Greg Burel

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SNS Planning and Capabilities Update

• Greg Burel

• Director, Division of Strategic National
  Stockpile
• Office of Public Health Preparedness and
  Response, CDC

• 2011 Public Health Preparedness Conference

• June 29th, 2011

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Agenda

• Mission
• Technical Assistance
• Executive Order 13527
• PAHPA Reauthorization
• Novel Distribution and Dispensing Models
• Challenges

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Strategic National Stockpile Mission

• Deliver critical medical assets
• to the site of a national emergency
• Stockpiling the assets and delivering them is
  important work
• That work is wasted if the capabilities and
  resources dont exist at the state and local
  level to utilize the assets
• Collaboration is key to making the SNS a
  continuing resource to the nation

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Technical Assistance
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DSNS Modeling Support

• Distribution
• TourSolver
• Optimized Distribution Routing software
• 396 registered users (as of 4/10/2009)
• CERA
• Modeled RSS capabilities in 36 cities
• Two year contract ended 12/2008
• Dispensing
• RealOpt
• Optimization tool for designing PODs and
  treatment clinic planning and operations
• Modeling Forum (snsmodeling.org)
• Purpose of promoting the exchange of ideas,
  models and simulations designed to improve
  emergency response efforts and public health
• 74 registered users

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Sharing and Improving Practices

• Collaboration with partners
• Federal Executive Board
• ASTHO
• NACCHO
• Sharing promising practices
• SNS ListServs (2)
• SNS Extranet
• SNS Mass Dispensing Satellite Broadcast Series
• 10 broadcasts since 2004
• October 2009 Legal Issues
• Continuing Education credits offered
• Regional CRI/SNS Workshops
• National SNS Training Summit
• Fund NACCHO/ASTHO SNS Advisory Groups
• Fund NACCHOs STOCK-Box

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Webinar Series

• Second Wednesday Webinars
• Revolving Topics and Presenters
• Archive available on SNS Extranet
• Recent Topics
• Integrating SNS, PHEP, and HPP Exercises with
  HSEEP (May 11, 2011)
• DEA Considerations in SNS Planning (April 2011)
• Executive Order 13527 Updates on Federal
  Planning (March 2011)
• Closed POD (February 2011)

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Division of Strategic National
StockpileDeployable Teams

• Stockpile Services Advance Group (SSAG)
• Experts on Strategic National Stockpile response
  and state/local capability
• Provides short-term technical assistance
• Members represent DSNS at Emergency Operations
  Center, Incident Response Coordination Team, etc.
• Receiving, Staging and Storing (RSS) Task Force
• Assists with receipt, staging, onward movement
  and re-supply
• Federal Medical Station (FMS) Strike Team
• Helps state/local officials set up, re-supply and
  recover

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Composite Measure

• Address the need for more accurate preparedness
  and response indicator
• Solution - link the functions and capabilities of
  dependent governmental sectors in the form of a
  composite measure
• Medical Countermeasure Distribution and
  Dispensing (MCMDD) composite measure
• Developed to serve as a collective indicator of
  preparedness and operational capability
• Measure states, directly funded cities, Cities
  Readiness Initiative (CRI) planning
  jurisdictions, U.S. territories and freely
  associated states
• Derived from results of state TARs conducted by
  DSNS staff, CRI TARs conducted by DSNS and state
  staffs, drill submissions, a single full-scale
  exercise, and compliance with programmatic
  standards

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State by State Preparedness Report

• Developed by CDC Office of Preparedness and
  Emergency Response (OPHPR)
• Data and Content from DSNS, Division of State and
  Local Readiness (DSLR), and Division of Select
  Agents and Toxins (DSAT)
• Provide visibility and measurability to Congress
  and the White House on the value of investments
  in preparedness
• Relatable stories and successes are key to
  communicating our accomplishments and identifying
  our needs
• Share your story with your SNS Program Services
  Consultant

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Benefits Beyond Terrorism Response

• 10 years of SNS planning, training and exercise
• Established nationwide capability to receive and
  dispense SNS MCMs
• Benefits beyond this target capability
• Red River Flooding 2009 and 2010 - Fargo, ND
• Tactical communications plans, public information
  messaging, incident management team protocols and
  procedures, and distribution networks developed
  through CRI planning efforts used to coordinate
  successful evacuation, mass care and sheltering
  of thousands of citizens
• 2009 H1N1 Response - Nationwide
• State and local health departments around the
  country utilized their CRI plans to receive,
  distribute and dispense H1N1 vaccines and
  antiviral drugs, and many MSAs reported using
  their plans to set up PODs for vaccination
  clinics, recruit volunteers, establish closed-POD
  partnerships and reach vulnerable populations.

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Executive Order 13527
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Executive Order 13527

• Signed on December 30, 2009
• Charged the federal government with establishing
  capability for the timely provision of medical
  countermeasures (MCM) following a biological
  attack
• Three sections identified specific requirements
• Section 2 US Postal Service delivery of MCM
• Section 3 Federal rapid response
• Section 4 Continuity of operations

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EO 13527 Section 2

• Postal Model
• Collaboration with HHS and USPS since 2004
• Proof of Concept Drills in 2006-2007
• EO 13527 reaffirms support for postal model
• Augments traditional PODs, does not replace
• Critical requirement for execution Security
  Planning

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EO 13527 Section 3

• Federal Rapid Responsedevelop the capacity to
  anticipate and immediately supplement the
  capabilities of affected jurisdictions to rapidly
  distribute MCM following a biological attack
• Interagency effort evaluated requirements based
  on state/local gaps and federal capabilities
• Three approaches identified
• Supplemental manpower
• Federal closed PODs
• Federal open PODs
• Ongoing efforts to explore
• Supplemental manpower (including security)
• Use of online medical screening to support PODs
• Decreasing MCM deployment timelines

