Emergency Preparedness and Response A CDC Update

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Emergency Preparednessand ResponseA CDC Update

October 2004
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Introduction
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Background
A brief history
1961 CDC takes over publication of the Morbidity
and Mortality Weekly Report (MMWR). The first
cases of a new disease, later called AIDS, was
reported in the MMWR in 1981.
1966 CDC launches the Smallpox Eradication
Program to eradicate smallpox and control
measles in 20 African countries. Smallpox was
declared eradicated from the world in the late
1970's.
1946 The Communicable Disease Center (CDC) opens
in Atlanta as part of the U.S. Public Health
Service (PHS). Its primary mission is to fight
malaria and other communicable diseases. 1947 A
token payment of 10 is made for 15 acres, the
home of the CDC headquarters today.
1951 The Epidemic Intelligence Service (EIS) is
established.
1955 The Polio Surveillance Unit is established.
Ten years later, CDC assumes PHS responsibility
for the control of polio.
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Background
1981 CDC reports the first cases of an illness
now called acquired immunodeficiency syndrome
(AIDS).
2001 September 11, 2001 attacks. Anthrax spores
released through mail resulting in five
casualties. 2002 Office of Terrorism
Preparedness and Emergency Response (OTPER)
established.
1983 CDC establishes a Violence Epidemiology
Branch. 1986 The Office of Smoking and Health
becomes part of CDC. 1988 CDC establishes the
Center for Chronic Disease Prevention and Health
Promotion.
2003 More than 3,000 Severe Acute Respiratory
Syndrome (SARS) cases are reported in 28
countries. 2004 Avian influenza, Hurricane
Response, Vaccine Shortage
1970 The Communicable Disease Center was renamed
the Center for Disease Control to reflect a
broader mission in preventive health. 1973 The
National Institute for Occupational Safety and
Health (NIOSH) becomes part of CDC. 1978 CDC
opens an expanded, maximum-containment
laboratory to handle viruses too dangerous to
handle in an ordinary laboratory.
1992 CDC adds Prevention to its name to reflect
a broader role and vision, but retains the
initials, CDC. 1993 CDC launches the National
Childhood Immunization campaign.
1996 CDC celebrates 50 years of
success. 1998 The first Surgeon General's
report on tobacco use among minorities is
released.
Source As Published on http//www.cdc.gov/od/oc/m
edia/timeline.htm
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Background
Same responsibility
New context
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Background 2004 Budget and FTEs
TPR funding represents 16 of CDC overall budget
and 6 of CDCs FTEs
DollarsIn Billions
FTEs
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FY 2003
Background 2004 Budget
FY 2004
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Strategy Health Protection Goals

• Preparedness
• People in all communities will be protected from
  infectious, occupational, environmental, and
  terrorist threats.
• Health Promotion and Prevention of Disease,
  Injury, and Disability
• All people, especially those at higher risk due
  to health disparities, will achieve their optimal
  lifespan with the best possible quality of health
  in every stage of life.

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Strategy Why Change Now?

• Aging population
• Emerging global infectious diseases
• Obesity
• Development of public health workforce and
  infrastructure
• Health disparities

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Strategy Imperatives

• Health impact
• CDC will be a customer-centric organization
• Public health research
• Leadership for the nations health system
• Global health
• Effectiveness and accountability

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Strategy Coordinating Centers and Offices

• Minimize silos
• Identify and capitalize on opportunities for
  coordination of research
• Decrease duplication and redundant activities
• Provide leadership, management, and
  accountability for cross-center goals

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Strategy Preparedness for All Hazards
OUR VISION People Protected Public Health
Prepared. OUR GOAL To combine our strengths in
times of crisis to minimize suffering and death.
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Strategy Connectivity
Desired State
DoD VA
Law Enforcement
Environmental (BioWatch)
Pharmacy Data
Border States
Public
Schools
Employers
Media
Cargo/ Imports
Laboratory
Immigration
Clinicians
First Responders
Hospitals
Veterinary
Vital Records
International
Quarantine Stations
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Strategy Go Deep
PREPARE DETECT REPORT
RESPOND CONTAIN RECOVER

• Surveillance
• Laboratories
• Response plans
• Medical countermeasures
• Exercising and proficiency testing

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Priority Activities Surveillance

• Improving Case Detection
• 24x7 Clinician Information Hotlines
• Health alerting and secure communications
• Clinician outreach
• Just-in-time and just-in-case educational
  materials
• Quarantine stations
• PHIN/ELR/Health record standards

• Improving Outbreak Detection
• Syndromic surveillance information
• BioSense

• Improving Exposure Detection
• BioWatch
• BDS and ADS
• Water Alliance

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Priority Activities Laboratories

• Improving Laboratory Safety and Security
• The Select Agent Program
• Registration and security risk assessment for
  possession, use, and transfer of select agents
• 350 registered entities, 370 inspections, 9000
  individual SRAs
• Training materials and tools to simplify
  compliance

• Improving Laboratory Capability
• Rapid diagnostic assays for biologic and chemical
  agents
• Environmental microbiology
• Antimicrobial resistance and agent
  characterization

