EffectsBased Planning and the National Strategy for Pandemic Influenza

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Effects-Based Planning and the National Strategy
for Pandemic Influenza

• SURVEILLANCE
• Jonathan Greene, EMT-P
• Office of Medical Readiness
• Office of Health Affairs

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National Preparedness - Assumptions

• Preparedness is local!
• Most events will be managed by Local and State
  authorities
• Events are not confined to jurisdictional and
  geo-political boundaries
• All jurisdictions should seek a common set of
  capabilities

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National Preparedness - Assumptions

• Preparedness for catastrophic events (major
  disasters and terrorism) is shared responsibility
• Major event will exceed the capacity of any
  single jurisdiction
• Certain events (terrorism) will trigger a Federal
  response, regardless of magnitude
• All levels of response will use a common
  framework - NIMS

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• BIOSURVEILLANCE
• The Systemic Process of Data Collection and
  Analysis for the Purpose of Detecting and
  Characterizing Outbreaks of Disease in Humans and
  Animals in a Timely Manner.

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BIO SURVEILLANCE BASICS
A Robust Biosurveillance Program
Includes Threat Information and Medical
Intelligence Environmental Monitoring Laboratory
Analysis Syndromic Surveillance Decision
Support Coordinated Action Plan
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Purpose of Biosurveillance

• Detect outbreaks and guide and monitor control
• Detect cases of public health importance
• Monitor distribution and spread
• Estimate burden and impact
• Prioritize allocation of resources
• Understand natural history of disease
• Provide a basis for epidemiologic research
• Evaluate interventions and public policy

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Phase 1 Target Capabilities
Common Planning Communications Risk
Management Community Preparedness and
Participation Prevent Mission Area Information
Gathering and Recognition of Indicators
and Warnings Intelligence Analysis and
Production Intelligence/Information Sharing and
Dissemination Law Enforcement Investigation and
Operations CBRNE Detection Protect Mission
Area Critical Infrastructure Protection Food
and Agriculture Safety and Defense Epidemiologica
l Surveillance and Investigation Public Health
Laboratory Testing Respond Mission Area Onsite
Incident Management Emergency Operations Center
Management Critical Resource Logistics and
Distribution Volunteer Management and
Donations Responder Safety and Health
Respond Mission Area (cont) Public Safety and
Security Response Animal Health Emergency
Support Environmental Health Explosive Device
Response Operations Firefighting
Operations/Support WMD/Hazardous Materials
Response and Decontamination Citizen Protection
Evacuation and/or In-Place
Protection Isolation and Quarantine Urban
Search and Rescue Emergency Public Information
and Warning Triage and Pre-Hospital
Treatment Medical Surge Medical Supplies
Management and Distribution Mass
Prophylaxis Mass Care (Sheltering, Feeding, and
Related Services) Fatality
Management Recover Mission Area Structural
Damage and Mitigation Assessment Restoration of
Lifelines Economic and Community Recovery
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Outbreak Detection ? Preparation, Response,
Recovery
Outbreak Attribution Natural vs Accidental vs
Intentional
Influenza Influenza
Influenza
Data courtesy of Medstar Georgetown University
Anthrax Cases in DC
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Syndromic Medical Surveillance
SPECIFICITY
DIAGNOSED DISEASE

• Test/Lab Results
• Pathology Findings
• Autopsy Results

UNKNOWN MEDICAL DISTURBANCE

• School/Work
• Absenteeism
• Over-the-Counter
• Pharmacy Sales
• Unexplained Animal/
• Human Deaths
• Nurse Triage Calls
• Stock Market Indices

RISK INDICATIONS WARNINGS

• Enviroclimatic
• Travel Patterns
• Media Information
• Internet Traffic
• Government Reports
• Telecommunication
• Commerce