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EO 13527 Section 4

• Continuity of Operations
• Protection of federal workforce to maintain
  government services
• Interagency effort
• Great challenges to overcome
• Engagement of state and local leaders to leverage
  resources and integrate plans

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PAHPA Reauthorization
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PAHPA Reauthorization

• Pandemic and All Hazards Preparedness Act
• Signed in 2006
• Being addressed by Congress this year
• Draft bill currently working in House Energy and
  Commerce
• CDC engaged with HHS, ASTHO, and NACCHO to
  identify needs
• Proposals developed, reviewed and finalized
  through HHS
• Participated in series of briefings to educate
  staff on Senate HELP Committee on key topics to
  PAHPA
• SNS
• BARDA and Advanced Development of MCM
• State and Local Perspectives

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Novel Distribution and Dispensing Models
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Innovative Approaches to Mass DispensingExamples
from the States

• Boy Scouts used to deliver medication during an
  event.
• CERT Door-to-Door Delivery
• Closed POD (utilities, businesses, faith based
  organizations, military installations, etc.)
• Drive through bank dispensing
• Drive through POD's (colleges and Universities)
• Grocery Store used for dispensing

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Innovative Approaches to Mass DispensingExamples
from the States

• Home Owner Associations - Fort Lauderdale
  (Broward County) use Home Owners Associations to
  facilitate mass dispensing to the public along
  with traditional POD models.
• Large and Small closed PODs
• Long Term Care Facility pharmacies used for
  dispensing
• Mass Transit Stations dispensing
• Mega POD - to facilitate mass dispensing in
  highly congested areas that is conducive to
  traffic grid-lock.

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Innovative Approaches to Mass DispensingExamples
from the States

• Mobile POD trailers
• Private physicians office Closed POD
• Retail Pharmacy
• School Bus Delivery
• Tele-pharmacy dispensing operations
• Tiered POD system (with most needed and highest
  population PODs opened first)
• USPS Dispensing

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Partnerships Between State and Local Health
Departments and Department of Defense

• Sample Partnership - North Dakota
• Closed POD MOAs in place with Minot AFB and Grand
  Forks AFB. Agreements first brokered by state
  health officials, then involved local health
  departments. Agreements cover active duty
  military, contractors and family living on base.
  Air Force medical staff will operate the PODs.
• Sample Partnership - Missouri
• MOU is in place with Fort Leonard Wood. In
  addition, four local public health agencies are
  engaged in planning activities with Whiteman AFB.
• AL Center for Emergency Response and Terrorism
  has initiated quarterly meetings with military
  and VA partners. Meetings include state and local
  public health agencies and cover a variety of
  planning topics, including interoperable comms
  and closed PODs for dispensing with federal
  military partners.

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Case Marriott Closed POD Pilot

• DSNS conducting pilot project with Marriott
  hotels to establish closed PODs for hotel
  properties in local jurisdictions
• 16 local public health jurisdictions will be
  invited to participate, totaling 60 Marriott
  property locations
• Current outreach to eight public health
  jurisdictions, totaling 37 property locations.
  Six of the eight jurisdictions agreed to
  participate, one decision is pending and one
  declined.
• To date, most work has been done in Washington,
  D.C., and San Diego County, Orange County and
  Riverside County, CA

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Case Internal Revenue ServiceClosed POD Program

• Objective
• To assist the states in establishing multiple
  closed POD sites
• To further enable the mass distribution of
  pill-form medicines during a regional or national
  emergency
• To provide these necessary medicines as a service
  to IRS employees, IRS contractors, and their
  family members in an efficient and expeditious
  manner
• To alleviate burden on public PODs
• Authority
• Homeland Security Presidential Directive-21
  (HSPD-21) authorized CDC to partner with other
  federal agencies and the 50 states to establish
  open and closed PODs to dispense medicines during
  a declared national or regional emergency.

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IRS Closed POD Overview

• Can currently service 321,700 IRS employees,
  contractors and family members
• 104 IRS facilities across the country are planned
  to be serviced through the closed POD program
• 33 facilities actually serve as closed PODs
• These 33 facilities also service an additional 71
  IRS locations within commuting distance
• IRS facilities with 500 employees are targeted
  as actual closed POD sites

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Developing Volunteer Capabilities

• One time funding opportunity announcement
• Pilot project between CDC/DSNS, state and local
  public health agencies
• Fund a nationally recognized community volunteer
  and support organization to develop plans to
  recruit, train, and maintain volunteers
• Support state and local public health agencies
  during a dispensing campaign
• Create an exportable model that can be applied by
  other organizations and agencies
• FOA open April 4th June 4th, 2011

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Challenges
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Dispensing Challenges

• Liability issues
• PREP Act
• Non-medical dispensing concerns
• EUA Issues
• Potential for delay in distribution
• Staffing Issues
• Volunteer pools
• High turnover rate at state and local levels
• Mandatory furloughs and work force reductions
• Limited and shrinking funds
• Logistics of achieving high throughput
• Exercise Needs

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Fiscal Challenges

• Reductions in PHEP funding
• Adding requirements at the state and local level
• Carrying the message
• State and local preparedness/state and local
  resources are key to effective response
• OPHPR Director Ali Khans testimony to House
  Homeland Security subcommittee on 5/17/2011
• Effectively using the SNS requires a
  collaborative effort by state, local, tribal,
  territorial, and federal partners on everything
  from MCM development to development of
  diagnostics to detection of an event to
  distribution and dispensing of MCM.

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• Thank you
• www.cdc.gov/phpr/stockpile/stockpile