laborate with agencies, disciplines, and entities with which they were previously not well acquainted, including, but not limited to, fire authorities, law enforcement, EMS, voluntary organizations, and communities.

Research and practical experience show that coordination among all agencies involved is one of the fundamental requirements of effective disaster response and that the lack of adequate coordination is one of the major problems encountered in the field (Auf der Heide, 1989; Tierney et al., 2001). Given the large number of federal, state, and local agencies involved in preparedness efforts, establishing adequate coordination across federal, state, and local levels is proving to be a challenge (Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction, 2003; GAO, 2003a; Clements and Evans, 2004). Within the federal government, preparedness and response activities are coordinated through the Department of Homeland Security (DHS). Coordination at the top levels of the federal government occurs through the Homeland Security Council (HSC), which is charged with ensuring coordination of all homeland security related activities among executive departments and agencies and promoting the effective development and implementation of all homeland security policies (White House, 2001). Day-to-day coordination of homeland security issues—both within the federal government and among federal, state, and local government agencies—is meant to occur through the Policy Coordination Committees (PCCs) of the HSC (White House, 2001). There are eleven PCCs for different functional areas, including a Medical and Public Health Preparedness PCC. The committee was unable to obtain sufficient information to determine whether and how Medical and Public Health Preparedness PCC actions or policy decisions shape CDC’s preparedness program and whether the PCC plays a role in strengthening CDC’s relationship with DHS.

Despite the existence of mechanisms for coordination at the top departmental level, such as the PCCs, it is not evident to the committee that adequate coordination and information sharing are occurring formally at the level of federal program staff involved in the day-to-day work of public health preparedness (GAO, 2003b). Although the creation of DHS holds the promise of streamlined oversight and funding, there are concerns that coordination between DHS and key preparedness functions in DHHS remains a significant challenge (GAO, 2003a). At the committee’s March 2004 meeting, conversation among presenters from federal agencies and the committee revealed that personal relationships and serendipity may be credited with some coordination and information sharing across agencies, but it was not immediately evident that there are sufficient and functioning formal mechanisms for coordination and collaboration between DHS and DHHS. Coordination must be planned with forethought and deliberation, not left simply to chance and the goodwill of program staff. Coordination

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