Introduction
The H1N1 influenza pandemic that the World Health Organization (WHO) declared officially in June 2009 brought to the fore issues of response and preparedness (Jhung et al., 2013). Jhung et al. have asserted that H1N1 is both a protracted and significant public health emergency that portends enormous effects in terms of mortality and morbidity. The possibility of a pandemic influenza virus presented challenges to federal and state health authorities in the United States (Trock et al., 2012). As such, this paper will explore the best practices to deal with a pandemic based on the state of Tennessee’s response to the 2009 H1N1 A pandemic.
Inter-agency Collaboration during a Pandemic
Interagency collaborative efforts play a fundamental role in building organizational capacity, as well as enhancing communication during an emergency (Trock et al., 2012). According to Reed et al. (2013), health organizations cannot respond effectively by working independently. Emergency response mechanisms achieve their intended goals when agencies utilize their resources and knowledge base collectively (Barrios et al., 2012). Interagency collaboration is one of the strategies that health officials in Tennessee adopted during the pandemic. The health administrators understood the value of close coordination with other state organizations.
The Department of Health (DoH) and Tennessee Emergency Management Agency (TEMA) assumed a fundamental role. The deployment of TEMA was essential to address security and logistic concerns if the pandemic worsened. DOH was a significant player in the emergency response team considering its background in health, resources, and contacts. The hybrid nature of Tennessee’s public health system necessitated the coordination of operations among state, regional, and independent players. Health officials accomplished this objective by activating the State Health Operations Center (SHOC).
The Significance of a Pandemic Crisis Action Plan
Interagency collaboration mechanisms are often complicated because the organizations involved have conflicting interests. Consequently, the implementation of team-based responses necessitates a raft of measures to deter incidences of failure (Jhung et al., 2013). First, a clear definition of goals and accountability ensures that the agencies progress in one direction (Trock et al., 2012). Trock et al. have noted that delineated leadership responsibilities and roles prevent conflict and disunity among participants. Finally, it is imperative to include all the relevant organizations in the team and to ensure that they have the capacity to commit resources when the need arises (Reed et al., 2013).
Health officials in Tennessee identified TEMA as the lead agency during the emergency. Nonetheless, TEMA abdicated this role to the Department of Health because the situation did not warrant extreme response levels. The health authorities determined that scaling-up TEMA’s resources to full capacity would have overstretched resources, in addition to eliciting public outcry. Thus, the decision to coordinate emergency response through DOH was crucial to prevent the unnecessary overutilization of resources. Most importantly, health officials coordinated communications between the state and other partners through the State Health Operations Center (SHOC).
Compliance with Federal Regulations
The process of planning and responding to the deleterious consequences of an influenza pandemic is very intricate. The elemental concern is that the novel influenza A virus can spread quickly over an expansive geographical area (Jhung et al., 2013). Barrios et al. (2012) have asserted that the explosive nature of influenza viruses has facilitated the development of pandemic plans, as well as response and preparedness frameworks. The US National Strategy for Pandemic Influenza (National Strategy) is one of such initiatives. According to the U.S Homeland Security Council (2012), the national strategy achieves three goals.
The first objective is to stop or minimize the spread of an influenza pandemic to the United States. The second aim is to control the spread of influenza within the country, as well as mitigating human suffering, death, and disease. The final purpose is sustaining infrastructural developments and easing the impact on the economy. Tennessee fulfilled these mandates by implementing basic preventive measures and distributing antiviral medications. In addition, state officials used CDC guidelines on school closures and prioritizing the recipients for limited vaccine supplies. The state officials also engaged representatives from the media to sensitize locals about preventive measures.
Ethical Issues in Pandemic Response
A myriad of critical ethical questions emerges when developing a public health planning, preparedness, and response strategy for pandemic influenza (Coleman, 2009). In essence, health agencies face the challenge of prioritizing the distribution of the vaccines, medications, and beds in intensive care units (Poland et al., 2009). Tennessee experienced a shortage of vaccines because of delays in production and distribution. The state recorded a surge of patients at the Le Bonheur Children’s Hospital due a severe outbreak among children. These challenges bring to the fore the problem of distributing scarce resources.
The distribution of limited influenza vaccines and antiviral drugs requires both explicit and implicit judgments based on various factors (Reed et al., 2013). First, utility considerations focus on benefits that individuals and communities may accrue from receiving vaccination and drugs (Poland et al., 2009). Secondly, considerations of equity give priority to the people with severe symptoms, the disabled and vulnerable populations (Coleman, 2009). Coleman has opined that the gold standard is to prevent discrimination during the distribution process based on gender, ethnicity, race, socio-economic status, or religion.
