Kunal J. Rambhia

Mass Vaccination for the 2009 H1N1 Pandemic: Approaches, Challenges, and Recommendations

The 2009 H1N1 pandemic stimulated a nationwide response that included a mass vaccination effort coordinated at the federal, state, and local levels. This article examines a sampling of state and local efforts during the pandemic in order to better prepare for future public health emergencies involving mass distribution, dispensing, and administration of medical countermeasures. In this analysis, the authors interviewed national, state, and local leaders to gain a better understanding of the accomplishments and challenges of H1N1 vaccination programs during the 2009-10 influenza season. State and local health departments distributed and administered H1N1 vaccine using a combination of public and private efforts. Challenges encountered during the vaccination campaign included the supply of and demand for vaccine, prioritization strategies, and local logistics. To improve the response capabilities to deal with infectious disease emergencies, the authors recommend investing in technologies that will assure a more timely availability of the needed quantities of vaccine, developing local public health capacity and relationships with healthcare providers, and enhancing federal support of state and local activities. The authors support in principle the CDC recommendation to vaccinate annually all Americans over 6 months of age against seasonal influenza to establish a standard of practice on which to expand the ability to vaccinate during a pandemic. However, expanding seasonal influenza vaccination efforts will be an expensive and long-term investment that will need to be weighed against anticipated benefits and other public health needs. Such investments in public health infrastructure could be important for building capacity and practice for distributing, dispensing, and administering countermeasures in response to a future pandemic or biological weapons attack.

A Survey of Hospitals to Determine the Prevalence and Characteristics of Healthcare Coalitions for Emergency Preparedness and Response

Previous reports have identified the development of healthcare coalitions as the foundation for disaster response across the United States. This survey of acute care hospitals characterizes the current status of participation by US hospitals in healthcare coalitions for emergency preparedness planning and response. The survey results show the nearly universal nature of a coalition approach to disaster response. The results suggest a need for wide stakeholder involvement but also for flexibility in structure and organization. Based on the survey results, the authors make recommendations to guide the further development of healthcare coalitions and to improve local and national response to disasters.

Everywhere You Look: Select Agent Pathogens

The United States regulates more than 80 human, animal, and plant pathogens as part of the Select Agent Program, imposing strict controls on access by U.S. researchers and laboratories. However, almost all of these pathogens are also found in nature. The map at the end of this article (see supplementary material at http://www .liebertonline.com/doi/suppl/10.1089/bsp.2011.0321/suppl_ file/Supp_Data.pdf) depicts the countries in which select agent pathogens caused disease between January 1, 2009, and October 31, 2010. Although pathogen security measures justifiably have been strengthened since 2001, the widespread natural occurrence of these pathogens indicates an inherent limitation of the regulations.

Response to the Sudden Closure of St. Vincent's Hospital: Learning from a Real, No-notice, Prolonged Surge Event

We qualitatively examined the impact of the permanent closure of St. Vincents Hospital in New York City on the remaining hospitals in the area and analyzed how these hospitals responded to this event. We conducted a descriptive survey consisting of interviews with clinical (n = 24) and administrative (n = 11) staff from 4 hospitals in lower Manhattan after the sudden closure of St. Vincents Hospital. These hospitals experienced a sudden and sustained increase in patient volume. Each was faced with specific constraints (eg, finances, physical plant, bureaucracy), but they developed similar strategic responses. Generally applicable principles included: soliciting innovative ideas from clinical staff, reexamining previous proposals to improve efficiency, fast-tracking stalled capacity-building projects, and focusing on improving patient care and flow. Three broad tactical themes were apparent: increases in staff and staff hours, use of alternative sites of care, and implementing novel ways of operating. The impact on hospital operations resulting from the closure of St. Vincents Hospital is a surrogate medical surge event and met thresholds for activating emergency operations plans. Novel operating methods used in response to this surge event offer practical and broadly applicable principles that might improve medical surge management in other hospitals.

Medical Reserve Corps volunteers in disasters: a survey of their roles, experiences, and challenges

The Medical Reserve Corps (MRC) was established in the Office of the Surgeon General in response to the spontaneous but disorganized outpouring of medical volunteers following the terrorist attacks of 2001. The mission of the federal MRC office is to provide organizational structure and guidance to the nearly 1,000 locally organized and funded MRC units that have grown up across the country and the more than 200,000 volunteer health professionals that staff these units. Despite the large size of this program and its numerous activations over the past decade, including in the Boston Marathon bombing and Hurricane Sandy, relatively little is known about the MRC, including the make-up of the units, the ways units have been used, and the challenges faced by MRC units and their volunteers. Here we report the results of a mixed-methods investigation of MRC unit organization, activities, and challenges.

Improving epidemic response: building bridges between the US and China.

I mproving Epidemic Response: Building Bridges Between the US and China was held in Washington, DC, on May 15, 2012. Hosted by the Center for Biosecurity of UPMC, this conference brought together leaders from China and the US who represent federal government, city and county governments, research organizations, industry, think tanks, and academia. The meeting provided a forum to increase mutual understanding of US and Chinese strategies for responding to major disease epidemics. It was also a venue for leaders, scientists, and officials from both countries to present their approaches to disease outbreak response and to consider effective practices and the potential for future collaborations in epidemic preparedness and response. Distinguished speakers and panelists explored a range of topics, from surveillance and sequencing, to medicine and vaccine development, to lessons from natural disasters, to partnerships between the respective federal agencies, to epidemic response in large cities.