If the nightmare of an avian flu pandemic emerges from the dark chapters of doomsday scenarios, it will fall to the Department of the Homeland Security, not the medical establishment, to manage the crisis, according to federal documents and interviews with government officials.
The DHS lead role, however, seems at odds with operational plans that call for the Department of Health and Human Services to be the government’s go-to agency in such a crisis.
According to current documents outlining operational plans for public health and medical emergencies, HHS “is the primary Federal Agency responsible for public health and medical emergency planning, preparations, response, and recovery.”
That HHS planning document, currently under revision and circulating among federal agencies for comment, seemingly conflicts with the federal National Response Plan, a kind of overarching playbook for how to manage any number of national disasters, from terrorist events to hurricanes and floods. But under the National Response Plan, which also plans for actions in case of pandemics, DHS assumes top authority when an “incident of national significance” is declared.
Officials from DHS and HHS told MSNBC.com that the departmental statements outlining the chain of authority aren’t in conflict at all.
An influenza pandemic “would obviously be declared an ‘incident of national significance and DHS would be the overall in-charge agency,” said Brian Doyle, a DHS spokesman.
Doyle noted the “unique partnership” his agency has with HHS. “HHS would be the lead agency on the health side of it,” he said, echoing comments made by Homeland Security Secretary Michael Chertoff in late August.
The first such “incident of national significance” was declared in August after Hurricane Katrina hit; however, federal coordination among agencies and state and local governments broke down on so many levels that even President Bush was forced to acknowledge that the plan was flawed.
In the event of a flu pandemic, “the way it works is that DHS is going to turn to [HHS] to work with the states and the locals on the actual health and medical response to what’s going on,” said Mark Wolfson, an HHS spokesman.
“In the meantime, if we’re dealing with a pandemic situation, where we’ve got people getting sick all over the country and all over the world, then what Homeland Security is going to be doing is coordinating the overall federal response to implications of the pandemic,” he said.
Role playing the pandemic
Federal officials have been role playing different flu outbreak scenarios for the past several months and the results have lead to revisions in the current plan, which was drafted last year.
Last year’s plan called for closing of schools, restricting travel and implementing textbook, lock-down quarantine measures. Those extreme measures jumped into the spotlight last week when President Bush suggested that federal military troops — not just the National Guard — may have to be called in to enforce a quarantine.
DHS officials privately acknowledge that any such forced quarantine could swiftly turn violent, with people rioting to get away from a perceived diseased area.
“If you quarantine it’s going to get ugly really quick, I’m afraid,” said a DHS official who spoke on the condition of anonymity, saying he was not authorized to talk about internal planning discussions.
It’s just that potential for chaos that has the administration examining the steps needed to allow the President to put federal troops in charge of the situation.
“These are all issues that we need to look at, and that's why [President Bush] thinks there needs to be a robust discussion with Congress and do we need to establish some sort of trigger that would automatically say the federal government, and specifically, the military, is the one that will be in charge of stabilizing the situation,” said White House Spokesman Scott McClellan during a Sept. 26th press conference. “And then the Department of Homeland Security would come back into play once the situation is stabilized,” McClellan said.
Some medical experts aren’t sold on the military’s hinted role in a pandemic. “One of the issues is that the current influenza pandemic plan is supposed to carry a large military role, the problem there is I’m not sure how much the military has, at this point, been involved with [dealing with pandemics],” said Dr. Stephen Morris, an epidemiologist, the National Center for Disaster Preparedness and founder of the Center for Public Health Preparedness.
Morris, however, isn’t bothered by the dual responsibility roles laid out by DHS and HHS officials. “So the reality is, once [the Federal government] kicks into action I think, yes, there are obviously roles for both of those agencies,” Morris said. “HHS does have the lead in the medical aspect…There are obviously a lot of non-medical things that will have to be done in terms of traffic control, logistics and I’m sure there will be a role for the Department of Homeland Security, so I agree it’s not mutually exclusive.”
Who’s on first?
It’s one thing to put down on paper how an agency will respond in case a pandemic hits; it’s a whole other matter to draft a plan detailing what agency will literally keep the trains running, the mail flowing and lights turned on.
The worst case mortality figures contained in the government’s current draft plan for dealing with a pandemic are 1.9 million fatalities, according an expert who has reviewed the plans. The best case scenario is 200,000 dead.
“How do you provide food, water ... basic security for the population?” asked Michael Osterholm of the University of Minnesota, a government adviser who has a copy of the draft plan and described it for The Associated Press.
The plan makes it clear that the U.S. is woefully unprepared should a pandemic hit. All kinds of shortages are noted, everything from not enough vaccines to the seemingly mundane: special surgical masks to prevent infection.
Democrats have criticized the administration for not having a plan. Sen. Tom Harkin, an Iowa Democrat, said in a statement Saturday that time for action was short.
“Having a plan on paper does nothing to protect us,” Harkin said while urging the administration to work with Congress on implementing protections against a pandemic. “Next month is too late. The United States is woefully unprepared for this, and we must get started immediately.”
The Associated Press contributed to this story.