1. Governor’s Taskforce for Pandemic Influenza Preparedness Issue Paper Credible and Effective Decision-making Workgroup Members Robert Rolfs, State Epidemiologist, Utah Department of Health Doug Springmeyer, Assistant Attorney General Sally Kershisnik, Nursing Director, Davis Co. Health Department Joseph Miner, Executive Director, Utah Valley Health Department Adi Gundlapalli, Adj. Assistant Prof. Infectious Dis., Univ. Utah School of Medicine Paul Patrick, Director of Bureau of Emergency Medical Services, UDOH Also reviewed by Pandemic Influenza Workgroup

2. Pandemic Influenza – Decision-making Planning Assumptions ► Simultaneous outbreaks across Utah and U.S.  Limited ability to share resources across jurisdictions ► Prolonged impact - 6-8 weeks in a given community ► Illness rates and absenteeism of 25% or more ► No vaccine for first 6-8 months and shortages after that ► Need for care may exceed capacity of health care system ► Shortages of antiviral medications, antibiotics, infection control and other medical supplies

3. Pandemic Influenza – Decision-making Challenges ► Uncertainty  Inability to plan for all contingencies  Need to adapt to changing circumstances ► Decisions that limit usual activities to limit spread ► School closures, movement restrictions, gathering cancellations ► Decisions about allocation of scarce resources  Who gets vaccine when available  Who gets lifesaving health care when it isn’t sufficient for all  Who receives antiviral treatment

4. Pandemic Influenza – Decision-making Importance of Decision-making The process by which decisions are made can help to maintain trust in leaders and their decisions ► Increasing cooperation with guidance that can reduce risk and minimize the impact of pandemic  e.g., staying home while sick or exposed, limiting social contact ► Helping to maintain community cohesion needed to sustain an organized community response through prolonged pandemic  e.g., accepting resource allocation decisions, volunteering

5. Pandemic Influenza – Decision-making Assumptions about Decision-making ► Consistent approach across jurisdictions following CDC or State guidance ► Operational decisions at local level ► Ensure consideration of community values ► Transparent process should increases trust in decisions made ► Build on and support existing decision-making processes

6. Pandemic Influenza – Decision-making Concerns ► Utah statute may not provide sufficiently clear emergency powers to respond to pandemic  Enforce cancellation of events or limit travel to prevent spread  Require that facilities be made available for medical care, or for confinement to limit spread  Suspend statute allowing altered scope of practice  Provide liability protection to providers caring for patients when usual care standards cannot be met

7. Pandemic Influenza – Decision-making Potential Decisions by Taskforce 1. Advisory Process ► Utah (either Utah Department of Health or Governor) should establish an advisory committee process that would be convened during a pandemic or similar public health emergency to provide technical and policy advice to the Executive Director and Governor. ► It is recommended that such a process be established and that it should:  Include a policy advisory group and one or more technical advisory groups;  Focus on critical decisions (see criteria included in paper);  Be established in advance;  Include a strong emphasis on communicating the process and decisions to the public.

8. Pandemic Influenza – Decision-making Potential Decisions by Taskforce 1. Advisory Process (continued) ► Advisory process should focus on critical decisions  Suggested criteria: ► Affect many people and important to those affected ► Guidelines and policies rather than implementation ► Controversial decisions or lack of clear evidence ► Difficult tradeoffs between benefits and costs  Examples: ► School closure policies ► Vaccine and antiviral priorities ► Triage of limited medical care (e.g., ventilators, ICU care) ► Event cancellations ► Enforced isolation or quarantine

9. Pandemic Influenza – Decision-making Potential Decisions by Taskforce 2. Local decision-making ► Local health departments should be the focus for health-related decisions within their jurisdictions. ► Including input from local boards of health and local elected officials in critical decisions can improve the transparency and acceptability of those decisions. ► Local health departments should prepare their local boards of health and elected officials for this role in advance of a pandemic.

10. Pandemic Influenza – Decision-making Potential Decisions by Taskforce 3) Recommend that Utah State Legislature examine current emergency powers for ability to respond to pandemic  Strengthen emergency powers of Governor and local elected officials  Capability for Governor to establish altered standards for medical care and provide liability protection  Clarify responsibility of governments to prepare for and bear economic impact of measures to respond to pandemic  Clarify roles and interaction of law enforcement, public safety, and public health officials in determining and enforcing decisions during pandemic/public health emergency

11. Pandemic Influenza – Decision-making Potential Decisions by Taskforce 3. Emergency Powers ► The Taskforce should consider recommending that the Legislature strengthen and/or clarify existing legal authority to better support effective decision-making during a public health emergency. The following issues deserve consideration:  Strengthening and expanding the emergency powers available to the governor and of local elected officials for use during a public health emergency;  Provide capability to the Governor to set altered medical care standards based on an advisory group process and to provide liability protection to medical care providers following those altered standards when adhering to usual standards is impossible;  Clarify the responsibility for bearing the economic impact of public health measures to limit spread of a pandemic or other similar infectious disease threat;  Clarify the roles and interaction of law enforcement, public safety, and public health officials in determining and enforcing decisions during a public health emergency.

12. Pandemic Influenza – Decision-making Potential Decisions by Taskforce Summary of Potential Recommendations 1. State advisory process for pandemic decision-making 2. Local decision-making 3. Examine emergency powers supporting response to a pandemic

14. Pandemic Influenza – Decision-making Potential Decisions by Taskforce 1. Advisory Process ► Utah (either Utah Department of Health or Governor) should establish an advisory committee process that would be convened during a pandemic or similar public health emergency to provide technical and policy advice to the Executive Director and Governor. ► It is recommended that such a process be established and that it should:  Include a policy advisory group and one or more technical advisory groups;  Focus on critical decisions (see criteria included in paper);  Be established in advance;  Include a strong emphasis on communicating the process and decisions to the public.

15. Pandemic Influenza – Decision-making Potential Decisions by Taskforce 2. Local decision-making ► Local health departments should be the focus for health-related decisions within their jurisdictions. ► Including input from local boards of health and local elected officials in critical decisions can improve the transparency and acceptability of those decisions. ► Local health departments should prepare their local boards of health and elected officials for this role in advance of a pandemic.

16. Pandemic Influenza – Decision-making Potential Decisions by Taskforce 3. Emergency Powers ► The Taskforce should consider recommending that the Legislature strengthen and/or clarify existing legal authority to better support effective decision-making during a public health emergency. The following issues deserve consideration:  Strengthening and expanding the emergency powers available to the governor and of local elected officials for use during a public health emergency;  Provide capability to the Governor to set altered medical care standards based on an advisory group process and to provide liability protection to medical care providers following those altered standards when adhering to usual standards is impossible;  Clarify the responsibility for bearing the economic impact of public health measures to limit spread of a pandemic or other similar infectious disease threat;  Clarify the roles and interaction of law enforcement, public safety, and public health officials in determining and enforcing decisions during a public health emergency.