We worked hand in hand with the fabulous crew from Metro Connections (the people that “ran” the conference). While this only provided a glimpse at the magnitude of work/time that went into the conference planning and production, it was very informative. It was very interesting to observe all the work that happens behind the scenes to make a conference or event go smoothly. It was also interesting to watch how a well-defined communication system worked. I have never personal seen how a well-defined communications system works in person, until now.

I thought there were tons of parallels between how the conference went and how things should be planned/produced on the public health side, aside from the fact the conference had huge public health implications. I plan to attend many more conferences and hope to be able to help plan and execute more in the future, but on a more practical side I hopefully will be playing an active part in mitigating infectious disease threats in my job. I would also imagine that meetings, work groups, forums, etc will be part of that job and I hope I remember the little things that I saw at the conference that made it run so smoothly, as they could all be adapted to whatever I do in the future. Things like being courteous, being prompt, knowing your role in the event, knowing who/where to go to get your question answered, being firm yet kind and respect are things most of us would think are commonplace but they are not. Its was interesting to see how the simple things I just listed (there are many more) made the conference function so much. Sure, the staff at Metro Connections is paid to be like that, but there is a reason why they do it. It makes their customers (the summit attendees) fell appreciated, respected and cared for. I was thinking if we (future public health practitioners) were more like that, we could probably get more done. In a sense, a lot of the partners/clients/business/public are customers of agency we work for. Public health in my opinion fits into many functional categories (health care, public works, public service, etc) and from my limited experience the “service” aspect of our work is sometimes forgotten, even though I think its one of the main reasons we are in the field (i.e. provide benefit to humanity).

Another point that became clear to me at the summit is that people want quick fixes to problems and that solutions are very rarely quick fixes. Towards the end of the summit, a poll was taken on what percent of companies have pandemic planning budgets only 25% did. Of that 25%, the funding was/is a one time deal for 55% of the companies. How can we expect to plan for something so complicated as pandemic influenza (or other public health issues) with one time funding. These are ongoing and complex issues and will not be fixed by devoting resources for a short amount of time to them. Patience and financial resource normally do not go hand in hand, but are required for pandemic influenza planning (and a plethora of things).

The final day of the summit was a good one. Julie Gerberding got things started with an animated talk about the CDC’s experiences on preparedness during the Anthrax attacks of 2001. She was candid in speaking of the mistakes that the agency made with false assumptions, and how they had to adapt their decision-making as information became available. Quite distressing is the fact that the perpetrators were never caught—meaning that it could happen again!? But the American public in general isn’t concerned about that. So it goes with our attention spans, and that is also the case with public concerns about avian & pandemic influenza. There was a large amount of media attention over a year ago, then the fervor died down even as bird & human cases continued to mount. Recent emergences of the H5N1 virus in a turkey flock in England have engaged the public’s attention again, and we all hope that this can become a “teachable moment” to encourage more people to begin their preparations for a pandemic.

The panel discussions that followed almost seemed to raise more concerns than resolutions. Experts from corporate human resources, government officials, and media personnel all discussed the various issues that needed address. How to cover sick leave for 30% of all employees and keep business running? What is the government’s role in making vaccine available? What about local governmental efforts? And importantly, will the newsmedia be a reliable source of information? What will the effect of non-vetted blogs be?

There was much interest among the conference attendees on how to manage worker absenteeism. I went to a breakout session in the afternoon that highlighted the plans of two different business models, and how they plan to keep operations running in the face of a pandemic. The first model is an internet service giant, where more than 70% of the workforce can realistically work from home when an outbreak strikes. Their major concern is therefore how to make sure that the telecommunications network continues to operate. The other corporation is a grocery store chain, who needs to have people physically continuing to deliver food items to stores—truck drivers & cashiers obviously can’t work from home. Their concerns were then completely different—how will the demand for groceries change? How to protect employees so they don’t get sick? What kind of unforeseen food shortages will occur, and whether to ration out scarce supplies all are complex questions. The representative of the company also admitted that many of the food suppliers for the grocery chain did not have well-laid plans yet, and there was discussion among the group about how to get the whole supply chain involved.

The ending session of the day dealt with the existing protective measures against Influenza: vaccines, respirators, antivirals, and masks. Approximately 25% of the companies present at the summit had invested in one of these protective devices, and there was much discussion about the usefulness. Unfortunately, the consensus was reached that there truly is no “magic bullet” that will spare everyone.

After Dr. Gerberding’s speech there where three panel discussions. They were simply amazing. It was delightful to hear experts in their fields answering questions and commenting on aspects of pandemic planning. There was a panel on human resources and pandemic preparedness, the role of business and government in pandemic planning and one on what to expect from the media during a pandemic. It was neat to see the reporters who have been writing the stories about H5N1 that I have been reading. It was also nice to see the government being asked tough questions on pandemic preparedness by the moderator and audience. We are making progress but still got quite a long way to go.

After lunch we had breakout seasons again. I was able to get to the breakout seasons on company planning case studies, which was fascinating. The presenters described their companies plans and planning process in detail and then turned the floor over to the audience for over an hour of discussion. The presentations were great but I enjoyed the frank and honest discussion that followed. It was so cool to see companies (even competitors) offering suggestions to each other on how to prepare, from the mistakes they made in planning.

