Read: Broadening the Public Health Security Agenda, by Patrick P. Rose
Listen to Podcast: Public Health – How Prepared Is the Nation?, by Patrick P. Rose
As the Ebola virus currently spreads across West Africa, public health officials around the world are closely monitoring this and other biological threats – both natural and malicious. A July 2014 flash poll of DomPrep readers suggests that funding and staffing cuts may play a large role in the nation’s ability to fully prepare for future biothreats. This article is a compilation of the anonymous survey responses shared by emergency planners, responders, and receivers.
Compared to other natural and human-caused hazards, biothreats are “one of the most underappreciated threats.” Unlike an improvised explosive device, which affects a specific location, or a hurricane, which offers hours or days of advance warning, bioagents can spread beyond geographic borders with the hosts sometimes unaware of the dangerous pathogens they are carrying. With the potential for spreading infections silently within and between communities, biothreats should hold a high priority for an all-hazards preparedness strategy (Figure 1).
Of course, the success of such strategies is dependent on early detection and accurateentification of the bioagents (Figure 2). Proper risk analysis, based on how widespread and how fast the biothreat is spreading, may offer some advanced warning, but “at some point the system will break and it will not be pretty.” The full impact of a biothreat will remain unknown until a successful attack occurs. “Hopefully then, this event will serve as a wake up call. Being aware of the type of problem is a great part of being selective in response. Good intelligence and accurate threat analysis is key in a time of decreasing resource allocation.”
Educating, Training & Staffing
Public health awareness, education, and training are important steps toward building resilient communities. Adequate funding and effective training will help communitiesentify biothreats, minimize risks to responders, caregivers, and the public, as well as respond to a biological incident. To better prepare emergency services personnel to safely and appropriately respond to any given biothreat, respondents shared the following suggestions (Figure 3):
- Make public health a full partner in all-hazards preparedness;
- Teach first responders about public health, especially epidemiology and surveillance;
- Educate the public on the importance of vaccines, proper hand hygiene, not travelling while possibly contagious, and other preventative actions;
- Include the “CBRNE Medicine” module into the curricula of universities’ medical/nursing schools to enhance the diagnostic capabilities of future frontline health professionals; and
- Train hospital staff and first responders on the no-cost, two-day course entitled “Emergency Response to Domestic Biological Incidents,” offered by the National Center for Biomedical Research and Training through Louisiana State University.
For an incident involving a bioagent, staffing shortages and attrition rates of healthcare workers are significant concerns. Because of the nature of the incident, understaffed hospitals likely would not be able to care for the influx of patients during a biological incident. To mitigate these staffing shortfalls, respondents reported that increased training to help hospital staff understand the threat and better alternatives for alternate care sites would be more effective than increased funding for additional staff (Figure 4).
Respondents expressed concern about the lack of infrastructure currently available for alternative care sites – with little staff available when the infrastructure does exist. For example, the current plan for vaccinations or prophylaxis points of dispensing response is problematic for many jurisdictions. “There are not nearly enough emergency workers to pull that off, especially with the given 48-hour requirement for every man, woman, and child to be covered.”
An epidemic, pandemic, or other public health emergency could overwhelm local hospitals and public health laboratories. Common health concerns – for example, measles, pertussis, tuberculosis, and emerging diseases – keep public health departments busy on a daily basis, which does not leave much for surge capacity. Alternative methods for dispensing medicines must include consideration of the realistic ability to staff the sites. Plans for surge personnel resources could include the Medical Reserve Corps. Although health departments have made progress, “there is still much work to do and to sustain.”
Although investment is needed in many areas of public health preparedness (Figure 5), funding is a significant concern among the survey respondents. “The technology and expertise are available for public health staffing, but there is no money to staff at appropriate levels.” Continuing budget cuts may make it difficult to deploy a full public health response when needed, but current spending must be done wisely.
One respondent pointed out that, “Investment needs to be made in public health for strengthening the community as well as for the infrastructure that provides surveillance, outbreak response, and training.” Another respondent stated that funding for technology has surpassed funding for oversight and effective regulation and asked, “If a nation cannot respond in a timely and effective manner to nonterrorist emergencies, how can it be trusted to respond to terrorist attacks?”
Although the 2009-2010 response to H1N1 demonstrated the nation’s public health systems ability to address a large threat, subsequent funding cuts have undermined that success, “We didn’t “dodge the bullet,” we responded vigorously and appropriately ... and it worked!” Regardless of the specific amount of funding, a strategic plan for public health preparedness should outline priorities to maximize the available resources.
Of course, talk without action is unproductive. Best practices and lessons learned develop over time, with actions to support their efficacy. “How can we really say what is a best practice at this point, especially for disasters we have little experience with (bioterrorism, for example)?” The National Health Security Preparedness Index, developed by the Association of State and Territorial Health Officials through a cooperative agreement with the Centers for Disease Control and Prevention, is one tool that provides an annual measure of health security and preparedness at the national and state levels.
To help agencies begin “doing,” survey respondents shared the following suggestions for improving the nation’s ability to prepare for and respond to biological incidents:
- Think of every individual as part of an emergency prevention and response team;
- Cooperate with other agencies outside of the hospitals and medical field;
- Develop a tactical or strategic view or approach for handling an emergency;
- Ensure that state-level chain of command are ready to manage an incident;
- Define a course of action that anyone could use to fill gaps when the chain of command is compromised;
- Create face-to-face opportunities to plan, train, exercise, and refine the plan;
- Involve the public as the first line of defense through awareness and encourage more reporting similar to, “If you see something, say something”;
- Emphasize year-to-year improvements; and
- Share what works – and what does not work – between jurisdictions facing similar threats.
“If we really want to see improvements, it’s time to get serious about helping each other out, avoiding mistakes others have made, and building resilient communities. Policymakers need to understand the shared responsibility aspect of preparedness and fund efforts that foster that kind of outcome.”