Homeland Security Watch

News and analysis of critical issues in homeland security

December 4, 2013

Expanding or Diluting Our Preparedness Priorities

Today’s guest blogger is “Donald Quixote”  Don comments frequently on Homeland Security Watch.  He writes under what he likes to call his nom de guerre because his agency frowns on its employees posting material without agency approval. 

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The House Committee on Homeland Security recently passed the Medical Preparedness Allowable Use Act (HR 5997)/ (HR 1791) authorizing the expansion of the use of existing grant programs for enhancing medical preparedness, medical surge capacity and mass prophylaxis capabilities during a natural disaster or terrorist attack.  Reportedly, it does not furnish any additional funding, but provides the ability to leverage the Urban Area Security Initiative and State Homeland Security Grant Program.

The pending bill can be viewed from several different perspectives.  The optimist may view this initial accomplishment as Congress finally addressing a very serious threat of a chemical or biological attack that may be looming, or  – rather more likely — the threat of a serious novel pandemic illness.  The pessimist may view it as the continued, wider distribution of limited resources between numerous partners in the ever-vague world of homeland security (whatever that entails, but that is another conversation).  I tend to believe it is both.

According to a Los Angeles Times article, the 2009 H1N1  influenza virus killed 10 times more than previously estimated by the World Health Organization.  A study published in the journal PLOS Medicine estimated the number that died was 203,000.  Although the number appears quite small when compared to the current world population and the momentous number that perished during the H1N1 Spanish Flu pandemic of 1918-1919, it remains a relevant number, if accurate, as a warning indicator.

However, how many of us truly appreciate the conceivably massive cascading consequences of a serious novel pandemic threat?

Are MERS, SARS, H1N1, H5N1 and H7N9 warning shots over the bow or just natural occurrences that come and go over time without serious implications?

The topic of biosecurity is not new to this blog.  Mr. Bogis and Mr. Wolfe have identified numerous areas of interest regarding the funding and resources already appropriated for biosecurity and biodefense.  There have been valuable discussions and debates regarding the perceived and actual risks and returns on investment.  The practical value of the previous investments and effectiveness of the many programs shall remain the subject of debate until they are partially or fully tested by an incident or event.

In the realm of a serious novel pandemic illness, I controversially continue to argue that it could easily outrank a conventional terrorist attack as a current threat due to the possibly catastrophic consequences to our citizens, critical infrastructure and civil stability on a broader scale.

We can only ignore the low-probability\high-consequence biological attack or serious novel pandemic illness threat until it happens.  Unfortunately, there is a long history of ignoring this threat because of limited resources and impaired strategic vision.

The Medical Preparedness Allowable Use Act, if ultimately enacted, may affect some change in this area or at least spark interest in expanded medical preparedness.


 

 

 

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9 Comments »

Comment by William R. Cumming

December 4, 2013 @ 5:49 am

Thanks Don!Nan Hunter seems to be the only one with a text out there on the legal aspects of health preparedness but could be wrong. Last I heard she was faculty at Georgetown U.

This bill would seemingly be subject to collateral referral to other House committees but perhaps am wrong.

Also I would argue that the grant authority already housed in DHS and HHS can encompass this mission but again perhaps wrong.

Has there been a GAO or CRS study of this problem and/or did the Administration request it? Was there a SAP on the language?

Remarkably [at least to me] there is no thorough legal or policy analysis of health concerns that might be addressed under existing disaster legislation that of course does include preparedness.

Perhaps as it did in the energy emergency area Congress could mandate an OLC/DoJ legal analysis!

In the early 90′s at the behest of HHS the existing DMO [Defense Mobilization Order] on the Nation’s blood supply was rescinded by FEMA on the basis that HHS would regulate this area. That never happened and Congress is long overdue to study blood issues, including allocation during mass casualty situations.

I have written several times to Virginia and other US Senators requesting this oversight.

The 1918 Pandemic killed almost 65% of the medical profession in the USA with no recovery of those numbers until about 1938.

