U.S. Department of Health and Human Services.  HHS.gov  Secretary Mike Leavitt's Blog

Pandemic Influenza

Viet Nam - Blog I

An Overview

The final three days of my trip to Southeast Asia were spent in Viet Nam. This was a follow up trip to my October 2005 visit. I focused on three issue areas: HIV/AIDS, Avian Influenza and the safety of imports. Meeting the new health minister was a priority as well.

As a general overview, I arrived in Hanoi on Tuesday night, the 15th of April. I spent Wednesday the 16th of April there working. On Thursday, I flew to Ho Chi Min City, where I spent the day working, and then on Friday, I was able to go out into the countryside, which always turns out to be a highlight.

In Hanoi, I visited the Ministries of Health and Agriculture; spoke to the American Chamber of Commerce; spent an hour interacting with students and faculty at the Hanoi School of Public health; and then met with Prime Minister Nguyen Tan Dung. In the evening, my new friend, Nguyen Quoc Trieu, the Minister of Health, held a banquet that none of our delegation will ever forget. This was not your routine diplomatic gathering. It was a party, full of personalities, music and bonding.

On Thursday I did media interviews, traveled to Ho Chi Min City, and toured the seaport in the same way I have many American ports; working to understand their role in the safety of imported products. I then visited a clinic our HIV/AIDS money supports, which is setting up the nation’s first methadone clinic as a way of assisting in the prevention of HIV/AIDS, and then met with the party leaders of the city.

Friday morning early, we drove into the countryside about three hours. Seafood is one of the biggest trade items between the U.S. and Viet Nam. I wanted to get a sense of the processes and sophistication levels in that industry, in a similar way as I was able to in India. The three hour drive by itself was worth the effort of going. I saw many different kinds of communities along our route in varying degrees of change.

I visited a large seafood processor and had a two hour discussion over lunch with a group of shrimp growers, a regulator and fellow who appears to have a job similar to an extension agent. I then went to meet with a group of chicken growers in a rural residential area along with public health people. We talked avian influenza.

Mike Leavitt at fish farm in Viet Nam

At fish farm in Viet Nam

In the evening, we had a reception at our hotel and picked up the midnight flight for a connection in Tokyo for D.C. These trips are non-stop events. By the time I get to the end of the week, I’m usually feeling exhausted, but greatly enriched. This was a successful mission, but I’m ready to get back into a normal routine. With the time zone changes, different beds most nights, and fifteen hour days, the last seven days feels like one continuous day.

I was able to keep better control of my diet and exercise routines this trip. Both usually take a hit on these forced marches. I think I got exercise all but two mornings and with only one major banquet, didn’t do any serious caloric damage. It’s a small victory in my long fight to stay healthy.

Having provided this overview of the trip, over the next few days I’ll post a series of observations I have as a result of the trip.

Indonesia

Written April 14, 2008

I’m in the Jakarta Airport, having just finished a day of meetings with Indonesian Government officials. I met with President Susilo Bambang Yudhoyono, Coordinating Minister for Family Welfare Aburizal Bakrie, Foreign Minister Noer Hassan Wirajuda, Agriculture Minister Anton Apriyantono, and Health Minister Siti Fadilah Supari. The meetings involved discussions on a group of issues, among them the control of H5N1 avian influenza, the U.S. Naval Advanced Research Laboratory (NAMRU-2) in Jakarta, and Indonesia’s departure from international expectations on sharing samples of influenza viruses.

I was here in October 2005 as we were scaling up our own pandemic preparedness in the United States. Being here is an important reminder of how different the problem looks from different perspectives. Indonesia has 245 million people, who live in a space about the size of New York State. About 60 percent of the country's area is water, since the nation is really thousands of islands. It appears to me that most of those people must have highly localized lives, and developing a national strategy on anything would be difficult.

The next presidential election in Indonesia will take place in 2009. Just like in the United States, the upcoming election has begun to affect the formulation of policy. The night before I arrived, local elections took place in the largest Province, West Java, and, in what appears to have been a surprise, an Islamist party took power. It would be similar to having a populist movement win a statewide election in California. The election in West Java is an event that will clearly begin to factor into everyone’s political calculus in Indonesia.

