DPH Commissioner Paul Cote Sees Broad Benefits from Pandemic Preparedness

Paul J. Cote Jr., Commissioner of the Massachusetts Department of Public Health

When Gov. Mitt Romney appointed Paul J. Cote Jr. as commissioner of the Department of Public Health (DPH) in October 2005, he described Cote as “the ideal candidate to help foster a healthier society through prevention, treatment, and education.” Although the DPH is charged with addressing numerous public health issues including substance abuse and strengthening the state’s public hospitals, improving emergency preparedness is at the top of Cote’s priority list. Bill Ryder, MMS counsel for state legislative and regulatory affairs, recently interviewed Commissioner Cote.

Q: How is the DPH balancing the need for preparedness with other public health priorities?

A: Clearly the issue of pandemic preparedness is one that is timely, of enormous public concern, and has great potential impact on the Commonwealth. Our task is to respond to a specific issue such as avian flu in a way that maximizes the value of the response for the benefit of public health preparedness in all areas.

The question that seems to be foremost in people’s minds is whether our planning for pandemic flu will entail a diversion of public health personnel and resources toward a single activity that might detract from other priorities in public health. Again, the challenge we have is to focus our attention on preparedness in ways that will have a broader benefit.

Q: What’s the role of vaccination in pandemic preparedness?

A: On the national front, the President’s push for new vaccine-manufacturing technology is very exciting, as is the broader research into antivirals. The advent of cell-based technology could make a huge difference for public health across the country and across the world.

One fringe benefit of the attention being paid to the avian flu is the fact that we can leverage people’s desire for a bird-flu vaccine into educational opportunities that prompt people to think about getting vaccinated for the regular flu season. To the extent that we bring attention to the utility of vaccination in general, we are raising consciousness -- not in a fearful way, but in a productive way that encourages people to become educated health care consumers.

Q: What is the current status of surge capacity in Massachusetts?

A: Massachusetts hospitals have very fine margins regarding capacity. We have only 13,000-plus acute-care beds. That is why we are looking at how we can create surge capacity by taking advantage of the resources of our physician offices and group practices. We’re pleased to work with the MMS on very detailed issues surrounding surge capacity, including issues of professional liability coverage for volunteer physicians. We are working together effectively in many areas.

Q: How important is clear communication during a pandemic?

A: In times of public health crisis, the public needs to hear a unified message. We have established relationships and procedures within the medical community and with first responders that will allow information to be shared effectively. Consequently, the leaders of the MMS, the Governor, and Dr. Al DeMaria, our director of communicable disease control, can all deliver the same message to the public regarding responses to medical emergencies and threats.

Clear communication will also enable us to most effectively assign and utilize health care volunteers in a time of crisis.

Q: Speaking of volunteers, please comment on the Volunteer Surveillance Corps.

A: The MMS and the DPH are working together to establish a network to increase awareness about the importance of prompt reporting that could indicate the emergence of a new infectious disease outbreak. Surveillance is also critical when responding to an established outbreak. New electronic medical records systems are giving us instant identification of outbreaks, and we need to continue investing in technology that will keep us ahead of fast-moving developments.

Dialogue now in areas of ethics and standards of care is also critical to ensure that we make decisions and establish protocols based on sound advice. It is hard to obtain and integrate good advice in the midst of a crisis.

Q: Any final thoughts?

A: As with health care reform in Massachusetts, there is a real urgency around maintaining and improving our infrastructure to respond to the threats we face. We are on the frontier of many ethical and philosophical issues in care as well. We need to promote dialogue, identify best practices based on outcomes, and promote understanding about effective public health activities. I value the opportunity to work with the MMS on these challenges.