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Providing a Framework for Public Health Action and Bioterrorism Preparedness: Recommendations for Federal Funding of Public Health Activities
Prepared by The Center for Infectious Disease Research and Policy University of Minnesota And The Workgroup on Bioterorrism Preparedness
The Center for Infectious Disease Research and Policy, University of Minnesota, brought together a Workgroup on Bioterrorism Preparedness on October 3, 2001. The Workgroup included members from the following organizations: the American Society for Microbiology, the Alfred P. Sloan Foundation, the Association of Public Health Laboratories, the Association of State and Territorial Health Officials, the Center for Infectious Disease Research and Policy at the University of Minnesota, the Council of State and Territorial Epidemiologists, Emory University School of Public Health, the Infectious Diseases Society of America, the Johns Hopkins Center for Civilian Biodefense Studies, the National Association of County and City Health Officials, the National Association of State Public Health Veterinarians, and NTI. The members did not seek endorsement from their respective organizations for the recommendations contained in this report and the recommendations may not reflect the position of the respective organizations.
The meeting of the Workgroup was supported by NTI.
Recommended Federal Funding for a Public Health Response to Bioterrorism
The following amounts are needed for hospitals and federal, state, and local public health agencies to effectively respond to bioterrorism. The funds identified below represent an initial investment in upgrading the public health system for biodefense. Additional funds will be needed to effectively maintain such systems over time. The numbers provided below represent a first effort to achieve broad consensus in the public health community regarding funding for bioterrorism; the numbers will likely be refined with further discussion.
|1. Improve State and Local Preparedness
|$835 million (broken out in items a-d)|
a. Bioterrorism Preparedness Planning
b. Staffing, Training, Epidemiology, and Surveillance
c. Information and Communication Systems
d. Laboratory Enhancement
|2. Upgrade CDC Capacity for Bioterrorism||$153 million|
|3. Develop Federal Expert Response Teams||$45 million|
|4. Improve Hospital Response Capabilities||$295 million|
|5. Improve Disaster Response Medical Systems||$62 million|
|6. Improve International Surveillance||$20 million|
|7. Improve Food Safety||$100 million|
|8. Develop and Implement Applied Research Initiatives||$50 million|
|9. Improve the National Pharmaceutical Stockpile (NPS)||$250 million|
|10. Accelerate Development of Smallpox Vaccine||$60 million|
|11. Develop Other Vaccines for Civilian Use||$100 million|
1a. Improve State and Local Preparedness: Bioterrorism Preparedness Planning (Amount: $35 million)
Justification for Funding Recommendations
Every state and all local communities with moderately large populations should have a bioterrorism preparedness plan in place and the plan should be validated through simulation exercises. Planning at the state or local level should involve the public health agency (or agencies) and all other agencies that would be involved in responding to a bioterrorism event. An estimated $500,000 is needed, on average, for each state and territory and for the largest metropolitan areas to support the costs of immediately developing and testing a comprehensive plan (assuming up to 70 jurisdictions).
State and local health departments must improve their ability to recognize and respond to bioterrorism events by integrating bioterrorism preparedness activities into existing communicable disease prevention and control programs.
Bioterrorism events may originate from or involve animal populations; therefore, every state health department should have a State Public Health Veterinarian who can provide expertise in zoonotic diseases. Currently, about half of the states have a designated State Public Health Veterinarian.
An effective response will require close coordination between federal, state, and local agencies. Expertise must be available at each level to meet the demands of a bioterrorism crisis. Although federal leadership will be critical, too much reliance on federal resources may limit the overall effectiveness of a response. An estimated 1.33 million dollars is needed per 1 million population per year to implement and maintain bioterrorism preparedness activities.
1c. Improve State and Local Preparedness: Information and Communication Systems (Amount: $200 million)
Several essential information systems have been developed (or are in development) to effectively disseminate outbreak and disease information within or across jurisdictions. Funds are needed to expand or fully implement these systems to assure an effective response to bioterrorism.
Epi-X is a rapid secure communication system for public health agencies that is sponsored by CDC for sharing information about outbreaks and critical health events as they unfold. This system would allow rapid communication of critical public health information in the event of a bioterrorism attack. Ongoing funds are needed to maintain the operation of Epi-X.
Rapid communication systems (such as two-way radios or other systems) also are needed to allow state and local agencies to effectively communicate during times of crisis when conventional modes of communication may not be accessible.
1d. Improve State and Local Preparedness: Laboratory Enhancement (Amount: $200 million)
The Laboratory Response Network (LRN) is critical to a successful response to bioterrorism. The LRN is a multi-level laboratory network composed of county, city, state, and federal public health laboratories and is designed to receive and analyze laboratory specimens from a range of sources. The system is designed to assure definitive identification of suspected bioterrorism agents as quickly as possible. Additional funding is needed to assure that LRN laboratories are prepared to accurately identify potential for full implementation.
Chemical terrorism preparedness also is needed and should be integrated into the laboratory improvements.
Resources for improved diagnostic testing and identification of potential bioterrorism agents by animal and wildlife laboratories also are needed, as is improved communication between human, animal, and wildlife laboratories.
2. Upgrade CDC Capacity for Bioterrorism (Amount: $153 million)
(Amount: $153 million)
3. Develop Expert Response Teams (Amount: $45 million)
(Amount: $45 million)
Public health management of a bioterrorism attack will be extremely challenging. Teams of national experts who can deal effectively with the demands of such a crisis should be recruited and trained. These experts should have extensive experience in management of outbreaks or have clinical experience with diseases caused by potential bioterrorism agents. The teams should be maintained on alert status and federalized as needed for deployment.
4. Improve Hospital Response Capabilities
5. Improve Disaster Response Medical Systems (Amount: $62 million)
Adequate disaster response systems are needed to coordinate disaster management during a bioterrorism event.
6. Improve International Surveillance (Amount: $20 million)
7. Improve Food Safety (Amount: $100 million)
8. Develop and Implement Applied Research Initiatives (Amount: $50 million)
9. Improve the National Pharmaceutical Stockpile (NPS) (Amount: $250 million)
Additional stockpiles of anti-infective agents are needed to effectively provide treatment and prophylaxis to large populations in the event of a wide scale bioterrorism attack. Ideally, enough medication to treat or provide prophylaxis to 40 million persons should be stockpiled. These supplies will need to be rotated on an ongoing basis.
10. Accelerate the Development of Smallpox Vaccine (Amount: $60 million)
(Amount: $60 million)
11. Develop Other Vaccines for Civilian Use (Amount: $100 million)
(Amount: $100 million)