CDC COOPERATIVE CDC COOPERATIVE AGREEMENT AGREEMENT
Public Health Emergency Public Health Emergency PreparednessPreparedness
4th Annual 4th Annual PHRST 7 Homeland Security PHRST 7 Homeland Security
and Preparedness Conferenceand Preparedness ConferenceMay 10, 2006May 10, 2006Charlotte, NCCharlotte, NC
Maribeth WootenMaribeth WootenEpidemiology Section, NC Division of Public Epidemiology Section, NC Division of Public
HealthHealth
A New NormalA New Normal
Preparedness:Preparedness:A Core Public Health A Core Public Health FunctionFunctionCentral Role of StatesCentral Role of StatesAll Emergencies Start LocalAll Emergencies Start Local
What We What We Have AccomplishedHave Accomplished
Components of the NC Public Health Components of the NC Public Health Preparedness and Response PlanPreparedness and Response Plan
SurveillanceSurveillanceDisease investigationDisease investigationLaboratory capacity and responseLaboratory capacity and responseVaccination/prophylaxisVaccination/prophylaxisQuarantine and isolationQuarantine and isolationMass careMass careMass fatalityMass fatalityPublic informationPublic informationCommand/Control/CommunicationsCommand/Control/Communications
What We Have What We Have AccomplishedAccomplished
Local Public Health CapacityLocal Public Health Capacity
Local BT Planners/CoordinatorsLocal BT Planners/CoordinatorsWorkforce Development/TrainingWorkforce Development/TrainingInformation Technology UpgradesInformation Technology UpgradesInternet Connectivity (HAN) Internet Connectivity (HAN) -- all all LHDs and >110 hospitalsLHDs and >110 hospitalsResponse Plans with local partnersResponse Plans with local partners
What We Have AccomplishedWhat We Have AccomplishedState & Regional Public Health State & Regional Public Health
CapacityCapacity
7 PHRSTs7 PHRSTs3 Regional Laboratories3 Regional Laboratories12 Hospital PH Epidemiologists 12 Hospital PH Epidemiologists Enhanced surveillance & response systems Enhanced surveillance & response systems (MOST, NC DETECT, NC EDSS, OMS, RNAs)(MOST, NC DETECT, NC EDSS, OMS, RNAs)Workforce Development/TrainingWorkforce Development/TrainingPHTIN UpgradesPHTIN Upgrades
BioterrorismCoordinator
NC Emergency Management
CDCLaw Enforcement: FBI, SBI
85 LHDs
Medical Facilities Academic Institutions
Military Installations
State Level Bioterrorism Team
7 P.H. Regional Surveillance Teams
NC Public Health Preparedness and Response
Linking of Response Linking of Response SystemsSystems
Medical & Mental Medical & Mental Health ServicesHealth Services
First RespondersFirst RespondersFire/EMSFire/EMS
Emergency ManagementManagement
PublicPublicHealthHealth
LawLawEnforcementEnforcement
What We Have What We Have AccomplishedAccomplished
Examples of Dual Use CapacityExamples of Dual Use Capacity
Hurricane responses in NC Hurricane responses in NC Hurricane responses outside of NCHurricane responses outside of NCE. coliE. coli outbreak at NC State Fairoutbreak at NC State FairLegionella outbreak in Western NCLegionella outbreak in Western NCSmallpox Vaccination ProgramSmallpox Vaccination ProgramFlu Vaccine Shortage ResponseFlu Vaccine Shortage ResponseWest Nile Virus West Nile Virus -- Vectorborne DiseasesVectorborne DiseasesSARS Response Winter 2003SARS Response Winter 2003
CDC Grant Funding History CDC Grant Funding History
Years 1 & 2 Years 1 & 2 Start up laboratory fundingStart up laboratory fundingYear 3Year 3 $ 24.2M$ 24.2MYear 4 Year 4 $ 26.2M $ 26.2M
(Base, $2.8M Smallpox, $1.8M SNS)(Base, $2.8M Smallpox, $1.8M SNS)Year 5Year 5 $ 20.5M$ 20.5MYear 6Year 6 $ 22.9M$ 22.9M
(Base, $2.5M Pan Flu)(Base, $2.5M Pan Flu)
Year 7Year 7 ??????
