cdc cooperative agreement public health emergency...

CDC COOPERATIVE CDC COOPERATIVE AGREEMENT AGREEMENT

Public Health Emergency Public Health Emergency PreparednessPreparedness

4th Annual 4th Annual PHRST 7 Homeland Security PHRST 7 Homeland Security

and Preparedness Conferenceand Preparedness ConferenceMay 10, 2006May 10, 2006Charlotte, NCCharlotte, NC

Maribeth WootenMaribeth WootenEpidemiology Section, NC Division of Public Epidemiology Section, NC Division of Public

HealthHealth

A New NormalA New Normal

Preparedness:Preparedness:A Core Public Health A Core Public Health FunctionFunctionCentral Role of StatesCentral Role of StatesAll Emergencies Start LocalAll Emergencies Start Local

What We What We Have AccomplishedHave Accomplished

Components of the NC Public Health Components of the NC Public Health Preparedness and Response PlanPreparedness and Response Plan

SurveillanceSurveillanceDisease investigationDisease investigationLaboratory capacity and responseLaboratory capacity and responseVaccination/prophylaxisVaccination/prophylaxisQuarantine and isolationQuarantine and isolationMass careMass careMass fatalityMass fatalityPublic informationPublic informationCommand/Control/CommunicationsCommand/Control/Communications

What We Have What We Have AccomplishedAccomplished

Local Public Health CapacityLocal Public Health Capacity

Local BT Planners/CoordinatorsLocal BT Planners/CoordinatorsWorkforce Development/TrainingWorkforce Development/TrainingInformation Technology UpgradesInformation Technology UpgradesInternet Connectivity (HAN) Internet Connectivity (HAN) -- all all LHDs and >110 hospitalsLHDs and >110 hospitalsResponse Plans with local partnersResponse Plans with local partners

What We Have AccomplishedWhat We Have AccomplishedState & Regional Public Health State & Regional Public Health

CapacityCapacity

7 PHRSTs7 PHRSTs3 Regional Laboratories3 Regional Laboratories12 Hospital PH Epidemiologists 12 Hospital PH Epidemiologists Enhanced surveillance & response systems Enhanced surveillance & response systems (MOST, NC DETECT, NC EDSS, OMS, RNAs)(MOST, NC DETECT, NC EDSS, OMS, RNAs)Workforce Development/TrainingWorkforce Development/TrainingPHTIN UpgradesPHTIN Upgrades

BioterrorismCoordinator

NC Emergency Management

CDCLaw Enforcement: FBI, SBI

85 LHDs

Medical Facilities Academic Institutions

Military Installations

State Level Bioterrorism Team

7 P.H. Regional Surveillance Teams

NC Public Health Preparedness and Response

Linking of Response Linking of Response SystemsSystems

Medical & Mental Medical & Mental Health ServicesHealth Services

First RespondersFirst RespondersFire/EMSFire/EMS

Emergency ManagementManagement

PublicPublicHealthHealth

LawLawEnforcementEnforcement

What We Have What We Have AccomplishedAccomplished

Examples of Dual Use CapacityExamples of Dual Use Capacity

Hurricane responses in NC Hurricane responses in NC Hurricane responses outside of NCHurricane responses outside of NCE. coliE. coli outbreak at NC State Fairoutbreak at NC State FairLegionella outbreak in Western NCLegionella outbreak in Western NCSmallpox Vaccination ProgramSmallpox Vaccination ProgramFlu Vaccine Shortage ResponseFlu Vaccine Shortage ResponseWest Nile Virus West Nile Virus -- Vectorborne DiseasesVectorborne DiseasesSARS Response Winter 2003SARS Response Winter 2003

CDC Grant Funding History CDC Grant Funding History

Years 1 & 2 Years 1 & 2 Start up laboratory fundingStart up laboratory fundingYear 3Year 3 $ 24.2M$ 24.2MYear 4 Year 4 $ 26.2M $ 26.2M

(Base, $2.8M Smallpox, $1.8M SNS)(Base, $2.8M Smallpox, $1.8M SNS)Year 5Year 5 $ 20.5M$ 20.5MYear 6Year 6 $ 22.9M$ 22.9M

(Base, $2.5M Pan Flu)(Base, $2.5M Pan Flu)

Year 7Year 7 ??????