TIME
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Process Model for Early Outbreak Detection
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Surveillance Data Flow
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Milestones for Early Outbreak Detection
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Defending Communities with Timely Detection and
Early Warning
30000
Population Exposed
20000
10000
0
0
5
2
4
6
8
10
12
3
10
15
20
25
Hours
Prevent
Protect
Contain / Decon
Treat
Warn
Wide area monitoring
Intel
Facilities Transport
Restoration Portable detection
Early diagnostics
Intel/Law PHO
Bldg. owner
Mayor
First responders Hazmat lead Forensics
Public Health Org.
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The Importance of CONOPs Worst-Case Model Results
Winter Attack Dose-Dependent Incubation Period
Probit Slope 0.7
For each day that the start of prophylaxis is
delayed, ?70,000 more people will become
symptomatic.
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The Importance of CONOPsWorst-Case Model Results

• Winter Attack Dose-Dependent Incubation Period
  Probit Slope 0.7

For each day that the completion of prophylaxis
is delayed, ?20,000 more people will become
symptomatic.
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Protection via Prophylaxis with Brookmeyer/
Wilkening Anthrax Incidence Curve(Optimal Case)
Campaign Duration
Delay in Detection
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Time is Critical
Days

More
Lives Lost
DELAYin Detection
Fewer
Shorter (1-2 Days)
Longer (4 Days)
Hours
DURATION of Campaign
Courtesy -CDC
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DHS Office of Health Affairs
VISION A Nation prepared for the health
consequences of catastrophic incidents

• MISSION The Office of Health Affairs serves as
  the Department of Homeland Securitys principal
  agent for all medical and health matters. Working
  throughout all levels of government and the
  private sector, the Office of Health Affairs
  leads the Departments role in developing and
  supporting a scientifically rigorous,
  intelligence-based biodefense and health
  preparedness architecture to ensure the security
  of our Nation in the face of all hazards.

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CMO and OHA Historical Perspective

• The DHS Chief Medical Officer was created as part
  of the Department of Homeland Security (DHS) 2005
  Second Stage Review
• The FY 2007 DHS Appropriations Bill authorized
  the CMO and five core responsibilities
• In response to the changing domestic security
  needs of the Nation, the Office of Health Affairs
  (OHA) was created as a part of the Departmental
  reorganization effective March 31, 2007
• OHA manages and serves as the Departments
  principal advisor and agent on all health
  preparedness issues

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Presidential Mandates forDHS Office of Health
Affairs

• HSPD-5 Management of Domestic Incidents
• DHS is the overall incident manager in national
  incidents
• OHA supports the Secretary and FEMA Administrator
  as advisor on all medical and public health
  matters
• OHA manages information flow from HHS, USDA, VA,
  and DOD on health preparedness issues
• OHA participates in operations and crisis
  planning during any national incident
• HSPD-7 Critical Infrastructure Identification,
  Prioritization, and Protection
• OHA works with public and private sector partners
  in protection of critical information,
  particularly the sections of food and
  agriculture, public health and healthcare, and
  emergency services

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Presidential Mandates forDHS Office of Health
Affairs

• HSPD-10 Biodefense for the 21st Century
• OHA ensures a coordinated architecture for
  bio-monitoring, biosurveillance, aerosol
  detection, clinical syndrome detection, response,
  and recovery from biological incidents

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Organizational StructureWho We Are
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OHA Key Role WMD and Biodefense

• Leads the Departments biodefense activities in
  coordination with other Departments and agencies
  across the Federal government
• National Biosurveillance Integration Center
  (NBIC)
• Integrates bio-monitoring activities of executive
  branch Departments to provide a biological common
  operating picture and facilitate earlier
  detection of adverse events and trends
• BioWatch
• Provides a bio-aerosol environmental monitoring
  system to our Nations largest cities for early
  detection of biological attacks
• Food, Agriculture, and Veterinary Defense
• Leads the Departments veterinary and
  agro-defense activities covering animal and
  zoonotic diseases and agricultural security
  issues related to livestock, food, and water
• Threats and Countermeasures
• Manages the Departments equities in Project
  BioShield

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NBIS Federal Network Integration
DOD
USDA
HHS
DOI
DOS
VA
DOT
EPA
USPS
DHS
DOC
DOJ
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BioWatch National Network

• Operates continuously in more than 30 major
  population centers
• Detects attacks against our Nations cities and
  other high value assets
• Poised to
• Enable early detection
• Provide situational understanding to guide
  response
• Share information among partners
• Integrate into the national networks of reference
  laboratories
• Serve as critical element in a national capacity
  to respond rapidly to bioterrorism events

