Pandemic Flu Preparedness Symposium

A Foundation-supported Los Angeles symposium brings together key decision-makers to share information, voice concerns and seek solutions to the inevitable gaps in their plans.

View symposium video (RealVideo)

Press Release: Pandemic Flu "Table Top" Exercise Brings Health Experts, Businesses, and Community Groups Together to Prepare for the Impact of an Outbreak

Pandemic Influenza
Issue Briefs

Business Sector

Community and Faith-Based Organizations

Critical Infrastructure

Education

Healthcare

The professional calm in the newscaster's voice belies the dire content of her message.

"Twenty-five days after Los Angeles reported the nation's first human case of bird flu, the city is at the epicenter of a lethal epidemic that is spreading rapidly around the nation," she reports. "In Los Angeles, 3,750 people have died of the highly contagious H5N1 virus, and health authorities estimate that as many as 59,000 L.A. County residents are now infected with the disease. The city health care system is stretched beyond the breaking point. Overwhelmed hospitals are running out of critical medical supplies."

As the report unfolds, disturbing revelations mount: Thousands of deaths across the country. Worsening shortages of doctors, nurses and hospital workers. National Guard units deployed in California and Texas to maintain order.

The fictionalized newscast was one of seven shown during a tabletop exercise at the Pandemic Flu Preparedness Symposium, held October 11, 2006, in downtown Los Angeles at the California Endowment's Center for Healthy Communities. The event drew some 150 participants, including an unprecedented gathering of leaders from health care, education, business, community organizations, and the governments of the City of Los Angeles, Los Angeles County and California.

"Pandemics are entirely natural," said Admiral John Agwunobi, M.D., M.B.A., M.P.H., assistant secretary for health, U.S. Department of Health and Human Services, during the morning plenary session. "They are as natural as hurricanes and earthquakes." The world hasn't seen a pandemic since 1968, Agwunobi said, but we can be sure another is coming. "It's not if, it's when."

The mildest pandemic of the 20th century, in 1968, killed nearly 34,000 Americans. The more famous 1918 pandemic killed approximately 500,000 people in the United States and an estimated 20 to 50 million worldwide. Roughly a third of the world's human population became ill. Some who felt fine in the morning were sick by noon and dead by nightfall. A contagion of this magnitude, public health experts say, is what we must prepare for.

Many agencies and organizations in the public and private sectors have begun that preparation. The Los Angeles symposium, organized by the Trust for America's Health and supported by grants from the Robert Wood Johnson Foundation, The Pew Charitable Trusts and The California Endowment, brought key decision-makers together so they could share information, voice concerns and expose the inevitable gaps in their plans.

As the day progressed, the complexity and gravity of so daunting a challenge became apparent as an array of issues and questions surfaced. By what mechanisms will antiviral medicine be distributed? Who decides whether to close schools? How can officials coordinate communication so the public doesn't get conflicting messages? Will quarantines be imposed? How will ad hoc health care sites created to handle hospital and clinic overflow be staffed?

There exists "a big disconnect between pandemic rhetoric and the actual pandemic planning," said Irwin Redlener, M.D., director of the National Center for Disaster Preparedness at Columbia University. "The federal government provides, for general hospital preparedness for disaster planning, about $475 million a year total for the whole country," he offered as one of several examples. "We need at least $5 billion right now … and then a billion dollars a year in maintenance."

An article in a mock tabloid distributed to symposium participants featured quotes from U.S. Health and Human Services and the Homeland Security Council warning that communities should not expect the federal government to rescue them during a pandemic.

"This is what is affectionately known as the YOYO principle—You're On Your Own," Robert Kim-Farley, M.D., M.P.H., director of communicable disease control for the Los Angeles Department of Public Health, explained to 19 participants in a private-sector breakout session, which he moderated. Attendees interested in four other categories-critical infrastructure; health care; education; and community, faith-based and social service organizations-participated in separate sessions.

The private-sector representatives seemed relieved and grateful for having an opportunity to exchange information, voice needs and hear what government agencies are planning. Intel, the Disney Company, Chevron Corp., City National Bank, Westfield Malls—had all been working on pandemic preparedness plans more or less on their own. Now they could compare notes.

"This is a very valuable venue in terms of allowing multiple sectors to learn about and understand what other people are thinking," Richard Wilkins, M.D., Chevron's general manager for health and medical services, said later. "It has also helped provide me with a much better understanding of what the state [government] is considering."

Lunchtime speaker, author John Barry (The Great Influenza: The Epic Story of the Deadliest Plague in History ), explained why, in some respects, our society is more vulnerable to a pandemic now than it was in 1918. For one thing, "we have a much larger population with weakened immune systems," from people with HIV/AIDS to the elderly and cancer survivors who have had radiation treatment or chemotherapy.

In the afternoon session, California first lady Maria Shriver emphasized how seriously Gov. Arnold Schwarzenegger takes the issue. "This has been a priority of Arnold's—to find out what we can do so that the first time we're talking about the pandemic is not in the middle of the pandemic," she said. "We want to get smarter on this subject. We want to get better prepared. We know that it's a government responsibility, but we're also well aware that we need to educate our citizens and make them understand that it's also their responsibility."

Earlier, George Murphy, M.A., a principal analyst at the Homeland Security Institute, had set the stage for the afternoon's tabletop scenario exercise. We are dealing with the first wave of "a 1918-like pandemic," he said. "The attack rate is 30 percent, [the virus] affects all age groups," and "the death rate is about two percent of the population." Participants should also assume a high rate of absenteeism, he added, a global disruption of the flow of goods and the unavailability of vaccine for six to eight months.

In moderating the exercise, former New York City Health Commissioner Margaret Hamburg, M.D., now serving as senior scientist for the Nuclear Threat Initiative, deftly kept the ball rolling among 21 decision-makers as the pandemic progressed in severity from Day 1 through Day 60. She provoked thoughtful discussion as she asked questions like these:

County public health, how are you going to prioritize your limited amount of TAMIFLU antivirals; and how are you going to explain those decisions to the public?

"You will notice," Hamburg said to the group as the exercise reached Day 4, "you haven't gotten any sleep."

By Day 60, she envisioned more lost than just sleep. "In the real world," she said, "had this scenario unfolded, I think probably we would have lost a number of you around the table."

"These kinds of events are always unsettling because they point out the many, many areas where we still have a lot of work to do," Redlener said afterwards. "On the other hand, they are vital, and it is essential that we continue to do them. We have to get better at them. Make them bigger, make them longer, expand our scope in trying to get people to figure out how they are going to work together in the event of a real crisis."

California's secretary of health and human services, Kimberly Belshe, M.P.A., put it succinctly: "California is doing a lot, but there is a lot more to do. That was clearly a take-away from this conversation. Frankly, I will take a number of ideas back to the governor."