DHHS Reallocation DecisionDHHS Reallocation Decision((why we had less money in BY5)why we had less money in BY5)

Cities Readiness Initiative (Cities Readiness Initiative (--$39M)$39M)Shift to CDC Shift to CDC BioSense (BioSense (--$11.9M)$11.9M)–– Quarantine Stations (Quarantine Stations (--$4M)$4M)

Pool available to statesPool available to states–– Was $864.9MWas $864.9M–– Now $810M (Now $810M (--6.3%)6.3%)

Reduced NC base amount (from $5M to Reduced NC base amount (from $5M to $3.9M)$3.9M)No SNS or Smallpox FundingNo SNS or Smallpox Funding

Reduced Federal Reduced Federal AppropriationsAppropriations

(why we had less money in BY6 and why (why we had less money in BY6 and why wewe’’ll have less money in BY7)ll have less money in BY7)

Potential Budget Year 7 FundingPotential Budget Year 7 Funding

Reduced Federal Appropriations to CDCReduced Federal Appropriations to CDCAnticipate 15% reduction in base funding Anticipate 15% reduction in base funding to all statesto all states’’ cooperative agreementscooperative agreementsPotential reduced NC base funding from Potential reduced NC base funding from BY6 $20.4M to BY7 $17.3MBY6 $20.4M to BY7 $17.3M

Current CDC Grant StructureCurrent CDC Grant StructureProject Period 2Project Period 2

(Budget Years 6(Budget Years 6--10)10)

No Focus AreasNo Focus AreasOutcomes DrivenOutcomes DrivenPrevent, Detect, Report, Investigate, Prevent, Detect, Report, Investigate, Control, Recover and ImproveControl, Recover and ImproveProvides objectives to be achieved by Provides objectives to be achieved by state, territorial, and priority local state, territorial, and priority local public health agenciespublic health agencies

CDC Grant StructureCDC Grant StructureProject Period 2 Project Period 2

Performance MetricsPerformance Metrics

State and Priority Local Health State and Priority Local Health DepartmentsDepartmentsPriority LHDs defined through Metropolitan Priority LHDs defined through Metropolitan Statistical Areas (MSAs)Statistical Areas (MSAs)Reportable to CDC at annual application Reportable to CDC at annual application and through regular progress reportsand through regular progress reports

CDC Grant StructureCDC Grant StructurePerformance MetricsPerformance Metrics

NC MSAsNC MSAsCharlotteCharlotte--GastoniaGastonia--Concord, NCConcord, NC--SCSC

Includes LHDs in the Includes LHDs in the following countiesfollowing counties::AnsonAnsonCabarrusCabarrusGastonGastonMecklenburgMecklenburgUnionUnion

Additional LHDsAdditional LHDs::IredellIredellLincolnLincoln

CDC Grant StructureCDC Grant StructurePerformance MetricsPerformance Metrics

NC MSAsNC MSAs

Albemarle Regional Health Services Albemarle Regional Health Services (Currituck Co.) defined as part of (Currituck Co.) defined as part of

Norfolk, VA MSANorfolk, VA MSA


Performance Metrics Performance Metrics NIMS ComplianceNIMS Compliance

How many FullHow many Full--Time Equivalent (FTE) public Time Equivalent (FTE) public health employees have emergency response health employees have emergency response roles specified in their job descriptions?roles specified in their job descriptions?How many have been trained in the National How many have been trained in the National Incident Management System (NIMS) within the Incident Management System (NIMS) within the last 24 months?last 24 months?


Performance MetricsPerformance MetricsEmergency Response Emergency Response

In public health emergency response plans In public health emergency response plans what is the estimated number of what is the estimated number of volunteers that are needed to support an volunteers that are needed to support an epidemiologic investigation? epidemiologic investigation? How many are trained for this function?How many are trained for this function?


Performance MetricsPerformance MetricsEmergency ResponseEmergency Response

In public health emergency response plans In public health emergency response plans what is the estimated number of what is the estimated number of volunteers that are needed for mass volunteers that are needed for mass prophylaxis?prophylaxis?How many are trained for this function?How many are trained for this function?


