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It is so important to remember that immunization protects both the people who receive it AND people who have not, and that when the percentage of vacinees falls too low, outbreaks occur.
While it is not known what kind of a flu season we will have this year, CDC does anticipate continued novel H1N1 (the pandemic virus from last year) activity, along with possible H3N2 and influenza B activity. The vaccine is already widely available in the United States in both injection and nasal mist form.
Pandemics of drug-resistant organisms are increasingly common and of increasing importance. Although these trends are worrisome, resistance in each of the infectious diseases mentioned above is being addressed through careful planning and programming. In one case however accurate data is nearly impossible to come by, and this makes intelligent and informed decision-making essentially impossible.
The next question is to what extent has this extensive use of antibiotics in farm animals adversely affected the health of people and animals. Despite these facts, there is not a comprehensive and widely accepted plan to address this threat. In other words, there is no effective veterinary control over the use of antibiotics in farm animals, and no serious commitment to limiting the usage of antibiotics to animals that are actually sick. It is clear that the Deepwater Horizon oil spill in the Gulf of Mexico is the largest known environmental disaster in U.S. The Oil Trajectory Map shows the estimated spread of the spill along the US Gulf coastline, and it is extensive.
This disaster highlights what is often the most overlooked phase of public health disasters—recovery.
EPA has observed low levels of odor-causing pollutants associated with oil on the shore in the Gulf region. EPA is also conducting additional air monitoring for ozone and airborne particulate matter. As is not hard to imagine, we do not have the systems to fully gauge the long-term effects of this disaster.
In the end, it would be useful if someone would calculate the cost of the disaster, response, and recovery. A new text message alert notification system has been set up for public use to receive alerts of interest from the Deepwater Horizon Response.
Recently we (Samuel Stebbins and Patricia Sweeney) returned from a week-long reconnaissance mission to Port-au-Prince, Haiti.
Expedition team members visited water sources, hospitals, schools, internally displaced persons camps, and local businesses to create this snapshot of Haiti’s recovery and reconstruction status. Another way to assess the severity of this disaster is to calculate the percentage of the population that was killed, injured, or displaced.
Analysis of the resources available for response and recovery is also a method that can be employed to assess the severity of a disaster.
Yet, perhaps the most significant challenges in the response to the earthquake in Haiti are communication and the coordination of response efforts. The NHSS was released January 2010 by the Office of the Assistant Secretary for Preparedness and Response (ASPR). Also released this past January was the Interim Implementation Guide (IIG) which references the period January–September 2010, after which a biennial Implementation Guide (IG) will be released.
Ensure situational awareness so responders are aware of changes in an emergency situation. Foster integrated health care delivery systems that can respond to a disaster of any size. Promote an effective countermeasures enterprise, which is a process to develop, buy, and distribute medical countermeasures. Ensure prevention or mitigation of environmental and other emerging threats to health.
Work with cross-border and global partners to enhance national, continental, and global health security. Ensure that all systems that support national health security are based upon the best available science, evaluation, and quality improvement methods.

The IIG notes in its assessment of current evaluation approaches that “there was a noteworthy lack of attention to outcomes, namely morbidity and mortality. The IIGlays out a concrete plan of action and timeline for ensuring that all communities have a clear set of measures.
The plan notes that health security is an integral part of overall national security, and that the NHSS is intended to complement and support other national strategies and priorities, including target capabilities and Emergency Support Functions as described by DHS.
Conduct a workforce gap analysis and develop workforce competencies for all sectors involved in national health security. Develop an evaluation framework, including plans for performance monitoring and evaluating the impact of investments.
Public health professionals from across the country gathered in Atlanta, Georgia during the third week of February for the 2010 Public Health Preparedness Summit. Modeling and simulation have been widely employed in industries such as air traffic control, transportation planning, defense, manufacturing, and the financial sector.
Pandemic influenza poses a substantial threat and non-pharmaceutical interventions (NPIs) may be the only response available in the initial phase of a pandemic until effective vaccines and anti-viral medications become available.
Patricia Sweeney, JD, MPH, RN, Elizabeth Ferrell Bjerke, JD, University of Pittsburgh, et al. This panel addressed the role of academic institutions in community disaster response and examined the legal and regulatory authorities that drive public health system preparedness and response. This interactive panel session, comprised of panelists from several Preparedness and Emergency Response Centers, shared innovative training and planning approaches and explored how computational modeling can be used to enhance education and as a tool for decision-makers to better plan and allocate resources for outbreaks.
Decentralized control and complexity of the public health system pose challenges to health department preparedness and emergency response. At universities nationwide, student epidemiology surge teams collaborate with local, state, and federal health agencies to provide support during emergencies. Typically, the people who are most affected are often those who can't be vaccinated - in the case of pertussis or measles, infants who were too young to complete the full series, and in the case of influenza, seniors for whom the vaccine may not always be fully effective.
President Obama emphasized the importance of individual and community preparedness in his August 27th proclamation, and encouraged all of us to be involved, whether through individual actions such as putting a preparedness kit in your car or through participation in volunteer group activities such as community response teams or statewide groups (SERVPA). The Food and Drug Administration (FDA) has proposed new policies which may or may not improve the situation, depending on the final result.
Not that the disaster could have happened, but that it has persisted for so many days without surcease. As a result of the spill, approximately 33% of the entire Federal Gulf of Mexico waters are closed to fishing as of June 28, 2010.
Some of these chemicals may cause short-lived effects like headache, eye, nose and throat irritation, or nausea.
Hurricane season has begun and Tropical Storm Alex has already become Hurricane Alex, but fortunately is not on a direct course with the oil slick produced by the ruptured BP well. Surveillance and testing are of major importance, as we monitor human, animal, ecosystem, and economic injury and health. This figure could be compared to the money that was saved by not planning effectively in advance, by not having adequate deepwater response capacity, by a rush to deliver barrels of oil without adequate protection. Prior to the earthquake, Haiti was already the poorest country in the Western Hemisphere, with a 2009 per capita GDP estimated at $7 billion USD, putting it well behind Nicaragua and Guyana, the next lowest countries.
Mortality and morbidity statistics in Haiti vary depending on the source, but most sources estimate approximately 200,000 dead, 300,000 injured, and up to 1 million displaced. Immediately following the earthquake, there were reportedly more than one thousand non-governmental organizations (NGOs) registered in the country. This omission is surely attributable to the difficulty of assessing outcomes outside real-world emergency events or functional exercises designed to simulate emergency events, all of which are fairly infrequent. There is a single reference to the 2002 Institute of Medicine (IOM) report, The Future of the Public’s Health in the 21st Century. Speaking to a packed house, Secretary Sebelius talked of how the public health system was tested, but given the previous all-hazards preparedness approach, a unified public health response, and interagency partnerships, there were many successes in meeting the challenge of responding to H1N1.
Lurie and her office would be leading a comprehensive review of their public health countermeasures. This session demonstrated how modeling and simulation techniques can be a benefit to public health preparedness planning such as vaccine distribution and preparedness planning.

