Public health management of antiviral drugs during the 2009 H1N1 influenza pandemic: a survey of local health departments in California

<p>Abstract</p> <p>Background</p> <p>The large-scale deployment of antiviral drugs from the Strategic National Stockpile during the 2009 H1N1 influenza response provides a unique opportunity to study local public health implementation of the medical countermeasure dispensing capability in a prolonged event of national significance. This study aims to describe the range of methods used by local health departments (LHDs) in California to manage antiviral activities and to gain a better understanding of the related challenges experienced by health departments and their community partners.</p> <p>Methods</p> <p>This research employed a mixed-methods approach. First, a multi-disciplinary focus group of pandemic influenza planners from key stakeholder groups in California was convened in order to generate ideas and identify critical themes related to the local implementation of antiviral activities during the H1N1 influenza response. These qualitative data informed the development of a web-based survey, which was distributed to all 61 LHDs in California for the purpose of assessing the experiences of a representative sample of local health agencies in a large region.</p> <p>Results</p> <p>Forty-four LHDs participated in this study, representing 72% of the local public health agencies in California. While most communities dispensed a modest number of publicly purchased antivirals, LHDs nevertheless drew on their previous work and engaged in a number of antiviral activities, including: acquiring, allocating, distributing, dispensing, tracking, developing guidance, and communicating to the public and clinical community. LHDs also identified specific antiviral challenges presented by the H1N1 pandemic, including: reconciling multiple sources and versions of antiviral guidance, determining appropriate uses and recipients of publicly purchased antivirals, and staffing shortages.</p> <p>Conclusions</p> <p>The 2009 H1N1 influenza pandemic presented an unusual opportunity to learn about the role of local public health in the management of antiviral response activities during a real public health emergency. Results of this study offer an important descriptive account of LHD management of publicly purchased antivirals, and provide practitioners, policy makers, and academics with a practice-based assessment of these events. The issues raised and the challenges faced by LHDs should be leveraged to inform public health planning for future pandemics and other emergency events that require medical countermeasure dispensing activities.</p

The environmental and public health benefits of achieving high penetrations of solar energy in the United States

We estimate the environmental and public health benefits that may be realized if solar energy cost reductions continue until solar power is competitive across the U.S. without subsidies. Specifically, we model, from 2015 to 2050, solar power–induced reductions to greenhouse gas (GHG) emissions, air pollutant emissions, and water usage. To find the incremental benefits of new solar deployment, we compare the difference between two scenarios, one where solar costs have fallen such that solar supplies 14% of the nation's electricity by 2030 and 27% by 2050, and a baseline scenario in which no solar is added after 2014. We monetize benefits, where credible methods exist to do so. We find that under these scenarios, solar power reduces GHG and air pollutants by ∼10%, from 2015 to 2050, providing a discounted present value of $56–$789 billion (central value of ∼250 billion, equivalent to ∼2 ¢/kWh-solar) in climate benefits and 77–$298 billion (central value of$167 billion, or ∼1.4&nbsp;¢/kWh-solar) in air quality and public health benefits. The ranges reflect uncertainty within the literature about the marginal impact of emissions of GHG and air pollutants. Solar power is also found to reduce water withdrawals and consumption by 4% and 9%, respectively, including in many drought-prone states