Pandemics, as seen during the spread of the H1N1 virus in 2009–2010, begin suddenly and spread quickly. They have significant impacts on our health, economy, supply chain, and social fabric. Following the H1N1 pandemic, the LMI Research Institute analyzed the federal response plan and those of 10 states. Its independent report, Pandemic Consequence Planning: Assessment of Preparedness and Response, identifies weaknesses and strengths, and recommends improvements to federal, state, and local pandemic preparedness and response.
Understanding Pandemics: Pervasive and Persistent
“A pandemic event is pervasive. It’s not just people getting sick, but is a severe disruption to the way we do business and the way we interact as a community,” explained Matt Daigle, Senior Public Affairs Specialist for LMI, and one of the study’s authors. “During such an event, people are looking to the government—whether it’s local, state, or federal—to guide them.”
The LMI Research Institute found that many pandemic plans relied on generic emergency response plans with a medical annex. They largely failed to address a pandemic’s pervasiveness and persistence, or the fact that the response must occur during the event, rather than after, as with disasters like hurricanes.
“Most of the plans also omitted the local perspective,” Daigle said. The plans included little information about local resources and capacity, and lacked local guidance on how to prioritize actions. Such input is essential to planning, as “it’s the people in the community who best understand local assets that state officials might be otherwise blind to,” Daigle noted.
Bi-Directional Communication Critical
The institute noted a significant communication weakness in the plans. Most communication was top-down—federal agencies providing guidance and recommendations to states—but with little bottom-up feedback regarding capacity shortfalls, resource availability, or private-sector assets that could be tapped in an emergency. LMI recommended bi-directional communication with guidance still coming from the top, but incorporating bottom-up input from local communities regarding capacity gaps such as a shortage of hospital beds, local and state readiness assessments, private sector resources, and financial constraints.
Communication to the public during a pandemic is also crucial. Social media can play a significant role. “It’s critical that government organizations and stakeholders stay current with how people are communicating and where they get their information. If there is a vacuum in the communications sphere, someone will fill it, and not necessarily with the messages you need to have out there,” Daigle said.
Social media, Internet, and email can be useful communication tools in rural communities, as their limited local media outlets may be more vulnerable to personnel shortages resulting from a pandemic. Communications outreach to businesses is also important because of that community’s influence over the working population.
Preparedness Plan Weaknesses
The LMI Research Institute found that plans consistently lacked details on three important categories: the economy and supply chain, mass fatalities, and medical surge management. The H1N1 pandemic had an estimated U.S. economic impact of $30-$40 billion. A pandemic can affect millions of people, and states are generally unprepared to deal with the economic loss from the missing productivity of millions of ill citizens during a prolonged period.
Plans also lacked details related to mass fatality management, such as providing guidance on where to find personnel and volunteers, how to recruit them, or how to credential them quickly. The institute identified weaknesses in planning for the surge in medical personnel and facilities anticipated. Most state plans failed to indicate how alternate care sites can be identified, how the scope of care can be expanded, and how legal requirements, such as patient documentation, can be modified or waived.
The research team included 15 members from LMI with experience in health and emergency response, logistics and supply chain management, vaccine stockpiles, economics, communications, and government services. Three independent subject matter experts also contributed: Ellen Embrey, former assistant secretary of defense for health affairs and director, TRICARE Management Activity; Judith Kauffmann, a visiting scholar with the Global Health and Foreign Policy Initiative; and Ambassador Robert Loftis, former special representative for avian and pandemic influenza at the State Department. Together, they spent three months analyzing plans, assessing economic impacts of the H1NI pandemic, and developing recommendations to improve pandemic consequence planning.
The LMI Research Institute made 18 recommendations related to pandemic preparedness and response. A sampling includes:
- Improve command and control capabilities through robust exercise planning,
- Invest in technology to support remote work and nontraditional, emerging communication initiatives,
- Establish a common communications framework for sharing information with the public,
- Address capacity issues,
- Develop national and international stockpiles of antivirals, personal protective equipment, antimicrobial gels, and other prophylaxes
- Develop pandemic surge capacity for personnel
- Leverage home schooling and distance learning concepts to support prolonged absences or school closures.