Tanja Popovic, MD, PhD, F(AAM), AM(AAFS)

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AAVMC/ASPH Joint Symposium April 23, 2007
CDC Preparedness and Partnerships in an Era of
Extreme Challenges, Extreme Global Connectivity
and Extreme Communication Revolution
Tanja Popovic, MD, PhD, F(AAM), AM(AAFS) Chief
Science Officer Centers for Disease Control and
Prevention
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The World of Extreme Challenges

• Emerging Public Health Threats

Human Genome
Aging Society
Globalization
Changing Demographics
Information Technology
Rising Health Care Costs
Aging Workforce
Public Health Infrastructure
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Urgent Threats
Space Shuttle Columbia Disaster Feb 03
Hurricane Katrina Aug. 05 - present
Tsunami Dec 04-Feb 05
RNC 2004 Aug 04
Hurricane Isabel Sept 03
Influenza Vaccine Shortage Oct 04-05
California Wildfires Oct-Nov 03
West Nile Virus Aug-Nov 04
West Nile Virus Aug-Nov 02
DNC 2004 July 04
Guam Typhoon Feb 04
World Trade Center Sept 2001
Hurricane Wilma Oct 05-Present
Influenza Sept 03
G8 Summit June 04
Ricin TularemiaAnthrax Oct-Nov 03
Marburg Virus Mar 05-Sept 05
SARS Mar-Aug 03
Hurricanes (Charley, Frances, Ivan, Jean)
Aug-Oct 04
2004 Summer Olympics June 04
Anthrax AttacksOct-Nov 01
Monkey Pox June-Aug 03
BSE Dec 03
Hurricane Rita Sept. 05 - present
Ricin Domestic Response Feb 04
Avian Influenza Jan-Mar 04
Northeast Blackout Aug 03
Anytime, Anywhere, Anybody
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Banda Aceh Shore (Before Tsunami) Source
DigitalGlobe
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Banda Aceh Shore (After Tsunami) Source
DigitalGlobe
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Extremism
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Urgent Realities
Everyday, Everywhere, Everyone
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Extreme Climate
Storms, Tornadoes, Hurricanes, Floods, Drought
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Extreme Poverty
Kevin Carter, Pulitzer Prize 1994
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Extreme Health Disparities
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Extreme Diet
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Extreme Environment
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Extreme Convenience
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Extreme Size
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What if Urgent Realities Happened in One Day?

• More teenagers and young adults
  died of suicide than from cancer,
  heart disease, AIDS,
  birth defects, stroke,
  pneumonia and influenza, and chronic lung disease
  combined.
• Suicide is the third leading cause of death for
  Americas youth.

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Extreme Globalization and Health Drivers

• Direct
• Increased global travel
• Increased trade in goods
• Technological change
• Indirect
• Urbanization
• Climate change
• Other environmental concerns
• Microbial drug resistance
• Changes to the public health infrastructure

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Extreme Communications
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Scientific Challenges
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Translation of Science to Practice
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Prevention
In the US 97 of health care funding goes to
those who are already ill 95 of health care
funding goes toward the last year of life
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BIGGER PROBLEMS!
HIGHER EXPECTATIONS!
TIME MATTERS!
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CDC Health Protection Goals
Healthy People in Every Stage of Life
Healthy People in Healthy Places
People Prepared for Emerging Health Threats
Healthy People in a Healthy World
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PREPAREDNESSPeople in all communities will be
protected from infectious, occupational,
environmental, and terrorist threats.
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Centers for Disease Control Prevention
OFFICE OF STRATEGY AND INNOVATION
OFFICE OF THE CHIEF SCIENCE OFFICER
OFFICE OF WORKFORCE AND CAREER DEVELOPMENT
OFFICE OF THE CHIEF OF PUBLIC HEALTH PRACTICE
OFFICE OF THE DIRECTOR
OFFICE OF ENTERPRISE COMMUNICATION
OFFICE OF THE CHIEF OPERATING OFFICER
OFFICE OF CHIEF OF STAFF
CDC WASHINGTON OFFICE
OFFICE OF EQUAL EMPLOYMENT OPPORTUNITY
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Three Overarching Categories
Pre-Event
Event
Post-Event

• Increase the use and development of
  interventions known to prevent human illness from
  chemical, biological, radiological agents and
  naturally occurring health threats.
• Decrease the time needed to classify health
  events as terrorism or naturally occurring in
  partnership with other agencies
• Decrease the time needed to detect chemical,
  biological, radiological agents in tissue, food
  or environmental sample that cause threats to the
  publics health.
• Improve the timeliness and accuracy of
  information regarding threats to the publics
  health

Decrease the time to identify causes, risk
factors, and appropriate interventions for those
affected by threats to the publics
health. Decrease the time needed to provide
countermeasures and health guidance to those
affected by threats to the publics health

• Decrease the time needed to restore health
  services and environmental safety to pre-event
  levels
• Increase the long-term follow-up provided to
  those affected by threats to the publics health.
• Decrease the time needed to implement
  recommendations from after-action reports
  following threats to the publics health.
• .

