By Larry Tate
June 19, 2006

During the 74th Annual Meeting, Seattle Mayor Greg Nickels moderated a session entitled “Pandemic Flu Preparedness: Are We Ready?” Mayors and government officials engaged in a lively dialogue on pandemic and avian flu preparedness. Seattle, noted by many, has gotten a marked head start on their preparedness efforts under the leadership of Nickels. The session, attended by 16 mayors presented no new information but generated many new questions and concerns among the mayors.

Normal flu outbreaks occur every year; pandemic outbreaks occur in cycles, the most recent in 1968, 1957, and 1918, and the world is overdue for another one. The current H5N1 virus, transmitted by birds, has killed 127 people, largely in Asia, most recently (and most seriously) in Indonesia, whose total of 36 deaths is expected to rise and eclipse Vietnam’s 42 deaths. Scientists speculate that as many as 30 of the deaths may have resulted from human-to-human transmission, mostly among family members. A mutation facilitating casual transmission between humans could lead to millions of deaths worldwide, as in the 1918 pandemic.

Nickels moderated the session, offering brief remarks as a follow-up to his plenary presentation in January, about such issues as “maintaining essential city functions” in a pandemic. Richmond (CA) Mayor Irma Anderson, Chair of the Children, Health and Human Services Committee, also made brief remarks.

Dr. Richard Besser, Director of the Coordinating Office for Terrorism Preparedness and Emergency Response at the CDC, highlighted the recently released “Implementation Plan for the National Strategy for Pandemic Influenza,” saying, “A pandemic WILL occur; if not H5N1, then another strain in the future.” He addressed such topics as a vaccine, which cannot be made until a deadly mutation is identified and analyzed, and the need for mayors to conduct “…exercises with relevant parts of the community.” Some federal planning money is now available, and he said he’s been going to various “state flu summits” around the country. “Let this be the first pandemic for which our country was prepared,” he said.

Shirley Harrington, from USDA APHIS, Veterinary Services, spoke of the issues affecting bird populations, which her agency is required to monitor. “We’re getting calls from people who see a dead bird anywhere and start to panic,” she said. Although international outbreaks are likely to precede any bird disease in this country, Besser added that, “We can’t assume an international outbreak will come first.”

A number of mayors in attendance had questions. Nickels asked about where early planning funds would best be spent. Besser said that “engaging the community” was more important than any attempt to stockpile Tamiflu, the only available medicine that might (or might not) be useful in a pandemic. “Exercising the plan is essential,” he stressed. (The national plan can be downloaded at www.whitehouse.gov/homeland/pandemic-influenza-implementation.html.)

Tucson Mayor Robert Walkup told of being the only elected official at a state meeting about pandemic preparedness, and his concerns about such issues as “quarantine in place.” He said, “I don’t know how to quarantine in place. Am I the only one?” Besser suggested that, first, “Forced quarantine won’t work.” More importantly, he emphasized that for mayors, “This is about leadership,” rather than technicalities of the health-care process. Preparing mayors for how to talk about the issue is the essential thing. Nickels added, “Having these early conversations is very valuable.”