The Centers for Disease Control and Prevention recommend numerous NPI options in response to pandemic influenza.
In this panel discussion investigators described ongoing work for measuring preparedness capacity and the effectiveness of partnerships in response and a framework to develop and assess organizational processes that inform and support coordinated action during a public health crisis. As chairperson of the Student Public Health Epidemic Response Effort (SPHERE), Diesel shared her personal experience developing a relationship with the Allegheny County Health Department and the benefits that the partnership has brought to SPHERE’s student members as well as the health department.
Comprehensive surveillance is an essential part of any effective plan, and understanding antibiotic usage in farm animals is required. Past history has shown that highly successful public health interventions such as seat belts and airbags are nearly always resisted by manufacturers as being too costly, and yet years later they are an essential part of our lives. 619 proposes the withdrawal from routine use of seven classes of antibiotics vitally important to human health from food animal production unless animals or herds are sick with disease or unless drug companies can prove that their use does not harm human health. Skimming, burning, booms, well collection, use of dispersants, and many other techniques are underway. Some people may be able to smell several of these chemicals at levels well below those that would cause short-term health problems.
However, even a near miss may generate ocean swells of a magnitude sufficient to affect the containment efforts.
Scientists who can work across disciplines will be of prime importance, as some of the effects may be reflected in the complex interplay of macroscopic and microscopic phenomena. And then perhaps we will learn the lesson (again) that prevention is better (and cheaper) than cure in a myriad of ways, and prioritize activities that truly protect human, animal, plant, and ecosystem health.
Just one example of the cognitive dissonance we experienced is depicted in the fact that we could buy modern conveniences such as a car cell phone charger and electric fans on a street amid huge areas of destruction. In the five months since the earthquake, roads have gone from bad to nearly unnavigable, with power lines still dangling over busy streets but ignored by all.
Ranging in size from tiny to huge, these NGOs may coordinate a single activity or provide a variety of services. The strategy sets priorities for government and non-government activities over the next four years, and is a requirement of Pandemic and All-Hazards Preparedness Act (PAHPA).
Appendix A also includes detailed funding information to states from various sources for the years 1999–2009.
It is possible that many if not all of these deaths were preventable with standard vaccines.
However, the current vaccine is protective against this variant and is highly recommended. Groups that already support this legislation include the American Medical Association, American Academy of Pediatricians, the Infectious Diseases Society of America, the American Nurses Association and the World Health Organization.
However, when prevention and preparation fail, as they have in the Gulf oil disaster, and mitigation is weak, response becomes the phase of the moment. Industries both large and small are already disrupted, and it isn’t known when they will be back on line and what the long-term effects will be. Trips of only a few kilometers take hours, there are very few standing churches, and ever worsening piles of garbage are accumulating in the streets and water floodways.
Cassano today announced that a 12-member FDNY, OEM and Department of Health and Mental Hygiene team will be sent to Port-au-Prince, Haiti, to help build a local Community Emergency Response Team (CERT) program.
Mitigation and response activities will be disrupted, barriers may be destroyed, and oil may be dispersed even more widely throughout the Gulf region. Each of the eleven clusters (Protection, Camp Coordination and Management, Water Sanitation and Hygiene, Health, Emergency Shelter, Nutrition, Emergency Telecommunications, Logistics, Early Recovery, Education and Agriculture) is led by a designated agency.
During our reconnaissance mission, expedition team member attendance at cluster meetings revealed that efforts to identify the NGOs remaining in country and the services they were providing were ongoing, but meeting significant challenges. Leadership from the Pan American Health Organization and World Health Organization will be essential in trying to protect the current population from the worst depredations of public health challenges and disasters while others work to resuscitate the economy and education systems for long-term recovery. Contributions of human error and inadequate technology are suspected and currently being investigated.

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