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Managing epidemics: an argument against blanket job cuts

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By Merilee Dannemann

The unvaccinated woman got on a plane in London. She flew to Washington, D.C., changed planes and flew to Denver, then on to Albuquerque, and from there drove home to Santa Fe.  She had measles.  
During the trip, she exposed other passengers from all over the world to this disease.
Preventing an epidemic involved 70 countries and four states, and cost $1 million, according to Dr. Chad Smelser, an epidemiologist with the New Mexico Department of Health.
A few other thought-provoking highlights from a recent presentation by Smelser:
More than half (54 percent) of all U.S.-reported plague cases are in New Mexico. Fortunately, the national totals are extremely small — 437 total cases reported in the 30-year period from 1970 to 2009. That’s more than enough for such a dreaded disease, wouldn’t you say?
A nasty intestinal disease called cryptosporidiosis infected a number of teenagers in 2008. It was traced back to a single statewide swimming meet.
Apparently, a little case of the runs is not enough to keep some competitive swimmers out of the pool.
A number of people, all related, became ill with a rare disease called tick-borne relapsing fever.   
Investigators found they had all been to a reunion at a remote mountain cabin and were able to find one mouse that carried the ticks.
Some New Mexicans will not be pleased to learn that the risk for salmonella is 85 times higher from beef jerky than from hamburger.
By tracking the occurrence of pertussis in small children, epidemiologists were able to figure out the best age to vaccinate, when children are younger than the age the disease most frequently occurs.
Many of us remember vividly the Hantavirus epidemic of 1993, when a few people died before the cause was discovered to be droppings from deer mice in certain rural areas. The disease caused not only the loss of lives but widespread fear, massive losses in tourism and even the cancellation of sports events in Northwest New Mexico.
From the first news reports to the discovery of the cause of the virus, I remember, took about six weeks.
I thought at the time it was a wonder of modern science, and I still do.
Infectious disease epidemiology is a function of government that gets no attention except when it is really needed. Then it is vital, and the program needs to be fully functional in order to be ready to respond when the threat occurs.
There’s plenty of criticism about government these days. While leaders talk about reducing inefficiency and waste, there isn’t enough serious examination of the basic question of what’s important and what’s not.  
I could write a short list of programs that don’t contribute much value to our citizens and taxpayers. Whether they are implemented well or badly, they might not be worth implementing at all.
But some programs are vital to our public wellbeing. Managing infectious diseases is such a program, and it is critically linked to other programs that also function outside the limelight.
When a life-threatening disease breaks out, suddenly we can perceive the value of a guy whose government job was stomping through the sagebrush, collecting data about mice.
I have argued elsewhere and will argue here that government should not rely on “across-the-board cuts” or reducing personnel through “vacancy savings.”
If the plague expert at the epidemiology bureau gets a better job somewhere else, no “across the board” hiring policy on earth would justify failing to recruit a replacement.

Merilee Dannemann
© New Mexico
News Service 2011