I didn’t have any political discussions about this with Indonesian officials. These are observations I am picking up from reading the local papers, and from talking with people at the U.S. Embassy. I’ve always found it important to understand the political context in which foreign government officials are operating- it helps you understand the filter through which they are seeing the world.

My first meeting was with Foreign Minister Noer Hasson Wirajuda. He is a sophisticated and well-educated man who spent five years doing legal studies in the United States. We talked at length about a group of themes related to the challenges of governing an undeveloped country. Later in the afternoon, our discussion continued. I think rather than discuss those in this entry, I will do a separate piece tomorrow.

Next, I visited the office of the Coordinating Minister for People’s Welfare, Aburizal Bakrie. A Coordinating Minister oversees several Ministries or areas of the Indonesian Government, and has the responsibility to coordinate their work. The meeting included the Ministers of Agriculture and Health.

Minister Bakrie is a noted businessperson. His family holdings are extensive, and their reputation looms large within the region. He speaks excellent English, and deals confidently with people. His business background is evident in his willingness to engage directly on problems.

Minister of Agriculture Apriyontono was invited because of the animal-health connection in avian Influenza. I met him in 2005 as well. Likewise, I have met multiple times with Health Minister Supari. She has become a controversial figure within the health world, because she has stopped sharing with the World Health Organization (WHO) any samples of influenza viruses that are circulating in Indonesia. She asserts that if a nation provides a virus from which a manufacturer makes a vaccine, that country is entitled to monetary compensation of some form. This is a dangerous course that threatens to undermine a worldwide agreement honored by nations for nearly 60 years. I wrote previously about this subject.

The Indonesian Health Minister has used the sample-sharing debate and the negotiations over the status of NAMRU-2 in Indonesia to set herself up as an antagonist of the United States, a position I suspect helps her politically among the constituency of her party.

NAMRU-2 is an important public-health asset in Indonesia. The lab is a WHO reference lab, which means the level of expertise there is high enough that the world accepts its work. If a communicable disease breaks out in South East Asia, any country can send samples of the virus there to have them identified. The laboratory has been in Indonesia for decades, and exists under a Memorandum of Understanding (MOU) between our Governments, which is up for renewal.

The MOU that governs the status of NAMRU-2 expired two years ago, and both sides have been trying to renew it. When I was in Indonesia in 2005, the lab was a major topic of conversation in my discussions with various Ministers, and with the President. At that time, I received absolute assurances the Indonesian Government would approve the MOU shortly.

Minister Supari recently issued orders to prohibit Indonesian institutions from providing tissue samples to NAMRU-2, under the justification that such sharing is not legal in the absence of an active MOU and a Material-Transfer Agreement. Her action is obviously linked to her global initiative to seek specific benefits for sharing samples.

To add more drama to this picture, Minister Supari, recently published a book in which she asserts the U.S. military is using influenza samples to create biological weapons. Secretary of Defense Gates was asked about the Minister's accusation when he was in Indonesia this past February; he replied, “That’s the nuttiest thing I’ve ever heard.”

All this background created great media interest in my visit. The morning of my discussion with Minister Supari, an article appeared in the English-language Jakarta Post that said I might refuse to meet with her. The truth is, I came all the way to Jakarta quite specifically to see her. Anyway, all this added up to a minor drama.

We met privately in Coordinating Minister Bakrie’s office for a while, and then joined the rest of our delegation and Indonesian Government staff who had gathered. The conversation was refreshingly straight-forward, an outcome I attribute to the style of the Coordinating Minister. While we talked about a number of other issues, such as HIV/AIDS, most of our time focused on the NAMRU-2 and sample-sharing. After a time, the Agriculture and Coordinating Ministers left, but Health Minister Supari and I continued our conversation.

