"Preparedness is the process of adapting, learning, and growing. We are facing new threats from new weapons all the time. We have to respond in ways that allow us to work together," said Michael Leavitt, Secretary of the U.S. Department of Health and Human Services, at an October 31, 2007, Director's Forum. Senior health representatives of eight allied nations (Canada, the United Kingdom, France, Germany, Italy, Japan, Mexico, and the United States), as well as representatives of the European Union and the World Health Organization (WHO), gathered in Washington this week for the 7th meeting of the Global Health Security Initiative (GHSI).
At the Director's Forum, Leavitt, former governor of Utah, recounted his experience with an anthrax threat at the Salt Lake City International Airport during the 2002 Olympics. From that experience Leavitt came to recognize the far-reaching repercussions of global health threats and the vital importance of global health security, preparedness, and cooperation. "I came away from that with a far better understanding of the dilemma," he said. "No one department, or agency, or government had the capacity to manage all the things that would have come about" had that threat been a reality. "Before 9/11 this collaboration wasn't happening. . . . there was no specific meeting oriented toward working out problems like this with our leading allies who face similar threats," he said. "That [Salt Lake City] incident…would not have been a localized incident. It would have been a global incident, and like so many others it could have been taking place simultaneously [with other attacks] in a coordinated way across the globe," he continued.
Since its inception, the GHSI has expanded beyond bioterrorism to address pandemic flu, establish a research lab network, an emergency contact network, a standardized risk-incident scale, and a forum to share lessons learned. The GHSI also supports and supplements the activities of WHO, including the organization of exercises and workshops examining topics ranging from the dangers of Q-fever, a zoonotic disease considered to be a potential terrorist threat, to best practices for isolation and quarantine.
Leavitt outlined three priority topics being addressed by the GHSI. First, he discussed the importance of virus sample sharing in order to successfully prepare for a global outbreak of pandemic flu. "Without sample sharing it is hard for us to keep track of how these viruses are changing, and without that information we can't develop new vaccines that protect us. The U.S. strongly supports the WHO efforts to meet the global need for influenza vaccine. We have provided over $10 million to the WHO to help countries that are developing and producing their own vaccine." Withholding virus samples for the purposes of procuring royalties on vaccines "is a dangerous, and I might add selfish, notion that cannot be accepted by the world, nor can it work at the practical level. Responding to a pandemic will demand cooperation from the entire world. No nation can go it alone," emphasized Leavitt.
Second, the GHSI is focusing on the development of global health threat countermeasures. This is a particularly difficult area of preparedness as the costs are high and the rewards are policy dependent, said Leavitt. For these reasons, the United States, historically the major-funder and developer of health threat countermeasures, "can no longer fill that role."
"We cannot continue to bear the burden alone. It is neither appropriate nor sustainable for the U.S. government to continue as the principal source of funding for countermeasure development. Instead the GHSI members need to work together to develop a global marketplace for medical countermeasures. Only a global marketplace can ensure continued development of these crucial commodities," he said.
Third, the GHSI will address issues of food and import safety. "This year more than 2 trillion dollars worth of products will be imported into the U.S., about twice the size of the entire economy of Brazil. These products come from 825,000 importers, through 300 different ports, and one thing is abundantly clear. We simply cannot inspect our way to product safety. Doing so would bring international trade to a standstill," Leavitt said. He cited two things that the United States must do: standardize quality measures in producing nations, and protect supply chains from terrorism. We should "treat imports like patients," focusing on prevention first and then intervention and response when necessary he said.
Prepared for Internal Threats
While global cooperation is essential to health security, Leavitt emphasized that U.S. efforts are "focused intensely on what we can do here at home. The U.S., in particular, has made major advances in preparedness since 9/11. One very visible change is right outside my office. What used to be a conference room is now a high-tech operations center that is staffed around the clock by officers of the U.S. Public Health Service. It is called the Secretary's Operations Center, and it exists for one primary purpose: to make certain we are never caught off guard by a health emergency, and to coordinate our activities should one occur."
Marking significant changes in the HHS mission, Leavitt noted, "We have become very much about medical response in our mission of health. We have had to reorganize our senior leadership to give emergency preparedness the prominence that it deserves." Last year Congress passed the Pandemic and All-Hazards Preparedness Act, which established the office of Assistant Secretary of Preparedness and Response, currently staffed by Rear Admiral Craig Vanderwagon. The act also transferred the National Disaster Medical System from the Department of Homeland Security to HHS, and established the Biomedical Advanced Research and Development Authority (BARDA), charged with overseeing medical counter-measures.
Addressing pandemic preparedness with a special emphasis on influenza, Leavitt said, "The federal government has made an enormous amount of effort and progress in building up the nation's defenses and planning for the future. We have licensed the first H5N1 vaccine for humans and have stockpiled enough antivirals to treat more that 40 million Americans. We have invested heavily in clinical research here at home and surveillance systems around the world. We have also developed a strategy and plan of action for medical counter measures. We have stockpiles now of necessary supplies. Our goal is to be able to respond within 12 hours, and bring a stockpile of basic medical supplies to any airport in the U.S., any state in the U.S."
However, while the federal government is investing heavily in preparation, Leavitt emphasized that much of the response needs to be local. "There needs to be preparedness at every level. . . . everyone needs a plan, and every individual can do something. We have held pandemic summits in every state. Our message in those summits was clear and unambiguous. We indicated that there is a federal role here and we will carry it out. But any community that fails to prepare, with the expectation that the federal government will come to their rescue, will be tragically wrong. . . There is no way for one government—state, federal, or otherwise—to be everywhere at the same time. And a pandemic is uniquely everywhere."
Preparatory exercises conducted with media outlets around the country are particularly important, said Leavitt. "We know that one of the most challenging aspects of a pandemic is how we inform without inflaming, how we inspire a sense of preparation but not panic. Dealing with media and helping them craft information messages as opposed to fueling the panic is an important part," he explained.
On the Right Track
"I'm confident we are on the right track, and that we are organizationally approaching it in a proper fashion. We remain committed to strengthening global health security, and we know that all of our countries are safer as a result of the work that has happened over the last several years," stated Leavitt. Wilson Center Board of Trustees' Chairman Joseph Gildenhorn concluded by saying, "The world demands a global effort to manage the complex health issues that arise every day…These issues are not merely humanitarian, they are also vital to national and world security."
By Michaela Hoffman