Expert answer:3000-word paper for H1N1 outbreak US 2009/10
Expert answer:the public health emergency for this assignment is H1N1 outbreak US 2009/10 Read the CDC document entitled Public Health Preparedness( attached below ) : Mobilizing State to State. There are nine preparedness goals in the background section. write a 3000-word paper that briefly describes the incident and then how and why aspects of the incident were handled well or could have been handled better according to this document. Each of the nine main goals of the CDC document must be addressed in your paper. If a particular one does not apply, state why (with a detailed enough explanation to support your opinion) and move on. I expect that you will be able to discuss or cite relevant topics. Do not include irrelevant extraneous material. The paper should utilize APA format.
lldvxs_cdc_report_on_public_health_preparedness___mobilizing_state_by_state_2__3_.pdf
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Public Health Preparedness:
Mobilizing State by State
A CDC Report on the
Public Health Emergency Preparedness
Cooperative Agreement
February 2008
Mobilizing State by State
Public Health Preparedness:
Mobilizing State by State
Public Health Preparedness:
Table of Contents
Executive Summary
3
Background
6
Methods
11
Section 1: Public Health Preparedness in the States and DC
Disease Detection and Investigation
Public Health Laboratories
Response
Moving Forward
12
13
16
21
27
Section 2: Snapshots of Public Health Preparedness in States
and Directly Funded Localities
29
Appendices
Appendix 1: Cooperative Agreement Funding
Appendix 2: DHS National Preparedness Guidelines and Priorities
Appendix 3: Overview of CDC Preparedness Activities
Appendix 4: Overview of ASPR Preparedness Activities
Appendix 5: Data Sources and Methods
Appendix 6: Category A and B Biological Agents
141
145
147
153
155
161
The events of September 11, 2001, and the
subsequent anthrax attacks both highlighted the
importance of public health during emergencies
and showed weaknesses in public health’s ability
to respond during a potential crisis. In 2002,
Congress authorized funding for the Public
Health Emergency Preparedness cooperative
agreement (hereafter referred to as the
cooperative agreement) to support preparedness
nationwide in state, local, tribal, and territorial
public health departments. As of 2007, the
cooperative agreement has provided more than
$5 billion to these public health departments.
CDC administers the cooperative agreement
and provides technical assistance to public health
departments. This report outlines progress and
challenges. It also describes how CDC and its
partners are working to address these challenges.
Progress continues. With support from
the cooperative agreement, public health
departments have improved their ability to
respond to emergencies.
Public health departments can better detect and
investigate diseases because of improvements
in the public health workforce and in data
collection and reporting systems.
•
The number of epidemiologists in public
health departments working in emergency
response has doubled from 115 in 2001
to 232 in 2006.* Epidemiologists detect
and investigate health threats and disease
patterns and work to minimize the negative
effects of a health threat in a community.
•
The number of users for the Epidemic
Information Exchange (Epi-X), a secure
CDC-based communications system that
helps track disease outbreaks, has increased
to 4,646 in 2006, up from 890 in 2001.
Users are primarily from state and local
health departments (75%).
•
All state public health departments now can
receive and evaluate reports of urgent health
threats 24/7/365, whereas in 1999 only 12
could do so. Previously, it was often difficult
for clinicians to reach a public health
professional after normal work hours.
* For 38 states and the District of Columbia (DC) responding to Council of State and Territorial Epidemiologists (CSTE)
surveys.
Mobilizing State by State
Public health threats are inevitable. Being
prepared for these threats can save lives and
protect the health and safety of the public
and emergency responders. The Centers for
Disease Control and Prevention (CDC) works
to support public health preparedness for all
hazards, including natural, biological, chemical,
radiological, and nuclear events. This work falls
under one of the agency’s overarching health
protection goals: “People prepared for emerging
health threats – people in all communities will
be protected from infectious, occupational,
environmental, and terrorist threats.” CDC
has established nine preparedness goals to
strategically direct resources towards achieving
this overarching goal.
Public Health Preparedness:
Executive Summary
Mobilizing State by State
Public health laboratories have increased
capability to test for biological and chemical
threats and to communicate information.
•
•
The number of state and local public health
laboratories able to detect chemical agents
has increased to 47, from 0 in 2001.
