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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)

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

Goal

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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 nation’s population

The District of Columbia received two times the base amount + an amount equal to its proportional share of the nation’s population

The nation’s three largest Municipalities (New York City, Los Angeles County and Chicago) received a base amount + an amount equal to its proportional share of the nation’s 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 anthracis:A 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 anthracis:A 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 Spores:New 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.