Author: Nicole Lurie, M.D., M.S.P.H., Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services
Every disaster affects people’s health – often in very different ways. In my tenure as Assistant Secretary for Preparedness and Response we’ve seen the H1N1 influenza pandemic, an earthquake in Haiti, the Deepwater Horizon oil spill, the nuclear emergency in Japan, the 2011 tornadoes across the US, numerous hurricanes, Superstorm Sandy, and a host of other instances like foodborne illness and weather events.
To protect people’s health as we respond to these events, we need to have knowledge and strategies based in sound science. So far in every event we’ve seen both great science successes, and – critically - significant gaps in knowledge. The response to the H1N1 pandemic offers good examples of both. There was evidence of real progress and success. Soon after the first cases appeared in the US, scientists quickly identified and characterized the new virus strain. As a new vaccine was developed at an unprecedented scale, we were able to determine priority groups for vaccination and the effective doses for adults and children. But there were critical gaps in knowledge too, and barriers to performing research in time to have helped treat ill patients. For example, we could have done much better studying the effectiveness of antiviral drugs and respiratory protective devices. The current research infrastructure – which includes funding, reviews, protocols - simply wasn’t built to be nimble and quick, as public health emergencies demand.
Other disasters have demonstrated gaps too. In the Gulf after the oil spill, people were understandably concerned about how exposure to oil and dispersants might affect their health. Unfortunately, studies conducted on previous oil spills didn’t offer enough information to allow us to answer that question. And we missed an opportunity to collect baseline data that would have helped us in the future.
Removing barriers and developing the infrastructure that will allow us to do disaster-related science is a critical issue and one of my top priorities, and my office is making quick progress in our work to promote what we’re calling “science preparedness and response.” Being able to conduct effective research before, during, and after disaster means we need to do things like identify scientists with needed expertise who can be ready to respond; identify and prioritize research needs; ensure rapid and appropriate human subjects review; be able to rapidly fund studies; and work to meet the needs and understand the concerns of affected communities. There is work underway globally, and much more needs to be done to set up agreements and the infrastructure to build this capability.
Here’s one promising recent step - in November in the midst of the response to Superstorm Sandy, I asked the Institute of Medicine and the New York Academy of Medicine if they would convene subject matter experts to identify priorities for immediate research (it was important to hold this kind of discussion as the response was still happening). Using the outcomes from this meeting, my office conducted additional assessments and we’re now requesting proposals for research to inform long-term recovery from Sandy. The research will be in key priority areas around community resilience and recovery, risk communication and the use of social media, health system response and health care access, evacuation decision making, and mental health. Check out the funding opportunity announcement Assistant Secretary for Preparedness and Response Grants to Support Scientific Research Related to Recovery from Hurricane Sandy.
I’ve been encouraged lately to see the international community of policy makers, academics, and scientists making science response a larger part of the conversation. It’s going to be critically important for making our nation and the world more resilient to disasters.
For a more detailed treatment of this subject, see an article that colleagues in HHS and I recently wrote in the New England Journal of Medicine.
