Department of Health and Human Services
Centers for Disease Control and Prevention
Agency for Toxic Substances and Disease Registry
Federal-State Working Relationships to Achieve National Preparedness
The CDC Perspective
National Governors Association Center for Best PracticesRegional Policy Workshop on Bioterrorism
New Orleans, March 15, 2004
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
2 People Protected – Public Health Prepared.
Outline
CDC’s Strategy Best PracticesWorkforceFunding
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
3 People Protected – Public Health Prepared.
CDC’s Strategy
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
4 People Protected – Public Health Prepared.
All-Hazards Approach
Science
Ser
vice
Sys
tem
s
Biological
ChemicalNuclear
Radiological
Trauma/Nat’l.Disasters
OUR VISIONOUR VISIONPeople Protected – Public People Protected – Public
Health Prepared.Health Prepared.
OUR GOALOUR GOALTo combine our strengths in To combine our strengths in
times of crisis to reduce times of crisis to reduce suffering and death.suffering and death.
Strategy
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
5 People Protected – Public Health Prepared.
Dimensions of Public Health Readiness
Nu
mb
er o
f C
ases
1
1,000s – 100,000s
Level of E
ffort
Assess – Diagnose – Isolate – Treat – Manage
Report – Mobilize Response – Investigate – Prophylaxis
Communicate to stakeholders and public – enhance surveillance & reporting
Deliver mass intervention – call up reserve workforce
Manage high volume of data and information
Activate community-wide mass care system – manage the dead
Command and control – vital to assure containment
Time
Reso
urces
Local
Global
PREPARE DETECT REPORT RESPOND CONTAIN RECOVER
Strategy
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
6 People Protected – Public Health Prepared.
Strategy
PreparednessDetection & Reporting RecoveryResponse &
Containment
Planning
Exercising
Partnering
Training
System Building
Testing
Surveillance
Clinician Training
Laboratory Diagnostics
Electronic reporting systems
Communicating
Clinicians
Public Health
General Public
Responders
Intervention
Therapies
Education
Quarantine
Contact tracking
Coordination
Monitoring community mental health
Apply Lessons learned – continuous response improvement
Workforce Activities
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
7 People Protected – Public Health Prepared.
Early detection/warning is critical to allow for early intervention.
The sooner we know the sooner we can intervene!
Key Services & Efforts – Detection
Strategy
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
8 People Protected – Public Health Prepared.
Key Services & Efforts – Detection
Hospitals
DoD& VA
Vital Records
Environmental(BioWatch)
PharmacyData
Veterinary
Laboratory
Cargo/Imports
Immigration
International
Schools
Employers
Law Enforcement
ACTION POINTIntersection of Information &
Analysis
Media
Clinicians
Public
First Responders
Quarantine Stations
Border States
Current State
Strategy
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
9 People Protected – Public Health Prepared.
Hospitals
DoD& VA
Vital Records
Environmental(BioWatch) Pharmacy
Data
Veterinary
Laboratory
Cargo/Imports
Immigration
International
SchoolsEmployers
Law Enforcement
Media
Clinicians
Public
First Responders
Quarantine Stations
Border States
ACTION POINTIntersection of Information &
Analysis
Key Services & Efforts – DetectionDesired State
Strategy
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
10 People Protected – Public Health Prepared.
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
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
Quarantine Stations– New York – Chicago – Miami –
Atlanta– Los Angeles – San Francisco – Seattle – Honolulu
Strategy
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
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Laboratory Response Network (LRN)
Key Services & Efforts – Detection
Strategy
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
12 People Protected – Public Health Prepared.
Strategic National Stockpile (SNS)
Repository of antibiotics, chemical antidotes, antitoxins, life-support medications, IV administration, etc., 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
Key Services & Efforts – Containment
Strategy
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
13 People Protected – Public Health Prepared.
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
Strategy
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)
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
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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.
Strategy
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
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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!
Strategy
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
16 People Protected – Public Health Prepared.
Strategy
Strategic Imperatives and Preparedness Workforce ObjectivesTimely, effective and integrated detection and investigation
Objective 1.2: Increase the number, skills and distribution of investigation professionals
Sustained prevention and consequence management programsObjective 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 workforceObjective 5.1: Increase the number and type of professionals that
comprise a preparedness and response workforceObjective 5.2: Deliver certification- and competency-based
training and educationCreative and effective management services
Objective 11.3: Promote leadership and management development across terrorism preparedness and response programs
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
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Best Practices
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
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Site visits by senior CDC management to:
Florida
New Hampshire
New York State
Texas
Washington State
Best Practices
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
19 People Protected – Public Health Prepared.
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.
Best Practices
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
20 People Protected – Public Health Prepared.
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)
Best Practices
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
21 People Protected – Public Health Prepared.
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
Best Practices
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
22 People Protected – Public Health Prepared.
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
Best Practices
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
23 People Protected – Public Health Prepared.
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
Best Practices
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
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Workforce
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
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Public Health Readiness Field Program (PHRFP):
1. Rapidly enhance preparedness of state, local and territorial public health agencies
2. Improve CDC’s 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
Workforce
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
26 People Protected – Public Health Prepared.
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
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
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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)
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
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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
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
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Workforce
PHRFP Basic Principles:
Emphasis on Staff DevelopmentMore 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 AgreementDuties of CDC field staff paid with BT Cooperative Agreement funds must be within the scope of the BT Cooperative Agreement
Customer FocusAssignments 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
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
30 People Protected – Public Health Prepared.
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
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
31 People Protected – Public Health Prepared.
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
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
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FUNDING
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
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Security Improvement
0.14%
Upgrading State & Local
84.10%
Anti-Infectious Agents0.18%
Upgrading CDC13.97%
Anthrax1.61%
* The appropriation amount of $1.16 billion does not include the rescission and indirect costs.
FY04 Appropriation by Budget Line ($1.16 Billion) (compared with $1.54 Billion in FY03)
Funding
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
34 People Protected – Public Health Prepared.
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
Funding
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
35 People Protected – Public Health Prepared.
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)
Funding
Centers for Disease Control and Prevention (CDC)Agency for Toxic Substances and Disease Registry (ATSDR)
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Funding Concerns
$80 unobligated reported on FSRs (11/1/03)
Draw-down lag
Supplanting
Allocation formula – change?
Funding