The emergence of a new public health threat serves as a reminder of the need for a collaborative emergency response network at the local, state, national, and international levels. The article “Evolution of Collaboration among Federal, State, and Local Agencies” in the Summer 2013 issue of The Public Manager has proven timely with the emergence of the Middle East Respiratory Syndrome (MERS). According to a June 19th, 2013, Associated Press story (“New MERS virus spreads easily, more lethal than SARS but source of infection still unknown”) 60 cases and 38 deaths have been attributed to the virus, with Saudi Arabia experiencing the most cases. Cases have also been found in countries such as Jordan, Britain, Germany, and Tunisia, with all being traced back to the Middle East region.
While this new virus is similar to Severe Acute Respiratory Syndrome (SARS), an international team of physicians has yet to determine the source of MERS, although they have concluded that it spreads easily through person-to-person contact and in hospital settings. According to the Associated Press, the virus is currently believed to have a 65% fatality rate (compared to the 8% fatality rate for SARS); although doctors acknowledge that they may be overlooking less severe cases that do not require treatment or hospitalization. Theories on the source of the virus range from camels and goats to foods contaminated by bats. Doctors are concerned that the virus could mutate into something more virulent and that there are currently no protective measures against it.
AP photo/Health Protection Agency
On the website for the Centers for Disease Control and Prevention, the agency outlines the steps it is taking in conjunction with the World Health Organization and other public health organizations. These steps include developing molecular diagnostics to correctly identify MERS cases, as well as developing assays to detect MERS antibodies. The CDC is working to get resources to state health departments, including testing kits and guidance for health providers and public health officials. The CDC has also taken an active role in the investigation of MERS in the Middle East, and is consulting on emerging cases. The agency is engaged in discussion with international partners on the possibility of developing a MERS vaccine.
In the latest issue of The Public Manager, “Evolution of Collaboration among Federal, State, and Local Agencies” examines the public messages of Health and Human Services Secretary Kathleen Sebelius during the 2009 response to H1N1 to track how the federal messaging regarding the response to the virus moved from mobilizing a short-term response to advocating for an enduring network approach. Issues of vaccine development, delivery, and dissemination during the H1N1 response illustrated why such a network must be strengthened and maintained in preparation for a more severe challenge in the future. In the face of a major pandemic, the lines of communication and response need to be able to be opened at once, and these lines must extend to local, state, and federal agencies in the U.S., as well as to private sector, non-profit sector, and international partners.
However, it must be acknowledged that the decentralized U.S. public health system presents many challenges to such an enduring system. Public health officials who are willing to devote time to relationship-building will be vital. “Evolution of Collaboration among Federal, State, and Local Agencies” illustrates that the federal government developed the right message during H1N1, but in preparation for MERS or the next grave threat those words must be translated into action nationwide and internationally.