DHHS Reallocation DecisionDHHS Reallocation Decision((why we had less money in BY5)why we had less money in BY5)
Cities Readiness Initiative (Cities Readiness Initiative (--$39M)$39M)Shift to CDC Shift to CDC BioSense (BioSense (--$11.9M)$11.9M)–– Quarantine Stations (Quarantine Stations (--$4M)$4M)
Pool available to statesPool available to states–– Was $864.9MWas $864.9M–– Now $810M (Now $810M (--6.3%)6.3%)
Reduced NC base amount (from $5M to Reduced NC base amount (from $5M to $3.9M)$3.9M)No SNS or Smallpox FundingNo SNS or Smallpox Funding
Reduced Federal Reduced Federal AppropriationsAppropriations
(why we had less money in BY6 and why (why we had less money in BY6 and why wewe’’ll have less money in BY7)ll have less money in BY7)
Potential Budget Year 7 FundingPotential Budget Year 7 Funding
Reduced Federal Appropriations to CDCReduced Federal Appropriations to CDCAnticipate 15% reduction in base funding Anticipate 15% reduction in base funding to all statesto all states’’ cooperative agreementscooperative agreementsPotential reduced NC base funding from Potential reduced NC base funding from BY6 $20.4M to BY7 $17.3MBY6 $20.4M to BY7 $17.3M
Current CDC Grant StructureCurrent CDC Grant StructureProject Period 2Project Period 2
(Budget Years 6(Budget Years 6--10)10)
No Focus AreasNo Focus AreasOutcomes DrivenOutcomes DrivenPrevent, Detect, Report, Investigate, Prevent, Detect, Report, Investigate, Control, Recover and ImproveControl, Recover and ImproveProvides objectives to be achieved by Provides objectives to be achieved by state, territorial, and priority local state, territorial, and priority local public health agenciespublic health agencies
CDC Grant StructureCDC Grant StructureProject Period 2 Project Period 2
Performance MetricsPerformance Metrics
State and Priority Local Health State and Priority Local Health DepartmentsDepartmentsPriority LHDs defined through Metropolitan Priority LHDs defined through Metropolitan Statistical Areas (MSAs)Statistical Areas (MSAs)Reportable to CDC at annual application Reportable to CDC at annual application and through regular progress reportsand through regular progress reports
CDC Grant StructureCDC Grant StructurePerformance MetricsPerformance Metrics
NC MSAsNC MSAsCharlotteCharlotte--GastoniaGastonia--Concord, NCConcord, NC--SCSC
Includes LHDs in the Includes LHDs in the following countiesfollowing counties::AnsonAnsonCabarrusCabarrusGastonGastonMecklenburgMecklenburgUnionUnion
Additional LHDsAdditional LHDs::IredellIredellLincolnLincoln
CDC Grant StructureCDC Grant StructurePerformance MetricsPerformance Metrics
NC MSAsNC MSAs
Albemarle Regional Health Services Albemarle Regional Health Services (Currituck Co.) defined as part of (Currituck Co.) defined as part of
Norfolk, VA MSANorfolk, VA MSA
CDC Grant StructureCDC Grant StructureProject Period 2 Project Period 2
Performance Metrics Performance Metrics NIMS ComplianceNIMS Compliance
How many FullHow many Full--Time Equivalent (FTE) public Time Equivalent (FTE) public health employees have emergency response health employees have emergency response roles specified in their job descriptions?roles specified in their job descriptions?How many have been trained in the National How many have been trained in the National Incident Management System (NIMS) within the Incident Management System (NIMS) within the last 24 months?last 24 months?
CDC Grant StructureCDC Grant StructureProject Period 2 Project Period 2
Performance MetricsPerformance MetricsEmergency Response Emergency Response
In public health emergency response plans In public health emergency response plans what is the estimated number of what is the estimated number of volunteers that are needed to support an volunteers that are needed to support an epidemiologic investigation? epidemiologic investigation? How many are trained for this function?How many are trained for this function?
CDC Grant StructureCDC Grant StructureProject Period 2 Project Period 2
Performance MetricsPerformance MetricsEmergency ResponseEmergency Response
In public health emergency response plans In public health emergency response plans what is the estimated number of what is the estimated number of volunteers that are needed for mass volunteers that are needed for mass prophylaxis?prophylaxis?How many are trained for this function?How many are trained for this function?
CDC Grant StructureCDC Grant StructureProject Period 2 Project Period 2
Performance MetricsPerformance MetricsImprovementImprovement
During all drills, exercises, and real events in the During all drills, exercises, and real events in the last 12 months, what was the average time from last 12 months, what was the average time from the end of the drill, exercise, or real event to the end of the drill, exercise, or real event to completion of the after action report? completion of the after action report? Time to implementation of corrective actions? Time to implementation of corrective actions?
