PANDEMIC FLU OUTBREAKS
What is the best way to prepare for a pandemic flu?
Welcome to clinicians roundtable.
Host is Susan Dolan.
Dave Gruber, Senior Assistant Commissioner for the Division
of Health Infrastructure Preparedness and Emergency Response for the state of
Mr. Gruber, welcome to the clinicians roundtable.
Glad to be here Susan.
How are states doing in terms of preparing for a pandemic
I think states are doing well. We have been preparing as a
country for the pandemic for years right now. For a few years in a very, very
intense way that said different states, different entities are at different
levels of preparedness and the reason for that is that there are just so many
areas that need to be addressed in preparing for pandemic that its probably
impossible for everybody to address them all in the fashion that we would like
New Jersey has received very high marks for strategies and
planning for a pandemic flu scenario. Tell us more.
Well, I think I would like to sort of avoid the, we are
doing very well reports. What we look at more is are we doing the best we can
to prepare and what we are doing consistent (01:30) with our partners
throughout the country is:
1. Recognizing that we have to prepare.
2. We are looking at the medical and public health
responsibilities that we have and addressing those.
3. Which is just as important as we are engaged with our
other partners across all sectors to include critical infrastructure, private
enterprise, and our faith based groups, and all those in the philanthropic areas
to make sure that the community as a whole is preparing. This truly will be a
Tell us more about how states are scored and ranked in this
Well, I think one of the biggest difficulties that all of us
have experienced is there has never been a true measure of success for
preparing for a pandemic. So, there are different groups that have tried to
come up with ways to measure. For example, the Trust for America has come up
with certain what they believe is ways to gauge whether a state is prepared.
The Centers for Disease Control have given us in the health department’s
measures of what we need to do. So, I do not really think there is a
consistent measure for preparedness. When you are looking at a pandemic
influenza, anyone who claims to be an expert right now is probably not telling
you the whole truth because none of us have really experienced a pandemic and
none of us have really seen whether or not the plans that we are putting into
place right now are the best plans.
Tell us more about the preparedness indicators, for example,
(03:00) the emergency preparedness growth.
When you look at preparedness indicators, they span the
gamut of various from stockpiles to preparedness drills, to having plans, and I
think that all states and all entities in one form or another have varying
degrees of completion of those indicators; however, I think that if you look at
it, it is a moving target. So for example, if you look at the indicators of a
group, they may be certain set 1 year, but a different data set another year.
Emergency preparedness and response for the health community as we know it
today is a new field. So, it is very, very difficult to come up with those
measures of success, with those measures of preparedness.
Tell us more about the antiviral stockpiling.
The antiviral stockpiling is a critical aspect in our
preparedness efforts. There is a national effort to ensure that states have
the ability to stockpile antiviral agents. Specifically, in 2006, the United
States Department of Health and Human Services began stockpiling treatment
courses, began allowing the states to purchase stockpiling treatment courses of
the antiviral drugs – Relenza and Tamiflu, and they supported that effort by
providing 25% of the cost. They subsequently subsidized 25% for state
purchases and the recommendation was that the states have enough antivirals on
hand to treat (04:30) approximately 10% of their population. Throughout the
country, different states have elected to approach the stockpiling in different
ways. In New Jersey, we have approximately 90 some percent of what was
recommended to us in addition to what the feds may give us during an event.
What is the shelf life of stockpiled antivirals?
The shelf life has just been increased and when we talk
antivirals again, I want to define that we are talking the two, the Tamiflu and
that is oseltamivir phosphate for the technical term and Relenza, which is
Zanamivir. For the Tamiflu, the expiration date is 7 years right now, it is
just been up within the last year or two to a 7-year shelf life.
How much federal funding is available for state
Well, if you ask me that question right now, the answer is
zero for flu preparedness. We have gotten significant amounts of money in the
past specifically for influenza preparedness and for pandemic influenza
preparedness. We were zero at this year; however, we do get the funding for
overarching preparedness, both in the form of Centers for Disease Control grant
and also from the assistant secretary for preparedness and response in helping
And how do the individual state efforts dovetail with other
states and the federal government in terms of preparedness?