Influenza pandemic has the potential to overwhelm the medical system. Trock et al. (2012) have asserted that the overutilization of the emergency department imposes an immense stress on hospital resources. Consequently, Poland et al. (2009) have demonstrated that patients who need urgent care desperately may leave the hospital without receiving any medical attention. Hospitals can avoid such a scenario by employing effectual triaging to ensure that only deserving individuals utilize the emergency department (Reed et al., 2013). Coleman (2009) has argued that efficient communication across health facilities and triaging processes facilitate the speed transfer of patients to hospitals with low capacity.
The eradication of highly contagious pandemics (such as Ebola, SARS) has also raised issues of morality and justice. For example, it is unethical to eradicate individuals suffering from an extremely contagious disease that has no cure (Poland et al., 2009). The limitations of medical countermeasures (vaccines and antiviral drugs) increase the susceptibility of vulnerable populations to the risk of potent infections. Nonetheless, public health countermeasures are vital to reducing the severity of an influenza pandemic (Reed et al., 2013). Innocuous techniques (personal hygiene and disease surveillance) and restrictive options (quarantine, travel restrictions, and social distancing) reduce the spread of the H1N1 virus (Barrios et al., 2012).
The application of quarantine, isolation, and social distancing measures without violating human rights raise pertinent moral questions (Thomas, Dasgupta, & Martinot, 2007). According to Poland et al. (2009), quarantine is justifiable in the case of very contagious diseases and for a reasonable duration to protect the public. Conversely, the recent events in West Africa following the Ebola outbreak highlighted the challenge inherent in social isolation. A case in point was the violent protests in Liberia when the government imposed a curfew in one of the Ebola-stricken slums (Hinshaw, 2014). Although such containment was necessary to protect and save lives, Hinshaw has argued that the lockdown had denied the residents the freedom of movement and association
The implementation of containment measures requires a delicate balance between community interests and the rights of individual citizens (Poland et al., 2009). Quarantine and other restrictive measures can legitimately delay the spread of contagious diseases or lessen health effects (Coleman, 2009). By contrast, the implementation of these interventions should consider ethical principles. These standards include justifiable harms, the achievement of public good, fairness, and mechanisms for due process (Poland et al., 2009). Thomas, Dasgupta, and Martinot (2007) have indicated that health authorities carry the legal mandate of ensuring that disease containment measures do not stigmatize or harm the affected individuals. Further, Coleman has suggested that preparedness plans should guarantee the quarantined populations’ accessibility to essential goods and services.
The intentional and unintentional release of pathogens raises fundamental legal questions. On the one hand, terror groups may use potent microorganisms to advance biological warfare, as was the case of the 2001 anthrax attack (Ostfield, 2009). On the other hand, biomedical research centers may contaminate the air or water sources with virulent pathogens accidentally. Affected populations have a right to retribution in both cases because the role of government agencies is to deter biosecurity and biosafety risks (Coleman, 2009). The federal government has instituted laws to govern the activities of private bodies engaged in biomedical research. Poland et al. (2009) have argued that these institutions are liable for damages and consequences that arise from their deliberate or inadvertent actions.
References
Barrios, L. C., Koonin, L. M., Kohl, K. S., & Cetron, M. (2012). Selecting nonpharmaceutical strategies to minimize influenza spread: The 2009 influenza A (H1N1) pandemic and beyond. Public Health Reports, 127, 565–571.
Coleman, C. H. (2009). Allocating vaccines and antiviral medications during an influenza pandemic. Seton Hall Law Review, 39(4), 1111-1123.
Hinshaw, D. (2014, August 21). Ebola virus quarantine sparks clashes in Liberia. Wall Street Journal. Web.
Jhung, M. A., Epperson, S., Biggerstaff, M., Allen, D., Balish, A., Barnes, N., … Finelli, L. (2013). Outbreak of variant influenza A (H3N2v) virus in the United States. Clinical Infectious Diseases, 57, 1703–1712.
Ostfield, M. (2009). Pathogen security: The illusion of security in foreign policy and biodefense. International Journal of Risk Assessment and Management, 12, 205–210.
Poland, G. A., Jacobson, R. M., Tilburt, J., & Nichol, K. (2009). The social, political, ethical, and economic aspects of biodefense vaccines. Vaccines, 27(4), D23-D27.
Reed, C., Biggerstaff, M., Finelli, L., Koonin, L. M., Beauvais, D., Uzicanin, A., … Jernigan, D. B. (2013). Novel framework for assessing epidemiologic effects of influenza epidemics and pandemics. Emerging Infectious Diseases, 19, 85–91.
Thomas, J. C., Dasgupta, N., & Martinot, A. (2007). Ethics in a pandemic: A survey of the state pandemic influenza plans. American Journal of Public Health, 97(1), S26-S31.
Trock, S. C., Burke, S. A., & Cox, N. J. (2012). Development of an influenza virologic risk assessment tool. Avian Diseases, 56, 1058–1061.
U.S. Homeland Security Council. (2012). National strategy for pandemic influenza. Web.