After the breakouts there was one last general gathering and a panel discussion. This panel discussion was probably my favorite, just because I am nerd. The panel contained one of the best minds on vaccines (Dr. Greg Poland), a brilliant infectious disease specialist (Dr. Mike Tapper), the public health manager for 3M (Edwin Scott) and the medical director for ISOS (Dr. Doug Quarry). They were asked some really tough questions by Dr. Osterholm (he moderated this panel) on what business should be doing with vaccines, antivirals, masks and respirators. They conceded that we do not have many medical options for the world. A luck few will get antivirals and masks/respirators with unknown efficacy and far fewer will get a vaccine that probably wont protect them much.

After her remarks, Dr. Osterholm then proceeded to describe the “Fog of Pandemic Preparedness”. It was pretty clear why he referenced “Fog” in his presentation. The more business prepare the more they realize they are not prepared. Its kind of like traveling down a road, where the destination is known but the directions keep changing as the fog rolls in so you cant see what your driving past. I thought the most interesting part of the presentation was the point he made about the US only investing 10 million ($US) in vaccine production capacity internationally. His clear call for a larger investment resonated loudly as there were some senior government officials in the room, along with some of the best and brightest from the business world.

Dr. Peter Sandman followed Dr. Osterholm’s presentation with a wonderful clear take on risk communication. I guess that is to be expected though, as he is a risk communication expert. One the many interesting points that he made was that it is ok to scare people. He made this very clear later on in the day when he was on a panel. Evidently, children are really good at understanding “bad” things. When you think of lots of children’s books they typically have a scary/tragic part to them. The problem with scaring children is that your freak out their parents who are worried about you scaring/hurting their children. My big take home point was to remember who else is impacted by what your communication…educating children/impact on their parents or educating employees/impact on consumers.

Then Michael Evangelides presented the results of a survey Deloitte did on business preparedness for pandemic influenza…there was lots of information in his presentation some really good (more people are preparing) some not so good (6% of respondents believe their supply chain would survive a pandemic).

Then it was off to a fantastic lunch, where we heard John Barry describe the history of the 1918-19 pandemic. It was amazing to hear little details that did not make it into his book and his thoughts on things like the new CDC Community Mitigation guidance. We learned later (during a little private time with him) that it took seven years for him to write The Great Influenza and he would not have done it if he realized how much work it was going to be. I imagine lots of people are glad that he did…it’s the best record of what happened back then. Brings up that age old saying, “those that don’t learn from history are doomed to repeat it”. I sure hope we keep learning and can figure out a way to prevent a repeat of 1918-19.

After lunch we had breakout seasons (there were 8 different ones). I ended up going to the one called “Designing and Conducting Effective Tabletop Exercises”. Dr. Kris Moore and Jill DeBoer (both from CIDRAP) presented and surprised me. I had heard how much work it was to do a “good” tabletop before but had no idea how much work was actually involved. I just hope I can find all my notes and remember this seasons in the future, when I am involved in tabletop exercises.

Just before dinner, we had the opportunity to meet the Honorable Madeleine Albright. This was a real treat, as it is very rarely you have the opportunity to hear such an figure speak candidly on topics ranging from why more people in public health should be in diplomatic service to her experience being Secretary of State and a mother. She then delivered a rather interesting speech drawling on her experience with disasters with thoughts toward the future, specifically on pandemic preparedness. She also thanked us for being there and working of the issue. The audience really appreciated that as most of the planning and work done for preparing for emergency and disasters is rarely used, and thus a “thank less job”.

Like I said, WOW what a day and tomorrow looks fantastic.

She discussed the parallels between what happened after hurricane Katrina and how not preparing for a pandemic of Influenza, could result in the same sort of disastrous public health, economical national crisis. A fellow student and I were discussing about how Katrina devastated the Gulf Coast, and how much of New Orleans could have been spared with the construction of sufficient levees However, because there was the mindset of "it won't/can't happen to us", and "let us deal with issues at hand versus preparing for the worst", the absolute worst situation did happen, and the area and people that were directly affected, in addition to those indirectly affected, are still struggling to comeback. That is how we justified the importance of devoting resources to pandemic preparedness even though there are obviously a countless number of other public health problems facing the country and the world today.

This morning Julie Gerberding, the director of the CDC, talked about the challenges facing pandemic preparedness as well as steps the CDC is taking to combat those challenges. There were also three panel discussions held this morning. The first one was on how various large businesses are addressing pandemic preparedness with representatives from Tyson, Exxon Mobile, 3M, and Deloitte discussing the steps they have already taken and the challenges they have been facing. The second panel discussion was on the role of government and pandemic preparedness. A question I had after this discussion arose after Alfonso Martinez-Fonts, who was representing the Department of Homeland Security, made the comment that the federal government is trying to make clear now that if a pandemic of influenza were to hit the U.S., state and local governments need to be prepared to deal with the situation, and not look to the federal government for much aid. I wonder how they expect state and local governments to be adequately prepared in the face of large budget cuts, where many state and local offices are left with a limited amount of resources that are often devoted to problems that are already happening, versus a situation like pandemic influenza that does not have a definitive arrival date.
The third panel discussion was on the role of the media in the light of a pandemic of flu. There were writers and reporters from such media as the Washington Post and Bloomberg News among others on the panel. One thing I never even thought about was how the internet may be affected if a severe pandemic hit. If millions of people were forced to stay home, work from home and students would have to attend online classes, the internet would be overloaded and could crash. Since the internet is a place where a growing percentage of people rely of receiving their daily news, panic, frustration, and fear of the unknown could occur. Bottom line, things have been brought to my attention that I never would have even thought about in terms of how important planning and being prepared is.