Now, more than ever—with the specter of avian flu and bioterrorism—programs to train and educate public health providers on infection control, prevention and mitigation are critically important.

If the state and local public health officials and professionals surveyed by HSToday are any indication, they are quite adept at training and educating decisionmakers at all levels—from hospital CEOs, their boards and medical staff to state and federal officials—on what to do and not to do in the event of not just a flu pandemic but outbreaks of any deadly viruses.

The training and education of everyone involved in public health—but especially those working in hospital environs—before the fact is essential for the prevention and control of a pandemic strain of influenza. Such education is even more important when it comes to infection control strategies involving respiratory hygiene and cough etiquette, hand hygiene, standard precautions, droplet precautions and, as appropriate, airborne precautions.

But it’s not just pandemic influenza that is of concern; it’s any highly fatal viral contagion that’s easily transmissible between humans. As HSToday has reported, counterterror officials’ increasingly are troubled by the possibility that terrorists will try to use naturally occurring deadly viruses or, more disturbingly, viruses genetically altered to increase their lethality, as a weapon of their twisted jihad. A pandemic not withstanding, educating and training America’s frontline public health providers on how to properly deal with fatal contagions is essential, if not vital, for public safety and homeland security.

But even without assistance from terrorists, infectious diseases are emerging more quickly and spreading faster than ever before—and becoming progressively more difficult to treat, according to the World Health Organization (WHO).

“An outbreak or epidemic in one part of the world is only a few hours away from becoming an imminent threat somewhere else,” reported The World Health Report 2007— A Safer Future: Global Public Health Security in the 21st Century.

The Department of Health and Human Services’ (HHS) comprehensive Pandemic Influenza Plan (http://www.hhs. gov/pandemicflu/plan/) includes guidelines for educating and training frontline public health responders, patients, family members and visitors. But while federal and state public health officials and professionals continue to urge hospitals and health clinics to hasten implementation of their education and training programs to incorporate HHS’ guidelines, the government’s own efforts to thwart and mitigate a pandemic have markedly slowed—even stalled out in some areas.

The rippling effect of this sputtering is reducing the urgency of these programs at the state and local levels, authorities angrily told HSToday.

Dr. Rajeev Venkayya, special assistant to the president for biodefense, recently confessed, “There is much work that remains to be done” in preparing for a pandemic or viral outbreak of any kind.

“Just to be brutally honest, we have a lot of trouble determining when we have an outbreak of disease in a community here in the US,” Venkayya said, emphasizing that “we need to have uniform biosurveillance capability to prepare not only for a pandemic but any outbreak of infectious disease.”

Venkayya said in the event of a global pandemic, the government will work to limit the number of people trying to enter the United States who might be infected and to detain those suspected of being a haven for the virus, but authorities told HSToday there is not a large enough force of people properly trained to detect and identify persons who are infected or may be infected.

“And don’t expect the existing federal public health force to be able to do the job of this sort of biosureveillance, either—they’re going to have their hands full just dealing with the problems of already having the pandemic virus in the US to begin with,” HSToday was told by a high-level federal public health official who frequently agrees to talk on condition of anonymity.

Vulnerabilities

Indeed, this vulnerability was demonstrated in the incident last May in which a Customs and Border Protection (CBP) officer allowed Atlanta lawyer Andrew Speaker, who was suspected of having a highly contagious form of tuberculosis, into the country even though the CBP officer’s computer terminal red-flagged him to be detained and isolated and instructed him to take specific personal protection measures.

The incident was a brutal wake-up call to the inadequate state of training and education that CBP and other border officials had been receiving with regard to making them understand the seriousness of the necessity of biosurveillance—or even their own personal protection. Homeland security officials admitted to having erroneously been led to believe such minimal front line defenses were in place.

CDC had put the man on the no-fly list and made CBP aware he had a dangerous communicable disease, and all US ports of entry were alerted. And still, the TB-carrier was allowed to enter the country.