To retest areas requiring retesting?To retest areas requiring retesting?
Potential North Carolina Budget Potential North Carolina Budget Year 7 FundingYear 7 Funding
Anticipate 15% reduction in NC base Anticipate 15% reduction in NC base awardawardFrom $20.4M to $17.3MFrom $20.4M to $17.3M
Budget Year 7 Budget Year 7 Funding PrioritiesFunding Priorities
Complete NC EDSS Project ($2.4M)Complete NC EDSS Project ($2.4M)Complete LIMS Project Complete LIMS Project 7 PHRST7 PHRST3 Regional Laboratories3 Regional LaboratoriesHospital PHE programHospital PHE programMaintain Statewide Surveillance Systems (NC Maintain Statewide Surveillance Systems (NC DETECT, NCHESS)DETECT, NCHESS)Support LHD Emergency Preparedness Activities Support LHD Emergency Preparedness Activities through Aid To County Fundingthrough Aid To County Funding
Aid To County Assistance FundingAid To County Assistance Funding(Funds that don(Funds that don’’t go to every LHD)t go to every LHD)
3 Regional BT Labs 3 Regional BT Labs 7 PHRSTs 7 PHRSTs
25 LHDs Internet Connectivity 25 LHDs Internet Connectivity (a diminishing program) (a diminishing program)
Proportional Aid to County Direct Proportional Aid to County Direct Funding (85 LHDs)Funding (85 LHDs)
Current Allocation StrategyCurrent Allocation Strategy
Base + proportional share formulaBase + proportional share formulaShare based on:Share based on:–– Population (60%)Population (60%)–– Total area (20%)Total area (20%)–– Land area (20%)Land area (20%)
Proportional Aid to County Direct Proportional Aid to County Direct Funding (85 LHDs)Funding (85 LHDs)
Current LHD funding estimates reflect Current LHD funding estimates reflect 15% reduction in federal appropriations in 15% reduction in federal appropriations in the CDC grant programthe CDC grant program
Potential ThreatPotential Threat--Based Aid to Based Aid to County Funding Factors County Funding Factors
Military InstallationsMilitary InstallationsNuclear Power PlantsNuclear Power PlantsInternational PortsInternational PortsInternational AirportsInternational AirportsState CapitalState CapitalState FairsState FairsStadiums and Arenas >10,000 Stadiums and Arenas >10,000 capacitycapacity
m
mm
m
m
m
m
G
G
GGMcGuire NPP
Brunswick NPP
Easte rn Band ofCherokee Indians
Pitt
Wake
Hyde
Duplin
Bladen
Pender
Bertie
Wilkes
Moore
OnslowUnion
Halifax
Robeson
Beaufort
Nash
Surry
Craven
Sampson
Iredell
Carteret
Columbus
Swai n
Burke
Brunswick
Johnston
Anson
Ashe
Guilford
Randolph
Harnett
Jones
Chatham
Macon
Rowan
Hoke
Martin
Lee
Stokes
Tyrrell
Stanly
Lenoir
Dare
Franklin
Buncombe
Granvil le
Davidson
Warren
Jack son
Haywood
GatesPerson
Caldwell
Wilson
Forsyth
Polk
Caswell
Orange
Rutherford
Madison
Gaston
Yadkin
ClayCherokee
Richmond
Cleveland
Davie
Pamlico
Rockingham
McDowell
Hertford
Alamance
Avery
Lincoln
Mecklenburg
Northampton
Edgecombe
Vance
Currituck
Yancey
Montgomery
Cabarrus
Durham
Graham
Scotland
Greene
Watauga
Henderson
Washington
Transylvania
Mitchell
Alexander
Alleghany
PerquimansChowan
New Hanover
Catawba
CamdenPasquotank
Wayne
Charlotte
Raleigh
Durham
GreensboroWinston-Salem
Fayetteville
Jacksonville
Asheville
High Point
Wilmington
GreenvilleGoldsbor o
Rocky MountBurlington ChapelHill
Southe rn Pines
Boone
Roanoke Rapids
Elizabeth City
MoreheadCity
Catawba NPP
Harris NPP
Ca mp LejeuneM arine Base
Cherry Point (Craven)
Sunny PointArm yTerminal
Seymour JohnsonAir Force Base
Fort Bragg Ai rForce BaseFort Bragg
US Coast GuardAir Stat ion (Pasquotank)
Kinston
North Carolina County Risks
0 50 100 150 Miles
GEM Branch Boundaries
60-Mile RRT ZonesMilitary BasesCitiesNuclear Power Plants
1-100,000100,000 - 150,000150,000 - 300,000300,000 +
County Population - Census 2000m RRT Base Station
R:I&P\IP-CHIEF\TARGET CITIES.PPT
Pandemic Influenza Pandemic Influenza Supplemental FundingSupplemental Funding
