Public Health Emergency Preparedness An Integrated Approach

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Public Health Emergency PreparednessAn
Integrated Approach

• Office of the Assistant Secretary
• Public Health Emergency Preparedness
• U.S. Department of
• Health and Human Services
• Jerome M. Hauer
• Assistant Secretary
• February 5, 2003

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Introduction

• HHS has been involved with public health
  preparedness for bioterrorist attacks against
  U.S. since 1999
• Efforts have greatly accelerated since 9/11
• HHS preparedness and response plan involves many
  components and stakeholders

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Why Are We Concerned?

• Since September 2001, heightened concerns about
  terrorists access to biologic agents
• Sophisticated dissident groups
• 1995 Aum Shinrikyo Sarin attacks, 2001 Al Queda
• Known BW programs in other countries
• Increasing numbers of laboratories with
  competence to produce agents -- difficult to
  track
• Internet
• Agents available from many sources
• Manufacturing methods on aerolization of smallpox

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Biological Weapons and Bioweapons Development
Programs

• Evidence alleging the existence of offensive
  bioweapons programs in 13 countries
• Soviet bioweapons program manufactured tons of
  anthrax in powder form
• Iraq admitted to producing 8,000 liters of
  concentrated anthrax powder
• Al Queda laboratories intending to make anthrax
  bioweapons recently discovered

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Biological Weapons and Bioweapons Development
Programs

• Following 1972 Biological Weapons Convention,
  some signatories continued work
• Bioweapons scientists from former Soviet Union
  recruited by other nations
• Iraq admitted to producing 19,000 liters
  botulinum, 3x more than needed for entire human
  population
• Russias work on splicing botulinum toxin into
  bacteria
• Smallpox adapted for use in bombs and missiles

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Potential Weapons

• Biological
• Chemical
• Nuclear
• Explosives, Guns

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Overall Goal HHS Bioterrorism Program

• To ensure sustained public health and medical
  readiness for our communities and our nation
  against
• bioterrorism
• infectious disease outbreaks
• other public health threats and emergencies

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Objectives ofHHS Bioterrorism Preparedness
Program

• Enhance capacities for early detection and
  control of infectious diseases
• Receipt and delivery of antibiotics and vaccines
• Strengthening laboratory systems
• Train the public health and medical workforce for
  bioterrorism preparedness and response
• Ensure community and regional health care systems
  are prepared for medical and psychological needs
  of victims, worried-well

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Objectives of the HHS Bioterrorism Program

• Develop effective risk communication and
  information dissemination strategy to address
  needs of stakeholders and the public
• Lead a national bioscience research and
  development effort related to civilian biodefense
• Coordinate medical and public health preparedness
  with other efforts at the community, State, and
  Federal level

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Enhanced Funding forAnti-Terrorism Efforts

• Prevention of Bioterrorism
• State and Local Assets
• Federal Government Assets
• Research and Developmen

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Transfers to Homeland Security

• Office of Emergency Response including 25
  regional emergency officers
• Includes headquarters, National Disaster Medical
  System, Metropolitan Medical Response System
• National Pharmaceutical Stocpkile
• Budget and decision to deploy DHS responsibility
• Secretary of HHS responsible for determining
  content of stockpile
• Smallpox Vaccine

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Different Funding Streams One Integrated Program

• Share a common purpose
• Complement and reinforce each others objectives
• Synchronize efforts as needed
• Build upon pre-existing plans

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Some Lessons Learned from Experience

• After-Action Reports typically describe
  communications systems that couldnt communicate
• Difficulty or impossibility of accommodating
  external assets
• Integration is the key
• Fragmentation is the curse

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Bioterrorism Preparedness Planning

• Must encompass coordinated systems approaches to
  bioterrorism including
• public policies
• incident command and management
• Include local, regional, public and private
  institutions
• Prevention requires Intelligence and Law
  Enforcement
• Public Health and Medical Systems required to
  prepare for, respond to, and lessen impact

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Major Focus on State and Local Assets

• All terrorism is local
• An effective national response requires an
  effective local and state response
• When a public health emergency event occurs, it
  unfolds at local level

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State and Local PreparednessThree Guiding
Principles

• Empower the States to seek integrated response
  capabilities within their borders
• Give States incentives to address inter-State and
  transnational preparedness
• Ensure that USG assets complement and supplement
  State assets

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Current Integrative Efforts

• The State is the primary unit of program
  organization
• Congress endorsed this policy in recent
  authorizing legislation
• (Public Health Security and Bioterrorism
  Preparedness and Response Act of 2002)

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Integration of HHS/DHS Programs

• Link efforts to prepare hospitals and health
  departments for infectious disease outbreaks and
  mass casualty events
• Encourage State officials to incorporate MMRSs
  within plans as appropriate
• Coordinate with other emergency management
  programs (e.g., FEMA, DOJ)

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State ProgramsHorizontal Integration

• State Health Officer Responsible for
• Enhancement of Health Departments
• Enhancement of Hospital Preparedness for Mass
  Casualty Events
• Coordination with Public Safety Agencies

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State and Municipal Advisory Committee
Participants

• State-local health departments and government
• Emergency management agencies and medical
  services
• Rural and urban health
• Police, fire department, emergency rescue workers
  and occupational health workers
• Community health care providers
• Indian nations and tribes
• Red Cross and other voluntary organizations
• Hospital community, including VA

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One Integrated ProgramThree Watchwords

• SPEED in making funds available for use
• FLEXIBILITY in how funds are used
• ACCOUNTABILITY for results obtained

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Oversight of Cooperative Agreements

• Financial auditing
• Are funds being expended in accordance with all
  applicable statutory requirements?
• Project monitoring
• Are activities being conducted consistent with
  the HHS-approved workplan?
• Readiness Assessment
• Have the activities under the cooperative
  agreement led to improved preparedness for
  bioterrorism and other public health emergencies

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Critical Smallpox Vaccine Policy Issues

• Factors to consider in decision-making process
• Level of threat risk of infection with smallpox
• Vaccine supply
• Expected adverse reactions
• Vaccinia immune globulin supply (VIG)
• Liability and compensation issues
• State and local smallpox operational planning

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Administration of Smallpox Countermeasures

• Recommended domestically for smallpox response
  teams, health care workers, emergency
  response/public safety workers
• Personnel associated with certain U.S. facilities
  abroad
• Section 304 of Homeland Security Act intended to
  alleviate liability concerns

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Smallpox Vaccination Issues

• Logistics/Costs of Program
• Education of Potential Vaccinees
• Medical Screening of Potential Vaccinees
• Costs for Treatment of Adverse Events
• Reimbursement for Lost Wages

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Beyond Smallpox Challenges We Face

• Finding qualified candidates for certain
  positions especially in more rural parts of the
  state
• Strengthening surge capacity and patient transfer
  needs
• Adhering to tasks within compressed timelines
  with multiple competing forces
• Integration of different programs at Federal,
  State and local levels

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Public Health Preparedness Program Challenges

• Maintaining the sense of urgency
• Speed in achieving an optimal level of readiness
• Demonstrating to Congress the need to maintain
  funding levels to support public health
  infrastructure
• Establishing and maintaining relationships with
  public health, hospitals, clinicians, health care
  providers, and other responders to ensure a
  cohesive emergency response system

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Office of the Assistant Secretary for Public
Health Emergency PreparednessDepartment of
Health and Human ServicesHubert H. Humphrey
Building, Room 636G200 Independence Avenue, SW
Washington, DC 20201tel [phone] fax
[phone]www.hhs.gov/ophp