Planning for the potential devastation of a worldwide influenza pandemic is challenging the traditional approach to public health issues, since most health departments in California are organized on the county level.

In 2006, at a California Conference of Local Health Officers meeting, several county health officers from Southern California were discussing pandemic influenza planning and found that they were struggling with many of the same issues. From that conversation, a collaboration has emerged that will facilitate information sharing and coordination of plans as.

The group is known as the California Southern Region Pandemic Planning Collaborative, or CSRPPC, and involves nine counties from San Luis Obispo County on the north to San Diego and Imperial Counties on the south. The group's first formal meeting was held in November 2006 in Orange County and was hosted by the Orange County Health Care Agency. County health officers, epidemiology staff and pandemic planners gathered not only to chart a course for the group's ongoing efforts, but also to begin to look at ways that others have collaborated on this important subject. A special guest at that meeting was Nancy Ridley, associate commissioner of the Massachusetts Department of Public Health, who shared collaborative efforts underway in the Northeast.

At that first meeting, the group decided to focus efforts on two key areas: community containment and risk communications. With representation from each county, two workgroups were formed and began a series of conference calls to share ideas and information while establishing some initial goals.

Community containment covers a wide variety of potential subjects, from when and how to utilize isolation and quarantine during a pandemic, to triggers for schools closings and recommendations on personal protective measures.

Risk communications focuses on ways to effectively communicate the community containment decisions to the public, as well as encourage individual and family preparations for pandemic influenza or other possible health emergencies.

It was not long before we learned that we were not alone in taking a regional collaborative approach. The Association of Bay Area Health Officials, or ABAHO, had also convened a Pandemic Influenza Working Group involving all nine Bay Area counties. This group's goal is to gain consensus on major information and actions, a goal that the CSRPPC had already identified as key to its success.

When CSRPPC members held their second face-to-face meeting on July 25, 2007, in Long Beach, Muntu Davis, MD, MPH, a deputy health officer from the Alameda County Public Health Department, was on hand to share information about ABAHO's progress and future efforts. In that one room, public health officials representing an estimated 30 million Californians were joined together for a single purpose. And that collaboration will continue, with a commitment from the Southern Region to participate in ABAHO's monthly pandemic workgroup meetings.

The implications of this regional and even statewide collaborative effort are clear. If and when the next influenza pandemic occurs, counties in California will have coordinated their response in an unprecedented manner. This ongoing cooperation also involves state and federal public health partners, increasing the likelihood that our actions will be well-coordinated, carefully planned and consistent from county to county. Where differences may exist in the way counties respond to a situation, we will have a better understanding of why those differences are necessary.

The importance placed on collaboration in pandemic planning also has implications for medical practices, hospitals and other healthcare organizations. If the worst of the predicted scenarios comes true, the next influenza pandemic will place unprecedented pressures on our healthcare system. It will take the coordinated effort of every physician, medical group, hospital and system, along with support from the public and private sectors, to weather the storm.

An influenza pandemic won't affect a single city, county, state or nation. It will affect all of us in ways that we might not be able to imagine. Now is the time to plan and develop relationships important to our success. The nine counties that make up the California Southern Region Pandemic Planning Collaborative have started that process, and we invite you to become involved in your local health department's pandemic influenza planning efforts.

Eric G. Handler, MD, MPH, is health officer for the Orange County Health Care Agency. His previous experience includes serving as the deputy secretary for Children's Medical Services in the Florida Department of Health and as chief medical officer for the Boston Regional Office of the Centers for Medicare and Medicaid Services. Dr. Handler received his medical degree from Chicago Medical School and completed his pediatrics training at LAC+USC Medical Center. He can be reached at ehandler@ochca.com.