For all the planning, prioritizing, and head scratching done by state and federal governments for the coming H1N1 flu crisis this fall, we still have fallen short, says Arthur Caplan in his most recent MSNBC column.

Why? The reasons are plentiful, but if you ask me the answer is simple: a public health infrastructure so weak that I’ve seen spider webs that provide more protection against passing threats.

Caplan blames whining healthcare workers, too little vaccine and a number of other causes, but I’ll let you read the essay yourself below or by clicking the link here. But no matter who’s analysis you believe, it’s clear—the swine flu response is pretty darn poor and shows no signs of getting better, and its our children and their caregivers who are paying the price–with their health.

Summer Johnson, PhD

U.S. swine flu response dismal at best
by Arthur Caplan

Few seem to want to say so, but this nation has mounted a dismal response to the swine flu epidemic.

By dismal I mean this: There’s not nearly enough swine vaccine to go around, there are conflicted messages about when the doses and antiviral supplies will arrive and half of all Americans are reporting they are too afraid to get the vaccine even if they are able to find it.

Health care workers are throwing fits when directed to take the vaccine, even if they work around high-risk patients, and there’s a breakdown of a strict distribution system to make sure the vaccine we do have is used to protect and save the most lives.

We have had the better part of a year to get ready for swine flu. And yet, the response to the pandemic H1N1 outbreak has been lousy. What would happen if a hostile power launched a large-scale bioterrorism attack against us with no warning?

The Obama administration bears much of the blame for the fear the public and health care workers have of the swine flu vaccine. The facts do not square with the fear.

Numbers of sick and dead are mounting
At least 129 have died in the United State from swine flu. Eighteen children died last week. Public health officials estimate that at least 1,000 adults have died so far from swine flu in this country alone. Hundreds have faced life-threatening hospitalizations. Millions more have been terribly sickened and lost time from work.

The fear factor is simply confusing. To put it bluntly, it makes no sense to be more afraid of the swine flu vaccine than the actual H1N1 flu. No vaccine in the past two decades has killed nearly so many children and adults. Yet, somehow the administration, public health officials and organized medicine and nursing have lost the battle to overcome fear, ignorance and just plain kookiness when it comes to the importance of vaccination for those at greatest risk.

Worse, efforts to tell health care workers — health care workers! — that they must get vaccinated if there is vaccine to give them have faltered. Nursing unions are in court arguing that they should have a right to choose when it comes to vaccination.

Few leaders in medicine or public health — much less the White House — have spoken up and said that if you are a health care worker, your ethical promise to put the health and safety of your patients first means you have an absolute duty to get vaccinated against both seasonal flu and swine flu unless you have a serious medical reason not to.

Some media outlets and blogs are not helping, either. There are way too many stories about screwball theories insisting that the pharmaceutical industry is pushing vaccination on innocent children for profit, alongside equally nutty and nonsensical recommendations to use garlic, echinacea, astragalus and “immune system” vitamins to fend off a virus that can kill pregnant women and babies.

The idea that garlic is effective against both vampires and viruses would be funny if it were not for the fact that people are dying. Should we face a more serious biological threat, many more people who are happily putting rubbing alcohol up their noses, not getting their kids vaccinated and swilling Chinese teas will die.

One very clear lesson from the current swine flu epidemic is that our safety and security demand much more in terms of effective public education and communication then we have seen to date.

Flunking the swine flu test
When it comes to the effective distribution of the swine flu vaccines and drug supplies we do have, America is flunking the test. Every day I listen to hospital officials complain that they cannot get enough vaccine, or even ANY vaccines, to take care of their high-risk patients and their staffs.

Yet, some swine flu vaccine, according to recent press accounts, has been released to more than a dozen companies including Wall Street firms Goldman Sachs, Citigroup and JP Morgan Chase. Some professional sports teams have gotten vaccine and vaccinated their players and coaches.

When politicians have bothered to get involved in talking about swine flu and what to do about it many have spent that time sounding like fools. Perhaps the best example has been the rhetoric directed at the idea that prisoners, including those at Guantanamo Bay, ought not to get vaccinated.

The posturing before the cameras in a competition to offer the worst advice has been a rare example of bipartisanship. Sen. Joe Lieberman, I-Conn., Rep. Bart Stupak, D-Mich., and the ever mind-numbingly off-base Rep. Roy Blunt, R-Mo., screamed that “accused terrorists will be first in line for H1N1 vaccines.” At least Blunt remembered that they are only accused.

The point, however, is that even if you don’t give two hoots for those stuck in limbo at Guantanamo or locked up in prisons and jails all over the nation, these prisoners pose a huge threat to you.

Prisons are prime breeding grounds for disease, including swine flu. The prisoners infect the guards who bring the virus home to their pregnant wives and kids. From there, it moves out into the neighborhood, the school, the airport and beyond.

Examine response for future crises
I am sure the crowd imprisoned at Gitmo will be happy to do their best to infect our troops. If you want to control the spread of swine flu, the best move is to vaccinate prisoners — whether they want to be vaccinated or not.

We are not doing a good job with swine flu. We need a national commission to review what has gone wrong with the response to the pandemic. And that same commission needs to take a long hard look at the lessons we need to learn before the truly nasty bug or batty terrorist packing anthrax, botulism or tularemia shows up on our shores.