The Smallpox Vaccination Program Public Health in an Age of Terrorism (2005) / Chapter Skim
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Appendix F: Review of the Centers for Disease Control and Prevention’s Smallpox Vaccination Program Implementation Letter Report #5
Appendix F: Review of the Centers for Disease Control and Prevention’s Smallpox Vaccination Program Implementation Letter Report #5
Pages 252-284
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From page 252... ...
1600 Clifton Road, NE Atlanta, GA 30333 Dear Dr. Gerberding: The Committee on Smallpox Vaccination Program Implementation is pleased to offer you the fifth in a series of brief reports providing timely advice to assist CDC in preparing for a potential smallpox emergency.
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From page 253... ...
The committee commends CDC for aiming toward indicators that will help state and local public health agencies document their progress on preparedness. Description of the Public Health Preparedness Project CDC has long recognized the importance of preparedness for bioterrorism and other public health threats.
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From page 254... ...
to support state and local agencies' bioterrorism preparedness activities. In the past 6 months, CDC has launched the Public Health Preparedness Project to help define a baseline level of public health preparedness and to assess how states are using the funds received through the CDC cooperative agreement.
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From page 255... ...
. Committee Tasks CDC asked that the IOM Committee on Smallpox Vaccination Program Implementation address the following tasks in their deliberations after the November 6, 2003 meeting (Henderson, 2003b)
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From page 256... ...
that it used as an organizing framework for assessing the 10 draft smallpox readiness indicators and developing their subsequent evaluative criteria. In developing these "scenarios," the committee recognized that these are not detailed scenarios that can be used for broad planning purposes but, rather, are general parameters of scenarios that are only meant to be used for the committee's purpose -- to help test the draft smallpox readiness indicators.
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From page 257... ...
. For this "no case" scenario, state and local public health agencies would need to focus, in particular, on training, vaccinating new members of response teams due to turnover, surveillance, planning, exercises, public information for false alarms, and clear lines of authority for decision-making.
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From page 258... ...
For this scenario, state and local public health agencies would need to focus, in particular, on frequent communication with the public, risk communication, close working relationships with the media, shifting legal authority among federal, state, and local entities, decision making about distribution and delivery of vaccine, clinical capacity, laboratory capacity, plans for disposal of human remains and coordination with Disaster Mortuary Operational Response Teams (DMORT) , and recovery plans.
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From page 259... ...
Detailed smallpox planning scenarios that represent the range of response activities that might be necessary could help state and local jurisdictions assess how this range of activities correlates to different levels of preparedness. It is important to recognize, however, that a real-life event probably is not going to proceed exactly according to any of the simple "scenarios" proposed by the committee, or more detailed scenarios yet to be developed.
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From page 260... ...
Little Variability in Types of Planning Activities Across Scenarios The general parameters of four scenarios that the committee used to assess the smallpox readiness indicators highlight key differences in the scope of response activities -- the pace of the response, the overall timeline for accomplishing response activities, supplies and personnel that are readily available -- but in terms of the planning activities that are required before the event, most of the same activities are needed. By examining the 10 proposed smallpox indicators, the committee determined that most of the indicators deal with planning activities that would be required of any community should smallpox appear anywhere in the world (e.g., enhanced surveillance, preparations for increased laboratory capacity, more frequent and widespread communications, expanded education and training)
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From page 261... ...
By having these decision-making and management process issues specified a priori, the likelihood of confusion, public mistrust, delay, and rushed decision-making will be reduced. Although it is outside state and local agencies' purview to plan for a nation-wide smallpox emergency that would affect all corners of the country and all segments of the national infrastructure (and the committee chose not to test the smallpox readiness indicators against such a catastrophic scenario)
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From page 262... ...
Furthermore, the committee discussed the issue of score-carding vis-à-vis the greater principle of continuous quality improvement, the purpose of the indicators, a framework for the indicators, and several important elements of preparedness that are underrepresented if not completely overlooked in the indicators. Due to time limitations and because the broader set of all-hazards indicators was still under development, the committee chose not to conduct a "big picture" determination of whether the 10 smallpox indicators are true predictors of smallpox preparedness.
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From page 263... ...
to help document "yes" answers to the 10 smallpox indicators and ensure well-rounded assessment of jurisdictions' capabilities in areas identified by the current indicators. Continuous Quality Improvement Measuring preparedness should be characterized as a process of continuous quality improvement within the public health system (CDC, 2003c)
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From page 264... ...
The committee recommends that CDC address its immediate need of measuring cooperative agreement compliance with a concise and simple set of indicators, and then use this set of indicators as the foundation of a longer, deliberative, national process to develop measures that address the full range and appropriate balance of preparedness activities. Distinct Indicators Needed for Federal, State, and Local Jurisdictions Further questions about the purpose of the indicators ask whose preparedness is being evaluated and whose accountability is being assessed.
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From page 265... ...
