Public Health Emergency Public Health Emergency PreparednessPreparedness

An Integrated ApproachAn Integrated Approach

Office of the Assistant SecretaryPublic Health Emergency

PreparednessU.S. Department of

Health and Human Services

Jerome M. HauerAssistant Secretary

February 5, 2003

IntroductionIntroduction

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?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 Potential Weapons

Biological

Chemical

Nuclear

Explosives, Guns

Overall Goal Overall Goal HHS Bioterrorism ProgramHHS 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 ofObjectives ofHHS Bioterrorism Preparedness HHS Bioterrorism Preparedness ProgramProgram 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 Objectives of the HHS Bioterrorism ProgramHHS 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 forEnhanced Funding forAnti-Terrorism EffortsAnti-Terrorism Efforts

Prevention of Bioterrorism

State and Local Assets

Federal Government Assets

Research and Developmen

Transfers to Homeland Transfers to Homeland SecuritySecurityOffice 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: Different Funding Streams: One Integrated ProgramOne 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 Some Lessons Learned from ExperienceExperience

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 Major Focus on State and Local AssetsState 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 State and Local PreparednessPreparednessThree Guiding PrinciplesThree 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 EffortsCurrent 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 Integration of HHS/DHS Programs 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:State Programs:Horizontal IntegrationHorizontal 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:One Integrated Program:Three WatchwordsThree Watchwords

SPEED in making funds available for use

FLEXIBILITY in how funds are used

ACCOUNTABILITY for results obtained

Oversight of Cooperative Oversight of Cooperative AgreementsAgreements

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 Critical Smallpox Vaccine Policy IssuesPolicy 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 Administration of Smallpox CountermeasuresCountermeasures

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 IssuesSmallpox 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: Beyond Smallpox: Challenges We Face 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 Public Health Preparedness Program ChallengesProgram 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 PreparednessDepartment of Health and Human Services

Hubert H. Humphrey Building, Room 636G200 Independence Avenue, SW Washington, DC 20201

tel (202) 401-4862 fax (202) 690-6512www.hhs.gov/ophp