Establishing Cross-Jurisdictional Agreements A New York Perspective

Background n New York State receives funds for public health preparedness & response to Bioterrorism –As a state with an international border, we also receive a carve-out for the Early Warning Infectious Disease Surveillance Project (EWIDS) –The level of funding is based upon the annual number of border crossings in the respective states on the CA/MX border.

EWIDS Objectives and Primary Areas of Focus n Communication Infrastructure n Epidemiology/Disease Surveillance Investigation Coordination n Public Information/ Risk Communication n Drill & Exercise to Evaluate the Plans

New York State Map Our land/water border with Canada is approximately 500 miles in length touching the Province of Ontario and Quebec

n Michigan began working with the Province of Ontario in 2004 on the EWIDS Project n New York, Minnesota and Wisconsin joined the group in 2005 and the Great Lakes Border Health Initiative began as a multi-state cross jurisdictional group

n New York began working with the Province of Quebec in 2004 on the EWIDS Project n Vermont, New Hampshire and Maine joined with NY and the Northeastern Border Health Initiative began as a multi-state cross jurisdictional group n Recent expansion of the NE group will also include Nova Scotia and New Brunswick

Developing an Alliance n Identify critical partners from participating state and Canadian province on your border……..make a directory n Plan face-to-face meeting for introductions and outline roles and responsibilities……..move meetings around n Develop a shared understanding of public health emergency response systems……..use a staffing or flow chart n Set up a steering committee and write a Term-of-Reference as a guiding document n Set up a sub-committee structure to meet the project’s objectives n Set up a series of monthly tele-conference calls n Design a work plan as a guide to accomplish project objectives……..use due dates to prioritize the work

Reality Check (Challenges) n States can not enter into international agreements of any kind without Congressional approval n Have the lawyers at the table from the beginning n Cultural, Political and Language differences (Quebec and Mexico) must be acknowledged and be part of your alliance plan n Tribal Nations on the border present many unique circumstances n Scope of the EWIDS Project is extremely broad

Example Actual EWIDS Grant Objective: n Rapidly detect a bioterrorist event along the US northern and southern border through a highly functioning mandatory reportable disease surveillance system

Example Actual EWIDS Grant Example: n Ensure the electronic exchange of infectious disease related information(including clinical,laboratory and environmental data) in standard formats between the computer systems of grantee public health department and those of the counter part agency across the international border

Federal Guidance has been limited to date: n New project with a very broad scope n Complex project with multiple federal/state/local partners who are all stakeholds

Example n Some federal partners include: DHS,DHHS,USCBP, CDC Division of Public Health Preparedness and Division of Global Migration & Quarantine, USDA n Some state partners include: DOH,SEMO, LHD, Tribal Nations

Lack of Coordination n Example : –International Agreement recently signed between the US and Canada to link the CDC’s PulseNet system to PulseNetCanada designed to trace outbreaks of nasty foodborne pathogens like e.coli n Example: –US, Canada and Mexico recently signed an International Security and Prosperity Agreement to guard our borders –Entire section on biosecurity at the border with timeframes of 24 months for deliverables on inter-operable disease surveillance systems –Draft and sign protocol within 24 months for mutual assistance and coordination in a cross border emergency

Ideas to Move Forward (Successes) n Primary relationships have been developed n Professionalism of Partners n Many plans are well underway n Commitment to be prepared is there n Federal Partners are listening to needs expressed by the border states

Summary n Meet who you want to work with face-to-face and build the relationship you will need n Write attainable short term goals so some degree of success is visible and do-able n Create a contact directory for communications and talk to one another n Set up a Steering Committee and sub-committee structure and tele-conference frequently with one another n Write a budget that can accommodate meeting your goals & objectives n Talk to your federal partners so they can hear what your up against and then ask for more funding

Contact Information: Richard Buck, Border Health Manager Public Health Preparedness Program NYSDOH 547 River Street Troy, NY