also must be planned and implemented during the preparedness or pre-event phase, beginning with effective communication about funding objectives and activities. For example, it is important for CDC staff to be familiar with relevant activities occurring in DHS and its programs funded and/or administered through FEMA and ODP, and for DHS staff to be aware of CDC priorities and activities to ensure the best use of limited federal preparedness resources.

State and local public health agencies receive funding through CDC’s Cooperative Agreement on Public Health Preparedness and Response for Bioterrorism, and health care entities are funded through HRSA’s National Hospital Bioterrorism Preparedness Cooperative Agreements. These cooperative agreement programs require that grantees conduct exercises that test public health and health care preparedness (and the integration between them) for an attack with biologic or chemical agents. Through the DHS Office of Domestic Preparedness Fiscal Year (FY) 2004 Homeland Security Grant Program and FY 2004 Urban Area Security Initiative Grant Program, states and some local emergency management offices receive funding to conduct exercises that test many of the same capacities and interagency collaborations expected by HRSA and CDC (DHS, 2003). Furthermore, FEMA, which is now under DHS, although its activities seem not yet fully coordinated with those of ODP, also oversees exercises relevant to chemical and radiation emergencies, which include public health components. The committee learned that sometimes states pool different sets of resources to conduct a larger drill or exercise involving a larger number of state and local agencies and community partners, and in other cases, the different funding streams are used to fund separate exercises (Schweitzer, 2004).

ODP has released guidelines for exercises and their evaluation through the Homeland Security Exercise and Evaluation Program (HSEEP). Although the committee is not aware of the nature and extent of CDC’s involvement in the development of the HSEEP guidelines, the committee believes it is important that both CDC and DHSODP work to ensure a reasonable level of compatibility and coordination. This is necessary because of the functional overlap between public health and other state agencies, and because some state public health agencies already plan and execute their bioterrorism preparedness exercises in conjunction with their state emergency management offices. While public health preparedness exercises are needed to assess the unique functions and goals of public health, they will ideally be coordinated with other types of exercises where appropriate. Since state emergency management offices will be following the HSEEP guidelines, and some state public health agencies may be participating in exercises that follow these guidelines, a certain level of coordination is necessary between CDC’s public health preparedness exercise guidelines



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