As state health officials prepare to dispense the first trickle of H1N1 flu vaccine next week, a new report warns of gaps in preparation and resources that could swamp responders at the same time health budgets are being cut.
Fifteen states could run out of hospital beds if an epidemic strikes 35 percent of the population, according to a report released today (Oct. 1) by the Trust for America's Health , a nonprofit health advocacy group. States could also face vaccine shortages if a significant number of people start getting sick this month, the report said. A presidential advisory panel has estimated that the H1N1 flu could infect 30 to 50 percent of the population and kill up to 90,000 people, far more than the 40,000 who succumb to the flu in an average year.
The Trust for America's Health report underscores the need for more public health funding, better cooperation between governments and for more outreach to those most at risk from the flu, said Jeffrey Levi, the trust's executive director.
"We need to really address the nation's ability to provide mass care during disasters," he said. "We cannot continue to take a band-aid approach to disaster response."
Under the report's scenario, California could experience about 168,000 hospital admissions in a single week, about 34,000 more admissions than total hospital beds in the state. In Delaware, the number of admitted patients could be double the number of available beds.
The report also warned that some states have not yet stockpiled the maximum amount of antiviral medication subsidized by the federal government. National pandemic plans suggest stockpiling enough antivirals to treat 25 percent of the population. But 13 states do not have enough antivirals to cover 20 percent of their population.
"This could be a problem if significant portions of people with underlying conditions that put people at risk, including asthma, diabetes, cancer, HIV/AIDS, and hear or kidney disease, become sick in states with limited antivirals available," the report said.
Meanwhile, health agencies have not been spared from the budget cuts that have decimated staffs in state governments nationwide. The report found that funding for state and local health preparedness efforts dropped 25 percent between 2005 and 2009.
A survey last month from the National Association of County and City Health Officials found that local health districts cut 8,000 positions this year and furloughed or reduced working hours for another 12,000. Maryland, for instance, cut 160 positions from its health department. Tennessee's budget cuts have prompted staff buyouts and a hiring freeze in the health department, said Dr. Tim Jones, Tennessee's state epidemiologist.
"People are working 20 hours a day here into the weekend," Jones said. "We're not businesses and so suddenly we're finding ourselves in the business of having to order and allocate medications and this is the kind of thing a big pharmacy chain could do with their eyes closed. For us, it means building systems from scratch and doing it in a few weeks."
Public health officials hope to reduce the number of people who get sick by rolling out one of the most ambitious vaccination programs ever. In the weeks ahead, the federal government will provide millions of free vaccine doses to state health agencies, who will then transfer the doses to about 90,000 distribution centers nationwide. The first batch of vaccines, expected next week, will be reserved for health care workers. Afterwards, health officials will focus their efforts on children, pregnant women and young adults with pre-existing conditions, all groups that are the most vulnerable to the H1N1 flu.
"Never before in this country have we launched a campaign to provide 250 million doses of vaccine in this period of time," said Dr. Paul Jarris, executive director of the Association of State and Territorial Health Officials .
Much of the logistical burden falls on states, he added. "I'd be surprised if anybody's sleeping in the states these days," he said.
In Tennessee, officials have been working to plan shipments to distribution centers and to educate the public about the need to reserve the first doses of the vaccine for high-risk groups, Jones said.
According to the U.S. Centers for Disease Control and Prevention , 26 states, mostly in the South, reported "widespread" pandemics last month. In Tennessee and Texas, flu cases have swamped hospitals and led staff to set up tents in parking lots.
Similar flare-ups could be in store in other states in the months ahead. In Oregon, economic forecasts warned that the disease could disrupt the economy if a significant number of workers have to stay home.