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Department of Health and Human Services Centers for Disease Control and Prevention Agency for Toxic

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Title: Department of Health and Human Services Centers for Disease Control and Prevention Agency for Toxic


1
Department of Health and Human ServicesCenters
for Disease Control and PreventionAgency for
Toxic Substances and Disease Registry
Federal-State Working Relationships to Achieve
National PreparednessThe CDC Perspective

National Governors Association Center for Best
Practices Regional Policy Workshop on
Bioterrorism New Orleans, March 15, 2004
2
Outline
CDCs Strategy Best Practices Workforce Funding
3
  • CDCs Strategy

4
Strategy
All-Hazards Approach
OUR VISION People Protected Public Health
Prepared. OUR GOAL To combine our strengths in
times of crisis to reduce suffering and death.
5
Strategy
Dimensions of Public Health Readiness

1,000s 100,000s
Global
Command and control vital to assure containment
Activate community-wide mass care system manage
the dead
Manage high volume of data and information
Number of Cases
Deliver mass intervention call up reserve
workforce
Level of Effort
Resources
Communicate to stakeholders and public enhance
surveillance reporting
Report Mobilize Response Investigate
Prophylaxis
1
Assess Diagnose Isolate Treat Manage
Local
Time
6
Strategy
Workforce Activities
Detection Reporting
Response Containment
Preparedness
Recovery
Planning Exercising Partnering Training System
Building Testing
Communicating Clinicians Public Health General
Public Responders Intervention Therapies Education
Quarantine Contact tracking Coordination
Monitoring community mental health Apply Lessons
learned continuous response improvement
Surveillance Clinician Training Laboratory
Diagnostics Electronic reporting systems
7
Key Services Efforts Detection
Strategy
  • Early detection/warning is critical to allow for
    early intervention.
  • The sooner we know the sooner we can intervene!

8
Strategy
Key Services Efforts Detection
Current State
Law Enforcement
Environmental (BioWatch)
DoD VA
Border States
Pharmacy Data
Schools
Public
Employers
Media
Cargo/ Imports
Laboratory
Immigration
Clinicians
First Responders
International
Vital Records
Veterinary
Quarantine Stations
Hospitals
9
Strategy
Key Services Efforts Detection
Desired State
DoD VA
Law Enforcement
Environmental (BioWatch)
Pharmacy Data
Border States
Public
Schools
Employers
Media
Cargo/ Imports
Laboratory
Immigration
Clinicians
First Responders
Hospitals
Veterinary
Vital Records
International
Quarantine Stations
10
Strategy
Key Services Efforts Detection
  • Improving Laboratory Diagnosis and Detection
    Capabilities
  • Smallpox Tularemia
  • Anthrax Radiation
  • - Plague
  • Botulinum Toxin
  • Chemicals in blood and urine
  • Improving Connectivity for Diagnosis and
    Detection
  • 24x7 Clinical Information Hotline Media and
    public outreach
  • Clinician outreach and communication
    Blended-media educational programs
  • Epi-X (2-way communication network) Other
    critical channels and audiences
  • Health alerting MMWR Dispatch
  • Quarantine Stations
  • New York Chicago Miami Atlanta
  • Los Angeles San Francisco Seattle
    Honolulu
  • CDC Laboratories
  • Biological Antimicrobial resistance assays
    Continuity of Operations Plan (COOP) Throughout
    Capacity, BSL-4 containment lab, scientific depth
  • Chemical Rapid Toxic Screen (150 agents)
    Blood and Urine Samples State Labs

11
Strategy
Key Services Efforts Detection
  • Laboratory Response Network (LRN)

12
Strategy
Key Services Efforts Containment
  • Strategic National Stockpile (SNS)
  • Repository of antibiotics, chemical antidotes,
    antitoxins, life-support medications, IV
    administration, etc.
  • Twelve, strategically located, 12-hour push
    packages
  • Tailored Vendor Management Inventory (VMI)
  • VMI deployable within 24 to 36 hours
  • Technical Advisory and Response Unit (TARU)
    support

13
Strategy
Key Services Efforts Containment
  • Environmental Microbiology
  • Water safety research
  • Detection and survival of select bacterial
    agents research
  • Research on remediation of environments and
    facilities
  • Exotic bacterial data collection with respect
    to the environment
  • Development of lab sampling methods and
    processes
  • Studies on the effect of common disinfectants
    on these agents
  • Smallpox Readiness
  • Vaccination of the medical frontline
    (healthcare, public health, etc.)
  • Pending licensed vaccine (for those who insist)
  • Early detection capacity
  • Rapid control and containment plans
  • Vaccination of population within 10 days
  • State and Local Efforts
  • Local, State, and Regional Response Plans
  • Field services support
  • SNS Capacity
  • Drive toward standards-based, federally
    delivered exercises (Level I to IV)

14
Strategy
Upgrading State and Local Capacity
  • 31 Centers for Public Health Preparedness
    assisting state and local public health emergency
    preparedness by improving the quantity and
    quality of the public health and healthcare
    response workforce.
  • Increasing the number of state and local public
    health professionals (1,886) who use Epi-X to
    share intelligence regarding outbreaks and other
    emerging health events including those suggestive
    of bioterrorism.
  • Cooperative Agreement for 62 state, major city
    and territory health departments expands
    epidemiology and surveillance capacity to detect,
    investigate, and mitigate health threats.
  • Rapid assessment of surveillance capacities in 8
    priority cities.
  • Forensic Epidemiology training sessions for
    public health and law enforcement professionals.