• Improving Laboratory Capacity
• The Laboratory Response Network (LRN since
  1999)
• 120 Confirmatory Reference labs providing
  identification of biological threat agents
• State and local public health, federal, military,
  international, veterinary, food and environmental
  testing facilities, as well as chemical
  laboratories
• APHL, CDC, DoE, FBI, EPA, DHS, DoD, FDA, USDA,
  others
• Monitoring and response

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Priority Activities Laboratories
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Priority Activities Response Plans

• Responding to environmental sensors and field
  testing devices
• BioWatch, BDS, water monitoring
• First responder testing

• Influenza Pandemic Planning
• Surveillance
• Healthcare preparedness
• Community containment methods
• Legal and policy issues
• Psychosocial

• Improving Preparedness Education
• Distance learning gt5 million cumulative viewers
  TPER topics
• Forensic Epidemiology Course
• State and Local Public Health education
  coordination (Focus Area G)
• Centers for Public Health Preparedness 23
  Schools of Public Health and 19 other
  university-based / academic programs
• Project Public Health Ready pilot projects in
  local health departments emphasis on planning,
  education, drills/exercises

• Improving Emergency Operations

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Priority Activities Response Plans

• Directors Emergency Operations Center (DEOC)
• 7,000 square feet 85 workstations operates
  24/7/365
• Focal point for emergency information
  collaboration
• Concept of Operations based on ICS/NIMS/NRP Model
  
• Staff support to assist in establishing state EOC
• Continuity of Operations Plan (COOP)

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Priority Activities Medical Countermeasures

• Strategic National Stockpile (SNS)
• National repository of antibiotics, chemical
  antidotes, antitoxins, life-support medications,
  IV administration, med/surg and airway supplies
• Twelve, strategically located, 12-hour push
  packages
• Tailored Vendor Management Inventory (VMI)
• VMI deployable within 24 to 36 hours
• Technical Advisory and Response Unit (TARU) and
  Webcast support

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Priority Activities State and Local Grant Program

• New Guidance
• Input to draft underway with intent to clearance
  by January
• March 2005 goal for guidance release
• Funding level unknown pending Congressional
  approval

• Coordinators/Project Directors Meeting
• October 25-26 in Atlanta
• New guidance, performance goals, exercises,
  pandemic influenza planning, direct assistance

• Workforce Capacity
• New hires at state and local levels
• Direct assistance available
• Boot camp training of CDC field staff starting
  Q1 of 2005

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Priority Activities Performance Goals
Based on Preparedness principles

• Systems are connected pieces
• Planning should be supported by evidence
• Focus is State support of a local response

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Priority Activities Performance Goals

• Need to base public health performance
  indicators/goals on
• Research
• Evidence
• Best Practices
• Multi-Disciplinary Team tasked to develop goals
  and measures for public health preparedness
• Indicators/goals are designed to be applicable to
  State and Local Public Health Preparedness Needs

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Priority Activities Performance Goals

• Mutually Understood Roles and Responsibilities
• Detecting the Outbreak
• Determining Cause and Risk Factors
• Implementing Measures to Control the Outbreak
• Each Section Includes
• Evidence
• Goals
• Measures
• Suggestions for Application
• Proof of Performance

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1. Mutually Understood Roles and Responsibilities
Priority Activities Performance Goals

• Is Public Health an Active Participant in the
  Jurisdictions Planning Process
• Do they know what you do?
• Do you exercise with other agencies?

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2. Detecting the Outbreak
Priority Activities Performance Goals

• 24/7/365 Reporting
• Providers---Who you gonna Call?
• Can someone take the Call?
• Do they know what to do?
• 24/7/365 Alerting Of Key Partners
• First Responders
• Health Care
• Other Jurisdictions

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3. Determining Cause and Risk Factors
Priority Activities Performance Goals

• Epidemiological Investigation
• Surge Capacity
• Interaction with Law Enforcement
• Laboratory Operations
• Relationship with regional Labs
• Packaging and Shipping

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4. Implementing Measures to Control the Outbreak
Priority Activities Performance Goals

• Emergency Communications
• Crisis and Emergency Risk Communication
• Incident Management and Coordination
• Mass Prophylaxis
• Quarantine
• Mass Casualty Care

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4. Implementing Measures to Control the Outbreak
Priority Activities Performance Goals

• Emergency Communications
• Redundant Communications
• Mass Prophylaxis
• Distribution and Dispensing of Prophylaxis to
  affected population
• Sufficient number of dispensing centers
• Timely (based on agent)

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4. Implementing Measures to Control the Outbreak
Priority Activities Performance Goals

• Incident Management and Coordination
• Activation of Public Health Incident Management
  (Compatible with NIMS)
• Participation with EMA
• Part of Unified Command if appropriate
• Integration with Public Health and Medical
• ESF-8
• Mental/Behavioral Health
• After Action Reports (with Follow-up)

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Priority Activities
PREPARE DETECT REPORT
RESPOND CONTAIN RECOVER

• Surveillance
• Laboratories
• Response plans
• Medical countermeasures
• Exercises and proficiency testing

• Mutually Understood Roles and Responsibilities
• Detecting the Outbreak
• Determining Cause and Risk Factors
• Implementing Measures to Control the Outbreak

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Questions
Daniel M. Sosin, M.D., M.P.H. Associate Director
for Science Office of Terrorism Preparedness and
Emergency Response djsosin_at_cdc.gov