Future Planning for the Public Health Emergency Preparedness Enterprise: Lessons Learned from the COVID-19 Pandemic: Proceedings of a Workshop (2022)

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Future Planning for the Public Health Emergency Preparedness Enterprise: Lessons Learned from the COVID-19 Pandemic Megan Snair, Shalini Singaravelu, and Scott Wollek, Rapporteurs Forum on Medical and Public Health Preparedness for Disasters and Emergencies Board on Health Sciences Policy Health and Medicine Division PREPUBLICATION COPY—Uncorrected Proofs Proceedings of a Workshop 

THE NATIONAL ACADEMIES PRESS  500 Fifth Street, NW  Washington, DC 20001 This activity was supported by contracts between the National Academy of Sciences and the Administration for Children and Families; American Burn Association; American College of Emergency Physicians; American College of Surgeons—Committee on Trauma; American Hospital Association; American Red Cross; Association of Public Health Laboratories; Association of State and Territorial Health Officials; Centers for Disease Control and Prevention; Council of State and Territorial Epidemiologists; Department of Defense; Department of Health and Human Services, National Institutes of Health under Contract no. HHSN263201800029I through the National Institute of Environmental Health Sciences, National Institute of Allergy and Infectious Diseases, National Cancer Institute, National Institute of Child Health and Human Development, National Institute on Minority Health and Health Disparities, and National Institute of Neurological and Disorders and Stroke; Department of Homeland Security; East West Protection LLC; Emergency Nurses Association; Food and Drug Administration; Healthcare Ready; Infectious Diseases Society of America; The MITRE Corporation; National Association of Chain Drug Stores; National Association of County and City Health Officials; National Association of Emergency Medical Technicians; National Highway Traffic Safety Administration; Office of the Assistant Secretary for Preparedness and Response; Trauma Center Association of America; and Uniformed Services University of the Health Sciences. Any opinions; findings; conclusions; or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/26805 This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2022 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Future planning for the public health emergency preparedness enterprise: Lessons learned from the COVID-19 pandemic: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26805. PREPUBLICATION COPY—Uncorrected Proofs 

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institu- tion to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineer- ing to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engi­neering, and Medicine to provide independent, objective analysis and ­advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY—Uncorrected Proofs 

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PLANNING COMMITTEE ON FUTURE PLANNING FOR THE PUBLIC HEALTH EMERGENCY PREPAREDNESS ENTERPRISE: LESSONS LEARNED FROM THE COVID-19 PANDEMIC1 SUZET MCKINNEY (Co-chair), Principal and Director of Life Sciences, Sterling Bay RICHARD SERINO (Co-chair), Distinguished Visiting Fellow, National Preparedness Leadership Initiative, Harvard School of Public Health JOHN ARMSTRONG, Division Director, Morsani College of Medicine, University of South Florida ANDREW PAVIA, Chief, Division of Pediatric Infectious Diseases, University of Utah School of Medicine LT. COL. CARLO ROSSI, Canadian Armed Forces Health Attaché, Health Readiness Policy and Oversight, Office of the Assistant Secretary of Defense (Health Affairs) JEANNE BENINCASA, Massachusetts Undersecretary for Homeland Security and Homeland Security Advisor to the Governor, Executive Office of Public Safety and Security STEVEN MITCHELL, Associate Professor, Department of Emergency Medicine; Medical Director, Harborview Medical Center Emergency Department, University of Washington, Harborview Medical Center DAVID ZONIES, Professor of Surgery and Associate Chief Medical Officer for Critical Care, Professor of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, School of Medicine, Oregon Health Sciences University JONEIGH S. KHALDUN, Vice President and Chief Health Equity Officer, CVS Health WINFRED RAWLS, Director, ASTHO Evolution of the Public Health Preparedness Project Health and Medicine Division Staff SCOTT WOLLEK, Senior Program Officer LISA BROWN, Senior Program Officer AURELIA ATTAL-JUNCQUA, Program Officer (until June 2022) SHALINI SINGARAVELU, Program Officer (from May 2022) MICHAEL BERRIOS, Research Associate KIMBERLY SUTTON, Senior Program Assistant 1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rap- porteurs and the institution. v PREPUBLICATION COPY—Uncorrected Proofs 