Performance MetricsPerformance MetricsImprovementImprovement

During all drills, exercises, and real events in the During all drills, exercises, and real events in the last 12 months, what was the average time from last 12 months, what was the average time from the end of the drill, exercise, or real event to the end of the drill, exercise, or real event to completion of the after action report? completion of the after action report? Time to implementation of corrective actions? Time to implementation of corrective actions?

To retest areas requiring retesting?To retest areas requiring retesting?

Potential North Carolina Budget Potential North Carolina Budget Year 7 FundingYear 7 Funding

Anticipate 15% reduction in NC base Anticipate 15% reduction in NC base awardawardFrom $20.4M to $17.3MFrom $20.4M to $17.3M

Budget Year 7 Budget Year 7 Funding PrioritiesFunding Priorities

Complete NC EDSS Project ($2.4M)Complete NC EDSS Project ($2.4M)Complete LIMS Project Complete LIMS Project 7 PHRST7 PHRST3 Regional Laboratories3 Regional LaboratoriesHospital PHE programHospital PHE programMaintain Statewide Surveillance Systems (NC Maintain Statewide Surveillance Systems (NC DETECT, NCHESS)DETECT, NCHESS)Support LHD Emergency Preparedness Activities Support LHD Emergency Preparedness Activities through Aid To County Fundingthrough Aid To County Funding

Aid To County Assistance FundingAid To County Assistance Funding(Funds that don(Funds that don’’t go to every LHD)t go to every LHD)

3 Regional BT Labs 3 Regional BT Labs 7 PHRSTs 7 PHRSTs

25 LHDs Internet Connectivity 25 LHDs Internet Connectivity (a diminishing program) (a diminishing program)

Proportional Aid to County Direct Proportional Aid to County Direct Funding (85 LHDs)Funding (85 LHDs)

Current Allocation StrategyCurrent Allocation Strategy

Base + proportional share formulaBase + proportional share formulaShare based on:Share based on:–– Population (60%)Population (60%)–– Total area (20%)Total area (20%)–– Land area (20%)Land area (20%)

Proportional Aid to County Direct Proportional Aid to County Direct Funding (85 LHDs)Funding (85 LHDs)

Current LHD funding estimates reflect Current LHD funding estimates reflect 15% reduction in federal appropriations in 15% reduction in federal appropriations in the CDC grant programthe CDC grant program

Potential ThreatPotential Threat--Based Aid to Based Aid to County Funding Factors County Funding Factors

Military InstallationsMilitary InstallationsNuclear Power PlantsNuclear Power PlantsInternational PortsInternational PortsInternational AirportsInternational AirportsState CapitalState CapitalState FairsState FairsStadiums and Arenas >10,000 Stadiums and Arenas >10,000 capacitycapacity

m

mm

m

m

m

m

G

G

GGMcGuire NPP

Brunswick NPP

Easte rn Band ofCherokee Indians

Pitt

Wake

Hyde

Duplin

Bladen

Pender

Bertie

Wilkes

Moore

OnslowUnion

Halifax

Robeson

Beaufort

Nash

Surry

Craven

Sampson

Iredell

Carteret

Columbus

Swai n

Burke

Brunswick

Johnston

Anson

Ashe

Guilford

Randolph

Harnett

Jones

Chatham

Macon

Rowan

Hoke

Martin

Lee

Stokes

Tyrrell

Stanly

Lenoir

Dare

Franklin

Buncombe

Granvil le

Davidson

Warren

Jack son

Haywood

GatesPerson

Caldwell

Wilson

Forsyth

Polk

Caswell

Orange

Rutherford

Madison

Gaston

Yadkin

ClayCherokee

Richmond

Cleveland

Davie

Pamlico

Rockingham

McDowell

Hertford

Alamance

Avery

Lincoln

Mecklenburg

Northampton

Edgecombe

Vance

Currituck

Yancey

Montgomery

Cabarrus

Durham

Graham

Scotland

Greene

Watauga

Henderson

Washington

Transylvania

Mitchell

Alexander

Alleghany

PerquimansChowan

New Hanover

Catawba

CamdenPasquotank

Wayne

Charlotte

Raleigh

Durham

GreensboroWinston-Salem

Fayetteville

Jacksonville

Asheville

High Point

Wilmington

GreenvilleGoldsbor o

Rocky MountBurlington ChapelHill

Southe rn Pines

Boone

Roanoke Rapids

Elizabeth City

MoreheadCity

Catawba NPP

Harris NPP

Ca mp LejeuneM arine Base

Cherry Point (Craven)

