Biological Threats and Terrorism Assessing the Science and Response Capabilities: Workshop Summary (2002) / Chapter Skim
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5 Assessing the Capacity of the Public Health Infrastructure
5 Assessing the Capacity of the Public Health Infrastructure
Pages 148-181
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From page 148... ...
However, there are many critical gaps in the public health infrastructure and many lessons to be learned from our response to the recent anthrax events. These gaps exist at every level federal, state, and local and in nearly every realm of public health, from federal laboratory diagnostic capacity to local first responder education.
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From page 149... ...
M.D., M.P.H. Acting Deputy Director, National CenterforInfectious Diseases, Centers for Disease Control and Prevention We are learning many lessons from the recent anthrax events.
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From page 150... ...
Extramural public health laboratories, including those in the Laboratory Response Network, were similarly challenged and also performed extraordinarily well. Laboratorians rose to the occasion, and a number of
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From page 151... ...
The CDC has a great deal of experience with collaboration, but we have never had to collaborate with so many partners for so long and so intensely. Key partners included state and local health departments, clinicians, health care facilities and organizations, and numerous federal agencies including other agencies in DHHS, the FBI, U.S.
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From page 152... ...
The information provided in this paper reflects the professional view of the author and should not be construed as an official position of the U.S. Department of Health and Human Services or the Centers for Disease Control and Prevention.
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From page 153... ...
The pleural effusions were hemorrhagic pleural effusions which were recurrent and a predominant feature of the clinical illness. Computed tomography of the chest was performed on eight patients, and mediastinal lymphadenopathy was present in seven.
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From page 154... ...
The program had two initial components: an intramural capacity development component intended to enhance CDC's bioterrorism response capacity and an extramural cooperative agreement program that served to develop state and local public health preparedness for a bioterrorist event. CDC's intramural activities included hiring of subject matter experts in priority areas of bioterrorism, expanding and enhancing the laboratory capacity to handle biological and chemical agents, development of specific communications technologies using the Internet, enhancing CDC's surveillance and epidemiology capacity, and developing and managing the National Pharmaceutical Stockpile.
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From page 155... ...
Koenig, M.D., FACEP National Director, Emergency Management Strategic Healthcare Group (EMSHGJ Veterans Health Administration Department of Veterans Affairs VA Missions and Organization The Department of Veterans Affairs (VA) is a cabinet-level department that has the care of veterans as its primary mission.
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From page 156... ...
Programs Emergency Management Missions EMSHG coordinates emergency management programs that ensure health care for eligible veterans, military personnel, and the public through the Federal Response Plan and the National Disaster Medical System (NDMS) during Department of Defense (DoD)
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VAMC Preparedness VA uses an all-hazard, CEM approach. The four phases of CEM mitigation, preparedness, response, and recovery are incorporated into each emergency management plan.
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From page 158... ...
VA provides personnel, pharmaceuticals and supplies upon request from DHHS under Emergency Support Function ESF #8: Health and Medical Services. In fact, since the FRP was promulgated by the Federal Emergency Management Agency (FEMA)
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From page 159... ...
. The TAC is a multidisciplinary group of internal VA leaders and emergency management experts from federal partner agencies such as DHHS, FEMA, DoD, CDC, and the Federal Bureau of Investigation.
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Director, University of Iowa Hygienic Laboratory President, Association of Public Health Laboratories The Laboratory Response Network (LRN) was instituted in 1999 in preparation for the U.S.
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From page 161... ...
Obviously fine-tuning is necessary. The good news is that the private laboratories rapidly became motivated to learn to test for bioterrorism agents and that public health laboratories developed greater ties with the emergency management community so that the next event can be more readily managed even if it involves greater numbers of human illnesses.
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From page 162... ...
Security arrangements range in the other state public health laboratories from sophisticated in California to minimal in other states. The CDC has reinforced its security following the events of September 11 when it was closed due to the threat of terrorism.
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From page 163... ...