It is important to remember that, while the NAMRU-2 issue is between the United States and Indonesia, the influenza-sample issue is between Indonesia and the other 192 Member States of the World Health Organization. The United States has been part of a group that has been trying to resolve the problem for the past two years. They have held numerous meetings, and various other types of negotiations. These have yielded a short list of things the parties believe the WHO Secretariat could do to improve its influenza program. The Minister mentioned this several times as "progress."

However, I could see little real progress in the key question whether contributing countries should receive direct, monetary benefits as compensation for sharing samples. The Minister’s main point is that what she wants should not be considered "royalties" or "compensation." What she says she wants is for the contributing countries to be eligible for some share of the value commercial companies create out of the influenza samples they provide. Or, as she expressed it in a hand-delivered letter to me later in the afternoon, “Allow me to reiterate that when I raised the term ‘monetary benefits,' I was not referring to any type of royalty, nor any type of quid-pro-quo arrangement, but rather to a method that leads to the allocation of values derived by commercial interests into one commonly defined system, which will provide benefits to those that have made contributions.”

I told the Health Minister two things. First, I understand her desire to assure people in her country have access to medicines and vaccines. This is a problem in developing countries all over the world. It is a complicated issue, but we need to address it, while preserving the incentives for innovation. I pointed out that technology is improving and might well hold solutions we don’t currently have. I used as an example the billon-dollar investment our nation has made in cell-based vaccine technology. Once we are using cell-based methods of making vaccines, the capacity and cost of making vaccines will dramatically drop, which will change the entire equation. The world is working on solutions.

However, linking sample-sharing to payment in any form will immediately begin to erode our ability to make vaccines at all, because once the practice of free and open sharing of viruses stops, the slope is slippery, and there will be no end to the demands.

The issues of the availability of vaccines and the sharing of samples are both legitimate ones, and we must deal with them both, but we should not link. World health should not be the subject of barter.

The second thing I told her is that I find it impossible to distinguish a difference between what she is seeking and royalties. The bottom line in both is this: share samples, get paid.

I would summarize the conclusion of my meetings this way: We celebrated the small list of consensus recommendations that are emerging from the multi-lateral discussion at the WHO on this matter, and committed to keep looking for solutions. The Coordinating Minister suggested we could find a solution within two months. He later reported that to his President in our meeting with him.

I have instructed my representative on this matter, Bill Steiger, to work with Ambassador John Lange, Secretary Rice's Special Representative for Avian and Pandemic Influenza, to continue our discussions with the Indonesians and others for the next two months. However, we cannot be party to an arrangement that will un-do 60 years of one of the world’s great public-health successes.

There are some situations that, despite our best efforts, we cannot resolve. In those cases, we just live with the added risk. The cost of Indonesia's refusal to share influenza samples is incrementally small. However, the damage done by accepting Indonesia’s view is profound, and simply unacceptable.

We will work on this for the next 60 days. If we haven’t been successful in resolving the matter, I think it will be time for the world to just accept Indonesia’s unwillingness to participate in the WHO influenza system, and move on to other ways of making the world safer. Perhaps when circumstances change, Indonesia will rejoin the mainstream on this issue.

Pandemic Exercise with Bloggers

We routinely hold readiness exercises at HHS on various emergency scenarios. Typically, people from various parts of the emergency management community sit around a square table, and a moderator paints a picture of a disaster unfolding. It is like a reader’s theater. As events are described, each actor assumes their part, describing what they are thinking and doing to respond.

Slowly, the moderator heightens the stakes and intensifies the nature of the problems, throwing out more complicated circumstances, and challenging the reasoning various players use. It is an excellent way to learn and refine emergency protocols.

Monday, we had another exercise on pandemic influenza. Included in the exercise was a group of journalists, including bloggers. Not amateur bloggers like me. Real pros, people who have built reputations with their readers for innovation and speed.

We invite journalists to participate in our exercises because managing their needs for information is a part of crisis management. We need to learn more about how bloggers would react and interact.

Television reporter Forrest Sawyer was the moderator. He has done several of our exercises and he’s very good. He laid out a set of facts that represent routine health news from around the world and laced it with a few interesting tidbits that could attract the interest of people following the flu world.

