Improving the CDC Quarantine Station Network's Response to Emerging Threats (2022) / Chapter Skim
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2 Organizational Capacity
2 Organizational Capacity
Pages 31-68
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Like any organization, OC underpins and shapes the identity and personality of the Centers for Disease Control and Prevention's (CDC's) Division of Global Migration and Quarantine (DGMQ)
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Other aspects of organizational capacity may warrant further exploration. DGMQ INFRASTRUCTURE The DGMQ works to maintain public health security by preventing the introduction, transmission, and spread of infectious diseases into the United States within a context of rapid global travel.1 The DGMQ is one of the nine offices and divisions housed within the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
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.2 This section provides an overview of the composition and function of the DGMQ's infrastructure, with a particular focus on the Quarantine and Border Health Services Branch (QBHSB) and the network of quarantine stations operated by the DGMQ.
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. 4 More information about CDC quarantine stations can be found at https://www.cdc.gov/ quarantine/quarantine-stations-us.html (accessed February 26, 2022)
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The ComET team works to train branch personnel and is responsible for communicating health information through various mechanisms, including posters, handouts, websites, and media responses. The RSST provides logistical support for operations at the quarantine stations.
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Quarantine stations located in areas that were at greater risk of Zika spread, such as the U.S.–Mexico border and Puerto Rico, built partnerships with local governments and community health workers to alert travelers about Zika risk (CDC, 2021b)
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The DGMQ's efforts focused on protecting travelers and other mobile populations and reducing the risk of importing and spreading COVID-19 by way of global travel. Activities included • taking regulatory actions, such as no-sail orders, quarantine mea sures for incoming international travelers, mask requirements on public transportation, and a rental eviction moratorium; • establishing public health guidance for managing infected travelers and travelers potentially coming from countries deemed at greater risk due to high countrywide transmission levels; • publishing travel guidance and health notices; • establishing and conducting public health entry screening; and • providing refugees, immigrants, and migrant workers with cultur ally and linguistically appropriate resources related to COVID-19.
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points of entry, only 20 of them contain quarantine stations (CDC, 2021c) , resulting in approximately 300 border entry points without any consistent public health service presence on site (CDC, 2021c)
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For example, from 2020 to 2021, the division addressed Ebola virus disease outbreaks, concerns on the Southwest border due to the large number of persons arriving for immigration into the United States, the evacuation of Afghan refugees, and the COVID-19 pandemic. Screening processes established to address COVID-19 increased demands on the DGMQ.
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The Maritime Activity, housed under the DGMQ, liaised with quarantine stations regarding communicable diseases of public health concern on maritime vessels, developed procedures for quarantine stations, and supervised management of outbreak response on vessels. The Vessel Sanitation Program (VSP)
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A substantial proportion of the DGMQ's core funding also supports the salary and benefits for DGMQ permanent staff responsible for executing mission and programmatic activities (Cetron, 2021)
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Although the salary and benefits proportion of core funding has increased year over year between FY2012 and FY2022, baseline funding has remained static (Damon, 2022)
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However, this anticipated core funding increase in budget comes almost 3 years into the pandemic and remains a critical need that has not been addressed swiftly enough. High-Level Overview of the DGMQ Budget: Fiscal Year 2021 and 2022 The committee was provided with a high-level overview of the DGMQ's budget for FY2021 and FY2022, including funding streams in aggregate -- reflecting both proposed and anticipated increases -- as well as categories in which funding is spent, and program spending power at current core funding levels (Damon, 2022)
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Spending Power DGMQ program spending power at current core funding levels is directly impacted by the need for increased staffing to sustain its mission and programmatic activities. In FY2021, 65 percent of the core funding ceiling ($45.1 million)
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Potential Funding Streams Currently, the DGMQ does not have sufficient core funding to support its personnel and programs. Increased core funding is needed to sustain programmatic activities so the organization does not have to rely solely on emergency funding that is only made available at some point after the start of an emergency (see Chapter 6)
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It is imperative that the DGMQ, including its quarantine stations, be appropriately staffed to fulfill its mission and execute its responsibilities. Trends in DGMQ Staffing Requirements and Levels Within the DGMQ, the number of permanent, FTE employees has remained static for years (Damon, 2022)
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increasing mission activities inclusive of response efforts. With a continued lack of core funding, the DGMQ has continued with an enhanced nonpermanent staffing footprint.
