• Edición impresa de Julio 20, 2010

Preparing for the Next Public Health Crisis

Establishing a Public Health Response Plan to Address Threats Such as the Gulf Oil Disaster

We’ve all seen pictures of the dreadful and continuing aftermath of the explosion on the Deepwater Horizon oil well in the Gulf of Mexico. The environmental cleanup and the economic consequences of this will last far into the future, and it’s hard to imagine that the time will come when fumes from oil, chemicals, and burning no longer pollute the air, oceans aren’t covered with sheets of oil, beaches aren’t stained with tar, and marshes aren’t clogged with residues. But with hard work that will eventually be the case. At that point the Unified Command—which was established under U.S. Coast Guard leadership to manage the response to this disaster—will fold, the cleanup workers will go home, and the raft of workers brought in from diverse agencies as part of the emergency response will be pulled back to deal with other more urgent tasks.

But health threats from the oil spill may linger unseen, perhaps for more than a generation. And we will not be fully prepared to address the public health problems that arise in the future unless there is an effective and coordinated handover of responsibilities for protecting public health from the emergency response agencies to agencies with the capability and capacity for long-term monitoring and management. Federal agencies have been pulled in as needed in the gulf spill response, but it’s not clear that the Health and Human Services response has been synchronized from the top to ensure effective delivery and coordination.

No systematic long-term monitoring and oversight was put in place with the Exxon Valdez spill in 1989, and now we wonder what we missed. Several studies following the Prestige oil spill off the coast of Spain in 2002 indicate that some respiratory problems in cleanup workers didn’t show up until years after the spill. Additionally, evidence suggests DNA damage occurred to these workers that could lead to cancers and alterations in hormone status.

This is not the first time the nation has faced such a crisis, and it won’t be the last. We have faced public health threats from the World Trade Center attack on 9/11, Hurricane Katrina, and the Exxon Valdez oil spill, and from infectious agents such as SARS, Avian flu, and H1N1 flu that fortunately did not reach crisis proportions but could have. The responses, while effective, have not been always been well coordinated. The Government Accountability Office in 2008 identified important lessons from the WTC response that could help develop responder health programs in the event of a future disaster, but the GAO recommendations have not been fully addressed.

The gulf oil crisis reminds us that it is essential to have a response plan that is activated early and can continue into the future for as long as needed. We do not need a new entity to put this system in place. Government has the expertise among the many HHS agencies to handle any given public health emergency, but different players may be called on at different times depending on the event. This transfer of responsibilities will occur mostly between HHS agencies, but it may also involve nonhealth agencies as well.

We propose that a single, high-ranking HHS official be designated to launch and oversee the coordinated response plan implemented whenever a situation arises that can threaten public health. We recommend this leadership role go to the assistant secretary for health, or ASH. The ASH would have responsibility for ensuring—in conjunction with other federal, state, and local agencies, academics, and the private sector—that needed services are delivered and information is collected, and that data, information, and resources are transferred to the responsible HHS agency or agencies.



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