15
Strategy
Key Services Efforts Containment
  • State and Local Cooperative Agreement Program
  • 90 of states have response plans for
    anthrax(78 exercised)
  • 100 for smallpox (86 exercised)
  • 90 for plague (76 exercised)
  • 85 for botulinum toxin (46 exercised)
  • 92 for RDD/Nuclear events (91 exercised)
  • 75 for Nerve Agents (70 exercised)
  • 25/50 completed their state-wide response plans
  • 50/50 completed their interim SNS plans work
    needed!

16
Strategy
  • Strategic Imperatives and Preparedness Workforce
    Objectives
  • Timely, effective and integrated detection and
    investigation
  • Objective 1.2 Increase the number, skills and
    distribution of investigation professionals
  • Sustained prevention and consequence management
    programs
  • Objective 2.3 Provide scientific and technical
    support for recovery programs associated with
    physical, psychological and environmental public
    health needs.
  • Coordinated Public Health Emergency Preparedness
    and Response
  • Objective 3.3 Provide technical assistance and
    resources to public health agencies to assure all
    jurisdictions have a ready emergency response
    system
  • Competent and sustainable workforce
  • Objective 5.1 Increase the number and type of
    professionals that comprise a preparedness and
    response workforce
  • Objective 5.2 Deliver certification- and
    competency-based training and education
  • Creative and effective management services
  • Objective 11.3 Promote leadership and management
    development across terrorism preparedness and
    response programs

17
  • Best Practices

18
Best Practices
  • Site visits by senior CDC management to
  • Florida
  • New Hampshire
  • New York State
  • Texas
  • Washington State

19
Best Practices
  • Florida
  • Developed critical institutional partnerships
    that will enable long-term readiness that is not
    dependent on current leaders
  • Investment in electronic disease mgmt system that
    will link disease detection-laboratory
    diagnosis-outbreak investigation-analysis.
  • Trained 500 lab staff in procedures for
    handling/transfer of critical agents
  • Conducted 4 exercises in collaboration with FBI ,
    HAZMAT, state/local law enforcement and
    fire/rescue
  • Emphasis on strong corrective action process
    following exercises
  • Vaccinated 4,000 persons who will implement mass
    smallpox vaccination, investigate cases and
    manage patients.

20
Best Practices
  • New Hampshire
  • Partnerships with hospitals, academic
    institutions and community stakeholders
  • All hospitals (26) have submitted emergency
    response plans
  • Monitoring OTC medicine purchases enhances
    detection system
  • Robust alerting system includes 96 of key
    response stake holders (hospitals, commercial
    labs, infection control practitioners, EMS staff,
    Dept of Education)

21
Best Practices
  • New York State
  • Contracts with local health depts have clear
    deliverables that cover all aspects of
    preparedness and response
  • Protocols for isolation and quarantine
  • Packaging/transport of lab samples
  • Processes for rapid diagnoses and agent
    confirmation
  • Plans to ensure rapid control and containment
  • Training of staff and reserve staff as events
    scale up
  • Plan linkage with state and regional plans
  • Partnerships with State Medical Society, Nurses
    Assoc, Healthcare Association, Community Health
    Center Assoc, Hospital Assoc, etc.
  • Developed sophisticated electronic communicable
    disease reporting and laboratory information
    systems
  • Can test for critical agents Variola major,
    vaccinia, tularemia, bot toxin, ricin toxin,
    brucellosis, glanders, Q fever

22
Best Practices
  • Texas
  • Partnerships include 12 Metropolitan Medical
    Response Systems, 22 councils of Governments,
    US-Mexico Border Health Commissions, FBI and
    state/local law enforcement
  • 3-member epidemiologic response teams assigned in
    each of the 8 regions
  • Relationships with 138 labs
  • Trained 60 Texas Medical Rangers a reserve
    corps of the Texas State Guard through the
    Center for Public Health Preparedness and
    Biomedical Research at UT-HSC in San Antonio.
    Plan to train a total of 1000
  • Conducted exercises to test ability to receive
    and distribute the SNS
  • Pre-event smallpox preparedness program
    vaccinated 2,400 hospital and public health staff