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Enhanced Laboratory Capacity CDCs Laboratory
Response Network
Sep 2001
2005

• State or Local Public Health Labs
• CDC Lab
• Federal or International Labs
• Military Labs
• Conceptualized Connections to Sentinel

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Outbreak Identification

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CDC Directors EmergencyOperations Center
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Preparations for Influenza Pandemic
NEXT ???
Hong Kong
Asian
Spanish
1918
1957
1968
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Situation Report Avian Influenza

• Widespread and spreading prevalence in migratory
  birds broad host range
• Continued outbreaks among domestic poultry
• Mammalian infection (cats, pigs, etc.) lethal
• Virus is evolving
• Sporadic human cases (gt260 reports to date)
• Most in young and healthy
• Case-fatality gt50 (163)
• Rare person-to-person transmission
• Sustained and rapid person-to-person transmission

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Federal Pandemic Influenza Plans

• HSC National Strategy for Pandemic Influenza
  11/2005
• HHS Pandemic Influenza Plan 11/2005
• Homeland Security Council (HSC) National Strategy
  for Pandemic Influenza Implementation Plan
  5/2006
• HHS Pandemic Influenza Implementation Plan
  (8/2006 draft)
• CDC Influenza Pandemic Operation Plan

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Pandemic Influenza Doctrine Saving Lives

• Slow spread, decrease illness and death, buy time
• Antiviral treatment and isolation for people with
  illness
• Quarantine for those exposed
• Social distancing
• Vaccine when available
• Local decisions
• Communicate, communicate, communicate!

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• Ethics Subcommittee of Advisory Committee to the
  Director established January 2005
• CDC Public Health Ethics Committee established
  May 2005
• Developed framework document to define the What,
  Why, and How of Public Health Ethics at CDC
• Conducted training in public health ethics
• Developed procedures for conducting consultations
  

• Development of Ethical Guidance for
• Pandemic influenza
• Released March 5, 2007
• www.cdc.gov/od/science/phec/guidelinesPanFlu.htm
• Guidance in Development
• Emergency preparedness and response
• Genomics
• Non-research data collections

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Where Do We Go From HereNext Steps for Public
Health Preparedness
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• Supporting state and local efforts
• Improving performance measures and accountability
• Expanding the use of exercises
• Sharing lessons learned
• Increasing speed of detection and responses
• Enhancing the SNS
• Partnering and meta-leadership

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State and Local Pandemic Influenza Planning
Checklist

• Community Leadership and Networking
• Surveillance
• Health System Partnerships
• Infection Control and Clinical Care
• Vaccine Distribution and Use
• Antiviral Drug Distribution and Use
• Community Disease Control and Prevention
• Communications
• Workforce Support

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Measurable Impact

• Supporting state and local efforts
• Improving performance measures and accountability
• Expanding the use of exercises
• Sharing lessons learned
• Increasing speed of detection and responses
• Enhancing the SNS
• Partnering and meta-leadership

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• Supporting state and local efforts
• Improving performance measures and accountability
• Expanding the use of exercises
• Sharing lessons learned
• Increasing speed of detection and responses
• Enhancing the SNS
• Partnering and meta-leadership

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INFLUENZA PANDEMIC FULL FUNCTIONAL (INTERNAL)
EXERCISE
Senior Leader OPLAN Seminar 28 Sep
Training/Exercise Methods Include Briefings/Semin
ars Tabletop Discussion (informal walk-thru and
discussion) Workshops and Functional Drills
(step-by-step rehearsal by phases/stages) Full
Scale Exercises
AAR
Influenza Pandemic OPLAN
DEOC Working Level Workshop 4 Oct
Current Focus
AAR
Functional Exercise Internal, Full Staff 31 Jan
1 Feb 07 (24 Hrs)