Turning to public health officials at the table, Mr. Sawyer asked if they found any of the news that day interesting or concerning. He did the same with the journalists, asking what they would do to get more information and how big a story they thought it was. As the facts became more concerning, several observations came to me.

I found it reassuring how important accuracy was to those that attended our session. They were willing to report rumors but made a point of distinguishing them as such. Many of them said they had separate sections of the page for rumors.

The blogs represented at our session tended to be rather specialized and the bloggers knew a lot about the subject matter. It made them better at challenging the facts they were given. I suspect in a major emergency we would be dealing with a broader range of understanding than in our exercise. These people knew their stuff.

I was surprised how much interaction there is between online communities. They seem to share information, monitoring one another’s sites.

More than one of the blogs talked about the way they use traditional news sources but provide added value. One example is translating foreign news articles into English.

I enjoyed watching the interaction between traditional media and blogs. It’s clear television, major radio and newspapers are monitoring blogs all the time. It is also evident most of them are starting to use blogs to supplement their own reporting. The unlimited supply of space and time is appealing to traditional journalists.

The exercise went most of the day. I was only able to stay until noon, but it was a morning full of learning.

The bottom line for me: Government needs to understand the blog world better, and factor it into the way we interact with people. A growing part of the world relies on bloggers for unvarnished information; something they are not sure they always get from us in government.

Thoughts On Your Comments

I’m sitting at my desk with a  bowl of soup for lunch.  I have 30  minutes and I’m thinking this might be a good time to respond to a few comments  you have sent. 

First, let me say, I do read the  comments. I just have a hard time finding the time to respond and make new  postings too.  So, I tend to concentrate  on new postings.

Comment on Guatemala  Inauguration
On January 18,  Science Teacher wrote:
Can you tell us whether the topic of H5N1 came up  with any of the representatives of Latin American countries? Is there concern?

Response:
I was  in Central America about a year ago working on  Pandemic issues with the health Ministers.   We have helped them build lab capacity and actually trained more than  200 people from Central America on pandemic  related issues.  It is not a top of mind  issue there, and they still have a ways to go on public health infrastructure.  Gratefully, we haven’t seen any H5N1 positive birds in that part of the world.

Comment on Guatemala  Inauguration
On  January 22, David A. Haley wrote:
Instead of talking about "safe" topics such as India or Guatemala, why don't you address  meaningful topics to the American people, such as what efforts you and the  Administration are undertaking to fix our healthcare system? Hello. Is anyone  home in Washington?

Response:
David, you are right in saying my writings have been fairly  heavily oriented to international work lately. I think if you look back in past  postings I have written about many different topics that fit the criteria you  lay out.  The concentration of recent  writings on international work reflects the fact that I traveled fairly heavily  while Congress was out of session.   International work is an important part of my work and it has a direct  reflection on the health of the Americas.  The safety  of imports is an example. Most of my time in India was focused on products  Americans consume. 

I should also confess that I use this blog as a way to keep track  of what I learn on these trips as a journal of sorts. 

I encourage you to keep reading as there will be lots of meaty  issues to discuss.

Comment on Day 5 in India
On January 17m Robins Tomar wrote:
It would be great if you could write one more post about your  overall experience, changes in feelings before and after your visit and some  recommendations from your experience.

This is just a request if you get time from your busy schedule.  Anyway I will be following your blog to know your opinions about what is  happening around us.

Response:
I would say one of the most of the most important changes in my  feelings were the kind of things that come when one actually sees a place  rather than reflecting what you have heard or read.

Here are just a couple of examples:

  • It is hard to adequately explain the challenges of population as large as India’s and how it impacts every public policy issue.         
  • I’m attracted to the people of India.  I have lots of friends in the U.S. of Indian heritage and seeing India created a new context for our relationship.
    In Utah there  is a community of people with roots in India.  They have become prominent in academic and  financial circles.  As governor, I was  often invited to attend their celebrations and events.  I always admired the way they worked to  preserve their connection to an ancestral home even though many of them have  become major successes in the U.S.  Now that I have seen that home, it is easier for me to understand their view of America and India.   
  • I found particularly helpful the understanding I gained of the small farmers in India and their political influence.  I wrote some about this in one of my postings.
  • The number and size of the drug and vaccine manufacturing facilities in India requiring FDA attention was an important actualization.
  • The intellectual connection between the U.S. and India came as a pleasant surprise.  I knew it       existed but didn’t have a sense of scale.

