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October 06, 2005

Avian Flu: Steep Learning Curve for Congress
Posted by Lorelei Kelly

On Monday, I was visiting a friend  in the House of Representatives--where approximately half of the staff are walking on sunshine and the other half have the sickly look of a pithed biology frog who knows what's coming (those would be the Republicans)  As I sat in the front office, I chatted with the receptionist intern. Hill interns have a much more mundane existence than their counterparts in other branches of government.  They spend a lot of time receiving and opening mail.  Although it's nothing compared to an impeachment trial, this job has become an above average thrill since the anthrax attacks during 2001-2002.  All Capitol Hill mail is now irradiated--the crispy yellow pages and nuked envelope paste adds to the excitement of what lies beneath the letter knife.

Anyway,  while sitting there, I noticed the intern open a pack of wall posters from the Center for Technology and National Security Policy at National Defense University.  They were handsome, instructive public health posters about how to  recognize bird flu and what to do about it.  My mom is a public health nurse, so I looked at them covetously and then watched with dismay as-- PLOP-- they went into the garbage can.   He then moved on to open a stack of boxes, each of which contained several  300 page hardbound volumes entitled "Ronald Reagan: Late a President of the United States"  The books were the  compiled memorial tributes delivered in Congress last June upon the death of Reagan, published by the Government  Printing Office. I noticed there were far too many to be of use in one office.  Maybe China will accept some as barter on our debt.

But back to the avian flu.  Throwing the posters into the trash  pretty much symbolizes how Congress has responded to new security issues since the end of the Cold War.  Global threats in particular just don't fit into the antique structure of Congress, and because they don't fit into the jurisdictions of existing committees, they fall between the cracks. This is particularly true of  trans-national security issues.  Such toics--like avian flu-- cross more than one committee's interests.  If you were to narrow it down,  the committees that handle security are primarily foreign relations and defense.  In Hill speak, the defense issues are handled by the HASC and the SASC.  The foreign relations by the HIRC and SFRC.   These oversight plans and jurisdictions are instructive.  The foreign relations plans are pages and pages long.  The armed services jurisdictions and oversight plans are quite a bit shorter, especially in the Senate where it is one paragraph plus change.  These descriptions don't reflect the fact that the military is involved in just about every important foreign policy issue that exists today.  Lots and lots of issues don't get their full measure of attention because they don't "fit".

I attended the Princeton Project on National Security conference last week along with Suzanne. On Friday,  a happy yelp arose amidst the gathering as one participant announced that the Senate passed legislation on Thursday to add $4 billion to fight avian flu.  This money was tacked onto the defense appropriations bill for 2006.  Now, I think that's great, but why can't we fund a solid and generous public health system like most normal countries?  Countries where public health is a high priority are far better prepared and defended against global pandemics and biological terrorism. Why does avian flu only get the urgency it deserves on a defense bill during wartime?  Something is wrong with this picture.

On a progressive note, check out the House Armed Services site on Committee Defense Review  This panel of Members convenes on a parallel track to the official committee hearings in order to bring up all sorts of new threats and security challenges.  It is bipartisan and, as Congresswoman Ellen Tauscher says, a chance to  "look at what challenges we're confronting rather than weapons programs we want to advance."  Fine words and an auspicious start.

p.s. I rescued the posters from the trash and now they are featured in several Washington offices. I also have a book of Reagan speeches.


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Good post Lorelei but that link to the Committee Defense Review doesn't work for me. My congressman Jim Saxton (R-Lockheed Martin) is on the HASC and I'd like to keep up
on this. Can you fix it?

Mark, here is the link cut and pasted from my own computer. This will take you to the page where you can then link into the committee defense review. Maybe it didn't work because it linked to a .pdf
I've notified the site admin, too. thank you.

... but why can't we fund a solid and generous public health system like most normal countries?

This is silliness. I'm an academic physician, and your statement couldn't be more wrong.

First, we have a modern public health system. It's called, the CDC. It gets billions of dollars a year to do its job, and it's one of the more sober, credible, serious government agencies out there. The people there are, by and large, superb.

We also have an NIH that works with CDC on public health research. They get another $25 billion or so, and a fair bit of what they do ends up benefiting public health.

You may have seen the recent news on the genetic mapping of the 1918 Spanish flu virus? Who did that? Researchers and public health professionals working hand in hand in the US.

