Global Response Begins At Home
On November 1, 2005, President George W. Bush announced the National Strategy for Pandemic Influenza, a comprehensive approach to addressing the threat of pandemic influenza.

The strategy outlines how we are preparing for, and how we will detect and respond to a potential pandemic.  Since this announcement, our Nation has taken a series of historic steps to address the pandemic threat.  In December 2005, Congress appropriated $3.8 billion.

The International Partnership for Avian and Pandemic Influenza, which launched at the United Nations in September 2005, has encouraged openness and coordinated action by the international community.

Here in the United States, we have made major investments in vaccine and antiviral development, research into the influenza virus, surveillance for disease in animals and humans, and the local, State, and Federal infrastructure necessary to respond to a pandemic.

The National Strategy for Pandemic Influenza announced by President George W. Bush consists of a three-pronged approach to responding to potential pandemic threats: (1) preparedness and communication; (2) surveillance and detection; and (3) response and containment.  Preparedness for a pandemic requires the establishment of infrastructure and capacity, a process that can take years.  For this reason, significant steps must be taken now.

The Strategy affirms that the Federal Government will use all instruments of national power to address the pandemic threat (National Strategy for Pandemic Influenza, Executive Summary).

The goals of the Federal Government response to a pandemic are to: (1) stop, slow, or otherwise limit the spread of a pandemic to the United States; (2) limit the domestic spread of a pandemic, and mitigate disease, suffering and death; and (3) sustain infrastructure and mitigate impact to the economy and the functioning of society.

The central pillar of the pandemic response will be in communities.  The distributed nature of a pandemic, as well as the sheer burden of disease across the Nation over a period of months or longer, means that the Federal Government’s support to any particular State, Tribal Nation, or community will be limited in comparison to the aid it mobilizes for disasters such as earthquakes or hurricanes, which strike a more confined geographic area over a shorter period of time.  Local communities will have to address the medical and non-medical effects of the pandemic with available resources.

This means that it is essential for communities, tribes, States, and regions to have plans in place to support the full spectrum of their needs over the course of weeks or months, and for the Federal Government to provide clear guidance on the manner in which these needs can be met.

In addition to this local response protocol, to be most effective, these measures require international preparation and coordination. The Federal Government will work with the World Health Organization (WHO) and through diplomatic contacts to strengthen these international mechanisms.  We will configure our own Departments and Agencies to deploy personnel and material in support of an international response upon the first reports of suspected outbreaks (National Strategy for Pandemic Influenza, Executive Summary).

During this transformation into a more prepared stance to fight a potential pandemic, there has been a renewed interest in clearly defining the role of the local agency by modernizing public health law. 

Our Legal Environment

In the 1970’s, environmental legislation was poor or non-existent.  The 1965 Solid Waste Disposal Act encouraged states to develop waste management programs.  The Clean Air Act and Clean Water Act had required installation of pollution control devises on smokestacks and pipes.

These acts did not directly dictate where the waste was supposed to go or the processing of the waste prior to disposal.  Landfills at the time were simply holes in the ground that were compacted by bulldozers until full and then covered with topsoil in preparation for commercial development above.

Medical waste was discarded through the municipal waste stream, garbage collection, and sanitation workers were exposed to potential infection.

Prior to the Resource Conservation and Recovery Act of 1976 (RCRA), there wasn’t stringent record keeping requirements to identify the origination of the waste.  The Resource Conservation and Recovery Act was enacted in 1976 to address the limitations of the existing legislation.

"A policy success is a government intervention, or the elimination of one, that improves the allocation of resources and reduces the degradation of the environment."

Theodore Panayotou, Green Markets

RCRA was the first environmental law to take a life-cycle approach when it established standards for waste from its generation to its disposal.  One of the best aspects of RCRA was the flexibility it offered private industry in explaining waste classification.  By clearly dictating the handling standards for medical waste, RCRA was a major step forward in disease outbreak control.

In addition to the list of regulated substances banned from conventional disposal, RCRA uses a characteristic system to explain its scope.  Under this characteristic system, any substance that meets any of the components (ignitability, reactivity, corrosivity, or toxicity) is regulated waste.  And this regulated waste has stringent disposal requirements.

The drawback of RCRA was not in its structure or scope but in its implementation.  While RCRA clearly dictated the handling standards in regards to medical waste, state agencies lacked standardized enforcement.  The Texas Commission on Environmental Quality (TCEQ) previously cited exemptions to the medical waste handling standards dictated by RCRA.

Previously, according to the TCEQ, the waste generated from a home or lodging was exempt from special handling requirements.  RCRA did not grant these exemptions.

A cornerstone of the EPA’s 2006-2011 Strategic Plan is the Cross-Goal Strategies that focus on reconciling federal direction and state implementation.  State environmental programs conduct a great portion of the day-to-day work involved in compliance and enforcement activities.

The EPA has placed higher priority in joint planning with States and Tribes.  This joint planning is already starting to clarify enforcement on the local level.

Closing the Gap between Federal Direction and State Implementation
When communicating remediation and disposal requirements to the public, city personnel display a consistent approach between federal direction, state implementation, and the local city level enforcement of RCRA standards.

This consistent approach will not only add efficiencies on an organizational level at the EPA but it will also increase the effectiveness in our government agencies and private industry’s protection of the public.  With the challenges that infection control brings, this increase in effectiveness is the best possible approach in the protection of society's health.