Indiana Pandemic Influenza Community Advisory Group Overview
(Adapted from a key informant interview with Dr. Theodore Bailey on April 17, 2007)
On August 18, 2006, the Deputy Commissioner of Health in Indiana asked Dr. Bailey to construct four Community Advisory Groups(CAG) that would focus on four major issue areas: antiviral prioritization, community disease containment, altered standards of care, and mental health/psychological first aid. The four sub-groups were assembled in three weeks, and they were to complete their discussions and establish recommendations within a month. A broad and politically diverse mix of 60 people was chosen to compose the groups. Members included first responders, special needs representatives, AARP, the ACLU, representatives for disabled children, private hospital groups, rural health, infectious disease specialists, pediatrics, and child advocacy/protective services. In his previous position, Dr. Bailey had worked as a physician at MethodistHospital, was well-known in the community, and his status and political neutrality allowed him to obtain people’s commitment to the groups in a fairly short timeframe.
The CAG sub-groups held their first meeting on October 2, 2006, and the groups met for two to three hours three times during the month of October. A subject matter expert presented 30 minutes of detailed background information for each group and a bioethicist was always present at each meeting to outline critical ethical features of each issue. Expectations of members,after being given this expert material, were to frame the discussion and then be blunt and aggressive in arriving at a desired outcome on the issue. The meetings were held with the goal of composing the Findings and Recommendations report by early November. The report was reviewed by the Commissioner’s office, approved, and reviewed again by CAG members to ensure that it was a fair representation of their deliberations.
The mental health sub-group disbanded after the report was submitted, because members of the group had reached advanced agreement about how they would respond in a pandemic. The other three groups changed membership to include more emergency department doctors and representatives from the National Guard.
The community disease containment group focused mainly on the issue of school closure. After Indiana’s school closure exercise, the group realized that they had received very little input from the Department of Education about how they would respond to school closure. In a pandemic influenza outbreak, the Commissioner of Health has ultimate authority to close schools. The CAG determined that they wanted to close schools early and before pandemic influenza was in the state. Exactly when to re-open schools, they would leave to the experts at the Health Department. Since children’s services and pediatrics were represented so heavily on the committee, their main objective was to save children’s lives. The CAG thus decided to recommend closure of all public schools when the first case of pandemic influenza was confirmed within the continental United States (including Alaska). They are continuing to look at ways to continue education and meal services, but the main goal is to keep children protected.
The sub-group on antiviral prioritization hasn’t been re-activated yet. The group that met last fall only discussed treatment issues. Indiana received $9.5 million dollars to spend on Tamiflu, and the CAG advised against allocating antivirals for prophylaxis. The group that is reconvened will operate under assumptions about effectiveness of antiviral prophylaxis. They will discuss how to allocate antivirals in a scenario in which it is feasible to allocate both for limited prophylaxis and mainly for treatment.
The mental health group works out of the Addiction and Emergency Management office of the Indiana Department of Family and Social Services. Representatives from the group went to Biloxi, Mississippi, to conduct relief after Hurricane Katrina, so they were already fairly well organized by the time the CAG was formed. The group is a broad mix of first responders and private/public practitioners. Members quickly decided on a model under which they would operate during a pandemic (Psychological First Aid). Currently and in the future, they are trying to work with consultants to increase the number of people trained under this model at the state level. Their approach is fairly practical: psychological therapy during a pandemic will consist of asking people whether their family is accounted for and whether or not they have food, water, shelter, and necessary medications. The mental health sub-group is also training representatives from faith-based organizations to be a lifeline for ill and vulnerable people in their communities. Their next steps will involve developing specific metrics based on exercises.
The altered standards of care sub-group has focused mainly on the logistics involved in establishing and operating alternate care sites. The group has ensured that the Indiana National Guard has been involved in many of their planning discussions. Guard members are accustomed to working in a particular system and have had surprising input to the discussions on alternate care sites. The discussions on altered care were fairly slow and unstructured until the National Guard was invited to the meetings; their involvement meant that the CAG was not ignoring practices that had already been established for alternate care and triage.
As the sub-groups move forward in their preparedness discussions and activities, members are attempting to challenge people’s perceived sense of entitlement. A number of community members were against the early closure of schools, and the groups want to ensure that their decisions are not based on adapting lifestyles to a pandemic at the cost of a greater death toll, especially among children.
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