A day after HHS declared a public health emergency in the U.S.because of the global flu outbreak, Richard Besser, acting director of the Centers for Disease Control and Prevention, made a comment that he repeated throughout the week: “What we call this,” he said, “matters less than the actions we take.”
As healthcare agencies wait for permanent leaders, acting heads take on H1N1 flu virus
As it turns out, the same could be said of Besser and several other healthcare leaders at the highest levels of U.S. government who are acting in unofficial, temporary positions while the country finds itself in what's described as a prepandemic period as of last week.
The expectation seems to be that these roles will be filled—some by appointment, others only after Senate confirmation—now that former Kansas Gov. Kathleen Sebelius has been approved as HHS Secretary (See p. 6).
Meanwhile, the government's flu-fighting team is composed of a mix of recent appointees and interim leaders who are managing the situation as scientists investigate the never-before-seen 2009 H1N1 virus, often referred to as “swine flu.”
The classical swine flu virus, an influenza type A H1N1 virus, was first isolated from a pig in 1930, according to the CDC.
At deadline on May 1, the CDC had confirmed 141 human cases of H1N1 flu infection in the U.S., including the death of a 23-month-old from Mexico who traveled with family to Texas and died there. Changing rapidly, the disease had spread to 19 states as of May 1.
The CDC began shipping 25% of each state's allocation of anti-viral drugs and protective equipment from the Strategic National Stockpile first to states that have been affected, and all states will receive their portion by May 3, Besser said in a news conference last week.
Meanwhile, President Barack Obama requested an immediate $1.5 billion in emergency funding from Congress to monitor and track the virus, and also to increase the nation's supply of anti-viral drugs and equipment.
Although Homeland Security Department Secretary Janet Napolitano is the principal federal official overseeing the current flu outbreak emergency, Sebelius leads the department that will coordinate disease surveillance, medical preparedness and guidance to public health professionals, according to remarks from John Brennan, adviser to the president for Homeland Security and Counterterrorism, in an April 26 press briefing with other federal officials.
The essential agencies responsible for this work include the CDC, which has Besser in an acting role; the Food and Drug Administration, which is being led by principal deputy commissioner Joshua Sharfstein, given that President Barack Obama's mid-March nomination of Margaret “Peggy” Hamburg has yet to be confirmed; and Raynard Kington, who is acting director at the National Institutes for Health. Keep in mind that the CMS administrator and U.S. surgeon general have also not been named.
Donna Shalala, the nation's longest-serving HHS secretary, under President Bill Clinton, acknowledged that even though Napolitano is the “overall coordinator” for the flu-outbreak efforts, the emergency should take precedence over all of Sebelius' other responsibilities. “Her immediate priority is the swine flu pandemic, and I'm sure she's getting right on top of it right now,” said Shalala, who added that “anything in government requires cooperation.”
That cooperation has extended beyond government agencies to some of the nation's healthcare associations. The American Medical Association developed a page on its Web site devoted to the issue. AMA President Nancy Nielsen said that the AMA learned from the CDC that the most “supportive course of action would be for us to disseminate accurate and timely outbreak information to our membership and the general public.”
When asked about similar guidance for hospitals, a spokesman for the American Hospital Association said in an e-mail that information regarding patients in a healthcare setting can be found on the CDC's Web site, cdc.gov/h1n1flu. On April 29, the CDC offered updated guidance for the hospital segment, which included information on patient screening, isolation precautions and how to handle potentially or actually ill personnel.
While the public health angle is being managed by the CDC, Gregg Pane—the director of national healthcare preparedness programs at HHS' Office of the Assistant Secretary for Preparedness Response, or ASPR—is the principal point of contact for the nation's hospitals. His office also has regional contacts who all report to him, said Gretchen Michael, a spokeswoman in Pane's office. Last year, ASPR disbursed $398 million to 62 states and territories to address all hazards. That figure has decreased gradually since 2006 (April 6, p. 6).
With a host of agencies contributing their expertise, there are certain characteristics that are essential for leaders to have in situations such as this one, according to Shalala. “Discipline on the message to the public,” Shalala said of those necessary skills. “Consistency—so everybody is answering the same way.”
With regard to their communication efforts for this never-seen-before influenza virus, the current government leaders have “done very well,” said Shalala, who now serves as president of the University of Miami.
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