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. Additionally, nearly half of the QBHSB Operations Team (the quarantine stations)
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. Among the 18 quarantine stations located at international airports in the network, there are currently 160 approved positions -- the majority of which are TERM NTE positions.
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Like the number of positions, the vacancy rates vary widely across the network of quarantine stations, from 25 to 75 percent as of November 2021 (Brown et al., 2021)
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In FY2022, 735 of the 770 positions for contractors and fellows were funded by response supplemental funding lines, while 35 were supported by core funding. Challenges in Recruiting and Retaining Permanent Staff The DGMQ currently relies heavily on TERM NTE staff, contractors, and fellows -- as opposed to permanent staff -- in order to execute its responsibilities, but this is inadequate and inefficient for operating with and sustaining long-term effectiveness.
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The DGMQ has also attempted to utilize nonfederal volunteer surge staff, but this gave rise to similar issues around security and medical clearance requirements, badging requirements, and access to IT systems. Quarantine Station Staffing Challenges Staffing of quarantine stations is also associated with a specific set of challenges.
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Presently, many quarantine stations operate in a single daytime shift (i.e., 9:00 AM–5:00 PM) with varying degrees of after-hours coverage and on-call response.
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Excessive vacancies within the quarantine station network and the inability to retain skilled and experienced staff jeopardize the ability of the DGMQ to accomplish its core mission of protecting the United States from the introduction of communicable diseases. Thus, the appropriate staffing of authorized positions within the individual quarantine stations is a critical necessity that needs to remain a priority for the DGMQ.
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Developing Strategies to Ensure Adequate Staffing • The DGMQ can explore a range of options to ensure adequate staffing, including the following: Explore the CRMD CDC PHI fellowship program14 and the Public Health Associate Program15 as a means of recruiting. • Partner with local jurisdictions to hire or assign staff to work in the quarantine stations.
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This change appears necessary and an appropriate common standard to implement across the network based on recent response requirements. However, the current high number of vacancies, which varies between quarantine stations, and the high number of TERM NTE positions will make this standard challenging -- if not impossible -- to meet for the entire network.
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. For example, the DGMQ offers an internal Training and Transformational Leadership Upskilling Series, where it works to bring topics of broad interest into the division training series and strategizes to offer these opportunities to personnel at strategic times to increase attendance.
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in Glynco, GA -- where new CBP officers receive their basic training, including training in supporting CDC quarantine station operations. Through training a cadre of 10–20 FLETC trainers to deliver the CDC module 60+ times a year, the DGMQ empowers the CBP to partner in training and saves a significant amount of staff time and resources in traveling to the FLETC to deliver training.
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However, there are a number of challenges that may be contributing to a culture at the DGMQ that limits its organizational capacity. These include structural constraints (e.g., inadequate financial and human resources)
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The continuous challenge of emergencies and pandemics over the last decade have stretched the DGMQ's capacity and ability to respond to global disease threats. The committee's assessment of the agency's organizational capacity finds that it is designed to operate in a past era -- before the last decade's unprecedented and profound health events.
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There is an opportunity to redesign quarantine stations, adopting new technologies and innovations (digital and diagnostic platforms) , altering workload and operational hours, incorporating telehealth, working smarter, and creating a network of modern quarantine stations for the future.
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Recalibration of the DGMQ's baseline funding would help the division meet the challenges of today's expansive border health landscape and heightened threats of novel in fectious disease outbreaks, thus enabling the DGMQ to meet its grow ing responsibilities and to be better prepared for a complex, uncertain, and demanding future. Conclusion 2-6: A pandemic fund that explicitly mentions the DGMQ as a recipient could allow the DGMQ to nimbly access funds during crises while awaiting legislative appropriation.
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Conclusion 2-10: The availability of modern technologies could influ ence the requisite skill sets of personnel assigned to quarantine stations. While medical consultation is clearly needed for the quarantine stations to fulfill their responsibilities, options that do not rely on on-site medi cal officers to reduce the work burden may be viable.
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2. The CDC should explore, along with the administration and Congress, the development of a user fee program to ensure that the division has a consistent and dependable source of revenue to cover the costs of operating the quarantine stations.
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2022. Quarantine and Border Health Services Branch: CDC, DGMQ.
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2021. Evaluation of jurisdictional & federal public health responses to past & current outbreaks & implementation of CSTE protocol for health department notification to CDC quarantine stations of infectious persons with recent travel.
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2006. Quarantine stations at ports of entry: Protecting the public's health.
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