Division Director, CIO OPLAN Seminar 17 Oct
AAR
AAR
Full Scale Exercise Internal/External 4-6 Apr
07 (48 Hrs)
Advanced Tabletop Significant Issue Forum 8 Dec
(Half Day)
AAR
Basic Functional Level Drills (6 Functional
Areas) 16 Oct 1 Dec 2-4 Hours Each
AAR
Weekly Conferences/Seminars (as needed) 30-60
Minutes Each
Final AAR Report
Internal Degraded Operations Exercise 16-17 May
07 (Full Day)
AAR
Desired CDC Director Participation
AAR
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• Supporting state and local efforts
• Improving performance measures and accountability
• Expanding the use of exercises
• Sharing knowledge and lessons learned
• Increasing speed of detection and responses
• Enhancing the SNS
• Partnering and meta-leadership

Learning is like rowing upstream not to
advance is to fall back. Chinese proverb
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Lessons Learned

• Establish partnerships
• Establish informal networks
• Align political environments
• Define community health terms, e.g., public
  health, quality of life
• Ground planning in the community
• Be ready for the unexpected
• Organize for success
• Assess and adjust leadership groups
• Start with and celebrate small successes
• Communicate, communicate, communicate

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Globalization and Communication
As we move into the 21st century, communication
may well become the central science of public
health practice. Edward Baker, MD,
MPH, Assistant Surgeon General
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Just in Time Communication

• Web / Webcasts/ podcasts/ radio
• MMWR
• Satellite Broadcasts
• EpiX / Health Alert Messages
• Hotlines

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• Supporting state and local efforts
• Improving performance measures and accountability
• Expanding the use of exercises
• Sharing lessons learned
• Increasing speed of detection and responses
• Enhancing the SNS
• Partnering and meta-leadership

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BioSense

• Enable early event detection and health
  situational awareness using real-time clinical
  data from hospitals
• Allow federal, state, local public health
  simultaneous access to health data to
• Analyze syndromes
• Visualize as geospatial maps, time series,
  patient line listings
• Query as needed

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CDC Connects Global Health Protection Network
FY04 Quarantine Border Health
Stations Field Epidemiology /Laboratory Training
Programs CDC Field Stations International
Business Connectivity DOD Laboratories New
Global Disease Detection Response
Sites International Rapid Response Teams New
InternationalLaboratory Response Network Sites
FY04 Laboratory Response
Network National Clinical Lab Orders DoD/VA Dx
Rx Records Biowatch Data Drug Sales Clinical
Care US hospitals and clinics in sentinel cities

INTERNATIONAL DOMESTIC
Global Health Protection Network
BioSense BiointelligenceCenter
D A T A E X C H A N G E
FY 07
FY 07
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CDC Connects Global Disease Detection and
Response Centers
3 ERO region
3 EMRO region
3 SEARO region
3 WPRO region
3 PAHO region
3 AFRO region
GDD Response Centers
GDD Response Centers
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• Supporting state and local efforts
• Improving performance measures and accountability
• Expanding the use of exercises
• Sharing lessons learned
• Increasing speed of detection and responses
• Enhancing the SNS
• Partnering and meta-leadership

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• Supporting state and local efforts
• Improving performance measures and accountability
• Expanding the use of exercises
• Sharing lessons learned
• Increasing speed of detection and responses
• Enhancing the SNS
• Partnering and meta-leadership

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Success Factors

• Commitment to a goal
• Capacity
• Strong science
• Big investment
• Sustainability
• Connectivity
• Leaders /meta-leaders
• Partnerships
• Multi-sector networks

Polio Eradication
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• J Environmental Health, April 07

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Public Health/Prevention Fellowship Program
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Potential Extramural Projects

• Association of Schools of Public Health (ASPH)
• Association of Teachers of Preventive Medicine
  (ATPM)
• Association of American Medical Colleges (AAMC)

Readiness Program Management to Leadership
Institutes to Translating Health communication
to Practice
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CDC Katrina Response

• CDC Personnel (deployed 700 people to 4 states)
• Health and safety messages (to general public,
  local/state health officials, media, partners,
  deployed staff)
• Medical supplies and Federal Medical Stations
  (SNS)
• Public health needs assessments, including
  environmental assessments (water quality, mold,
  infection control, mosquito control)
• Disease surveillance activities
• Mental health assessments and response
• Technical assistance to state and local health
  departments and response partners
• PHS Veterinary Team

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the 40s
the 50s
the 60s
the 70s
the 80s
the 90s
today