I could go on and on, but this will give you a small sense of what the trip did for me.


Comment on Electronic Medical  Records and the Medicare Sustainable Growth Rate
On December 3, Chris Farley wrote:
The US  government/we the people already own an excellent EHR - the VA's VistA system. It is fast, simple to use, incredibly  stable and a large portion of the work needed to make it viable in private  practice is already done. Two organizations have taken it,  "de-veteranized" it and gotten it CCHIT certified. With a small  fraction of that cost, the system could be fully upgraded and modified to meet  all of the needs of the commercial market-place and fully implement the quality  measures and disease registries necessary to adopt pay for performance and  improve the quality and lower the cost of healthcare

Response:
I am a big admirer of VISTA and  the Veterans Administration.  In fact, I  borrowed the National Coordinator of HIT from the VA, Dr. Rob Kolodner.  The problem comes in creating compatibility  between other systems and the VA because most patients, even in the VA system, deal  with multiple providers outside their system.   We need to achieve interoperability.   As you point out, there are some providers who are using the VA system  as a foundation to develop smaller systems and we welcome that.  This answer is short but in the press of  time, I’ll leave it at that.

Comment on Electronic Medical  Records and the Medicare Sustainable Growth Rate
On December 3, Chris Farley wrote:
It is very easy for the Sec of HHS to say that Electronic records  are the answer to rising Medicare costs. It is very short-sighted to ignore the  reality that the numbers of the Medicare-eligible are increasing every month.  Besides, with increased litigiousness of society, has the HHS conducted an  objective study of what percentage of procedures physicians carry out are just  to protect themselves against frivolous law suits?

Response:
There are a number of studies that document the practice of defensive  medicine.  I would support reforms that would  minimize the practice or perceived need.   Many believe that the development of best practice quality measures will  provide some protection.

Comment on Electronic Medical Records  and the Medicare Sustainable Growth Rate
On December 3, Chris Farley wrote:
While agreeing that the current formula is an utter failure, I  would like to point out that Physicians are now working at 2005 reimbursement  levels (far from keeping pace with inflation). The moral of this horror story  is that if professionals are paid their legitimate dues, they will not abuse  the system. It is useful to remember that neither the gas nor electricity  prices; employee salaries nor office rent; neither liability premiums nor cost  of EMRs have stayed at 2005 levels - unlike Medicare payments under this  convoluted SGR formula. I have yet to see any effort by Medicare or any other payee  to actually interact with practices that have had extensive experience with EMRs  to identify real world solutions to real world problems. Until that happens, it  will be unreasonable for Mr. Leavitt to expect physician practices to  voluntarily adopt Electronic records. So if HHS would like to push this idea,  let there be a level playing field and objectivity in assessment of its impact.

Response:
I stand by my belief that the system doesn’t work well.  You would be amazed at the amount of work  Medicare does to estimate what things cost for doctors and therefore what the  reimbursements should be.  The truth is, command  and control regulator systems rarely get it right.  A well informed marketplace where consumers  have information on quality and price will both make the relationship between  doctor cost and charges far fairer.

In a previous entry, I talked about walking through a grocery  warehouse with 50,000 items and asked the manager what would happen if the  government started setting prices on every item.  His answer was right, in my view: “fewer  products, higher cost, and continual arguments.”  I told him, he had just described Medicare  reimbursement.


Well, the soup is gone and my time is up so I’ll conclude and post.

 

Pan American Health Organization Meeting

The Pan American Health Organization had its annual Washington meeting last week. We used the occasion to sign the Memorandum of Understanding on the regional training center the United States is helping with in Panama. The need for skilled medical workers is acute all over the world. The health ministers from Panama, Honduras, Costa Rica, and Guatemala joined in signing with the United States. Nicaragua is also participating but will sign the MOU later.

