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Transcript 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
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
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
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
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
Biological
Chemical
Nuclear
Explosives, Guns
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
Objectives of
HHS 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”
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
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
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
Share a common purpose
Complement and reinforce each other’s
objectives
Synchronize efforts as needed
Build upon pre-existing plans
Some Lessons Learned from
Experience
After-Action Reports typically describe
communications systems that couldn’t
communicate
Difficulty or impossibility of
accommodating external assets
Integration is the key
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
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
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
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
SPEED in making funds available for
use
FLEXIBILITY in how funds are used
ACCOUNTABILITY for results obtained
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
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
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
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