When implemented, it will provide reciprocal communications links, feedback of results to the private laboratories and of needs to the public health laboratories. The LRN should be linked with other laboratory networks that have complementary functions.
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From page 164... ...
In truth, it is an inevitable, necessary and highly laudable use of funding. A major concern to the bioterrorism response community is the prospect of false positive and false negative tests that may be produced by devices currently owned or being sold to first responders and to citizens.
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From page 165... ...
Columbia University Mailman School of Public Health The public health system is at the forefront of our defenses against bioterrorism, as it is against infectious diseases in general. As demonstrated by the recent anthrax events, the first indication of an attack may well be the appearance in emergency rooms or doctors' offices of people sick with an unexpected illness.
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From page 166... ...
Currently, there are seven academic centers in the system. Columbia University was one of the first academic centers in the system to receive funding, Columbia's center at the Mailman School of Public Health is partnered with the New York City Department of Health to focus on emergency preparedness, including bioterrorism and infectious disease preparedness.
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From page 167... ...
There are continuing needs in these areas, as well as in the closely related area of hospital preparedness, which the Center is continuing to address. Shortly before September 11, we met with the Office of Emergency Management (OEM)
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From page 168... ...
These messages can then be emailed by the local Health Authority via the NHS net to Hospitals and GP surgeries who are on the system or by fax if they are not (all UK GPs, except for a very few, now have a fax)
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From page 170... ...
In the recent anthrax episode, there were so many instances of suspected exposures that the FBI wasn't able to determine which were credible. But we were able to get local health officers en*
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From page 171... ...
Public Health Communication A critical deficit in our plan exists in the area of public and media communications. The original national plan included an Internet backbone, hardware, secure websites, curriculum, distance learning, public information, and media programs.
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From page 172... ...
Expanding Level C laboratories could also help in the transfer of applied research from biotech partners to the public health network. I happen to be an Briny Reserve officer and Commander of one of two small infectious disease teams that have been organized into something called Consequence Management Medical Response Teams.
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From page 173... ...
The Federal Emergency Management Agency is tasked with the lead in consequence management for a terrorist incident. While FEMA took the lead for the World Trade Center and much of the response funding, the agency did not do so for the bioterrorism response of the anthrax event.
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It implies to me that the bioterrorism response systems must be integral parts of the regular infectious disease surveillance and control systems if they are to be exercised regularly, and perform when needed. Fourth, in the end, public health response capacity is trained people.
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Essentially all the discretionary funds are federal. Therefore, I would like to propose six principles by which new federal bioterrorism grants be allocated to state and local health departments.
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From page 176... ...
Local public health agencies, along with the National Association of County and City Health Officials in Washington, DC, have been engaged in bioterrorism preparedness work since 1999, in partnership with CDC, representatives of state health departments, and representatives of local boards of health. Local health officials urge that the following principles and factors guide the work ahead: Principles 1.
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From page 177... ...
Local Public Health Infrastructure There is no such thing as a consistent local public health system. There are approximately 3,000 local public health departments in the U.S.
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From page 178... ...
Financing Needed An absolute funding level needed to assure local public health preparedness cannot be defined, especially given the many shortcomings associated with the lack of consistency among local health departments nationally. It has been estimated that between $835 million and $1.3 billion are needed annually for five years to develop a fully prepared local and state public health system.
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From page 179... ...
These are not comprehensive, but they do represent priorities for public health preparedness. First, there is a need to strengthen the local and state public health departments.
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From page 180... ...
One example of the need was the shortage of surge capacity in the laboratory during the recent anthrax incident. We should take steps to avoid the situation where CDC needs to conduct Level A lab analysis for anthrax, and states may be back-logged to a degree that could jeopardize public health.
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From page 181... ...
We also need to think about cross-training between the intelligence community and the public health community. We in public health have been hearing about the importance of documenting the chain of custody of samples for forensic purposes, and many have not understood the term "chain of custody", public health professionals may need some training in forensic sciences to better understand the needs of that community.
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