The RAND Technical Document TR-239: Exemplary Practices in Public Health Preparedness - Term Paper Example

The RAND Technical Document TR-239: Exemplary Practices in Public Health Preparedness Abstract Public health preparedness has assumed a far greater importance after incidents such as the September 11terrorist attacks and the flu epidemics that have threatened not only the United States of America, but also the world. Biological threats are invisible and a very tiny amount of biological agents, such as Anthrax, can devastate large communities. Thus, it is important to be prepared and identification of the best efforts directed towards improving public health preparedness in the United States of America motivated the RAND report TR-239. However, just like any other research effort, there is always a room for improvement. This critique of the previously mentioned report attempts to present a discussion about the perceived shortcomings of the RAND report. Contents Introduction 1 A Critique of the RAND Report on Practices for Public Health Preparedness 3 Conclusion 10 Bibliography/ References 12 Introduction Public health refers to the art and science of disease prevention, infection control and organization of health services and emergency response to disease as well as the promotion of physical and mental health, hygiene and healthy population. 1 A public health emergency can be expected to arise as a result of the spread of infectious disease which is the result of the natural spread of a virus or bacterial infection. However, development of “weapons of mass destruction”, including biological weapons that have the potential for causing widespread threat to life by introducing highly contagious and deadly biological agents have posed new threats. 2 Several nations, including Iran, North Korea and the deposed Iraqi regime of Saddam Hussein have been suspected of possessing biological weapons that are capable of indiscriminate and widespread destruction. Links that the previously mentioned regimes have with terrorist organisations have posed new threats related to covert operations that result in biological attacks and it is also possible for natural public health emergencies to present themselves at any time. The recent threat of global flu pandemic and the rapid spread of avian flu are examples of public health emergencies. 3 Thus, it is important for any nation, including the United States of America, to develop and to implement public health preparedness plans. Crisis management demands that due attention be paid to the magnitude of the disaster and an appropriate response should be presented while having regard for the potential future developments that are possible. 4 This means that it is necessary to have established plans and procedures for foreseeable crisis situations. Emergency response plans are likely to consider perspectives related to risk, coordination between various agencies, coordination building mechanisms, technology, law, policy and available resources including people, finance and communication resources etc. However, it is only possible to act properly if the evolving situation is being adequately monitored and the crisis planners have considered and planned for the worst possible scenarios. Thus, preparedness is an important consideration in the management of crisis which must be monitored so that an appropriate response is possible and a difference exists between emergency response and crisis management. Proper crisis management demands that possible sceneries that are likely to develop are considered in advance and contingency plans are available. The RAND report which is the subject of this discussion was prepared to try to identify those activities and practices that are likely to enhance preparedness for bioterrorism and other public health emergencies, such as the rapid spread of a contagious virus infection, in the United States of America. 5 Such threats cannot be ignored because it is possible for a terrorist organisation or a hostile power to engage in a biological attack relatively cheaply, easily and anonymously with little fear of detection and the natural replication of new virus or bacterial strains pose constantly evolving threats to humans. This essay presents a critique of the previously mentioned RAND report which was prepared after a close examination of many public health preparedness practices from around the country. A Critique of the RAND Report on Practices for Public Health Preparedness Although it must be admitted that the RAND report which is the subject of this discussion has gone to extraordinary lengths to examine what can be done to monitor evolving biological threats, it is felt that this report is short on what can be actually done to best manage and contain the previously mentioned threats. After all, simply monitoring and presenting information related to the monitoring over all kinds of exotic communication links alone is not likely to contain a potential disaster and it is important to properly use the information that has been gathered. It appears that out of the seventy three preparedness practices that were identified as being suitable for inclusion in the report, a vast majority of the exemplary public health practices are about monitoring the public health situation, but nothing has been mentioned about any strategy for dealing with serious threats. Also, when a potential for crisis related to biological threats presents itself, especially those threats that are associated with bioterrorism, a need exists to somehow act quickly to protect many lives, including the lives of humans who are engaged in monitoring and evaluating threats. Thus, something should have been said about what preparedness practices related to a response to a rapidly developing threat were found to be exemplary. Strategies for response to an evolving catastrophe are expected to put into action rapid prevention and containment plans, minimize deaths and deferred cases and effective coordination of available resources to not only counter a crisis but also to prevent other crisis. 6 It is important that attention should be directed towards considering worst case situations and also the political and international crisis situations. The previously mentioned have not been considered in the RAND report. For outbreak of a disease or a natural biological calamity it is important to consider those people who are likely to be without a health insurance and who are also likely to be from the poorer segments of the society, without a health insurance. Specific preparation and response plans are important and these should be directed towards the known biological agents that can cause a crisis. Best practices that are associated with a strong mobilization and coordination capability for dealing with a crisis or an emergency should be worthy of consideration. 