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Final Thoughts

Assistant Secretary for Preparedness and Response Robert Kadlec concluded the workshop with a keynote presentation that focused on the notion of a public–private partnership being critical to many of the programs at HHS. Public–private partnerships are essential to the mission of HHS and ASPR because, speaking in military terms, HHS and ASPR do not have battalions or divisions of individuals at their command, he said. Rather, much of the nation’s ability to protect its health in the face of pandemics, bioterrorism, and other large-scale events relies on public–private partnerships, with the federal government serving the role of convener and the source of some funds that can promote certain kinds of behaviors and activities, Kadlec explained.

As Kevin Yeskey stated in the workshop’s opening presentation, the coalitions that have been created have demonstrated their effectiveness and shown they can make a tremendous difference in both preparedness and response. Similarly, said Kadlec, the small amount of critical infrastructure funding distributed through HPP made a significant difference during Hurricane Harvey to the patients and communities that hospitals serve. He added that the Ebola event drove home the lesson that there is no such thing as just-in-time preparedness.

Looking to the future, ASPR is focused on building the coalitions into a regional system, and Kadlec said he looks forward to receiving feedback from the community that will improve this program. His hope is that the community will see this program not as a top-down directive but as a means of nurturing and endorsing something implemented by communities at the local and regional levels. At the same time, he said this approach will only

work if every organization and community is committed to it and believes it will be a benefit to participate in the coalitions.

From his perspective, he believes that preparedness has broad support in Congress from members of both parties who are committed to finding better ways of protecting the American public from a range of threats that are happening almost daily. “I would like to think that when I am done here, and more importantly when we are all collectively done here creating an enduring capability for our country, that we will look back and take a great deal of pride in knowing we are all committed to something that was bigger than ourselves and more enduring than we can imagine,” said Kadlec. After putting in a plug for NDMS, he said that he and his colleagues are open to new ideas. He concluded his remarks by asking the participants to contact their representatives and senators to voice their support for the Pandemic and All-Hazards Preparedness Reauthorization Act.

DISCUSSION

Lewis Kaplan asked Kadlec how he envisions codifying the interactions between the federal government and the private sector so that information flow is bidirectional as well as dispersed. Kadlec replied that he is in the process of creating an organizational element in ASPR that will engage in outreach on a continual, rather than episodic, basis. He noted that BARDA already has this type of interaction codified as a regular part of its operations.

John Dreyzehner noted that he recently testified before the Senate Health Committee in support of the reauthorization. He made the point that in his experience, logistics and material are important, but that people and the relationships they form are really the safety net. Given the importance of relationships, he wondered how Kadlec plans to preserve existing relationships when the Strategic National Stockpile (SNS) completes its move from being part of CDC to being part of Kadlec’s purview. Kadlec said that little will change other than the fact that the person in charge of the SNS will report to him instead of the CDC director. The purpose of the shift, he said, is to build a more coherent effort that should not affect the daily execution of the SNS, but should allow ASPR and CDC to work more closely together. He noted that starting April 1, 2018, he will have a representative from CDC in his office, and someone from ASPR will serve in the office of the CDC director. The plan is to expand ASPR’s footprint with CDC at the regional and state levels, similar to the way that FEMA works with every state. “As we consolidate our efforts between ASPR and CDC, we hope to make [those interactions] more seamless,” said Kadlec.

Thomas Kirsch asked Kadlec to comment on his vision for improved regional health system preparedness and response that will incorporate

other federal assets, such as the VA and DoD facilities. Kadlec replied that during Hurricane Maria, national disaster medical assistance teams were stretched thin by the scope of the situation in Puerto Rico. Fortunately, there was a little-used section of the original Pandemic and All-Hazards Preparedness Act that allowed the VA to help, and the result was that the assistance teams saw 36,000 people in Puerto Rico and the VA saw 21,000 people, including VA beneficiary family members and the general public.

Going forward, ASPR has been working with the VA to expand the opportunity to use their physical facilities, personnel, logistics, electronic systems, and training to maximize its participation in large-scale disasters. Working with DoD is a little more challenging, he said, but he has several of his key deputies working with the special operations community at Fort Bragg to create opportunities to train and benefit from their experiences in Afghanistan and Iraq. The thing to remember, though, is that DoD’s mission is overseas, not here, but given that, ASPR is trying to help DoD with preparing for the proposed Mission Zero, an amendment to the Public Health Service Act to facilitate assignment of military trauma care providers to civilian trauma centers in order to maintain military trauma readiness and to support such centers in times of need. He noted that during the December 2017 Amtrak derailment in Washington State, many of the injured were treated at Madigan Army Medical Center because it was embedded in the regional trauma coalition. On that note, the workshop was adjourned.

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