By Crystal D. Swann and Carol Moody Becker
January 31, 2005

The "hot button" issues of drug importation and distribution of the flu vaccine were considered by the Children, Health, and Human Services Standing Committee (CHHS) that met on January 18, with Richmond (CA) Mayor Irma Anderson, Chair, presiding over the session. Also considered by the seventeen mayors in attendance were HIV/AIDS legislation and the Conference of Mayors' newest health initiatives — the Mental Health Task Force and "Healthy Cities."

Drug Importation

The U. S. Health and Human Services (HHS) Task Force on Drug Importation Report, December 2004, questions the: (1) safety of reimported prescription drugs; (2) legal recourse consumers have against foreign suppliers; (3) the projected savings; (4) the impact upon research and development; and (5) enforcement of intellectual property rights. Expanding further upon these points, Amit K. Sachdev, Deputy Commissioner for Policy, Food and Drug Administration (FDA), explained that beyond monitoring the safety of reimported drugs produced in the United States, there is the challenge of determining the safety of imported foreign versions of American drugs as well as drugs not produced in the U. S. at all. Sachdev added that the U. S. consumer pays 50 percent less for generic drugs and that the savings on reimported drugs are expected to be small — 1 to 2 percent.

Columbia (SC) Mayor Robert Coble said that some cities have a drug reimportation program or Web site for their employees. He noted that while the FDA prohibits reimportation, the agency has not taken action against these cities. He suggested that FDA hold a meeting this spring with employers to clarify its position on penalties regarding reimportation.

Burlington Mayor Peter Clavelle questioned Sachdev on the federal projection of limited savings. Clavelle explained that his city has saved 40 percent on reimported drugs and added that he knew of no case in the country where reimported drugs have resulted in harm. He feels that FDA should spend more time on the availability of affordable drugs rather than on reimportation.

Distribution of Flu Vaccine

The flu vaccine is critical to the preventive health of the world, as explained by Lance E. Rodewald, MD, Director of the Immunization Services Division of the Centers for Disease Control and Prevention (CDC). It saves 42 billion lives a year and is now a recommended vaccine for children. The 2004 shortage of flu vaccine came about suddenly on October 5 when the United Kingdom withdrew the major producer of the vaccine — Chiron — from the market due to problems with the supply, and the United States followed suit. This move was complicated by the fact that the other producer of the flu vaccine, Aventis, had already distributed its supply.

CDC's challenge was three-fold: 1) how to allocate the distribution gap; 2) how to facilitate the distribution gap; and 3) how to make better use of live vaccine. CDC's policy decisions responding to the challenge were: 1) give distribution authority to state/local public health agencies; 2) come up with a rationing formula; and 3) broaden the recommendations of the American Committee on Immunization Practices. At this point, almost 75 percent of Americans over 65 years of age have been vaccinated, and 40 percent of children have received this service.

Long term considerations are: a) solidifying vaccine financing; b) increasing the number of manufacturers; c) supporting an effective public health immunization workforce; and d) pandemic influenza. Dr. Rodewald concluded that the 2004 shortage of flu vaccine "has given us a teachable moment" to prepare for the future.

Conference Mental Health Task Force

Toledo Mayor Jack Ford, Chair of the Conference Mental Health Task Force, reported on the January 17 meeting of the task force and its action agenda for the immediate future. Ford indicated his commitment to continuing to raise awareness among the mayors on the importance of de'stigmatizing depression and bipolar disorders. The mayor, along with Anderson, decided to focus this first year on the impact that untreated mental illness has on a city's workforce. Anderson underscored the fact that this disease, while not curable, is treatable.

HIV/AIDS

Speaking about the Ryan White CARE Act, Andrea Densham, Director of HIV Care Services and Planning for the Chicago Department of Public Health, told the mayors how critical it is to reauthorize this legislation which will expire in September. Ms. Densham explained that this legislation provides community funds for the care of those living with HIV/AIDS, especially the most vulnerable. Without reauthorization of this legislation, these persons may have to seek emergency room services__a costly option for communities.

Physical Fitness/Federal Perspective

Three hundred thousand persons die annually from sedentary lifestyles, according to Melissa Johnson, Executive Director of the President's Council on Physical Fitness and Sports (fitness.gov). Johnson related sedentary lifestyles to the dramatic rise in obesity in the United States since 1985, noting that in four states 25 percent of the population is now obese. As a result, the current generation of children may be the first that will not live as long as their parents.

Johnson described the Steps to a HealthierUS, a presidential and HHS initiative, as one designed to help Americans live longer, better, and healthier lives by reducing the burden of diabetes, overweight, obesity, and asthma by addressing the three related risk factors — physical inactivity, poor nutrition, and tobacco use (healthierus.gov). Started in 2003, 40 communities have received grants to implement innovative community-based programs to prevent and control chronic diseases.

In addition to including health in a city's strategic plan and filtering all decisions through the lens of health, Johnson recommended that mayors "walk the walk" by personally promoting exercise initiatives and opportunities. She suggested that mayors use "Take the President's Challenge" as a model to promote physical activity, making it the "Take the Mayor's Challenge" (presidentschallenge.org).

Physical Fitness/Mayoral Perspective

Austin Mayor Will Wynn told the mayors about his city's Steps to a HealthierUS initiative, which includes MarathonKids (marathonkids.com) that involves 30,000 elementary school children who pledge to walk 26 miles in 26 weeks. They run the last quarter mile in the University of Texas stadium, receiving a tee shirt and recognition for their achievement. Austin also is now tracking nutrition in the schools and hopes to improve the contents of school vending machines. The faith-based community has a walking fitness ministry called "Fit for a King," and employers have walking challenges for their employees. Mayor Wynn urged the mayors to connect the dot between the high cost of health and the benefits of a walking program.

Highland Park Mayor Michael Belsky told the mayors that his city has committed to connecting all sections of the community with contiguous sidewalks and walking trails. Called the "Greenways Initiative," this effort is part of Highland Park's master plan and will be accomplished by funding a portion of the Initiative annually for the next twenty years. The Greenways Initiative complements "Healthy Highland Park" that was described by the city's Wellness Coordinator, Rob Manfredini, as including: a) an assessment of the cost-benefits of preventive health measures; b) a task force to get the less affluent to use health resources and services; and c) twenty-four community health lectures throughout the year.