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National Architecture for Biodefense

• Biosurveillance National Biosurveillance
  Integration Center (NBIC)
• Capitalizes upon existing surveillance systems
  focused on, respectively, human disease, food,
  agriculture, water, meteorology and the
  environment. NBIC will collate, integrate, and
  analyze the information from these systems with
  relevant threat and intelligence information and
  disseminate this all-source information to
  appropriate Federal departments and agencies.
• Vision A national biological situational
  awareness capability with a global view to
  protect the United States and its interests.
• Scope Provides decision-makes early recognition
  of biological events natural or man-made
  through acquisition, integration, analysis and
  dissemination of information through interagency
  cooperation and collaboration.

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Food, Agriculture, Veterinary Defense

• DHS is overall incident manager during national
  incidents
• Links together resources and expertise of USDA,
  HHS, DOD, state, tribal, and local governments,
  and the private sector to protect and respond to
  threats to the Nations agriculture and food
• Mitigates vulnerabilities in food, agriculture,
  and water systems
• Develops a robust biological threat awareness
  capacity

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OHA Key Role Medical Readiness

• Leads and sustains a comprehensive, integrated,
  andcollaborative framework that protects the
  health security of the Nation
• Medical First Responder Coordination
• Leads DHS role in improving medical first
  responder readiness for catastrophic incidents
• Serves as the principal DHS representative to the
  medical first responder community
• Incident Coordination
• Leads health security operations for incident
  management supporting HSPD-5
• Works with FEMA-NRCC to improve coordination with
  DHS in support of Emergency Support Function-8
• Radiological/Nuclear Response Recovery Planning
• Leads citizen actions mandated by War Fighter
  Supplemental Bill
• Coordinates with DNDO and FEMA on
  Radiological/Nuclear scenarios

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Office of Health Affairs Integration

DOD Health Affairs Homeland Defense
HHSPreparedness Response

VA U/S Health


USDA Food Safety Research, Ed.
Economics Marketing Regulatory Pgms
DOS Democracy Global Affairs


Private Sector Partners Critical
Infrastructure Healthcare Systems EMS
State Local Government Homeland Security
Advisors Public Health Directors Emergency
Managers

OHA (DHS) WMD Biodefense Medical Readiness Worker
Health Safety
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Medical Response A Public-Private Partnership
Public Health
Different worlds intersect in catastrophic
incidents
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The Larger Infrastructure Puzzle
Water
Postal and Shipping
Agriculture and Food
Government Facilities
Dams
Banking and Finance
Public Health and Healthcare
Information Technology
DefenseIndustrial Base
Telecommunications
National Monuments
Emergency Services
Chemical
Nuclear Reactors, Materials, Waste
Commercial Facilities
Transportation
Energy
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Critical Infrastructure - Health Care Sector
Healthcare Public Health
Critical/Essential Infrastructure

• Protect
• Prepare
• Respond
• Recover

• Prepare
• Respond
• Sustain
• Recover

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National Planning Scenarios

• Nuclear Detonation 10k Nuclear Device
• Biological Attack Aerosol Anthrax
• Biological Disease Pandemic Influenza
• Biological Attack Plague
• Chemical Attack Blister Agent
• Chemical Attack Toxic Industrial Chemicals
• Chemical Attack Nerve Agent
• Chemical Attack Chlorine Tank Explosion
• Natural Disaster Major Earthquake
• Natural Disaster Major Hurricane
• Radiological Attack Radiological Dispersal
  Devices
• Explosives Attack Bombing Using Improvised
  Explosives Devices
• Biological Attack Food Contamination
• Biological Attack Foreign Animal Disease
  (Foot-and-Mouth Disease)
• Cyber Attack

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Biological Attack

• Detection
• Federal-level biosurveillance
• Federal or State syndromic surveillance
• Local clinical detection

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Biological Attack

• Response
• Local clinicians
• Local State Public Health
• Strategic National Stockpile
• FBI, DHS
• Recovery
• State and Federal EPA
• CDC, OSHA
• Local contingency plans

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INTEGRATION Emergency Support Functions
INTEGRATED HEALTH PLANS ACTION
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