The 1918 Pandemic also caused a permanent shift in ARC [American Red Cross] policy where it had previously provided more than first aid in its emergency shelters.

MUCH TO BE DONE!

Comment by William R. Cumming

December 4, 2013 @ 6:43 am

Stafford Act extract:

Sec. 301. Waiver of Administrative Conditions (42 U.S.C. 5141)
Any Federal agency charged with the administration of a Federal assistance program may, if so requested by the applicant State or local authorities, modify or waive, for a major disaster, such administrative conditions for assistance as would otherwise prevent the giving of assistance under such programs if the inability to meet such conditions is a result of the major disaster.

Comment by Bruce Martin

December 4, 2013 @ 1:06 pm

The topics in this act were allowable and encouraged under the Metropolitan Medical Response System grants, subsumed into SHSGP several years ago. That program provided several hundred thousand dollars per year to 120+ cities/regions. A number of them did good planning and collaborative efforts. IMO the program was challenged by an overly broad list of activities for the funding provided, as well as unclear expectations and priorities. This resulted in locally specific choices that seemed to be difficult to grasp by grant managers. The program I observed bought PPE, exercised with hospitals, trained responders, provided H1N1 PODs, and planned, as did many.

We seem to rearranging deck chairs at times.

Comment by Donald Quixote

December 4, 2013 @ 4:44 pm

Mr. Martin

I concur that many of the activities could be addressed through other funding sources and programs prior to the development of this bill. The bill appears to expand the funding opportunities and possibly enlarge the lanes in the road for other groups to partner with public health and medical services as they compete for the same limited funding. On the other hand, that may just be wishful thinking. Without the ever-hated directives and restrictive guidance with the funding, will the new funding be wisely invested by the recipients in a coordinated fashion? The naturally occurring pathogenic concerns continue with each new article or report. Below are another four articles pertaining to H7N9, H2N2, H5N1 and MERS.

H.K. Beefs Up Checks at Borders After First H7N9 Case

Dec 4, 2013 – Hong Kong activated part of a pandemic preparedness plan, stepping up surveillance of travelers with fever, after confirming its first case of a new strain of bird flu that killed 45 people in mainland China.

Border control points have implemented disease-prevention and control measures, including enhanced body-temperature checks, the city’s Centre for Health Protection and Department of Health said today in a statement. Seventeen people who had contact with a domestic helper thought to have caught the H7N9 flu virus in the neighboring city of Shenzhen are in quarantine.

http://www.businessweek.com/news/2013-12-03/hong-kong-beefs-up-flu-checks-at-borders-after-first-h7n9-case

1950s Pandemic Influenza Virus Remains a Health Threat, Particularly to Those Under 50

Dec. 3, 2013 — St. Jude Children’s Research Hospital scientists have evidence that descendants of the H2N2 avian influenza A virus that killed millions worldwide in the 1950s still pose a threat to human health, particularly to those under 50. The research has been published in an advance online edition of the Journal of Virology.

http://www.sciencedaily.com/releases/2013/12/131203124911.htm

Pregnant woman with MERS gives birth by emergency C-section; baby well

A man, his pregnant wife and their eight-year-old son have tested positive for MERS in the United Arab Emirates, the World Health Organization announced Monday.

The woman, who was eight months pregnant when she contracted the virus, gave birth by emergency C-section to a healthy baby boy. But later Monday, the National, an English-language newspaper in Abu Dhabi, reported that the woman had succumbed to her illness

http://www.montrealgazette.com/health/Pregnant+woman+with+MERS+gives+birth+emergency+Csection+baby/9236393/story.html

Pigs in Southern China Infected With Avian Flu

Dec. 19, 2012 — Researchers report for the first time the seroprevalence of three strains of avian influenza viruses in pigs in southern China, but not the H5N1 avian influenza virus. Their research, published online ahead of print in the Journal of Clinical Microbiology, has implications for efforts to protect the public health from pandemics.

http://www.sciencedaily.com/releases/2012/12/121219174158.htm

As discussed in the August 14, 2012 posting by Mr. Wolfe, there are existing national biosurveillance strategies, directives and centers. The question is: how well are they understood, implemented and coordinated? According to GAO, there may be some room for improvement.

