Department of Health and Human Services (DHHS)

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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)

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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

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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

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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

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Bacillus anthracisA Long-Standing Threat (2)

• Ubiquitous easy to obtain
• Easy to grow in large quantities
• Easy to work with surreptitiously

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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

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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.

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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.

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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.

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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.

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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.

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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

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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.