Camilo Alleyne resigned as Health Minister of Panama a couple of weeks ago. However, he was honored at PAHO and I had a chance to see him. It should be acknowledged that the regional training center vision was originally advanced by him. I quickly saw its value and pledged U.S. support as have all the health ministers and Presidents in Central America.

I met with Minister Turner, the new Minister of Health in Panama. She has pledged her continued support and signed the MOU on behalf of Panama.

Regional training of skilled workers has great potential in other areas of the world. We are exploring a joint effort with the Brazilians in Africa.

Dr. Margaret Chan the Director General of the World Health Organization was in town for PAHO. We had a couple of meetings during which most of our time was spent discussing HIV/AIDS, malaria and pandemic influenza. Her natural and comfortable candor makes her an effective leader of WHO. That job requires a person who can be straight with people in a calm and even-handed way. Margaret Chan is good natured, but very direct. We have been friends for a couple of years now. We visited five countries in South East Asia together when she was leading WHO efforts on pandemic influenza (H5N1).

To learn more about Region Health Care Training Centers, visit www.globalhealth.gov

Response to 8/14 comment

In response to my first posting (Wading Into Blogdom), a commenter asked for an update on the H5N1 situation in Africa.  I’d like to pass on a report given to me by Dr. Marina Manger Cats of the CDC, who is based in South Africa.

Dear Sir,

At the reception held in your honor on Monday 20 August in Johannesburg, we spoke very briefly about Avian Influenza Preparedness (my work at CDC South Africa) and you requested an update, to possibly use for your blog.

We were having a regional training on Avian Influenza Rapid Response Training in South Africa this week, from 20-23 August, for countries of the Southern Africa Development Community (SADC). I am giving you an update only now, after completion of this Trainer of Trainers course, to be in a better position to give a more up to date picture.

South Africa – CDC Avian Influenza (AI) Pandemic Preparedness 

Background

South Africa has developed its own Emerging and Re-Emerging Infectious Diseases Epidemic Preparedness and Response Guidelines (2006) and an Influenza Pandemic Preparedness Plan (2006). The National Department of Health (NDOH) is developing country specific guidelines for Highly Pathogenic Avian Influenza (HPAI) Pandemic Preparedness and Response, with the assistance of the National Institute for Communicable Diseases (NICD), based in Johannesburg. A “roll-out” plan for provincial and district level training in HPAI preparedness and response has been implemented in 3 of the 9 provinces and is supported indirectly by CDC-South Africa (through funding to NICD), together with others.

CDC Areas of AI Activity

  • Preparedness and Communications
  • Surveillance and Detection
    • Laboratory Capacity
  • Response and Containment

CDC  AI  Focus:

  • Sentinel Surveillance
  • Rapid Response Training
  • Laboratory Strengthening
  • Outbreak Response
  • Infection Control
  • Communications

Overview

The NICD is part of the National Health Laboratory Services (NHLS), which consists of 3 geographic branches in the country encompassing 250 laboratories. The NICD functions as a reference laboratory for the region and has highly specialized expertise in house.  For example: in the recent Marburg outbreak in Angola, NICD served as a GOARN (Global Outbreak Alert and Response Network) partner and reference centre.

With CDC AI funds (CDC’s Coordinating Office of Global Health 2006 and 2007), the NICD is strengthening its diagnostic capacity for HPAI. The Onderstepoort Veterinary Institute (OVI) in South Africa serves as a reference centre for diagnosing types of HPAI (in animals), and provides training of personnel for the Southern and Eastern regions of Africa in early detection and containment of HPAI.

Inadequate financial resources were identified as a major bottleneck to operationalization of national strategic HPAI Preparedness plans. Linkage and improvement of avian and human influenza surveillance, was identified as one of the main areas needing strengthening. The NDOH is interested in strengthening HPAI surveillance through training. The coordination between the veterinary and human health sector for HPAI preparedness, is also an area needing strengthening in South Africa, as it is in many countries.

