Future Planning for the Public Health Emergency Preparedness Enterprise Lessons Learned from the COVID-19 Pandemic: Proceedings of a Workshop (2023) / Chapter Skim
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3 Coordinating Surveillance and Medical Countermeasure Response
3 Coordinating Surveillance and Medical Countermeasure Response
Pages 23-38
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From page 23... ...
GLOBAL AND DOMESTIC SURVEILLANCE Vivian Singletary, director of the Public Health Informatics Institute, facilitated a discussion with speakers around the current state of surveillance, how things have changed since the onset of the COVID-19 pandemic, key challenges in making improvements for the future, and what elements of a better system are necessary to inform a stronger response in future emergencies. Reflections on Domestic and Global Surveillance Janet Hamilton, executive director at the Council of State and T erritorial Epidemiologists, said, "We can probably all remember where we were during those initial case investigations in December 2019 when COVID-19 began emerging." The U.S.
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From page 24... ...
Electronic laboratory reporting had also made numerous strides as the pandemic went on, she said, and great progress had been made on case-based surveillance systems and thinking about the needs for different locations. Hamilton went back to the state of things in December 2019, reminding people that public health departments were likely going to find out about new cases of suspected COVID-19 from a physician phone call.
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Many public health agencies are using data infrastructure that is decades out of date. Data modernization initiatives are in further development, Rivers noted, but continued sustained investment is necessary to keep these systems operational and ready to respond to future events.
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She called out the immense investment of $40 billion in health care for electronic health records (EHRs) , but so far just $1 billion has been set aside for a national public health system delivering data and updating systems.
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Hamilton added that a number of health departments have moved into a new space and are obtaining electronic case reporting for COVID-19 and other conditions under public health surveillance from health care. Looking forward, she saw electronic reporting as a critical component.
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But to support all of those things, the sector will still rely on strong data and information systems. Discussion John Wiesman of the University of North Carolina at Chapel Hill said another essential policy needed is a unique patient identifier tied to a database where one can find basic information about a specific patient, so the same details and preexisting conditions do not need to be collected every time they have a visit.
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MEDICAL COUNTERMEASURES AND MEDICAL SUPPLY CHAIN CONSIDERATIONS Before facilitating the panel, Monique K Mansoura, executive director for Global Health Security and Biotechnology at the MITRE Corporation, provided a framing for the session.
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This section summarizes speakers' reflections and discussions on medical countermeasures, including supply chain considerations, effective medical countermeasures delivery, multiagency coordination and governance of the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) , and needs for supply chain resilience.
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Supply Chain Resilience and Adaptation Jarrod Goentzel, founder and director of the Massachusetts Institute of Technology Humanitarian Supply Chain Lab, explained that his center has been around for more than 50 years. The Humanitarian Supply Chain Lab works closely with the private sector and the Federal Emergency Management Agency (FEMA)
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From page 32... ...
At the stockpile and demand management level, he shared a study supported by the Administration for Strategic Preparedness and Response (ASPR) that his team conducted from July 2020 to July 2021 to determine appropriate PPE stockpiles for a state-level public health agency.
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Some levers were fairly intuitive, such as reusing masks to reduce demand; however, others were more surprising. For example, decreasing patient diagnostic test turnaround time from 2 days to 1 day decreases the need for N95 mask use in skilled nursing facilities by 22 percent.
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The government could use this type of process more broadly, to work with the private sector, Goentzel explained, and more cooperative problem solving ahead of crises would build relationships. He outlined three emerging areas in the future of health emergency supply chains:
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Even if the plans fail, the relationships built will be critical in pivoting and responding. Public Health Emergency Medical Countermeasures Enterprise Gigi Gronvall, senior scholar at the Johns Hopkins Center for Health Security, highlighted a recent National Academies study that she was involved in, covering the PHEMCE (NASEM, 2021)
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Gronvall replied that you need to do a little digging to know what goes into the stockpile, but it is possible to find statements from private companies that announce when the government has purchased large orders of anthrax or smallpox vaccine, which demonstrates that this type of information is already available and does not seem to be a security risk, she explained. Goentzel said people should not just consider the Strategic National Stockpile, as all available stockpiles are part of the buffer to buy time, so increasing transparency and coordination across stockpiles and the actors involved helps to understand the level of supply involved.
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Goentzel stated that there are also modeling opportunities to better understand disease trajectory, supply chain resilience, and the effect of delivering medical countermeasures on epidemiological models and vice versa. Gronvall noted that this is another reason why the National Academies' committee recommended an advisory board for the PHEMCE.
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