23
Best Practices
  • Washington
  • Assessed all local health jurisdictions and
    hospitals to determine emergency preparedness and
    response capacity
  • Expanded public health workforce at the district
    level
  • A new emergency response planners in each of the
    9 districts
  • 9 new learning specialists to coordinate and
    evaluate preparedness training
  • 17 new epidemiology response and surveillance
    coordinators
  • Critical preparedness capacities are included in
    the comprehensive public health improvement
    planning process result is performance-based
    and outcome-driven planning

24
  • Workforce

25
Workforce
  • Public Health Readiness Field Program (PHRFP)
  • 1. Rapidly enhance preparedness of state, local
    and territorial public health agencies
  • 2. Improve CDCs ability to respond to terrorism
    and other urgent health threats
  • 3. Address the long-range need for public health
    leaders at federal, state and local levels

26
Workforce
  • Background
  • State and Local authorities concern over their
    ability to recruit, hire, train, and retain
    qualified personnel
  • Assignment of CDC staff has been a successful
    model for CDC to assist state and local agencies
    with program planning and implementation
  • FY 03 appropriation . . . employees of CDC .
    . . assigned or detailed to States,
    municipalities or other organizations under the
    authority of Section 214 of the Public Health
    Service Act for the purposes related to the
    homeland security, . . . shall not be included
    within any personnel ceiling applicable to the
    Agency . . . during the period of detail or
    assignment.
  • OTPER Field Services Office formed November 1,
    2003

27
Workforce
  • Background Existing CDC Field Programs
  • Career Epidemiology Field Officer (EPO)
  • NCHSTP (STD, HIV, TB)
  • Immunization (NIP)
  • Quarantine Officers (NCID)
  • BioWatch Laboratorians
  • Chronic Disease Prevention (NCCDPHP)

28
Workforce
  • PHRFP Overview
  • Multidisciplinary and multi-level
  • Strong training component
  • Leverage and coordinate readiness activities of
    other CDC field programs
  • Assignments within State/Territorial and Local
    public health agencies
  • Field Services support by OTPER as necessary

29
Workforce
  • PHRFP Basic Principles
  • Emphasis on Staff Development
  • More than a staffing service for state and local
    agencies -- a long term professional development
    program
  • Expand and enhance
  • Do not supplant the current federal, state and
    local public health workforce
  • Linkage with the BT Cooperative Agreement
  • Duties of CDC field staff paid with BT
    Cooperative Agreement funds must be within the
    scope of the BT Cooperative Agreement
  • Customer Focus
  • Assignments funded by the BT Cooperative
    Agreement will be in response to a request by a
    grantee and reflected as a DA award on the Notice
    of Cooperative Agreement to the grantee

30
Workforce
  • PHRFP Training Program
  • Rigorous Basic Training Boot Camp
  • Follow-on courses for specified for several
    career tracks
  • Competency-based
  • Utilize/Adapt existing training
  • Certification and CEUs
  • Available to State/Local staff also

31
Workforce
  • We hope the PHRFP will
  • Meet state and local public health preparedness
    needs
  • Foster the dual use concept
  • Mitigate the silo-effect of categorical programs
    at federal, state, and local levels
  • Provide Support and enhance the good work the
    categorical programs do
  • Emphasize BT while also support an all-hazards
    approach
  • Make a dent in long range public health work
    force needs

32
  • FUNDING

33
Funding
FY04 Appropriation by Budget Line (1.16
Billion) (compared with 1.54 Billion in FY03)
The appropriation amount of 1.16 billion does
not include the rescission and indirect costs.
34
Funding
FY04 Funding Upgrading State and Local Capacity
  • Bioterrorism Cooperative Agreement 872 Million
  • Centers for Public Health Preparedness 29.4
    Million
  • Advanced Practice Centers 5.5 Million
  • Technical Assistance and Oversight 17.9
    Million
  • Epidemic Intelligence Exchange (Epi-X) - 1.8
    Million
  • Cooperative Agreement Technical Assistance
    13.8 Million
  • Public Health Field Readiness Program 2.2
    Million
  • Health Alerting 9.4 Million

Total 934.4 Million
35
Funding
CDC Goals for 2004
  • Full Development of the Performance Indicators
    that focus on
  • Rapid detection and reporting to allow for early
    intervention
  • State and regional plans that are
    scenario-specific (CBRN) that are developed to
    take into account a variety of scalable events
    (100 - 1,000 casualties) that will
    challenge/stress the response system
  • Public health workforce (improve the quality and
    quantity)
  • Implement the Public Health Readiness Field
    Program
  • Partnering with the Centers for Public Health
    Preparedness
  • Stronger ties with HRSA and DHS (HSPD 8)

36
Funding
  • Funding Concerns
  • 80 unobligated reported on FSRs (11/1/03)
  • Draw-down lag
  • Supplanting
  • Allocation formula change?
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