Budget / Funding:

CDC Avian Flu funds for 2006 and 2007 for South Africa have been earmarked to the amount of USD 1Million for each year.

Training:

With CDC-South Africa and CDC-Kenya (GDD) support, a Rapid Response Training for HPAI Preparedness and Response for participants from 13 countries from the SADC region was held South Africa. This training was hosted by NICD from 20-23 August 2007 in Johannesburg with the assistance of CDC, FAO, WHO, USAID and with the concurrence of the South African National Department of Health. There were 54 participants from SADC countries as well as The Seychelles. The participants were senior human and veterinarian health epidemiologists, as well as laboratorians and health educationists. It was a unique opportunity for these professions to work together through HPAI preparedness and response (paper) exercises. It was also an opportunity to liaise with the NICD, which is a reference laboratory for the region.

Partners:
Partners for Preparedness and Rapid Response Highly Pathogenic Avian Human Influenza in South Africa:

South African Partners

  • NHLS (National Health Laboratory Services )/
  • NICD (National Institute of Communicable Diseases
  • OVI (Onderstepoort Veterinary Institute)
  • NDOH (National Departments of Health)
  • NDOA  (National Department of Agriculture)
  • NOD  (National Department of Defense )
  • NDFA (National Department of  Foreign Affairs)
  • Private sector: SAPA (SA Poultry Ass.)
  • Other: Wildlife Conservation Society

Other Partners

  • SADC
  • AU-IBAR
  • UN Agency Partners:
  • OCHA
  • UNSIC
  • FAO
  • WHO
  • USG Partners:
  • CDC
  • USAID
  • IFRC

Sir, I hope this information covers some of the areas you are interested to know more about.

The support of the HHS through CDC and other USG agencies has helped to support local initiatives for HPAI preparedness. The challenge is to keep the interest and commitment in HPAI preparedness high on the agenda.

We are working on that and we hope that through your assistance, this will be continued.

Sincerely yours,

Marina Manger Cats, MD, MPH
CDC-South Africa Avian Influenza Officer

From Montana: 8/16/07

Thanks to all of you who commented and wished me luck. I quickly reviewed all the comments. It’s clear the pandemic influenza blog is still generating conversation.

Several of you expressed interest in Tamiflu being an over the counter drug. I don’t possess the technical background to detail the challenges presented by that idea, however, I feel certain its status as a serious antiviral is a significant barrier.

I can’t remember if I mentioned on the pandemic blog that we are testing various distribution alternatives, including making available medical home kits with personal supplies of various emergency medications. CDC actually designed the kit and we have placed 5,000 of them in homes. We need to assure that families don’t break them open and use the medications etc. in advance of a true emergency. I’m told the first phases of the test have gone well.

We’ve also tested postal service delivery of medications in emergency situations in two cities with a third test scheduled soon. Those have been extremely instructive.

Tonight I’m sitting in a hotel room in Montana. I’ve got the television on in the background. Ironically, Charlie Rose’s program is about pandemic influenza. He has David Nabarro, Jeff Koplin, Larry Brilliant and a couple of others on. It’s a very thoughtful discussion.

My primary reason for being in Montana was to work with Senator Max Baucus. We visited a Boys and Girls Club in Bozeman.

One of the blog comments I read tonight was from Goju who referred to herself as “an ordinary mom,” and said she was glad to have her health care concerns heard. The event I did with Senator Baucus was an opportunity he provided to hear from several “ordinary moms” about SCHIP (State Children’s Health Insurance Program). Their situations were all a little different but all expressed how important it was to them.

They are right; SCHIP needs to be reauthorized before September 30th so no child’s coverage is endangered. There is significant disagreement right now between the Senate, House and Administration on what constitutes a low income child. We need to get reauthorization done and then get on with the question of how we solve the problem for adults and children who aren’t eligible for SCHIP or other programs for those in hardship.

I am a passionate believer that our nation, in a relatively short period of time, could organize a system so that every American could have access to affordable health insurance coverage; a topic for another night.

Friday, I’m headed to Africa. I hope to use this blog to record some of my feelings and experiences.

-Mike Leavitt