I think that when you look at the process, the federal
government has used in rolling out the (06:00) pandemic plan, their attempt was
to come up with general guidelines that would be passed down to the state;
however, a reliance on the states to be the heavy lifters for the preparedness
in response effort. So, we have along with the other states have taken the
guidance given to us by the federal government and apply them specifically to
our individual states. We talked with the other states regarding preparedness
efforts and how we might work together, but I think the critical thing to bring
up for a pandemic is that unlike hurricane in which perhaps a state might be
affected and others might be able to assist them, here in a true pandemic
everybody is going to be affected, and the ability for states to help each no
matter how much they want to may be significantly impeded.
Mr. Gruber, tell us more about what is happening at the
public health laboratories?
I think the public health laboratories much like everybody
else that is preparing for a pandemic has to look at the surge capacity that
they be able to bring to the table when asked to conduct a larger amount of
sampling than they would normally do on a daily basis. This would be
particularly important during the beginning stages when physicians,
epidemiologists were trying to determine whether or not there was an outbreak
and the actual strain and the extent of the outbreak. So, laboratories are
looking at how they might handle that surge capacity. Additionally, (07:30)
based on the possible effects of a pandemic on the population as a whole, the
laboratories and others are looking how they are going to deal with the reduced
workforce. Based on those who either may be sick, may be affected because
their family members are sick or may be fearful to come to work.
Tell us more about biosurveillance efforts.
I think that one of the positive things that we can bring up
is that biosurveillance is occurring right now regardless of whether or not
there is a threat of pandemic or not. So, our epidemiologists, our public
health departments in New Jersey and throughout the country and CDC and the
world health organization have a strong, strong surveillance effort that
monitors the status of infectious disease, and I think if the people wanted to
go onto the CDS web site or the WHO web site, they get a good feeling that
everybody was looking at it right now.
Are the states increasing the rates for immunizing adults
Oh I think we have to define what immunizations we are talking
about. I think that what the states are doing is heavily promoting any of
those over 65 to (09:00) get their annual flu shots and that is a critical
aspect for maintaining good health which is one of the key aspects of
preventing disease via pandemic or any other disease. So, there is an active
effort each year to ensure that those who might most be affected by influenza
get their immunizations or their flu shots.
Describe the effort in terms of recruiting volunteers if
there were a pandemic outbreak.
I think the effort for recruiting volunteers again is a good
new story and that it is not specifically related to a pandemic. It is related
to an overarching effort by health departments throughout the country to ensure
they are capable of responding to any event that has health component to it.
So, there are 2 main programs in the health arena that involved the recruitment
of volunteers, one is the MRC or Medical Reserve Corps program that has been in
effect for a while, but has significantly grown over the course of the past few
years. Another program is the WHIP program, which is a federal program that
focuses on ensuring that volunteers from one state have the ability
credentialized and licenselized to act in another state should states look for
a mutual support.
What is your best advice for preventing a pandemic flu
I think the best advice for presenting an outbreak is
twofold. First of all for the medical community and the public health
community, continue the preparedness efforts that we have engaged in and even
though we are facing staffing and funding shortages throughout the county, we
have to somehow overcome those and continue the strong preparedness efforts
that have gone on in the past few years. As far as the individual, good
hygiene is really the key to prevention of disease. That is (10:30) hand
washing, it is covering your mouth when you cough or when you sneeze, and just
having the common courtesy of making sure that the things stay clean and remain
clean and you stay home if you get sick.
Are there efforts underway to secure more funding?
Well, the states are always asking for more and I think that
we would hope that the new <__10:54___>, which is a federal bill
requiring health preparedness and response is the impetus for those at the
federal and the federal legislative arena to fund what they are telling us we
have to support. So, I think that I will refer to some federal people to help
me out with this question, but obviously at the state level, we are not going
to turn down any money that comes to us to help us with our support efforts.
What led to your interest in this area?
Well, first of all my degree is in microbiology and that was
a long, long time ago. So I have always been interested in infectious and
communicable diseases, but more recently in my position at the Department of
Health and Human Services and responsible for the preparation in response to
any outbreak, it is imperative that I do stay interested.
What is your take-home message?
I think the take-home message is to continue the effort that
has already started in preparing up for a pandemic to ensure that a state
health officials and others that we continue the effort, but not cry wolf and
cause the country to get pandemic influenza burnout, but that the effort is
maintained so that (12:00) should we be faced with this disastrous type of
disease that were where we need to be.
Mr. Gruber, thank you for joining us to discuss pandemic flu
It is my pleasure Susan. Thank you.