ANDREW POPE, Senior Board Director (until July 2022) CLARE STROUD, Senior Board Director (from July 2022) Consultants LAURA RUNNELS, LAR Consulting, LLC MEGAN SNAIR, SGNL Solutions, LLC vi PREPUBLICATION COPY—Uncorrected Proofs 

Reviewers This Proceedings of a Workshop was reviewed in draft form by indi- viduals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical com- ments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: NICOLE LURIE, Coalition for Epidemic Preparedness Initiatives MONIQUE MANSOURA, The MITRE Corporation ANDREA TENNER, San Francisco Department of Health Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by CARLOS DEL RIO, Emory University School of Medicine. He was responsible for making certain that an indepen- dent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies. vii PREPUBLICATION COPY—Uncorrected Proofs 

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Contents ACRONYMS AND ABBREVIATIONS xi 1 INTRODUCTION 1 Organization of Workshop, 2 Organization of Proceedings, 2 2 PUBLIC HEALTH EMERGENCY PLANNING: LESSONS FROM PAST AND PRESENT FOR THE FUTURE 5 Experiences Before and During COVID-19, 5 Assessing Public Health Emergency Preparedness Capabilities, Authorities, and Funding, 13 3 COORDINATING SURVEILLANCE AND MEDICAL COUNTERMEASURE RESPONSE 23 Global and Domestic Surveillance, 23 Medical Countermeasures and Medical Supply Chain Considerations, 29 4 EQUITY, RISK COMMUNICATION, AND PUBLIC ENGAGEMENT 39 Equity and Engagement with Historically Marginalized Populations, 39 Risk Communication and Public Engagement, 47 ix PREPUBLICATION COPY—Uncorrected Proofs 

x CONTENTS 5 COORDINATION, GOVERNMENT, AND LEADERSHIP 55 Coordination in Washington State: A Case Study, 55 Coordination at the Federal Level, 62 Public–Private Partnerships, 68 Leadership, 74 6 REFLECTIONS 81 Workshop Lessons, 81 Opportunities for Action, 83 Opportunities for the Forum, 85 REFERENCES 87 APPENDIXES A Workshop Agenda 89 B Speaker and Planning Committee Biosketches 97 PREPUBLICATION COPY—Uncorrected Proofs 

Acronyms and Abbreviations AIHC American Indian Health Commission APHL Association of Public Health Laboratories ASPR Administration for Strategic Preparedness and Response (formerly Office of the Assistant Secretary for Preparedness and Response) ASTHO Association of State and Territorial Health Officials BARDA Biomedical Advanced Research and Development Authority CDC Centers for Disease Control and Prevention COVID-19 coronavirus disease 2019 CLIA Clinical Laboratory Improvement Amendments CMS Centers for Medicare & Medicaid Services CSC crisis standards of care DHS U.S. Department of Homeland Security DoD U.S. Department of Defense EHR electronic health record EMS emergency medical services EUA emergency use authorization FDA Food and Drug Administration FEMA Federal Emergency Management Agency xi PREPUBLICATION COPY—Uncorrected Proofs 

xii ACRONYMS AND ABBREVIATIONS GHS global health security HHS U.S. Department of Health and Human Services HIPAA Health Insurance Portability and Accountability Act HIV human immunodeficiency virus HPP hospital preparedness program LEED Leadership in Energy and Environmental Design MCM medical countermeasure MERS Middle East respiratory syndrome MOCC medical operations coordination cell NACCHO National Association of County and City Health Officials NASEM National Academies of Sciences, Engineering, and Medicine NHSPI National Health Security Preparedness Index OCR Office of Civil Rights (HHS) PANCAP pandemic crisis action plan PCR polymerase chain reaction PHCC Public Health Communications Collaborative PHEP Public Health Emergency Preparedness Cooperative Agreement PHEMCE Public Health Emergency Medical Countermeasures Enterprise PPE personal protective equipment PPP public–private partnership RSV respiratory syncytial virus SARS severe acute respiratory syndrome SNS Strategic National Stockpile STRAC Southwest Texas Regional Advisory Council TFAH Trust for America’s Health TRACIE Technical Resources, Assistance Center, and Information Exchange (ASPR) WHO World Health Organization WMCC Washington Medical Coordination Center PREPUBLICATION COPY—Uncorrected Proofs