Swine Flu Tests Public Health System

SOURCE: AP/Miguel Tovar

People wearing face masks stand near the home of Gerardo Leyva, one of the first victims of swine flu, in the town of Xonacatlan, Mexico.

By P.J. Crowley, Andrew J. Grotto | April 27, 2009

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Swine flu has now caused more than 100 deaths in Mexico and more than 20 confirmed cases in five U.S. states, making the issue of public health—global, national and local—a paramount national concern once again. Officials are also monitoring six confirmed cases in Canada and investigating suspected cases in France, Israel, New Zealand and Spain. Prudent steps being taken by governments at all levels demonstrate a basic capacity to detect, identify, and respond to the outbreak of disease, following investments made in the aftermath of significant recent episodes involving SARS and avian flu.

Still, authorities do not yet have the benefit of full information about this dangerous flu strain. Are we experiencing the tail-end of an outbreak, or the tip of a global pandemic? Why are mortality rates higher in Mexico? What are the chances this flu strain will fade away only to reappear during the regular flu season later this year? Having answers to these questions is essential to gauging risk and crafting the appropriate policy interventions.

In the meantime, even if the outbreak is well contained, it will yield important lessons that should inform future national security and public health decision-making. We can think of several questions to consider even though we are in the early stages of an event that could still develop into a crisis.

The first is, did international institutions and individual governments collaborate and cooperate effectively? So far, the answer is “yes” and “pretty well.” Contagious disease knows no boundaries, a strong argument for why the United States should help build competent institutions of government in other countries, even during a period of economic turmoil.

Felipe Calderon’s government in Mexico deserves much credit for its response to the outbreak. Despite having its hands full with a war against drug cartels, Mexico aggressively responded to the outbreak and shared its knowledge in a timely way with its neighbors and the World Health Organization. Mexico’s response to this crisis has been broadly effective and demonstrates that the country possesses real capabilities and resources. A recent military report suggested that Mexico was in danger of becoming a failed state. These events show that the Obama administration was right to debunk that conclusion.

A second issue involves cooperation both within the U.S. federal government and among federal, state, and local governments. Again, the early signs are positive. The Department of Homeland Security is now the centerpiece of the federal response, and there is solid evidence of effective coordination among DHS and the Departments of Defense and Health and Human Services. Federal stocks of medical supplies, including antivirals, have been authorized for release and distribution around the country as a precautionary measure.

The Centers for Disease Control is in contact with and closely monitoring actions taken at the local level, which leads us to the third and arguably most important question going forward. Since public health is first and foremost a local responsibility, how well will local authorities perform, particularly if the disease spreads further?

The public health system in the United States—the network of federal, state, local, and private-sector entities responsible for the health of the nation’s population—has been under stress for decades, even before the current economic crisis. While medical surveillance systems have improved, particularly in rural areas, they are largely dependent on an informal network of public health, veterinary, and natural resource professionals and are not yet incorporated into a national system of public health. And despite our state-of-the-art medical technology and dedicated health professionals, we do not have sufficient medical infrastructure in many parts of the country to accommodate everyone who might need medical care in a crisis.

Public health became a national security concern in the aftermath of the 2001 anthrax attacks. But this emerging swine flu epidemic poses a more significant and more likely threat to the United States and the region. It will be important to act aggressively and sensibly, deepen national and international relationships and trust, learn valuable lessons, and continue to make prudent investments to improve public health capabilities across the country and around the world.

Andy Grotto is a senior national security analyst and P.J. Crowley a senior fellow at the Center for American Progress.