•
All states now have public health
laboratories that can quickly communicate
with clinical laboratories. In 2001, only
20 states reported having public health
laboratories with this capability. Once a
threat is confirmed in one laboratory, other
laboratories need to be quickly alerted since
they might receive related case samples
(indicating that the threat is spreading).
Public Health Preparedness:
The number of state and local public health
laboratories able to detect biological agents
has increased to 110 in 2007, from 83 in
2002.
•
More than twice the number of state public
health laboratories are conducting exercises
to test their ability to handle, confirm, and
report results for chemical agents (from 16
in 2003 to 38 in 2006).
Public health departments have developed
response plans, implemented a formalized
command structure, and conducted exercises.
Such activities were rare prior to 2001.
•
All states now have plans to receive, store,
and distribute the Strategic National
Stockpile (SNS), a national repository of
antibiotics, other life-saving medications,
and medical supplies.
•
Seventy-three percent of states reviewed
have satisfactorily documented their SNS
planning efforts.
•
In 2005, public health departments in
50 states and DC trained public health
professionals about their roles and
responsibilities during an emergency as
outlined by the Incident Command System,
while in 1999 only 14 did so.
•
All states now participate in the Health
Alert Network, which allows for the
rapid exchange of critical public health
information.
Challenges remain. Building on progress in
public health preparedness will require ongoing
commitment.
•
Public health departments report difficulties
in recruiting and retaining qualified
epidemiologists, according to a 2006 CSTE
survey.
•
Disease surveillance systems need to be
strengthened. In 2007, 16 states did not
report any plans to electronically exchange
health data with regional health information
organizations (networks of healthcare
provider organizations that allow the
electronic sharing of health information
among members).
•
To facilitate surveillance, public health
departments need to ensure an appropriate
legal framework before a disaster occurs;
otherwise, states may be unable to share
critical public health information with other
jurisdictions.
The public health laboratory workforce
needs improvement. Thirty-one state public
health laboratories reported difficulty
recruiting qualified laboratory scientists,
and 39 state public health laboratories
reported needing additional staff to perform
polymerase chain reaction, a rapid DNA
testing technique to quickly identify
bioterrorism agents, according to a 2007
Association of Public Health Laboratories
survey.
•
Public health laboratories need to increase
the use of advanced technology and broaden
testing abilities, including radiological
testing. Currently, no state public health
laboratory can rapidly identify priority
radioactive materials in clinical samples.
•
Public health departments need to sustain
a system of all-hazards planning, training,
exercising, and improving. This system
should be ready to help at-risk populations,
such as the elderly and others who may need
help controlling chronic diseases.
•
Moving forward. CDC is working with state
and local public health departments on initiatives
that include:
Increasing the use of electronic health
data for preparedness and response by
networking surveillance systems and using
real-time data;
•
Expanding laboratory testing;
•
Establishing commercial partnerships
to supply needed medicines to at-risk
populations during an emergency;
•
Developing and evaluating a core
curriculum for preparedness through the
Centers for Public Health Preparedness, a
national network of academic institutions
with a common focus on public health
preparedness;
•
Improving legal preparedness by helping
states and other jurisdictions implement
public health mutual aid agreements, which
enable sharing of supplies, equipment,
personnel, and information during
emergencies;
•
Exercising public health systems to
continuously improve capability and
demonstrate readiness; and
•
Collaborating with partners to develop
accreditation programs for state and local
public health preparedness.
Achieving the overarching goal, “people prepared
for emerging health threats,” is critical to the
health and safety of our communities. This
report represents CDC’s commitment to sharing
information on a program that contributes to
this goal.
Mobilizing State by State
Public health and other response
agencies need interoperable emergency
communication systems. In 2007, the
Department of Homeland Security reported
that many cities and metropolitan areas have
established multi-agency communications,
but more progress is needed to expand
interoperable communication across
jurisdictions and levels of government.
•
Public Health Preparedness:
•
Mobilizing State by State
Public Health Preparedness:
“
“
When people ask me what’s the biggest challenge in public health, I
have an easy answer. For large-scale disasters and more routine threats
to health, the major problem we face in public health is complacency.
We’ve made a lot of progress in our preparedness efforts, but we’re
not done yet. We need long-term investment to really get us where we
want to be.
