Tennessee H1N1 Issues in Healthcare

Tennessee H1N1

Issues in Healthcare Response: Tennessee and the H1N1 Flu Outbreak of 2009

Coordinating responses to impending epidemics is not always easy, especially when a great deal of that preparation depends on the availability of a vaccine that has yet to be developed or manufactured. This and other problems conspired to produce a significant health concern for Tennessee during the 2009 outbreak of the H1N1 influenza virus, which the World Health Organization had warned might be the worst flu epidemic seen in four decades. Though the state and its various health departments and officials eventually encountered the issue with a fair degree of success and with limited impacts on public health and both public and private institutions. Still, things could most definitely have gone better with more foresight and potentially with more resources, and while it is easy to say this in hindsight it is important to assess the problems that arose in this case and the manners in which they might possibly be addressed.

Defining the Problem

Tennessee and its various state and regional health departments and officials faced a confluence of two primary problems during the 2009 H1N1 flu outbreak. Problems with vaccine production and a complete lack of vaccine availability during the initial outbreak of the flu in the spring of that year foreshadowed issues that would be experienced during the more widespread and virulent outbreak of the fall season, after school had gone back into session (CDC, 2010; WHO, 2010; Giles & Howitt, 2011). It was not until October that the vaccine became available, and even then only on a limited basis and without a full understanding of dispersal needs and priorities amongst officials and practitioners a like (CDC, 2010; Giles & Howitt, 2011). The exact nature of the problem is quite complex and is a result of the complexity of the public health network(s) in Tennessee as well as the sheer resource issue of vaccine availability, and though primarily fact-based in nature these problems necessarily touch on ethical issues just as would any other public health or safety concern.

Put succinctly, the problem here involves hierarchies and communication structures breaking down, or the mismanagement of people and resources that resulted in more negative impacts than would otherwise have been experienced (Porche, 2004; Gilbert et al., 2010). The factual issues of the case include the scarcity of the vaccine, especially in a non-mist form, and the pre-existing hierarchy and network(s) of public health entities in the state, which had presumably been designed and enacted by previous legislation and could not be easily changed (Gilbert et al., 2010). Ethical issues include both those affecting the patient population, as communication and hierarchy problems reduced the level and quality of care that patients received, and those affecting health care providers and officials, who were often left with confusing and even conflicting information that did not demonstrate the level of knowledge or acknowledgment that they both deserved and required as a means of providing appropriate care. Addressing these issues can take place with the design and implementation of the same practical guidelines, however.

Resource Needs

Though "resource" is typically understood in a physical context, there are both tangible and intangible resources needed to fully address this problem, and a better utilization of existing human (and other) resources, as well. If an effective H1N1 vaccine had been developed and produced prior to the outbreak, even the somewhat disconnected and confused public health system in place in Tennessee could have easily and effectively provided the necessary preventative care to patients. On the other hand, had a vaccine been readily available the epidemic would not have been an issue identified by the World Health Organization or the Centers for Disease Control at all, and thus to say that this resource would have solved this problem is somewhat specious as in truth it would have prevented it altogether (CDC, 2010; WHO, 2010). In other words, it was the lack of this resource that brought the deeper and more complex problems to light and having a vaccine for H1N1 would only have postponed the problem until the next viral epidemic for which there was no vaccine occurred.

The true "resource" that is required to solve the central problems in this case are a more established and fully understood hierarchy and network of communication from the top levels of the Tennessee public health department to the other organizations, entities, and individuals involved in the actual provision of vaccines and other health services to the Tennessee population. While it is important in such widespread and far-reaching networks to ensure that individual elements within the network are empowered to make decisions as they see fit, it is even more important that each node in the network is given access to all relevant information in a current and comprehensive manner (Porche, 2004). A plan needs to be in place for dealing with these health issues that takes the potentials of each entity's position in the public healthcare network into account, such that there is greater consistency and efficiency in the decisions made by each of these individual entities (Porche, 2004). If all counties or health districts/departments had similarly understood the potentials of the mist-form vaccine, as one key example, the vaccine shortages for the population at large would not have been as severe even though certain high priority could not have utilized this vaccine (Giles & Howitt, 2011). Furthermore, beyond simply having a better plan and hierarchy in place for the dissemination of information during such an epidemic, there needs to be a better and more strictly defined hierarchy of communication and distribution in general, as this is the only way to effectively facilitate the implementation of better communication during emergencies or other similarly extreme situations (Porche, 2004).

In-Situ Solutions

While the pre-existence of other resources, from an H1N1 vaccine to a better system of communication amongst Tennessee public health agencies and entities, would have helped to ease the situation presented in this case, there were also choices that could have been made to more effectively address the problem even with the resources that actually existed. Dr. Cooper's decision to let the Tennessee Emergency Management Administration (TEMA) stand down certainly seemed reasonable at the time, but without a real system of controls in place it was unwise to undue this centralized and more directly responsive entity's position in the fight to limit the spread and impact of H1N1 (Porche, 2004; Giles & Howitt, 2011). Allowing the TEMA force to stay in place as a key entity in coordinating the dispersal of information and of the vaccine itself could have perhaps alleviated much of the imbalance that was observed in the use of vaccines and could also have helped reassure the public that there was true attention being paid and applied in a consistent manner across the state's counties and regions. While it cannot be said from the details given in the case that TEMA's ongoing involvement would certainly have made a difference, it is certain that a lack of real central control and involvement contributed to the problems observed in the case, and TEMA might have provided the centrality and the accessibility that was truly needed (Porche, 2004).