Title: Department of Health and Human Services Centers for Disease Control and Prevention Agency for Toxic
1Department 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
2Outline
CDCs Strategy Best Practices Workforce Funding
3 4Strategy
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.
5Strategy
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
6Strategy
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
7Key Services Efforts Detection
Strategy
- Early detection/warning is critical to allow for
early intervention. - The sooner we know the sooner we can intervene!
8Strategy
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
9Strategy
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
10Strategy
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
11Strategy
Key Services Efforts Detection
- Laboratory Response Network (LRN)
12Strategy
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
13Strategy
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)
14Strategy
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.
15Strategy
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!
16Strategy
- 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 18Best Practices
- Site visits by senior CDC management to
- Florida
- New Hampshire
- New York State
- Texas
- Washington State
19Best 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.
20Best 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)
21Best 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
22Best 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
23Best 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 25Workforce
- 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
26Workforce
- 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
27Workforce
- 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)
28Workforce
- 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
29Workforce
- 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
30Workforce
- 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
31Workforce
- 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 33Funding
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.
34Funding
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
35Funding
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)
36Funding
- Funding Concerns
- 80 unobligated reported on FSRs (11/1/03)
- Draw-down lag
- Supplanting
- Allocation formula change?