of the disease and international students who may be stranded due to travel restrictions
- Involve the public, not only on topics such as stockpiling but also on issues such as school closures and ethical decision-making
- Reach out to small businesses to see that they are prepared and aware of available resources
NGA state pandemic preparedness report
Sep 15 NGA press release
Jul 19, 2006, CIDRAP News story "Governors group issues planning guide for states"
Mar 14 CIDRAP News story "HHS issues pandemic planning guide for states"