Pandemic Flu: An Argument for Excess Capacity

Today, Effect Measure examines how the traditional economic model of supply-and-demand is affecting preparedness for pandemic flu. The maker of Tamiflu - one of the only antiviral drugs that's effective against H5N1 flu symptoms - is cutting back on production:

Roche is now planning to cut production of its antiviral Tamiflu because, they say, supply is exceeding demand...

Roche defends its actions by saying that it is simply responding to market forces. The current non-pandemic market for Tamiflu does not justify increased production.

But is a traditional market the appropriate model for catastrophe preparedness? The folks at Effect Measure argue it's not, because excess capacity is required if we are to quickly respond to the initial waves of pandemic flu:

How long would it take them to restore full capacity? Four months ... So this isn't "speedy," and even when running full blast, supply wouldn't meet need. In such circumstances supply has to greatly exceed demand. It's not economically efficient. Neither is a pandemic. So we need to go outside the market mechanism. Just like the vaccine situation.

How far outside the market mechanism to go is a question for political leaders. But developing excess capacity is clearly required in some situations.

In terms of the current state of preparedness, a lack of excess capacity is not just relevant to antiviral drugs. In the event of a flu pandemic, there will be a lack of personnel and resources. As the American Public Health Association recently pointed out. (My post is here.)

[I]f staffing levels remain stagnant, the current health care workforce cannot be depended on in event of a flu pandemic.

The problem doesn't stop with personnel. We also don't have enough beds, as the Trust for America's Health reported late last year. (Also see my post.)

Half of states would run out of hospital beds within two weeks of a moderately severe pandemic flu outbreak.

Along with a shortage of healthcare personnel and physical resources, there will be no vaccine - and a shortage of other medicines, as the CDC recently pointed out in its interim guidelines for community flu preparedness. (My post is here.)

It is highly unlikely that the most effective tool for mitigating a pandemic (i.e., a well-matched pandemic strain vaccine) will be available when a pandemic begins. This means that we must be prepared to face the first wave of the next pandemic without vaccine and potentially without sufficient quantities of influenza antiviral medications.

For local preparedness professionals, collaborating and sharing information with public health agencies, healthcare providers, business leaders, etc. is critical.

Planning resources are available. For instance, the list of all State pandemic flu plans can be found here, and a local planning checklist is here.

Update 04-27-2007: Here's a bit more information from a recently released GAO report on public health preparedness.

First, late in 2007 the CDC plans to publish an updated report on the status of public health preparedness:

CDC plans to issue a report by the end of 2007 providing a “snapshot” of the progress recipients have made in building emergency readiness capacity and addressing how CDC will measure capability in the future.

The Health Resources and Services Administration (HRSA), which focuses on hospital preparedness, is not certain when more information will be available:

HRSA officials said that decisions about whether to issue a report in 2007 on recipients’ progress had not been made.

Also, for formality's sake I'm using the wrong term. "Capacity" is out; "capability" is in:

Early in a program, performance measurement systems can focus on measuring capacity, such as equipment and supplies purchased and personnel hired. As programs mature and more data and scientific evidence are available, performance measurement systems can focus more on measuring capabilities, such as whether personnel are trained and can appropriately use equipment and supplies.

This is more consistent with the Interim National Preparedness Goal and draft Target Capabilities List.

Cross-posted at the Institute for Preventive Strategies.