Comment by William R. Cumming

December 4, 2013 @ 6:42 pm

I would be interested in any published materials on Federalism issues in US Public Health arena.

N.B. federal grants are often not accompanied by more than paper audits of compliance with requirements. Almost like general revenue sharing.

Comment by Donald Quixote

December 6, 2013 @ 10:08 am

New health preparedness index gives US overall good marks

12-05-13

Public health preparedness in the United States boasts “substantial” strengths that reflect important gains made over the past decade, but there’s also room to improve, according to a painstaking review prepared by a consortium of about 25 governmental and non-governmental health agencies and organizations.

After a 2-year effort to gather and analyze existing state-level data from a wide range of sources, the consortium awarded the nation an overall health security preparedness score of 7.2 on a scale of 10, with state scores ranging from 5.9 to 8.1. The scores reflect a total of 128 variables or measures.

The National Health Security Preparedness Index (NHSPI), as it’s called, was released yesterday by the Association of State and Territorial Health Officials (ASTHO), which led in developing it, along with the Centers for Disease Control and Prevention (CDC).

The index is billed as the most comprehensive measure of health preparedness to date, and the only one that attempts to provide a single composite measure for the country.

http://www.cidrap.umn.edu/news-perspective/2013/12/new-health-preparedness-index-gives-us-overall-good-marks

Comment by Donald Quixote

December 11, 2013 @ 10:22 am

An interesting development for the H7N9 virus.

New H7N9 bird flu resists drugs without losing ability to spread

Tue Dec 10, 2013

(Reuters) – Scientists have found that a mutation in a new strain of bird flu infecting people in China can render it resistant to a key first-line treatment drug without limiting its ability to spread in mammals.

The discovery means that unlike seasonal flu strains, which often become less transmissible when they develop resistance to drugs like Roche’s Tamiflu, the new H7N9 bird flu does not lose any of its spreading potential with drug resistance.

While this does not make H7N9 any more likely to develop into a human pandemic, researchers said it means doctors should be prudent in their use of anti-viral medicines to treat H7N9 cases, and consider using drugs other than Tamiflu, such as GlaxoSmithKline’s Relenza, where possible.

http://www.reuters.com/article/2013/12/10/us-birdflu-drug-resistance-idUSBRE9B90RF20131210

Comment by Donald Quixote

February 12, 2014 @ 4:14 pm

The House of Representatives Monday passed the Medical Preparedness Allowable Use Act (H.R. 1791) amending the Homeland Security Act of 2002.

The bill authorizes the use of Urban Area Security Initiative and State Homeland Security Grant Program funding for enhancing medical preparedness, medical surge capacity and mass prophylaxis capabilities, including the development and maintenance of an initial pharmaceutical stockpile, including medical kits and diagnostics sufficient to protect first responders, their families and immediate victims from a chemical or biological event.

The legislation does not authorize new funding but it ensures that grant funds under the State Homeland Security Grant Program and Urban Area Security Initiative can be used to enhance medical preparedness and purchase medical countermeasures.

http://www.hstoday.us/briefings/industry-news/single-article/house-passes-measure-to-enhance-medical-preparedness-during-disaster/cd3bdd961f7c9bb8f77b8f9998e370ae.html

http://beta.congress.gov/bill/113th-congress/house-bill/1791?q=%7B%22search%22%3A%5B%22H.R.+1791%22%5D%7D

Comment by Donald Quixote

May 20, 2014 @ 12:41 pm

This is a conversation provoking article that is either an over-reaction to an unlikely threat or a serious warning with a 09/10/01 like catastrophic result with our failure to connect the dots.

http://med.stanford.edu/ism/2014/may/bioterror-0519.html

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