From the CEO

Back to School: H1N1 and MCH Preparedness

By Mike R. Fraser, PhD

Almost 11 years ago I started working in the area of “bioterrorism.” My work involved supporting local health departments in their efforts to assess preparedness, use best practices to respond to bioterrorism, and share lessons learned about emergency preparedness with all local health departments. The work was controversial. One respected public health professional told me point blank that a “bioterrorism attack has less of a chance of happening than throwing a snow ball in Santa Clara. We need that money for childhood immunizations.” I told him he was right about the immunizations and I also hoped he was right about the probabilities of an attack but public health preparedness was important nonetheless. During my time in preparedness I visited many local and state health departments, as well as other offices within the Centers for Disease Control and Prevention, and heard similar chatter about bioterrorism being a remote possibility. But then anthrax happened. Then SARS. Then Katrina. And now H1N1. 

Years of public health planning have taken place and yet we still have lots of work to do to assure our nation’s women, children, fathers and families are prepared for “bioterrorism” — this time courtesy of Mother Nature. Are we ready? Predictions are that H1N1 will be widespread but only cause “mild” illness (I am not sure I ever had a “mild” flu, they all stink if you ask me)! Predictions are also that pregnant women and young children are most at risk for serious illness including facing a disproportionate rate of morbidity from H1N1. H1N1 will also be a very serious issue for many children and youth with complex or special health care needs. It seems clear that H1N1 will be a virus that impacts Maternal and Child Health (MCH) populations disproportionately — not only pregnant women and children but also those least likely to have a routine source of medical care or a place to get reliable health information. We can’t put our heads in the sand: H1N1 will involve MCH leadership and already has. I know many of you have worked in your state’s emergency operations center, have fielded questions about H1N1 from family and community groups, and are working with stakeholders in your state to prepare for a potential outbreak this fall. We want to learn from that experience as we look to the fall and H1N1 as an emerging issue for all of us.  

Many of us have started thinking about how to best engage state Departments of Education and other players in a potential outbreak. The U.S. Department of Health and Human Services has begun to work closely with officials in the Department of Education, modeling partnerships that are happening at the state and local levels as well. School nurses, school-based health clinics, and other education-related health facilities need to be engaged in planning for H1N1 along with MCH professionals in public health agencies and in the clinical care setting. Schools do a lot more than just educate these days — they provide medical and social services, act as pharmacies, meeting points, and provide peer counseling and support. Many children receive two meals a day at school, and schools are social and cultural resources for entire communities. When schools close a lot more is lost than opportunities to learn and yet the best intervention we had this spring to address H1N1 was to close schools and practice social distancing techniques to mitigate the spread of this novel flu virus. We have to begin to consider the social impacts of school closings, and work with partners to anticipate major issues that may result. 

Whatever the fall brings in terms of H1N1 we can only be better off if MCH programs have been integrated into their agencies’ preparedness planning and response activities. Your colleagues down the hall in public health preparedness may need you now more than ever — have you told them why? And with over $600 million new dollars for H1N1 preparedness going to local and state health departments now might be a good time to think about how to work together on specific MCH related preparedness projects. If you have a good idea for collaboration or a model practice that you think others should know about regarding H1N1 preparedness, please let us know. AMCHP will continue to share information on H1N1 with its members and MCH leaders including passing along information we receive from partners closely monitoring H1N1 in the field.  

This year we are facing a different kind of “back to school” which is an event that already triggers lots of anxiety for kids and parents. Getting ahead of a potential outbreak — the essence of preparing — is something MCH programs should do and I know many of you are doing now. AMCHP and its partners will look to learn from you and advocate for those things that would make your work more effective and more efficient. I look forward to hearing from you and working together to tackle the many complicated issues this new virus will pose for you and your states’ MCH populations.