$350M Congressional appropriation $350M Congressional appropriation OneOne--time emergency pandemic influenza time emergency pandemic influenza funding for statesfunding for statesExecuted through CDC PH Emergency Executed through CDC PH Emergency Preparedness Grant programPreparedness Grant programPhase I funds $100M Phase I funds $100M Phase II funding $250MPhase II funding $250M
Pandemic Influenza Pandemic Influenza Supplemental FundingSupplemental Funding
Phase IPhase I
NCNC’’s share = $2,547,844s share = $2,547,844Added to base grant award in BY6Added to base grant award in BY6
Pandemic Influenza Pandemic Influenza Supplemental FundingSupplemental Funding
Phase I Phase I –– Local FundingLocal Funding
LHD funding completed using Request for LHD funding completed using Request for Proposal formatProposal formatBased on LHD Pan Flu Local Assessment and Based on LHD Pan Flu Local Assessment and Gap Analysis (from CDC)Gap Analysis (from CDC)$977,491 in LHD funds requested by NC in $977,491 in LHD funds requested by NC in application to CDCapplication to CDCRepresents 44 LHD requestsRepresents 44 LHD requestsFunded work must be completed by 8/30/06Funded work must be completed by 8/30/06
Pandemic Influenza Pandemic Influenza Supplemental FundingSupplemental FundingPhase I Phase I –– NC PrioritiesNC Priorities
Local Planning Initiative Local Planning Initiative –– UNCCPHPUNCCPHPOnline CD Nurse Avian Flu / Pandemic Online CD Nurse Avian Flu / Pandemic Influenza Training Influenza Training Public Information Campaign Public Information Campaign
Pandemic Influenza Pandemic Influenza Supplemental FundingSupplemental FundingPhase I Phase I –– NC PrioritiesNC Priorities
Model Planning Curriculum Workshops Model Planning Curriculum Workshops --Medical Surge Capacity plans for hospitals, Medical Surge Capacity plans for hospitals, LHDs, EMSLHDs, EMSContingency Planning for EMS systemsContingency Planning for EMS systemsPrivate provider training Private provider training
Pandemic Influenza Pandemic Influenza Supplemental FundingSupplemental FundingPhase I Phase I –– NC PrioritiesNC Priorities
Regional business and industry pandemic Regional business and industry pandemic influenza summitsinfluenza summitsRegional pandemic influenza summits for Regional pandemic influenza summits for response partners (public health, EMS, response partners (public health, EMS, hospitals, law enforcement, emergency hospitals, law enforcement, emergency management)management)
Pandemic Influenza Pandemic Influenza Supplemental FundingSupplemental FundingPhase I Phase I –– NC PrioritiesNC Priorities
WebWeb--based tabletop exercises (similar to based tabletop exercises (similar to Eight Ball) Eight Ball) -- law enforcement and law enforcement and community health centers community health centers Additional regional (RAC) webAdditional regional (RAC) web--based based exercisesexercises
Pandemic Influenza Pandemic Influenza Supplemental FundingSupplemental FundingPhase I Phase I –– NC PrioritiesNC Priorities
Surge Capacity Upgrades to the NC Surge Capacity Upgrades to the NC Immunization Registry Immunization Registry
Pandemic Influenza Pandemic Influenza Supplemental FundingSupplemental Funding
Phase IIPhase II
Remaining $250M of $350M Congressional Remaining $250M of $350M Congressional AppropriationAppropriationAnticipated NC Award of $5M if formula Anticipated NC Award of $5M if formula based (population)based (population)Some discussion of competitive and Some discussion of competitive and formula based allocations to statesformula based allocations to states
Pandemic Influenza Pandemic Influenza Supplemental FundingSupplemental Funding
Phase IIPhase II
Anticipate guidance and funding award to Anticipate guidance and funding award to follow closely with PH Emergency follow closely with PH Emergency Preparedness Grant Budget Year 7Preparedness Grant Budget Year 7
CDC COOPERATIVE AGREEMENT CDC COOPERATIVE AGREEMENT Public Health Emergency Public Health Emergency
Preparedness Preparedness
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