What we have here is a failure to communicate!

With the first set of vaccines for H1N1 ready to arrive in the U.S. next week for patient use, the dynamics of public education have reared their ugly head in what has turned out to be perhaps a bigger issue than the flu itself- getting vaccinated. Amazingly, the Department of Health Services is doing little to educate the public, and therefore the first responders and healthcare workers who need the vaccine the most are expressing concerns regarding its viability, side-effects and safety.

To say America is not concerned would be idiocy. To say that something is broken in the way we have dealt with our first modern pandemic would be shortsighted. Even as the CDC and the DHS are quick to announce vaccine availability, many aren't keen on having the shots at all. What we have here is a failure to communicate.

In the world of Emergency Management, Business Continuity and Disaster Recovery, communication is king. You don't say 'we are working on the problem,' or 'we'll give you more information when it comes available to us,' during a disaster, or an outbreak. A good Public Information Officer in any Emergency Management Team knows that you tell it like it is, including the downside if there is one. Simply put, during disasters, honesty is the best policy.

Bright statements like "A flu shot is a flu shot, is a flu shot" from the FDA have done little to educate the public. So where is the public turning to get their information? From extremist websites and politically (if not profit) oriented websites that sell fear and Armageddon as the real reason you need not to be vaccinated. The result: misinformation trumps poor information and the potential for disaster spikes.

It's not hard to understand why the Department of Health and the CDC along with FEMA are not keen on recommending or out right explaining what steps or stages would lead to mass vaccination- we've screwed up on that front one too many times. In 1976, as we all know, there were many deaths associated with the swine flu inoculation program that caused Guillian-Barre disease and thousands of deaths. The debate still rages as to how many of those deaths were a result of the vaccine itself. However, after public protests, federal officials abruptly stopped the program.

A more recent and not often heard of consideration around mass inoculations occurred in 2002. According to Jacob Weisberg in his book The Bush Tragedy, Dick Cheney and then president George Bush debated a nationwide smallpox vaccination as a counterterrorism step. However, Bush overruled Cheney because of the potential for thousands of deaths. (Statistically, smallpox vaccine kills between one and two people for every million persons inoculated.)

In the last week of September healthcare workers took to the streets in a rally to protest mandatory vaccination for H1N1 in front of the state capitol. The rally, according to CBS news, was to call for "Freedom of choice in vaccination and in healthcare." How the two issues became conjoined is a testament to how important proactive federal messaging is during a crisis. The Public, confusing the current news cycle on the healthcare debate believes that this is somehow related to the H1N1 vaccine.

More than just healthcare workers are confused. Parents of the most vulnerable to this flu, young children, don't know what to make of it all. The Association of American Physicians and Surgeons opposes mandatory vaccinations for schoolchildren, noting that the vaccine approval process in general has been "contaminated by flawed or incomplete clinical trials."  American parents agree - Reuters published a study from Consumer Reports on September 30th that found that 50 percent of parents are holding off on the vaccine because "they don't know enough." Of them, 14 percent have ruled it out all together.

As the Obama administration ramps up the distribution of vaccine to over 250 Million doses by the end of this year, little if anything about what to expect, when to expect it, and if the vaccines are highly recommended, have some downsides for children, or might become mandatory has been said.

Leaving us, as Emergency Responders to ask ourselves; How will we respond to these questions without federal guidance? At this late point in the H1N1 response, you needn't worry too much. Good information is on the way. Disney has launched an excellent 'wash your hands' PSA on all of their networks this week and CNN begged their viewers to send in their stories to the CNN Health blog so we can all stay updated. Seriously? You bet. These two national networks seem to be the sole provider of pubic health information.

Here's some information you may find actually helpful when you consider H1N1 vaccinations. There is an important 1905 ruling from the U.S. Supreme Court Case titled Jacobson vs. Massachusetts that was affirmed in 1922. In the case the court held out the states requirement to obtain a free smallpox vaccine or pay five dollars. In the majority vote that held the law, there is some writing that is good case law for mandatory vaccination. The law being challenged was state statute chapter 75, 137: "The board of health of a city or down, if, in its opinion, it is necessary for the public health or safety, shall require and enforce the vaccination and revaccination of all the inhabitants thereof, and shall provide them with the means of a free vaccination. Whoever, being over twenty-one years of age and not under guardianship, refuses or neglects to comply with such requirements shall forfeit $5."

When the case was lost by Jacobson and he was found in error, it was moved to Supreme Court, and in Mr. Justice Harlan delivered the opinion of the court: "We pass without extended discussion the suggestion that the particular section of the statute of Massachusetts now in question is in derogation of the rights secured by the preamble of the Constitution of the United States..." So it seems that the federal case law does not support mandatory vaccines. However, I am not a lawyer and many people, whom have read the case, as I have, find that the courts left this case widely open for interpretation at the state and federal level.

This is where it gets personal. I've gone on record as saying that the biggest threat to healthcare workers is not H1N1 but a group of crazies like some of the people who watch The Alex Jones Show and other conspiracy-hype alternative media. It only takes one zealot to create another Oklahoma City Bombing, but this time it could be in your hospital or urgent care unit.

To prove I was wrong, I received 15 death threats the day after I made that speech. Even today, there is a YouTube video that portrays me, a CEO who has dedicated his life to Public Safety and Emergency Response as the devil himself.

Here's where it gets professional. If you're not including security, disaster recovery and business continuity in this years budget as the threats to your staff, your facility and your operations increase with the flu and the public perception of it, then you are at greater risk of harm by lack of preparedness than you are of a surge or harm this flu itself.

In the meantime, let's hope that 'Smoky the Bear', or the 'Give a Hoot Don't Pollute' campaigns of our childhoods reemerge to help educate Americans so that we can do our work as public servants and help our patients and partners. Perhaps if they were more educated based on Public Service Announcements from our federal government, and not Disney, CNN or internet megalomaniacs we'd be able to concentrate on treating the flu- not preparing for terror.