Public Health Infrastructure under Pressure
by Michael Hill
As chair of NACCHO’s Public Health Infrastructure and Systems Committee and Director of the City of El Paso Department of Public Health, I would like to share my insight on the H1N1 pandemic in terms of public health infrastructure. I found that recent investments in building public health capacity to meet situations like this has made us much more prepared than we were. But this pandemic did not necessarily follow the textbook, and was not exactly what we had been taught to expect.
Our epidemiology program was substantially impacted especially during the first wave of the outbreak in the spring. Case and contact investigations were conducted on every laboratory-confirmed H1N1 case. This quickly overwhelmed our small epidemiology staff and did not allow for adequate attention to be directed to other reported diseases. H1N1 funding was used to quickly build epidemiology surge capacity, but more work will be needed to be ready for future events such as this.
The public health laboratory was also overwhelmed during the first wave as public health laboratories were initially asked to analyze every specimen from every suspected case. Instead of conducting public health surveillance, our lab was involved with diagnostic testing of hospital and clinic patients for several weeks. This level of effort for H1N1 took most available manpower away from their normal duties. Again, bio-terrorism funding gave us an enhanced laboratory capacity but not enough ongoing staff to meet this type of peak demand.
The Immunization Program was not severely affected until vaccine became available in mid-October. Since then, our immunization staff has been involved in overseeing the administration of vaccine from our five neighborhood clinics. Additionally, immunization staff oversees the call center where appointments are taken. Funding that has been allocated by the Texas Department of State Health Services and the CDC Cooperative Agreement has helped to minimize the impact on on-going services in this division as it has allowed us to hire temporary nursing staff. Without financial resources to hire temporary nurses and clerical staff, we would not have been able to meet our community’s vaccination needs.
In late April, the Public Health Preparedness Program staff responded quickly to the events of the pandemic by instituting key aspects of its Pandemic Influenza plan. There was a steep learning curve and situational awareness became a challenge as we attempted to follow the daily progression of cases nationwide.
Many investments made by the Preparedness Program became valuable, including solid relationships with our partners. A Crisis and Emergency Risk Communications Plan was activated and remains in effect. This plan assisted a great deal as the health department was the focal point for extensive media coverage. El Paso’s proximity to the border with Mexico brought additional media attention as issues arose regarding traveler’s health and border crossings at the international bridges and the airport. The relationships with stakeholders became increasingly valuable as we began to exhaust our internal resources.
Like our colleagues around the United States (and the world) we rose to the occasion, helped by the years of preparedness funding. There remains a need to fund workforce capacity in health departments to make sure that staff are available and trained to respond to emergencies—rather than relying on temporary staff hired and trained at the last minute. The nation’s health is in good hands. But health officials and health departments are now exhausted. More attention and support is needed to make sure we continue to make the country a safe and healthy place to live.
Michael Hill, Director of the City of El Paso Department of Health in Texas, can be reached at MichaelHill@elpasotexas.gov.