7 Plans for handling the domestic political situation in the event of a crisis and coverage for marginalised people are also important. All of the previously mentioned should have some mention in a document that is about preparedness for a major crisis involving substantial threat to life and social order. Although the government in the United States of America does emphasize policy coordination amongst different agencies of the government how this is done is not apparent from the report that is about public health preparedness. It is important that any crisis preparedness or emergency response strategy should try to provide the best possible and the most effective readiness for the worst possible scenario at the lowest possible cost. However, economics and cost benefit analysis has not been considered as being a factor in RAND technical report that is the subject of consideration for this discussion. All preparedness best practices that have been selected for inclusion in the RAND report should be described fully with recognition for the utility of a best practice in crisis management, the main goals that are expected to be met as a result of adopting a best practice, how this best practice can fit into an overall response plan and what implementation measures are desirable for any given practice. Although it should be understood that every crisis is likely to present novel situations and limitations do exist with regard to the risk recognition that is possible, attempts should have been made to try to explain how specific practices connect up with an overall response plan. It has been recognised that a new variant of a virus evolves out of the existing types over a period of time. This means that a new virus type has to be identified and a suitable vaccine has to be developed over time. The process of developing new vaccines can take months and this means that first a new virus variant has to be identified and then a vaccine should be developed as quickly as possible. However, biological weapons that are likely to be used by terrorists or hostile powers are unlikely to be anything radically new and this means that methodologies for such biological weapons are likely to exist. A preparedness best practice or plan should include references to stockpiling of vaccines or antidotes for rapid deployment should a need arise and the means for deploying such agents is critical in a rapid response that is expected to save as many as possible. Perhaps the preparedness best practice report should have mentioned something about stockpiling and rapid deployment methodologies that are likely to be very useful in the event of a real biological attack against the nation. Although a wide consultation was attempted for the preparation of the RAND report on exemplary best practices for public health practices, including identification of scientific and grey literature, examination of conference proceedings, consultation with professional associations and state public health authorities together with monitoring of news releases, it is surprising that the United States military was not consulted in an attempt to classify those best practices that are likely to be of interest. The military is not a public health authority or an agency with vested interest in the public health function however it is the military which is likely to have performed a very thorough research on dealing with biological weapons threats because in times of war the biological weapons threat is something that cannot be ignored. It is not just the frontline troops that are likely to be attacked with an assortment of biological weapons, but military personnel who are behind the frontline and important population centres are also likely to be a threat during a war. Thus, although many military plans and technologies are likely to be classified, perhaps interviews or consultation with the United States military on their preparedness for countering biological threats will have been worth the effort. Although the time that is available for responding to a natural public health threat is relatively far more than what is likely to be available for a biological attack, both of the previously mentioned threats are invisible. Often, it is only the symptoms that they present in living organisms that provide a first indication that a threat exists and to counter the threat decontamination equipment and protective gear for first responders is likely to be needed. Also, many biological threats that can be used against population centres have no available vaccines. 8 Thus, an essential component of preparedness is to analyse possible threat scenarios and to provide a capacity for a rapid first response to be possible. It may make sense to have a mobile laboratory that can be rushed to a scene on a trailer but it is equally important to have strategic reserves of material and equipment that can be used in localities in the event of a biological attack. Personnel who are likely to be the first responders have to be well trained and as the number of threats increases, it is important to be able to rapidly identify what a threat is and how to deal with it. Although communication systems that are dedicated to disseminating information about biological threats to authorities are important, it is also necessary to have first responders alerted to how o deal with a threat rapidly. Thus, a lot more is involved in public health preparedness then threat monitoring. The exemplary best practices report that has been prepared by RAND should also have included some suggestions about what direction preparedness should take for the nation, states and localities. This means that an attempt should have been made to try to briefly add to a mere description of best practices and emphasize on what has been lacking in the overall efforts to improve public health preparedness around the country. However, unfortunately this was not done and those policymakers who read the report are likely to find it to be somewhat incomplete because they are not likely to be able to decide about how to better focus their future efforts. New developments related to sensors and mathematical modelling for the spread of disease offer possibilities that extend beyond the efforts that are directed towards using communication channels in exotic ways and these should have been presented to the readers. Conclusion It should be understood that the team that prepared the RAND report on exemplary best practices for public health have indeed put in the effort to try to discover what best efforts were being made around the nation. However, it will appear that the authors have become bogged down in describing how communication systems are being used to present information related to threats. It is sad to note that after going through a huge amount of researched material related to public health preparedness those who prepared this report were in a good position to provide an indication to the readers about any shortcomings in the efforts that are being made. However this was not done and thus an opportunity was denied to the readers to better understand how they could try to improve on the focus of research related to public health preparedness. Bibliography/ References 1. Cashman, John R. (2008). Emergency Response Handbook for Chemical and Biological Agents and Weapons. CRC Press. 2. Encyclopaedia Britannica. “Bioterrorism Preparedness” presented in article “Health and Disease”. (2008). Encyclopaedia Britannica. Ultimate Reference Suite.  Chicago: Encyclopaedia Britannica. 3. Encyclopaedia Britannica. “War on Terrorism” presented in article “United States”. (2008). Encyclopaedia Britannica. Ultimate Reference Suite.  Chicago: Encyclopaedia Britannica. 4. Encyclopaedia Britannica. Public Health. (2008). Encyclopaedia Britannica. Ultimate Reference Suite.  Chicago: Encyclopaedia Britannica. 5. Peng, Zongchao (2008). Preparing for the Real Storm during the Calm: A Comparison of the Crisis Preparation Strategies for Pandemic Influenza in China and the U.S. Journal of Homeland Security and Emergency Management: Vol. 5: Iss. 1, Article 47. Retrieved: October 5,2008, from: http://www.bepress.com/jhsem/vol5/iss1/47 6. Tanielian, Terri et al. (2005). RAND Technical Report TR-239: Exemplary Practices in Public Health Preparedness. Rand Corporation. Retrieved: October 5, 2008, from: http://www.rand.org/pubs/technical_reports/2005/RAND_TR239.pdf Read More