Download public health emergency response

Public Health Emergency
Preparedness
An 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
Introduction
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HHS has been involved with public health
preparedness for bioterrorist attacks against
U.S. since 1999
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Efforts have greatly accelerated since 9/11
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HHS preparedness and response plan
involves many components and stakeholders
Why Are We Concerned?
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Since September 2001, heightened concerns
about terrorists’ access to biologic agents
Sophisticated dissident groups
 1995 Aum Shinrikyo Sarin attacks, 2001 Al Queda
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Known BW programs in other countries
Increasing numbers of laboratories with
competence to produce agents -- difficult to track
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Internet
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 Agents available from many sources
 Manufacturing methods on aerolization of smallpox
Biological Weapons and Bioweapons
Development Programs
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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
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
 Russia’s work on splicing botulinum toxin into
bacteria
 Smallpox adapted for use in bombs and missiles
Potential Weapons
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Biological
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Chemical
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Nuclear
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Explosives, Guns
Overall Goal
HHS Bioterrorism Program
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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
Objectives of
HHS Bioterrorism Preparedness Program
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Enhance capacities for early detection and
control of infectious diseases
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Receipt and delivery of antibiotics and vaccines
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Strengthening laboratory systems
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Train the public health and medical workforce
for bioterrorism preparedness and response
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Ensure community and regional health care
systems are prepared for medical and
psychological needs of victims, “worried-well”
Objectives of the
HHS Bioterrorism Program
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Develop effective risk communication and
information dissemination strategy to
address needs of stakeholders and the
public
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Lead a national bioscience research and
development effort related to civilian
biodefense
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Coordinate medical and public health
preparedness with other efforts at the
community, State, and Federal level
Enhanced Funding for
Anti-Terrorism Efforts
 Prevention of Bioterrorism
 State and Local Assets
 Federal Government Assets
 Research and Developmen
Transfers to Homeland Security
Office of Emergency Response including 25
regional emergency officers
 Includes headquarters, National Disaster Medical
System, Metropolitan Medical Response System
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National Pharmaceutical Stocpkile
 Budget and decision to deploy DHS responsibility
 Secretary of HHS responsible for determining content
of stockpile
 Smallpox Vaccine
Different Funding Streams:
One Integrated Program
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Share a common purpose
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Complement and reinforce each other’s
objectives
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Synchronize efforts as needed
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Build upon pre-existing plans
Some Lessons Learned from
Experience

After-Action Reports typically describe
communications systems that couldn’t
communicate
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Difficulty or impossibility of
accommodating external assets
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Integration is the key
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Fragmentation is the curse
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
Major Focus on
State and Local Assets

All terrorism is local
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An effective national response requires
an effective local and state response

When a public health emergency event
occurs, it unfolds at local level
State and Local Preparedness
Three Guiding Principles

Empower the States to seek integrated
response capabilities within their borders
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Give States incentives to address inter-State
and transnational preparedness

Ensure that USG assets complement and
supplement State assets
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)
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)

State Programs:
Horizontal Integration
State Health Officer Responsible for
 Enhancement of Health Departments
 Enhancement of Hospital Preparedness for
Mass Casualty Events
 Coordination with Public Safety Agencies
State and Municipal Advisory
Committee Participants
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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
One Integrated Program:
Three Watchwords
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SPEED in making funds available for
use
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FLEXIBILITY in how funds are used
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ACCOUNTABILITY for results obtained
Oversight of Cooperative
Agreements
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Financial auditing
 Are funds being expended in accordance with all
applicable statutory requirements?
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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
Critical Smallpox Vaccine Policy
Issues
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Factors to consider in decision-making
process:
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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
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
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
Beyond Smallpox: Challenges
We Face
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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
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
Office of the Assistant Secretary
for Public Health Emergency Preparedness
Department of Health and Human Services
Hubert H. Humphrey Building, Room 636G
200 Independence Avenue, SW
Washington, DC 20201
tel (202) 401-4862
fax (202) 690-6512
www.hhs.gov/ophp