JEFFERSON CITY - As avian flu outbreaks continue their westward spread from Asia into Europe, Missouri is ratcheting up preparedness in case of a pandemic migration to the states.
Numerous public health officials and community leaders gathered last Thursday at Saint Louis University for a Missouri pandemic planning summit.
Gov. Matt Blunt signed an agreement with the U.S. Department of Health and Human Services Deputy Secretary Alex Azar at the Feb. 23 summit. The agreement will give Missouri more than $1.8 million for pandemic preparation and planning.
The event was an opportunity for leaders to develop the best processes by which plans can reach local schools and businesses, said Aaron Winslow, Missouri's Community and Public Health Emergency Coordination Chief.
"This will help to raise serious awareness to the good base of knowledge and expertise in the state," he said.
"We're in good shape," Winslow said. "Some of our plan has been in place for a while, some of it is new. We've added lab capacity and bolstered surveillance since 2001, so we've made good progress on things unique to a pandemic."
Missouri began planning for a pademic flu outbreak more than 10 years ago, said Eddie Hedrick, the Emerging Infections coordinator for the Missouri Health Department.
"We'll have a combination of systems that would be utilized if needed," Hedrick said. "The federal government would have a lot of control, though, on how a strategic national stockpile of vaccine would be distributed."
Although a vaccine has yet to be developed for bird flu, Missouri health officials already are developing plans on how to distribute it.
"Recent shortages have brought a lot of attention to the possibility of an outbreak," Hedrick said. "Bad distribution systems were to blame for those shortages."
Only one of the four major vaccine manufacturers in the world resides in the United States, a decline from past years, he said.
"Distribution was not profitable for companies and protection was limited, so they got out of business," Hedrick said. "Now the federal government is giving incentives to companies to develop vaccine."
In most of Missouri's 115 counties, the vaccine storage site would be based at the local public health center.
But the distribution of vaccine is only part of the problem. Manufacturing enough vaccine to fight an outbreak is another looming predicament.
"It takes time to manufacture this vaccine," Hedrick said. "Based on current technology, it would take six to eight months after the start of a pandemic to make and distribute accurate vaccine. It would not be given all at once, but at about 20 million doses a month.
Hedrick said he believes future technology, just a few years down the road, may allow for quicker distribution.
Should a pandemic reach the America, such a vaccine would need to be protected. Hedrick says the need for security will depend on the amount of vaccine produced.
"Security is going to be a big issue when the vaccine comes," he said. "The federal government will make the major decisions regarding where and when the need for security will be at that point."
Early last month, the state Health Department endorsed a federal a pandemic flu plan for the state that outlined the ranking of priority groups who would receive the vaccine in the event of an emergency.
The first tier includes vaccine and anitviral manufacturers and health care workers directly involved with patient care.
Joining them are those who have one or more influenza high-risk conditions, depending on age, those who have a history of pneumonia, pregnant women, those who have household contact with immunocompromised people who would not be vaccinated due to a likely poor response to the vaccine, public health emergency response workers, and key government leaders.
The second tier includes those who are healthy and at least 65 years old or 6 to 23 months old, as well as certain remaining public health emergency responders, public safety workers, utility workers, transportation workers who move critical supplies, and telecommunications/IT for network operations.
The third tier includes other key government health decision makers and a number of funeral directors/embalmers.
The last tier includes people from ages 2 to 64 who are not in any of the above categories.
The plan gives further definitions and rationales for each grouping.
Hedrick says many key figures came together to form this list including ethicists, public representatives, and vaccine makers.
The National Vaccine Advisory Committee voted unanimously for the priority recommendation listing in July, 2005. All states were encouraged to follow the suggested listing to ensure uniformity and cooperative planning.
Representatives of public and private sector stakeholder organizations, academic experts, and members of the U.S. departments of Defense and Health, and and Veteran's Affairs agency also participated in deliberations of the list.
"This is a national ranking system that is consistent throughout the country," Hedrick said. "Without consistency, people would be running across the country to get vaccine."
A separate priority list is in place for Tamiflu, a drug that is taken after an individual contracts bird flu, that can soften the impact of the flu's effects.
Prioritization for Tamiflu is a little different from that of a prevention vaccine. In the case of a pandemic, patients who have actually been admitted to hospitals will get first opportunity for the Tamiflu.
Winslow said Missouri's preparedness in comparison to other states looks good.
"We're as far along, and in a lot of cases, further along, than most states," he said. "Polling shows that Missouri routinely falls in the top 1/3 for preparedness among states when it comes to these types of situations."
Public education and cooperation will be vital to beating a possible outbreak of avian flu, Hedrick said.
"A huge concern is finding ways to educate the public," Hedrick said. "Public and health professionals coordinating their messages to the public is important. Mixed messages will only confuse and upset people."
Hedrick says a lot of flexible thinking and planning is needed for a variety of possible scenarios.
"A pandemic may happen in a totally different manner than first planned," he said. "Flexibility, consistency, and communication will be required."
Hedrick said he wants Missourians to practice community prevention in pre-pandemic times, because he knows people must change their behaviors if a flu comes.
"Good hygiene, staying home if infected for the good of the community will help end the spread of a flu if it does come," he said. "Public responsibility will be crucial."