Yesterday Secretary Napolitano confirmed some of our speculations and observations regarding the policy framework currently being implemented.
During her late afternoon news briefing the Secretary explained, “By Friday we were beginning to assemble the information, inform the inter-agency team that would need to work this issue over the weekend. And under HSPD-5 [Homeland Security Presidential Directive 5], I was designated as the principal federal official, and we began—that whole process was well underway as we worked throughout the weekend.”
Otherwise, I cannot — yet — find any official documents or even semi-official statements regarding the operational plan per se. Not surprisingly these kind of “inside-baseball” questions are not — yet — being asked. Today the Secretary will testify before the Senate Homeland Security and Governmental Affairs Committee. Her prepared testimony may be a good source for this kind of information.
Can we discern the operational plan from behavior? In October 2007 Homeland Security Presidential Directive 21: Public Health and Medical Preparedness was released. This was intended to set out the strategy and principal operational steps, “to plan and enable provision for the public health and medical needs of the American people in the case of a catastrophic health event through continual and timely flow of information during such an event and rapid public health and medical response that marshals all available national capabilities and capacities in a rapid and coordinated manner.”
I don’t know that anyone in the Homeland Security Council staff, DHS, or elsewhere has even glanced at this artifact of the Ancien Regime. But a quick review suggests they might have. The HSPD argues, “the four most critical components of public health and medical preparedness are biosurveillance, countermeasure distribution, mass casualty care, and community resilience.”
In regard to biosurveillance, there is some controversy. Some of the key concerns have been set out in comments made on this blog in recent days (especially see the comments to this prior post). Basically it comes down to “what did you know, and when did you know it.” But there is also also a claim that investment in enhanced biosurveillance specifically paid off in this case (see editorial note at end of this prior post). What can be stated confidently is that since Tuesday April 14, the US biosurveillance system has been on high alert, and as far as we can tell seems to be operating effectively.
The second critical component is Countermeasures Distribution. During yesterday’s news briefing the Secretary emphasized in her opening statement, “I issued a public health emergency declaration. That permitted today the—an emergency authorization that allows the FDA [U.S. Food and Drug Administration] to proceed to permit things like Tamiflu to be used for populations that they otherwise wouldn’t be used for—in this case, for example, very, very young children… We are in the process of activating our national stockpile of antiviral drugs. The priority is placed on states that have been affected, as well as states along the border. And antivirals already are on the way to some of these states. All states will have access to the national stockpile and full deployment is expected by the third of May.” According to plan?
There is not yet much mass media discussion of Mass Casualty Care. But we can see and hear signs of preparation. For example, Winchester, Virginia health officials held a public meeting to confirm readiness and communicate confidence. According to the Winchester Star, “Health officials say they are prepared for any cases of swine flu that might be diagnosed in the area. The Lord Fairfax Health District and Winchester Medical Center have plans in place to isolate anyone diagnosed with the illness and to maintain necessary services should an outbreak occur.” The HHS Agency for Healthcare Research and Quality has conducted several educational and planning events precisely to prepare for mass casualty care. HHS has also developed a Medical Surge Capacity and Capability Handbook. But, not surprisingly, a June 2008 report by the GAO found potential problems.
I hope Winchester’s self-assessment is accurate and reflective of most others. I also hope we don’t have a real-world test.
Community Resilience was identified by HSPD-21 as the fourth critical component. The White House directive explains, “Where local civic leaders, citizens, and families are educated regarding threats and are empowered to mitigate their own risk, where they are practiced in responding to events, where they have social networks to fall back upon, and where they have familiarity with local public health and medical systems, there will be community resilience that will significantly attenuate the requirement for additional assistance.”
Yesterday Secretary Napolitano reported, “The Department of Homeland Security is conducting conference calls with state public health and homeland security officials on a daily basis to discuss developments related to swine flu, and I’ve reached out to the governors of each of the states where a confirmed case has arisen… We are reaching out to the private sector to make sure that they are preparing, and to inform them of the latest actions we are taking. It’s important that they be thinking ahead about what they would do should this erupt into a full-fledged pandemic, which it has not yet, by the way.”
Similar quotes could be generated from CDC, Governors, Mayors, and others. Is there enough being done? Is it possible too much is being done? If we over-do this, will the public be resistant to risk readiness for future pandemic threats? What’s the right balance?
For the purpose of identifying key elements of the policy-and-practice nexus, is HSPD-21 a fundamental document or — if the document is unknown to current decision-makers — are the principles and priorities articulated in HSPD-21 being efffectively implemented? Are you observing gaps in either the principles or the implementation?