Your Responses to the Essay "H1N1 Preparedness"
December 12, 2009
We've received some very useful and insightful feedback to the essay, H1N1 Preparedness. If you'd like to add your own comments, please read the article and enter your thoughts in the sidebar.
Varnee Murugan - MPH student, Yale School of Public Health
I wholeheartedly agree with the recommendations in this paper. However, I think it is also important not to take too narrow a focus on this issue. Health systems strengthening will be extremely important here and primary health care should not be neglected. By bolstering primary health services, improving governance and mangement, and investing in basic infrastructure, surveillance and laboratory activities will run more effectively and efficiently. Please ensure that pandemic preparedness doesn't become yet another vertical program. If you truly want to think long term, everyone will benefit if there are investments made in health systems strengthening.
Dr. Nosayaba Osazuwa-Peters
The recent H1N1 influenza is a testament to the pestilence of the 21st century.
It also showed however that the earth is a global organism, and so no matter what advances the US or other rich nations make, outbreaks like the H1N1 will continue to affect negatively on earth; directly, through immigration, tourism and other factors, and indirectly through the health economics of the world.
The way forward is simple: Address the issue of health inequalities; devote more attention to preventive medicine research; synthesize a strategy for disaster and pandenmics preparedness.
Again, the Alma-Ata declaration holds the key. If all nations of the earth, spearheaded by the US, can champion the course of Alma-Ata, outbreaks will be better controlled if not totally prevented. So instead of spending all the millions in the world in fashioning new technologies and looking for modern breakthroughs, what will still benefits humanity as a single entity more is sometime truly global: the Alma-Ata way!
Lynn Etheredge - Rapid Learning Project, GW University
The major missing piece that i see in the analysis and recommendations is not in the traditional public health area (prevention, vaccines) but in the US (and world) capacity for "rapid learning" about best clinical treatments, particularly for higher risk patients, in a public health emergency. The limited ability to do "comparative effectiveness research" is a serious problem even for normal medical care issues -- but an acute problem for public health emergencies, e.g. HiN1, where children and have suddenly been found to be much more vulnerable. Rx testing & clinical trials for pediatrics are a serious gap in clinical evidence, even in the best of circumstances, For H1N1, it has taken HHS many months even to put together a network of ICUs, which needed a new contracting procurement & going through each institution's IRB approval process for participating in research. Even today, 22 million patients & 6 months into the pandemic, there is limited ability to provide guidance on such important issues as use of anti-virals, ventilator use, "double coverage" antibiotic therapy for children with H1N1, asthma & pneumonia, etc. A recent NYTimes op ed (enclosed) highlights the still-unresolved questions about how to assess genetic influence factors in risk (possibly more useful for H1N1 than traditional public health groupings) and treatment. With electronic health records, already for millions of patients in institutions with first-rate health programs (Kaiser-Permanente, Denver Health, Childrens Hospital of Philadelphia, etc.) it would be relatively easy for HHS to design, pre-contract & prepare for rapid-learning networks about best clinical care in public health emergencies, The US needs to do this & the world also needs such capacities on the front line that can quickly offer better guidance to community physicians, hospitals, and clinics.