The more prepared we are, the faster and better we will respond. Of course, budgets are finite and we cannot possibly prepare for every contingency. Prudent emergency managers, therefore, often first consider the threat and use that assessment to drive allocation of preparedness dollars. Many of them have recognized that the biological threat from nature and terrorists alike is real and present. The key to biodefense and management of biological emergencies therefore, is getting ahead of the impact of these inevitable incidents. The public and private sectors have taken many important steps to prepare, but we remain far from capable of responding optimally to events with the potential for far-reaching consequences.
The Blue Ribbon Study Panel on Biodefense recently released the report, A National Blueprint for Biodefense: Leadership and Major Reform Needed to Optimize Efforts. This bipartisan report contains 33 recommendations, each with action items designed to aid implementation. Six of the recommendations address emergency preparedness in particular, and, if acted upon, will enable the Nation to get ahead of the impact of biological incidents.
Allow emergency service providers to protect themselves
Intelligence will only get us so far in addressing the biological threat, so we must take other measures to mitigate the impacts of an outbreak. Vaccination is one of our best defenses, preventing illness if intelligence fails us or if a serious threat emerges from nature. For instance, the events of 2001 demonstrated the reality of the anthrax threat, yet each month, the federal government discards hundreds of thousands of short-dated, excess or expired anthrax vaccine doses.
After years of consideration, the Department of Homeland Security (DHS) should pilot a program to offer these vaccines before they expire to emergency service providers that want them. If successful, DHS should subsequently develop a more comprehensive voluntary vaccination program addressing additional biological threats faced by emergency service providers. Pre-deployment of medkits and the establishment of personal protective equipment guidelines and requirements would have significant downstream benefits, and the Department of Health and Human Services (HHS) carry these out.
Forward deploy Strategic National Stockpile assets
The federal government has resisted putting medkits in the hands of emergency service providers, fearing loss and misuse of their contents – despite pilot programs demonstrating the opposite. Similarly, requests for forward deployment of Strategic National Stockpile (SNS) assets have met with resistance. The Centers for Disease Control and Prevention (CDC) should forward deploy elements of the SNS to at-risk jurisdictions that have demonstrated they can manage the contents of their allotment responsibly. New York City, for instance, has shown it can stand up points of distribution faster than federal SNS assets can arrive. This wasted time unnecessarily puts lives at risk.
Institute a process to develop infection control guidelines
We can also pre-establish the process for developing infection control guidelines. There is no reason to wait for the next biological incident before emplacing a process that ensures federal agencies such as CDC and Occupational and Safety and Health Administration work together; solicit and incorporate input from non-federal public and private sector experts and practitioners; and communicate new or modified guidelines clearly. While it is not possible to predict exactly which infectious disease will create the next biological event, it is possible to establish in advance a process to develop effective infectious control guidelines when needed.
Create a stratified hospital system
Successful hospitals provide expedient life-saving treatment while executing sound business plans. Some choose to offer specialized care (e.g., pediatric, trauma), which in turn allows them to be reimbursed for a greater variety of increasingly expensive services. A national system of stratified hospitals offering tiered levels of care allows patients to get the treatment they need relatively nearby. Making treatment of highly pathogenic infectious diseases a specialty reimbursable by the Centers of Medicare and Medicaid Services if a hospital is accredited to do so would build on our existing hospital system and leverage an exponentially larger and more reliable source of funding than the much smaller Hospital Preparedness Program.
Strengthen the public health community
Beyond the delivery of healthcare to individuals, surveillance, laboratory testing, bioinformatics and epidemiology are also critical to effective emergency preparedness and maintenance of public health. The public health community depends on federal funding to execute these activities. To ensure the public health community can alert emergency service providers and healthcare deliverers to take action and best direct their limited resources, Congress must increase funding for CDC’s Public Health Emergency Preparedness (PHEP) cooperative agreements.
The Blueprint for Biodefense contains additional recommendations and action items to improve our national ability to prevent, deter, prepare for, detect, respond to, attribute, recover from and mitigate biological incidents. While all of these areas are important, emergency preparedness is key to effective biodefense.