Tough Tradeoffs Challenge Easy Resolution: Conclusions from Pandemic Influenza Exercises in Two States

This paper reports the conclusions drawn from more than 150 hours of facilitated discussions by participants in 36 school closing tabletop exercises (12 in Alabama and 24 in Mississippi) between January, 2007 and April 2008. Participants included school administrators, classroom teachers and counselors, school nurses, child care specialists, public health professionals, government leaders, and first responders. All exercises included a didactic component offering information on seasonal, avian, and pandemic influenza (including proposed pharmaceutical and non-pharmaceutical countermeasures); a series of three audio-video vignettes describing a pre-pandemic setting, a pandemic onset, and finally a mid-point in the first wave of a pandemic. Each scenario was followed by facilitated group discussion with a summary by the facilitator. All scenarios were designed by the Centers for Disease Control and Prevention (CDC) as part of the “Pandemic Influenza Guidance Supplement to the 2006 Public Health Emergency Preparedness Cooperative Agreement Phase II”. The facilitators focused discussions on the following areas: 1) public health risks and countermeasures, 2) the school closing decision making process, and 3) the impact of school closings. Discussion sessions illustrated a series of important policy and procedural concerns. Among the more important were: (1) initial reluctance of public school officials to advocate individual initiative while preferring to abdicate decision making to higher authorities; (2) absence of provisions for decision making guidelines regarding prolonged closings in school crisis planning documents; and (3) consistent agreement that school closing represents an effective and necessary countermeasure for pandemic influenza.