Events :: December 14, 2005

Gaps in the National Flu Preparedness Plan: Social Science Planning and Response [Mr. Gordon, Mr. Baird]

On December 8, 2005, the Science Committee’s Ranking Democrat Rep. Bart Gordon (D-TN) wrote to Secretary of Health and Human Services Michael Leavitt, to Director of the Office of Science and Technology Policy Dr. John Marburger, and to Dr. Julie Gerberding, the head of the Centers for Disease Control and Prevention. He said, "We need a national dialog on the role of the public as a partner in disaster preparedness and response."  On December 14, Gordon and fellow Science Committee Member Rep. Brian Baird sought to open that dialog with a briefing that examined the weak use of social science knowledge in preparing the public for a possible outbreak of pandemic influenza.

In early November, President George Bush released the National Strategy for Pandemic Influenza, accompanied by the Department of Health and Human Services Pandemic Influenza Plan issued by Secretary Leavitt.  The Department stated, "If a pandemic influenza virus with similar virulence to the 1918 strain emerged today, in the absence of intervention, it is estimated that 1.9 million Americans could die and almost 10 million could be hospitalized over the course of the pandemic, which may evolve over a year or more."  The Strategy and Plan were intended to organize the Nation’s response to what would be a massive public health crisis.  Rep. Gordon undertook an evaluation of the Plan’s ability to protect people in the event that a flu strain does turn pandemic.

In his letter, Gordon focused on the Plan’s guidance for Federal, State and local officials who would be deciding how to distribute available supplies of vaccines or antiviral drugs and possibly initiating quarantines or other restrictions on movement - and trying to communicate their reasons for these decisions to the public.  Recent episodes - contamination of Congressional offices by mail-borne anthrax in 2001 and the massive upheavals created by Hurricanes Katrina, Rita and Wilma - showed that providing timely and useful information to decision-makers and the public in emergencies was a difficult proposition and needed extensive preparation in the planning for emergency responses.  The Science Committee had held a hearing November 10 on the failure to use the insights from decades of social science research when preparing the response plan for Hurricane Katrina, and Gordon saw parallels in the new Strategy and Plan for pandemic flu.  He wrote:

"...Experts agree that should a highly lethal form of human influenza, such as H5N1, present itself in the next several years, vaccines and antivirals will fall short.  Social distancing, effective communication, and other public health measures will be our only realistic line of defense.  This is the realm of social scientists.  Yet, neither the National Strategy nor the HHS plan makes effective use of current human behavioral and social science research.

"The HHS plan recognizes the importance of addressing the social dimensions of a pandemic but does nothing more than list them as considerations and needs.  There is no indication of how HHS intends to address these issues; there is no indication that they expect anything more than for the states and localities to magically know how to address the items listed.  Agreed, many of the social issues are the providence of the state and local government.  However, the states and local governments look to the Federal government for guidance and best practices.  Such guidance is lacking in the current Pandemic Plan...."

 Read Mr. Gordon's letter »

To fill in what was missing, Rep. Gordon invited three experts in biosecurity and preparedness to brief Members:

• Clete DiGiovanni, M.D., Public Health and Medical Advisor, Advanced Systems and Concepts Office, Defense Threat Reduction Agency (Fort Belvior, VA).  A Department of Defense psychiatrist, trained at the Johns Hopkins Hospital, before his retirement from Federal service in September 2002.  Dr. DiGiovanni focused on the psychological aspects of domestic terrorism following the March 1995 release of sarin gas in the Tokyo subway by members of the Aum Shinrikyo cult.  He served on the World Health Organization Working Group on Prevention of International and Community Transmission of Severe Acute Respiratory Syndrome (SARS) and co-authored a study of compliance with quarantine restrictions during the 2003 SARS outbreak in Toronto.  In 2002, Dr. DiGiovanni helped to write the DTRA report, Reactions of an American Community to a Bioterrorist Attack.
• Baruch Fischhoff, Ph.D, Howard Heinz University Professor, in the Department of Social and Decision Sciences and Department of Engineering and Public Policy, Carnegie Mellon University (Pittsburgh, PA).  A member of the Institute of Medicine of the National Academy of Sciences, he has served on some two dozen NAS/NRC/IOM committees.  He is a Fellow of the American Psychological Association and recipient of its Early Career Awards for Distinguished Scientific Contribution to Psychology and for Contributions to Psychology in the Public Interest.  He is a Fellow of the Society for Risk Analysis and recipient of its Distinguished Achievement Award.  Dr. Fischhoff's research includes risk perception and communication, risk management, adolescent decision making, medical informed consent, and environmental protection.
• Monica Schoch-Spana, Ph.D., Senior Associate, Center for Biosecurity; Assistant Professor of Medicine, University of Pittsburgh (Baltimore, MD).  Dr. Schoch-Spana, a medical anthropologist, helped established the UPMC Biosecurity Center after 5 years with the Johns Hopkins Center for Civilian Biodefense Strategies.  Dr. Schoch-Spana has led research, education, and advocacy efforts to encourage greater consideration by authorities of the general public's capacity to confront bioattacks constructively - a realm she has termed "the people's role in biodefense."  She organized the 2003 national summit, Leadership during Bioterrorism: The Public as an Asset, Not a Problem, and chaired the Working Group on "Governance Dilemmas" in Bioterrorism Response that recently issued consensus recommendations to mayors, governors, and top health officials.  Dr. Schoch-Spana has also served as Principal Investigator for a national study of public communications during the anthrax crisis of 2001.

"I cannot stress this enough - should a highly lethal form of flu surface in the next few years, the biological sciences - vaccines and other medicines - will not save us," stated Rep. Gordon.  While the Pandemic Influenza Plan calls for stockpiling medicines, they will not be available for a significant fraction of the U.S. population before 2007.

As Mr. Baird noted, "Investing in biological research and stockpiling of medicines is the right thing to do because these investments can make a huge difference in our ability to protect the public, but we must develop and communicate effective public health response strategies because those are the strategies that Federal, state and local authorities will have to rely on until the biological investments begin to pay off."

For that to happen, said Dr. Fischhoff, "Social scientists need to be part of the planning team, so that plans are based on science, not intuition.  Otherwise, citizens will receive advice that does not make sense to them, breeding distrust - like some of the hurricane evacuation messages."

Experience shows that effective crisis communication is delivered by one knowledgeable and authoritative spokesperson, and plans must be structured so that information reaches that person even as an emergency disrupts the ability to share it. "Social scientists have been studying people’s responses to risks intensively since World War II," continued Dr. Fischhoff. "Research conducted both in the armed forces and on the home front has identified patterns of behavior that can be expected to occur with pandemic flu, or any other risk. A focus of the research has been providing the information that people need, in the form that they need it, in order to make effective decisions."

 Read more of Dr. Fischhoff’s commentary »

"In recent disasters, we’ve seen that the Federal response to certain situations has great room for improvement," said Rep. Gordon in summarizing the discussion.  "That’s what today’s discussion is all about - insuring we have a solid workable plan in place."

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