1. Public Health Emergency Preparedness An Integrated Approach Office of the Assistant Secretary Public Health Emergency Preparedness U.S. Department of Health and Human Services Jerome M. Hauer Assistant Secretary February 5, 2003

2. Introduction 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

3. 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

4. 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

5. 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

6. Potential Weapons Biological Chemical Nuclear Explosives, Guns

7. Overall Goal HHS 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

8. Objectives of HHS Bioterrorism Preparedness Program 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”

9. Objectives of the HHS 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

10. Enhanced Funding for Anti-Terrorism Efforts  Prevention of Bioterrorism  State and Local Assets  Federal Government Assets  Research and Developmen

11. Transfers to Homeland Security Office 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

12. Different Funding Streams: One Integrated Program Share a common purpose Complement and reinforce each other’s objectives Synchronize efforts as needed Build upon pre-existing plans

13. Some Lessons Learned from Experience 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

14. 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

15. Major Focus on State 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

16. State and Local Preparedness Three 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

17. Current 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)

18. Integration of HHS/DHS 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)

19. State Programs: Horizontal Integration State Health Officer Responsible for  Enhancement of Health Departments  Enhancement of Hospital Preparedness for Mass Casualty Events  Coordination with Public Safety Agencies

20. 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

21. One Integrated Program: Three Watchwords SPEED in making funds available for use FLEXIBILITY in how funds are used ACCOUNTABILITY for results obtained

22. Oversight of Cooperative Agreements 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

23. Critical Smallpox Vaccine Policy 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

24. Administration of Smallpox Countermeasures  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

25. Smallpox 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

26. Beyond Smallpox: 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

27. Public Health Preparedness Program 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

28. Office of the Assistant Secretary for Public Health Emergency Preparedness Department of Health and Human Services Hubert H. Humphrey Building, Room 636G 200 Independence Avenue, SW Washington, DC 20201 tel (202) 401-4862 fax (202) 690-6512 www.hhs.gov/ophp