DISCUSSION: What will make the Prioritization Guidance Acceptable?

COMMENT: Truth Telling

Submitted by Katharine Fisher on 12/6/07 8:08 AM

What will make the Prioritization Guidance acceptable?

The truth.

My government needs to remove the words "scare" and "panic" from it's vocabulary. When meetings take place, when operational objectives are defined, those words should be disallowed at the table.

It is completely acceptable to tell our citizens "we don't know" if you really don't know the answer to a question posed.

It is completely acceptable, and even preferable, to tell our citizens that you wish to remain flexible in your choices of action until the critical data comes in. It's fine to explain to our public that until that time, you are functioning using "guidelines" based on estimates and projections that may change. You need to be clear that they may change, and change substantially.

To be trusted, any Prioritization Guidance must be anchored in the best data currently available (even if that data is expected to change). I find the greatest fault with your current Guidance lies in your assumptions regarding the age groups that will be most affected by pandemic flu and the CFR projected.

I am one of those very few Americans who reads the local Indonesian news on a daily basis. I am one of less than a handful of that group who is willing to additionally watch the videos that often accompany stories of H5N1 cases in Indonesia. I have watched dozens of them. They are nearly all of children. If they are not of children, they are of young mothers of young children (or those in that demographic).

Your assumptions, to me, that an H5N1-related pandemic will be mild, or will adhere to seasonal flu rubrics re. cohort or CFR - (and again, an H5N1-related pandemic is realistically what we are here today worrying about and planning for) - is dangerously off base. The data on H5N1 that we have collected - not 50 or 100 year old data, but current data - suggests the very real possibility of a pandemic virus with great virulence, and one which prefers the young.

Research out of St. Jude suggests that a pandemic strain based on the H5N1 virus need not attenuate in its virulence. This data, by our top researchers, needs to be presented to the American people along side your data (I assume there is data, not just supposition) that a pandemic strain will attenuate and will strike the same demographics as a seasonal flu.

Clearly, we don't know which scenario will be the case. You simply cannot guarantee to the American people that your scenario will end up being the one that unfolds here. Our public needs to be ready for a scenario more like that which is happening, in real time, today, with the H5N1 virus in Indonesia (and elsewhere). Of the approx. 100 dead there, most have been children and young adults. I have seen their faces. I believe that if you had been watching the progress of this virus in that amount of detail, that your planning assumptions might have turned out differently.

Again, if you hesitate in telling the American public about the reality of what H5N1 is and what it can do, and what a pandemic strain *may* do if it is H5N1-related, what will occur is that poor decisions will be made based on incomplete or incorrect data and false assumptions.

I am a member of a local Board of Education. You cannot tell my fellow local citizens that a pandemic strain might be disastrous to our children without them looking at you as if you had three heads. The people making the decisions to close school, to keep them closed under pressure, will need to understand the difference between a seasonal flu epidemic and a pandemic strain that may be H5N1-related and the harm it could do to the children in their charge. You are a long way from having educated my fellow BOE members (and my fellow townspeople), and I am sure others all around the nation, about these dangers. Unequipped with the appropriate knowledge, these fine people may make the wrong decisions, and tragically so.

They will ask later why you didn't give them a complete set of information on which to base their decisions. They will ask why the planning assumptions for this Vaccine Prioritization Guidance were based on seasonal flu demographics and why no one warned them of the clear danger to our children that an H5N1-related pandemic, if it ends up being that, clearly posed based on the world's experience of that virus.

So start with the absolute truth, if you truly wish your Prioritization Guidance to be acceptable. If children and young adults may be at substantial risk, you must revise your planning assumptions and communicate this to the American people. If a high CFR pandemic is possible, you must explain to them that we may be reduced to survival mode for a while, and thus keeping on the heat, lights, fuel flowing for critical exigencies, and the task of security, must be the first tier priority (I agree with that). If they don't understand the extent of the danger that has led to that prioritization, they may not accept your assumptions. They may wish their children to be vaccinated first, or grandma, and without clearly understanding the great societal risks, will reject your proposal.

Make sure your plan is grounded in truth, then tell it. Sometimes you do well with this - you have not shied away from telling pregnant women they are at extreme risk. Be as forthcoming with every other citizen. Banish the words "scare" and "panic" and expect your fellow Americans to rise to the challenge. Censor and obfuscate, though, and we may have a real mess on our hands as things unfold.

The first thing our government can do for us is be honest. Use real data, put it out there (i.e. use mass media, not just frameworks and guidelines few will read), be clear that we are concerned about H5N1 and all that implies, push for education on more than hand washing, and clearly delineate the risks or the American public will reject even thinking about the subject.