The committee recommends that federal agencies and CDC, specifically, be held accountable for their unique federal responsibilities in an emergency response and assessed on their progress in facilitating national public health emergency preparedness. Key message #3: CDC should address its immediate need of measuring cooperative agree ment compliance with a concise and simple set of indicators, and then use this set of indicators as the foundation of a longer, deliberative, national process to develop measures that address the full range and appropriate balance of preparedness activities.
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From page 266... ...
CDC noted that it is moving away from the focus areas described in the CDC cooperative agreement guidance for FY 2003 (CDC, 2003a) but did not explain what, if any, new framework would be used, and one does not emerge from the indicators document, other than the four chronological goals (pre-event activities; detection and reporting; response and containment; recovery)
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, and most important, for the National Public Health Performance Standards (CDC, 2003c) , which are used by many public health agencies to measure performance and ensure continuous quality improvement (NACCHO, 2002)
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From page 268... ...
With their ethnically and culturally diverse populations, service and social organizations, opinion leaders, and faith groups, communities can contribute knowledge and other resources to the work of keeping the population healthy. Bioterrorism is just one of the threats to the public's health, and developing purposeful community engagement in preparedness should be part of the range of activities conducted by the public health agencies and their partners.
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From page 269... ...
parallels the connections between public health agencies at all levels and health care providers in hospitals, health centers, and communities. Although the CDC and HRSA cooperative agreement guidance documents are somewhat analogous, and make references to each other (and include an appendix about cross-cutting activities and benchmarks)
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From page 270... ...
In addition to considering indicators that assess such linkages, the committee recommends that CDC collaborate with HRSA to integrate the preparedness indicators into one document, in order to help the health care and public health communities work hand-in-hand to plan, implement plans, and evaluate their readiness to respond to threats (including, but not limited to, a smallpox attack) and to avoid requiring duplicate reporting from states.
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From page 271... ...
It is important that federal and state public health agencies consider the possibility of weaponized smallpox and the need for environmental sampling, as well as the limiting factor of laboratory biosafety level. Furthermore, in a crisis, laboratories share some of the workforce and resource concerns of the public health agencies and health care entities.
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From page 272... ...
CDC has stated that the assessments that will be conducted through the Public Health Preparedness Project will help identify technical assistance needs and gaps in preparedness of state and local public health agencies (Henderson, 2003a)
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From page 273... ...
. Panelist Comments About Surge Capacity · Changes in the scope of practice of EMS providers for emergencies should be considered, since the health care training that these personnel have received could, where appropriate, contribute to surge capacity in mass vaccination clinics (Fischler, 2003)
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From page 274... ...
These indicators are an important step in ensuring that states receive clear guidance on how to become more prepared to respond to a public health emergency, understand how they will be held accountable, and are assured of the federal role in national preparedness for a public health emergency. By addressing the three tasks with which CDC asked for advice (reviewing the smallpox readiness indicators, identifying criteria that could be used for the smallpox indicators, and developing smallpox scenarios that could be used to test the smallpox indicators)
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From page 275... ...
2003. Transcript from the IOM's Committee on Smallpox Vaccination Program Implementation Meeting Four on November 6, 2003, Washington, DC:9-11, 13.
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From page 276... ...
2003. Transcript from the IOM's Committee on Smallpox Vaccination Program Implementation Meeting Four on November 6, 2003, Washington, DC:180.
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2003. Transcript from the IOM's Committee on Smallpox Vaccination Program Implementation Meeting Four on November 6, 2003, Washington, DC:213-214.
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. Indicator 1.3.4.1: Local and/or state public health has trained govern mental and nongovernmental agencies for surge capacity at mass distri bution sites for medical countermeasures (e.g., vaccination)
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Indicator 2.3.1.1: Local and/or state public health maintains core per sonnel who are trained to provide technical assistance in the differential diagnosis of smallpox syndrome. Indicator 3.1.10.1: Local and/or state public health trains health care personnel to provide differential diagnosis of smallpox syndrome.
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Indicator 3.1.12.1: Local and/or state public health has secured com munity resources for surge capacity as sites for medical care and moni toring for potential victims of a smallpox outbreak (e.g. facilities)
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From page 281... ...
Because this indicator only applies to pre-event activities, it is only applicable to scenario 1; it is presumed under scenarios 2, 3, and 4. Within the framework provided by the Ten Essential Public Health Services, this indicator corresponds to Essential Services 1 and 2.
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This indicator applies to all scenarios. Within the framework provided by the Ten Essential Public Health Services, this indicator corresponds to Essential Service 7.
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From page 283... ...
4. The committee recommends that CDC address its immediate need of measuring cooperative agreement compliance with a concise and simple set of indicators, and then use this set of indicators as the foundation of a longer, deliberative, national process to develop measures that address the full range and appropriate balance of preparedness activities.
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From page 284... ...
284 THE SMALLPOX VACCINATION PROGRAM ing, but not limited to, a smallpox attack) and to avoid requiring duplicate reporting from states.
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