What Needed to be Done Wasn't Unknown

In October 2018, the Bipartisan Commission on Biodefense, co-chaired by former Connecticut Senator Joe Lieberman and former Secretary of Homeland Security Tom Ridge, issued a report, Holding the Line on Biodefense, that was subtitled “State, Local, Tribal and Territorial Reinforcements Needed.”  The 60-page report discussed “scenarios in which fast-moving and deadly diseases spread throughout the nation and the world,” pointing out that “each level of the government has yet to develop sufficiently comprehensive plans for addressing the need to provide for public health, safety, and security during and after large-scale biological events.”

The report’s Executive Summary and Conclusion follow.  The full report is available here.   

EXECUTIVE SUMMARY

The US Census Bureau counts a staggering 89,004 local governments in the United States. Among them are 3,031 counties, 19,522 municipalities and 16,364 townships. There are 573 tribes, 14 territories, and thousands of other special districts across America–each with a responsibility to serve the people who call those places home. Sometimes that service is in response to an emergency.

Our hometown heroes – emergency medical services, police, firefighters, doctors, nurses, pharmacists, lab technicians, public health professionals – are on the front lines keeping us safe. Maybe it’s from a flash flood from a stalled rainstorm. Perhaps it’s from a derailed train carrying hazardous liquids.

These types of incidents can be handled with resources provided by local and state governments, but when events are severe - widespread in scope and damage – they may require intervention by our federal government. Whether it’s a terrorist attack (e.g., September 11, 2001) or a natural disaster (e.g., Hurricane Katrina), the nation will quickly step up and respond, offering additional support and funding.

Unfortunately, there is grave concern that a large-scale biological event will prove to be the exception to this rule. Devastation could be vast and swift, and local resources would be very quickly depleted. The thousands of state, local, tribal, and territorial (SLTT) governments that are the backbone of our nation will have to fend for themselves for far too long until federal assets arrive, and Congress can provide emergency supplemental funding to support response and recovery.

“…thousands of state, local, tribal, and territorial governments that are the backbone of our nation will have to fend for themselves for far too long until federal assets arrive, and Congress can provide emergency supplemental funding to support response and recovery.”

In October 2015, the Blue Ribbon Study Panel on Biodefense issued its first report, A National Blueprint for Biodefense: Leadership and Major Reform Needed to Optimize Efforts.

The majority of the report’s recommendations focused on our national government, touching only briefly on SLTT needs. The Panel promised to return to them later and revisited these issues during a special focus meeting on the campus of the University of Miami in January 2018. The Panel explored needed SLTT emergency medical services, hospital, pharmacy, laboratory, and public health department capabilities and capacities necessary to respond to large-scale biological events.

The Panel found that basic biological preparedness, response, and recovery infrastructure varies widely throughout the United States, placing the entire nation at risk. If one community, for example, does not have access to a laboratory in their state that can quickly identify a biological threat, then they are immediately vulnerable and so are those who live in bordering states.

It reminds us that states, localities, tribes, and territories play a huge role in national security. We would like to see state governors, territorial governors and administrators, tribal leaders, mayors, borough council presidents, and township supervisors make biodefense a greater priority before biological attacks, accidents, outbreaks, epidemics, and pandemics place the lives of their constituents at risk.

In the pages that follow, the Panel recommends key steps that will increase the capability of SLTT to share with the federal government the burden of preparedness for, response to, and recovery from large-scale biological events. These eight recommendations are:

• Unify and establish a new National Emergency Medical Services system, including the creation of a National Emergency Medical Services Agency at the Department of Health and Human Services.

• Improve distribution of the Strategic National Stockpile and other stores of pharmaceuticals, equipment, and essential medical supplies, with enhanced training and assured access to pharmacy readiness data.

• Layer health care delivery across the nation and plan for when hospitals and other facilities are overwhelmed and overrun.

• Authorize all laboratory response networks to test for biological agents.

• Allow federally recognized tribes to enter into their own Public Health Emergency Preparedness cooperative agreements with the Centers for Disease Control and Prevention.

• Strengthen biosurveillance in, and eliminate burdensome transportation requirements for, the territories.

• Allocate response funding before biological crises occur with a credible Public Health Emergency Fund and sufficient assistance under the Stafford Act.

• Address public expectations by making biodefense a priority for all elected leaders throughout the nation.

CONCLUSION

The United States is unaccustomed to responding to events that exceed resources available within the nation. With time and additional appropriations, the nation eventually responded extensively to terrorist events (e.g., September 11, 2001) and naturally occurring disasters (e.g., Hurricanes Irma and Maria). Unfortunately, the Panel expects that large-scale biological events will prove to be the exceptions. States, localities, tribes, and territories will have to fend for themselves while the federal government puts what assets it has available towards ensuring national security and societal stability.

We can describe scenarios in which fast-moving and deadly diseases spread throughout the nation and the world. We can zero-out resource availability in inventories and spreadsheets, and accurately describe the impact on patient management, waste management, disposition of the dead, public safety, and public health. Despite the predictability these afford, each level of the government has yet to develop sufficiently comprehensive plans for addressing the need to provide for public health, safety, and security during and after large-scale biological events.

“…each level of the government has yet to develop sufficiently comprehensive plans for addressing the need to provide for public health, safety, and security during and after large-scale biological events.”

Public health takes a population approach to health and health care delivery. Public health officials make decisions based on population data and statistics, and in a highly resource constrained environment, they make decisions that favor the greater good, doing the best they can for the most people. Beyond a certain point during a biological catastrophe, everything will become public health. Leaders will then have to do the best they can with the resources they have at their disposal to ensure the survival of the constituents for whom they are responsible.

We can take steps now to reduce the impact large-scale biological events will have on our states, localities, tribes, and territories. By rectifying shortfalls in EMS, improving SNS distribution and pharmacy readiness, increasing hospital surge capacity, augmenting laboratory response capacity, rectifying shortfalls in tribal emergency preparedness, overcoming barriers to territorial biosurveillance and response, delineating response funding before biological crises occur, and assuming broader leadership of biodefense, we can enable all levels of government and the private sector to defend the nation against biological threats and their potentially large-scale consequences.