Background
Public health threats are inevitable. Being
prepared can save lives and protect the health
and safety of the public and emergency
responders during disasters. A prepared public
health system involves continual improvement
of the system’s ability to prevent, protect against,
respond to, and recover from the consequences
of emergencies.
The Centers for Disease Control and Prevention
(CDC) works to support public health
preparedness for all hazards, including natural,
biological, chemical, radiological, and nuclear
events. This work falls under one of the agency’s
overarching health protection goals: “People
prepared for emerging health threats people in all communities will be protected
from infectious, occupational, environmental,
and terrorist threats.” CDC has established
nine preparedness goals to strategically direct
resources towards achieving this overarching
goal. These goals are associated with six public
1
— Dr. Julie Gerberding, CDC Director
health preparedness activities: prevent, detect and
report, investigate, control, recover, and improve
(Table 1).
The events of September 11, 2001, and the
subsequent anthrax attacks both highlighted the
importance of public health during emergencies
and showed weaknesses in public health’s ability
to respond during a potential crisis. According
to a 2002 Institute of Medicine report, the
public health infrastructure suffered from
“vulnerable and outdated health information
systems and technologies, an insufficient and
inadequately trained public health workforce,
antiquated laboratory capacity, a lack of realtime surveillance and epidemiological systems,
ineffective and fragmented communications
networks, incomplete domestic preparedness
and emergency response capabilities, and
communities without access to essential public
health services.”1
Institute of Medicine, The Future of the Public’s Health in the 21st Century; 2002
In 2002, Congress authorized funding for
the Public Health Emergency Preparedness
cooperative agreement (hereafter referred
to as the cooperative agreement) to support
preparedness nationwide in public health
departments.2,3 Within each funded jurisdiction,
public health departments at the state, local,
tribal, and/or territorial levels work together to
improve preparedness.
CDC administers the cooperative agreement
and provides technical assistance to state,
territorial, and major metropolitan public
health departments. This technical assistance
leverages CDC expertise in disease detection
and investigation, public health laboratories,
and response, including crisis communication.
CDC’s longstanding working relationships with
public health departments are critical to the
success of this program.
agents, and naturally occurring health threats.
Detect and Report
Decrease the time needed to classify health events as
Goal 2 terrorism or naturally occurring in partnership with other
agencies.
Goal 3
Improve the timeliness and accuracy of communications
Goal 4 regarding threats to the public’s health.
Investigate
Decrease the time to identify causes, risk factors, and
Goal 5 appropriate interventions for those affected by threats to the
public’s health.
Control
Decrease the time needed to provide countermeasures and
Goal 6 health guidance to those affected by threats to the public’s
health.
Recover
Decrease the time needed to restore health services and
Goal 7 environmental safety to pre-event levels.
Improve the long-term follow-up provided to those affected
Post-Event
Goal 8 by threats to the public’s health.
Improve
Decrease the time needed to implement recommendations
Goal 9 from after-action reports following threats to the public’s
health.
The cooperative agreement funds 50 states, four metropolitan areas (Chicago, Los Angeles County, New York City, and
Washington, DC), five territories (Puerto Rico, the Northern Mariana Islands, American Samoa, Guam, and the U.S. Virgin
Islands), and three freely associated states (the Federated States of Micronesia, Palau, and the Marshall Islands).
3
CDC began funding selected public health departments in 1999, but the cooperative agreement’s support of 62
jurisdictions did not begin until 2002.
2
Mobilizing State by State
Event
Decrease the time needed to detect and report
chemical, biological, radiological agents in tissue, food or
environmental samples that cause threats to the public’s
health.
Public Health Preparedness:
Table 1: CDC Preparedness Goals
Prevent
Pre-Event
Increase the use and development of interventions known to
Goal 1 prevent human illness from chemical, biological, radiological
Mobilizing State by State
Figure 1: Cooperative Agreement Allocated Funding, Fiscal Year 2002-2007
(in millions)
Public Health Preparedness:
Source: HHS Press Releases; 2002-2007 – data for all 62 funded jurisdictions
As of 2007, the cooperative agreement has
provided more than $5 billion to public health
departments (Figure 1). Appendix 1 presents
historical cooperative agreement funding levels
for each funded public health department.
•
Quick and accurate communication across
local, state, and federal levels;
•
Ongoing enhancement of state and local
public health programs through a cycle of
planning, exercising, and improvement
plans;
•
Protecting the health of the community and
first responders during an emergency; and
•
Helping communities recover from
emergencies.
