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Department of Health and Human Services DHHS

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Title: Department of Health and Human Services DHHS


1
Department of Health and Human Services (DHHS)
  • Overview of FY04 DHHS Cooperative Agreements on
    Public Health (CDC) and Hospital (HRSA) Emergency
    Preparedness and Response
  • William Raub, PhD
  • Principal Deputy Assistant Secretary
  • Office of Public Health Emergency Preparedness
  • 14 January 2005

2
Office of Public Health Emergency Preparedness
(OPHEP)

Goal
  • To ensure sustained public health and medical
    readiness for our communities and our nation
    against
  • Bioterrorism
  • Other Infectious disease outbreaks
  • Other public health threats and emergencies

3
CDC Cooperative Agreements forPublic Health
Emergency Preparedness and Response
  • CDC Focus Areas
  • Preparedness Planning/Readiness Assessment
  • Surveillance and Epidemiological Capacity
  • Biological Laboratory Capacity
  • Chemical Laboratory Capacity
  • Communications and Information Technology
  • Risk Communication
  • Education and Training

4
CDC Cooperative Agreements forPublic Health
Emergency Preparedness and Response
  • CDC Funding History
  • Allocations since September 11, 2001
  • FY02 949.70 million
  • FY03 1.04 billion
  • FY04 849.59 million
  • FY02-04 total 2.84 billion

5
HRSA Cooperative Agreements forHospital
Emergency Preparedness and Response
HRSA Priority Areas
  • .
  • Regional Hospital Surge Capacity
  • Beds, Personnel, Equipment
  • Isolation capacity
  • Mental health services
  • Trauma/burn care
  • Emergency Medical Services
  • Linkages to Public Health
  • Hospital Laboratories
  • Surveillance Patient Tracking
  • Education and Preparedness Training
  • Exercises

6
HRSA Cooperative Agreements forHospital
Emergency Preparedness and Response
  • HRSA Funding History
  • Allocations since September 11, 2001
  • FY02 125 million
  • FY03 498 million
  • FY04 498.00 million
  • FY02-04 total 1.121 billion

7
Public Health and Hospital Preparedness and
Response Cooperative Agreements
  • CDC/HRSA Combined Funding History
  • Combined Allocations since September 11, 2001
  • FY02 1.07 billion
  • FY03 1.53 billion
  • FY04 1.34 billion
  • FY02-04 Grand-total 3.9 billion

8
Public Health and Hospital Preparedness and
Response Cooperative Agreements
  • FY04 Cross-Cutting Activities
  • To ensure that selected CDC and HRSA supported
    preparedness activities are coordinated and
    integrated at the state and local levels
  • Cross-cutting section identical in both CDC and
    HRSA guidance documents
  • Responses were to be identical whether submitting
    for CDC or HRSA funding

9
Public Health and Hospital Preparedness and
Response Cooperative Agreements
  • Six Cross-Cutting Critical Benchmarks
  • Incident Management
  • Joint Advisory Committee
  • Laboratory Connectivity
  • Laboratory Data Standards
  • Jointly Funded Health Department/Hospital
    Activities
  • Preparedness for Pandemic Influenza

10
Public Health and Hospital Preparedness and
Response Cooperative Agreements
  • Eight Cross-Cutting Activities
  • Surveillance
  • Coordination with Indian Tribes
  • Populations with Special Needs
  • Planning for Psychosocial Consequences
  • Education and Training
  • Academic Health Centers Involvement
  • IT System Interoperability
  • Border States (Mexico and Canada)

11
Public Health and Hospital Preparedness and
Response Cooperative Agreements
  • CDC/HRSA FY04 Funding Formulas
  • Eligible Applicants (N 62) and Formulation of
    Funding Allocations
  • Each of the 50 States and Puerto Rico received a
    base amount an amount equal to its proportional
    share of the nations population
  • The District of Columbia received two times the
    base amount an amount equal to its proportional
    share of the nations population
  • The nations three largest Municipalities (New
    York City, Los Angeles County and Chicago)
    received a base amount an amount equal to its
    proportional share of the nations population
  • The Commonwealth of the Northern Mariana Islands
    and the Territories of American Samoa, Guam and
    the U.S. Virgin Islands received a base amount
    an amount using a population-based formula
  • The Federated States of Micronesia and the
    Republics of Palau and the Marshall Islands
    received a base amount an amount using a
    population-based formula

12
The Cities Readiness Initiative
  • End Prevent mass mortality and morbidity from
    diseases for which antibiotics are an appropriate
    medical countermeasure.
  • Means Mass distribution and dispensing of
    antibiotics provided by the CDC-based Strategic
    National Stockpile
  • Strategy Address potential threat from
    aerosolized Bacillus anthracis

13
Bacillus anthracisA Long-Standing Threat (1)
  • Lends itself to terrorist use
  • Spore form (vegetative state) can be made into a
    powder with some difficulty
  • N.B. 2001 Mailings USPS BDS System

14
Bacillus anthracisA Long-Standing Threat (2)
  • Ubiquitous easy to obtain
  • Easy to grow in large quantities
  • Easy to work with surreptitiously

15
Slurry of B. anthracis SporesNew Twist on Old
Threat
  • Dispersal as aerosol with commercially available
    equipment
  • B. thuringensis sprayed for pest control
  • Plume can cover many square miles

16
Connecting the Dots (1)
  • Terrorists have ready means to expose densely
    populated areas to aerosolized B. anthracis
    spores.
  • Those who inhale an infectious dose will be at
    high risk for inhalational anthrax.

17
Connecting the Dots (2)
  • The appearance of symptoms of inhalational
    anthrax will be the first indication that someone
    has inhaled an infectious dose.
  • The first cases of inhalational anthrax are
    likely to occur within 48 hours.

18
Connecting the Dots (3)
  • Untreated, inhalational anthrax is 90 fatal.
  • Even with intensive care, survival is 50 at
    best.
  • A hundred cases could overwhelm the healthcare
    system of a typical large city.

19
Connecting the Dots (4)
  • A large outdoor release of aerosolized B.
    anthracis spores could put hundreds of thousands
    (and possibly millions) of people at risk.
  • With healthcare facilities overwhelmed,
    fatalities could number in the tens of thousands.

20
Connecting the Dots (5)
  • Mass chemoprophylaxis is the only means to
    prevent catastrophic loss of life following such
    an exposure.
  • Given the characteristics of the anthrax
    organism, the entire at-risk community should
    receive chemoprophylaxis as soon as possible
    after exposure.

21
CRI Objective
  • Provide Antibiotics to At-Risk Population
  • Which Could be the Entire Metropolitan Area
    Plus Commuters and Transients
  • Within 48 Hours of Decision to Do So

22
CRI Significance
  • How well we implement CRI may be the difference
    between life and death for tens of thousands of
    people.
  • We have a moral imperative to explore every
    potential modality for mass chemoprophylaxis.
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