Sunny PointArm yTerminal

Seymour JohnsonAir Force Base

Fort Bragg Ai rForce BaseFort Bragg

US Coast GuardAir Stat ion (Pasquotank)

Kinston

North Carolina County Risks

0 50 100 150 Miles

GEM Branch Boundaries

60-Mile RRT ZonesMilitary BasesCitiesNuclear Power Plants

1-100,000100,000 - 150,000150,000 - 300,000300,000 +

County Population - Census 2000m RRT Base Station

R:I&P\IP-CHIEF\TARGET CITIES.PPT

Pandemic Influenza Pandemic Influenza Supplemental FundingSupplemental Funding

$350M Congressional appropriation $350M Congressional appropriation OneOne--time emergency pandemic influenza time emergency pandemic influenza funding for statesfunding for statesExecuted through CDC PH Emergency Executed through CDC PH Emergency Preparedness Grant programPreparedness Grant programPhase I funds $100M Phase I funds $100M Phase II funding $250MPhase II funding $250M


Phase IPhase I

NCNC’’s share = $2,547,844s share = $2,547,844Added to base grant award in BY6Added to base grant award in BY6


Phase I Phase I –– Local FundingLocal Funding

LHD funding completed using Request for LHD funding completed using Request for Proposal formatProposal formatBased on LHD Pan Flu Local Assessment and Based on LHD Pan Flu Local Assessment and Gap Analysis (from CDC)Gap Analysis (from CDC)$977,491 in LHD funds requested by NC in $977,491 in LHD funds requested by NC in application to CDCapplication to CDCRepresents 44 LHD requestsRepresents 44 LHD requestsFunded work must be completed by 8/30/06Funded work must be completed by 8/30/06

Pandemic Influenza Pandemic Influenza Supplemental FundingSupplemental FundingPhase I Phase I –– NC PrioritiesNC Priorities

Local Planning Initiative Local Planning Initiative –– UNCCPHPUNCCPHPOnline CD Nurse Avian Flu / Pandemic Online CD Nurse Avian Flu / Pandemic Influenza Training Influenza Training Public Information Campaign Public Information Campaign


Model Planning Curriculum Workshops Model Planning Curriculum Workshops --Medical Surge Capacity plans for hospitals, Medical Surge Capacity plans for hospitals, LHDs, EMSLHDs, EMSContingency Planning for EMS systemsContingency Planning for EMS systemsPrivate provider training Private provider training


Regional business and industry pandemic Regional business and industry pandemic influenza summitsinfluenza summitsRegional pandemic influenza summits for Regional pandemic influenza summits for response partners (public health, EMS, response partners (public health, EMS, hospitals, law enforcement, emergency hospitals, law enforcement, emergency management)management)


WebWeb--based tabletop exercises (similar to based tabletop exercises (similar to Eight Ball) Eight Ball) -- law enforcement and law enforcement and community health centers community health centers Additional regional (RAC) webAdditional regional (RAC) web--based based exercisesexercises


Surge Capacity Upgrades to the NC Surge Capacity Upgrades to the NC Immunization Registry Immunization Registry


Phase IIPhase II

Remaining $250M of $350M Congressional Remaining $250M of $350M Congressional AppropriationAppropriationAnticipated NC Award of $5M if formula Anticipated NC Award of $5M if formula based (population)based (population)Some discussion of competitive and Some discussion of competitive and formula based allocations to statesformula based allocations to states


Phase IIPhase II

Anticipate guidance and funding award to Anticipate guidance and funding award to follow closely with PH Emergency follow closely with PH Emergency Preparedness Grant Budget Year 7Preparedness Grant Budget Year 7

CDC COOPERATIVE AGREEMENT CDC COOPERATIVE AGREEMENT Public Health Emergency Public Health Emergency

Preparedness Preparedness

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