PAYSON ROUNDUP | by Peter Aleshire consulting publications editor | Aug 27, 2019
Rural Arizona counties are preparing for the apocalypse.
Well — providing they get the grant.
Hey. Better late than never.
To be specific, Navajo County along with Apache and Gila counties are all lining up for state and federal money to plan a comprehensive response for the kind of pandemic that killed 50 million people after World War I — as a virulent strain of the flu flashed across the world.
The Navajo County Board of Supervisors at its last meeting approved the application for a $250,000 grant from the Arizona Department of Health Services and the federal Centers for Disease Control to establish a system to distribute antibiotics, vaccines and newly developed drugs if a pandemic rips through Arizona. The grant application will come before every county in the state in the next several months, courtesy of the Arizona Bureau of Public Health and Emergency Preparedness.
It sounds like science fiction spawned by a dark mind, but public health experts warn that the nation remains woefully unprepared for fast-spreading, potentially incurable diseases. A recent case in point is Ebola, now once again rippling through the Congo. The easily spread viral disease has a 65 percent mortality rate. The Congo has had 10 outbreaks in the past 40 years, with the most recent spread killing 1,800 people.
Most Americans think of the threat of such pandemics as a Third World problem, held at bay here by modern sanitation and health care systems.
However, Bill Gates has been battling AIDS, malaria and other diseases for more than a decade through the world’s largest charity — the Bill and Melinda Gates Foundation. At a conference, he recently warned that the world remains woefully unprepared for deadly viruses and bacteria incubated by overcrowding, poor sanitation, overuse of antibiotics and global travel patterns.
Medical researchers have developed only a handful of effective vaccines against viral diseases. Many poor countries can’t afford the vaccinations and in many rich countries exaggerated fears of vaccine side effects have left much of the world vulnerable to even well-known viral disease like measles.
The Navajo County Board of Supervisors at its last meeting approved the development of a public health emergency preparedness program to train county workers to receive, distribute and stockpile critical items — like vaccines, antibiotics and other medications needed to cope with a pandemic or “outbreak event.”
The program would also help local hospitals to set up protocols and systems to handle the huge number of potentially infectious patients such an outbreak could generate.
Each county will have to provide a detailed budget to qualify for the state and federal support. The county will establish a point person in the event of such a medical emergency, train workers to handle the crisis and pull together local coalitions of health care workers and public safety officials.
The state has set up four regions to coordinate responses. Navajo and Apache counties are in the northern region, along with Coconino and Yavapai counties and the Hopi, Kaibab-Paiute and Navajo reservations. Gila County’s in the central region, along with Maricopa and Pinal counties and the Gila River, San Carlos Apache, White Mountain Apache and Salt River Pima-Maricopa tribes and communities.
Each county and tribe can apply for state and federal money to pull together its public health emergency plan.
Rural counties have lower population densities, which reduces the speed with which a pandemic can spread. However, rural areas in Arizona also have less access to health care — including vaccines. One survey showed only 51 percent of people living in rural America have job-based health care covered, compared to 57 percent in urban areas. The Affordable Care Act drove down the percentage of Americans without health coverage to the lowest levels in decades, but rural areas still lagged. About 30 percent of rural residents in the state get their health care covered through the Arizona Health Care Cost Containment System (AHCCCS), but the state-run health care system for low-income workers has far fewer health care clinics and facilities in rural areas.
Vaccination rates lag even for established diseases easily preventable with safe vaccines. It requires a 95 percent vaccination rate to acquire “herd immunity” from common viruses like measles, mumps and rubella. But statewide, the vaccination rate has fallen to 93 percent, according to the state department of health resources.
Only about 40 percent of the state’s kindergarten students have a vaccination rate high enough to prevent the spread of a measles outbreak — much less still incurable diseases like Ebola or the kind of flu strain that proved so lethal worldwide in 2018.
The vaccination rates by county for kindergartners in 2019 stood at 92 percent in Apache County and 93 percent in both Gila and Navajo counties, according to the state department of health resources. All three counties fall below the 95 percent threshold for “herd immunity,” which dramatically slows the spread of a virus through the population.
The potential for lethal damage from a new viral threat is possibly even greater, since such a virus would spread quickly without an effective vaccine and only limited drug options for treatment. That’s why the state is scrambling to get each county to set up an emergency response system in case such a virus gets loose.
The history of the 1918 flu epidemic remains a haunting reminder of what can happen, despite a century of advances in battling bacteria and viruses. The flu virus in 1918 spread from birds to humans, which meant most humans didn’t have natural defenses against the bird-based strain. About 500 million people were infected, about one-third of the world’s population. The strain killed roughly 10 percent of those infected, especially those younger than 5 and older than 65. The virus also had an unusually high mortality rate among those 20 to 40, a population normally resistant to fatal side effects from viral infections.
Medical experts are still not sure why that strain proved so lethal, although the lack of a vaccine or effective antibiotics coupled with the worldwide disruption of public health systems by World War I all likely played a role.
Less lethal flu pandemics afflicted the world and caused millions of deaths in 1957-58, 1968 and 2009.
And that’s just the flu — one of the most intensively studied viruses in the world, whose effects are limited by a sophisticated, worldwide flu vaccine system.
The state hopes to at least lay the groundwork for a coordinated response with grants to each county in the state to prepare an emergency response.