We also have 50 state public health departments. Those run the range from excellent to really mediocre. Most counties and major cities have their own public health departments as well, with similar variations in quality.

So we have a layered public health system that actually works pretty well and is 'modern' in every sense. One can quibble about certain issues, one can argue that the system might need more money or more this-or-that. But the claim that we're not funding a 'solid and generous public health system' is specious and demonstrates a lack of seriousness, and an over-abundance of partisan chops.

Mr. White,
you are obviously a professional, so maybe your job provides a tidy benefits program for you. Your institution also might be on the gravy train of dinero leaving Congress for research or epidemeological studies via CDC. I don't think over 40 million Americans without health insurance (and I assume that many of them get no care at all) is 'silly' however. I do think that these uncared for individuals have something to do with lack of public health infrastructure, someplace, somehow, maybe in community health centers or outreach programs? I know I don't have to get into the difference between a cause and a correlation though, since you're an academic and all.

Lorelei and Steve,

I also would like to see individual health care distributed more universally and equally in the United States. But I would like to know more about the impact of our current unequal system of health care distribution on US public health. Does the United Staes have a poor track record of responding to global pandemics, and inhibiting their spread inside the US? Are there some recent examples of communicable diseases spreading more rapidly and widely in the United States than in other developed countries with different kinds of health care systems?

Is there no other government spending specifically related to avian flu besides the recently allocated $4 biliion?

Knowing the US as a visitor(I have a family member and his family living there)I as an Australian find it inexplicable that so many US citizens have no access to health care,in the world's richest country.Here in Austalia we have a had a universal national health scheme for more than 30 years. Its' paid for by a small levy(1.5%) paid on ones taxcable income. I receive for this visits to my local doctor which costs nothing, medicines as prescribed by him, at about $4 US,per item,and the use free of public hospitals. Last year I had a major brain ilness(enureism) and had a month in hospital,with 4 operations,and then a months in rehab. All this costs me nothing at all Everyone in Australia pasy the levy if you have an income...those not receiving an income,the sick,children,the elderly,unemployed are all covered too. I have a small "card" like a credit card which gives me entry and access to all services. It really works,as do similar schemes in France,Britain,Finland,and many other countries,so why not the US ?..or is the US not" modern " enough to structure such a system ?

After last year's flu vaccine panic I see a serious lack of public health structure. So many people are unserved by the health care system due to lack of insurance. People are suffering and dying from preventable disease. We should see this as a marker for the gaps in the system, because the points of failure for basic preventive health care are the same points where an emergency response to an epidemic will run into trouble.

In the US county I live in, uninsured people can go to any of a number of county public health department sites and get a TB test for a small fee -- $12 or $18, something like that. They can get tested for STDs for a nominal fee, I think $1. HIV tests are probably free. Children can get the full range of childhood immunizations for free, if they claim they lack insurance.

The last I heard flu vaccines were available only for people who are particularly exposed, mostly health care workers, because there weren't enough vaccines available, and the avian flu shots weren't available at all for the same reason.

But we are well-prepared for traditional epidemics. Children are required to have documentation showing they are immunised before they can go to public school, or else give solid reason why not, and most children are immunised.

We have a volunteer system to set up lots of immunisation points in an emergency to immunise lots and lots of people quickly. (Part of the problem is that the fewer the sites, the more people may be exposed to an infective agent while they wait to be immunised.) The people and the communications network are set up, all they need are the vaccines.

To control avian flu the health department is encouraging everyone to wash their hands. To control west nile virus we are encouraging everyone to eliminate breeding spots for mosquitoes. Also we have teams that catch mosquito larvae and test them for west nile virus, and announce it when they find some.

We don't let children go without medical care. I knew a family that had no coverage and helped them register with the county aid. In only one month they were issued health insurance for the children for which there was no co-payment. But then two months later they got a letter saying they didn't qualify after all and they could appeal. The appeal process took 2 months, and they were reinstated, but two months later they were again disqualified and they found they got their children reinsured quicker by simply applying again which took only one month. With an average of only 4 hours waiting every other month they could keep their children insured about 2/3 of the time.

Our health service tests animals for rabies and checks buildings for asbestos. They monitor air quality, drinking water, and radon. I question their ability to be excellent at so mamy varied skills, but they are excellent at giving the impression of competence.

Health system is big problems in all over the world in my country the health department has declared the existing rate contract for the purchase of medicine five year ago but still yet we no receive any progress in this matters.

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