The cooperative agreement supports:
•
•
Collaboration among state, local, tribal,
and territorial public health departments,
research universities, and other responder
agencies;
Rapid identification of biological and
chemical agents by public health laboratories
across the country;
Collaborating for preparedness. Local response
agencies, including public health departments,
are usually the first to respond during an
Quick and Effective Collaboration – Minnesota Bridge Collapse
When the Interstate 35W bridge collapsed in Minneapolis in 2007, public health professionals
were ready. According to the Minnesota Department of Health, cooperative agreement funding
allowed public health to expand, strengthen, and exercise systems that contributed to a fast and
effective response.
Within 10 minutes of the incident, state public health staff, hospitals, and emergency medical
services began monitoring real-time information on the number of patients, their condition,
and available hospital space. Local, state, and federal agencies worked together to determine if
harmful substances were released into the environment and initiated measures to protect public
health during the cleanup. State and local public health staff coordinated behavioral health and
grief support services using a network of registered and credentialed volunteers.
emergency. For multi-state or severe emergencies,
CDC may be asked to provide additional public
health resources and coordinate response efforts
across multiple jurisdictions. CDC monitors and
often responds to major events that are potential
nationwide health threats (Figure 2).
4
the Department of Justice, and the Department
of State. Appendices 3 and 4 detail how CDC
and ASPR offices are currently working towards
improving preparedness.
CDC and pubic health department partners
include the American Public Health Association,
the Association of Public Health Laboratories
(APHL), the Association of Schools of Public
Health, the Association of State and Territorial
Health Officials, the Council of State and
Territorial Epidemiologists (CSTE), and the
National Association of County and City Health
Officials (NACCHO). These organizations
share best practices and lessons learned, conduct
research, and provide training to public health
professionals.
CDC, Division of Emergency Operations (DEO) Epi-Aid data; 2007
Mobilizing State by State
CDC works under the strategic leadership of
the Assistant Secretary for Preparedness and
Response (ASPR) in the Department of Health
and Human Services (HHS). Under the National
Response Framework, HHS is responsible for
coordinating federal assistance to supplement
state, local, and tribal resources in response
to public health and medical care needs for
potential or actual emergencies. To achieve this,
HHS works with other federal departments,
including DHS, the U.S. Department of
Agriculture (USDA), the Department of
Defense, the Department of Veterans Affairs,
From October 2006 through September
2007, CDC deployed more than 170
staff to 31 states to assist public health
department investigations. The health
problems included an unexplained
cluster of patients with neurologic
disease, tuberculosis, and hurricanerelated health threats.4
Public Health Preparedness:
The National Preparedness Guidelines, published
by the Department of Homeland Security
(DHS), establish a vision, capabilities, and
priorities for national preparedness. CDC
preparedness goals support the target capabilities
outlined in the National Preparedness Guidelines
in areas such as detecting threats, public health
laboratory testing, and communications. See
Appendix 2 for more information on the
National Preparedness Guidelines and DHS
preparedness priorities.
CDC Field Deployments
Mobilizing State by State
Local, state, and
federal agencies
must collaborate
to effectively
prepare for
and respond to
emergencies.
Public Health Preparedness:
10
Figure 2: Timeline of CDC Emergency Responses
XDR/MDR tuberculosis (May)
Hurricane Dean (August)
Mumps (April)
Tropical storm Ernesto (August)
E. coli in spinach (September)
E. coli (December)
Presidential inauguration (January)
Marburg virus (March)
Hurricane Katrina (August)
Hurricanes Rita and Wilma (September)
Avian influenza (January)
BioWatch (February)
Guam typhoon (February)
Ricin domestic response (February)
Cities Readiness Initiative (March)
G8 Summit (June)
Democratic National Convention (July)
West Nile virus (August)
Hurricanes Charley, Frances, Ivan,
and Jean (August)
Summer Olympics (August)
Republican National Convention
(August)
Influenza vaccine shortage (October)
Asian tsunami (December)
Space shuttle Columbia disaster (February)
SARS (March)
Monkeypox (June)
Northeast blackout (August)
Hurricane Isabel (September)
Ricin, tularemia, and anthrax
(October)
California wildfires (October)
Domestic influenza (December)
Mad cow disease (Dece …
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