NCDP Perspectives

The following are the prepared remarks of Jeff Schlegelmilch, Deputy Director of the National Center for disaster Preparedness at Columbia University’s Earth Institute, for the May 1 Public Meeting of the Blue Ribbon Study Panel on Biodefense to Discuss Budget Reform.

I would like to thank the panel for the invitation to speak today, as well as for your continued work towards improving our nation’s biodefense capabilities.

At the National Center for Disaster Preparedness at Columbia University’s Earth Institute, we have been at the forefront of understanding these issues for over a decade by conducting primary research on preparedness, response and recovery, as well as conducting policy analysis and advocacy, and through the development of tools and trainings for the practice community.

The nation has come a long way over the past decade and a half, due to the leadership of those of you on this panel, among many others. Our capacities have grown, our understanding of the threat landscape has become more sophisticated, and a new generation of leaders are emerging who have been better prepared to prevent and manage 21^st century bio threats. However, as the panel has articulated, this progress is stymied and threatened by chronic budgetary shortfalls, disparate authorities on biodefense and difficulty unifying the many perspectives and interests that make up the mosaic of our national biodefense system.

In addressing the budget issues, and based on the work of our center, I posit three areas of focus in my remarks today: 1) increasing resources and attention to building local biodefense infrastructure, 2) establishing a national emergency fund for public health response, and 3) fostering a new kind of public/private partnership that goes beyond the current focus on research, development and supply chains.

Public health happens at the community level. It is where healthcare facilities are located, and it is where our public health systems interface with actual people. To illustrate it simply, a national stockpile of pharmaceuticals is only useful if there is a community practitioner to put it in your arm in time to save your life. In national planning, this often referred to as the “last mile”, or where national assets are transferred to state and local systems to carry out the job of protecting the public’s health. However, this is also by far the most complex place along the continuum of biodefense. State and local governments have their own systems, politics, relationships and resources that can vary widely. It is hard to capture this in concise statements, and even harder to measure or even define progress.

State and Local public health preparedness funding has been cut by about a third, with hospital preparedness funding reduced by about half since peak levels. These funding streams were not necessarily designed to be permanent. However, what we have learned is that preparedness systems function as infrastructure. It requires long-term planning and stability in funding, as well as clear measures of performance. All of which remain elusive.

The alignment of capabilities across programs and creating 5-year funding authorization cycles has been a step in the right direction, however uncertainty in the annual appropriation processes and a virtual absence of locally relevant measures of preparedness have limited the value of these changes.

Our first recommendation is to enhance the core funding vehicles for the “last mile” by increasing funding for the Public Health Emergency Preparedness Program and the Hospital Preparedness Program to their peak 2003/2004 levels, while also appropriating funds multiple years in advance. This should happen initially for a 5 year period, with a parallel investment to define optimal levels of preparedness, so we can finally address the unanswered questions: “how much funding is required?” and “what is the quantified value of our national investment?”.

Of course stabilizing preparedness funds is only the first step. Local communities would still require specific and sufficient resources to respond effectively to a bio event, natural or intentional. Due to the lack of a funded public health response vehicle, public health chronically finds itself needing to either pull resources from other programs, request emergency funding from Congress, or limit response actions due to resource constraints. Our recent experience with Zika Virus saw all of these sub-optimal options in play. The saving of lives should not be a political process, and yet too often it is hampered by partisan maneuvering.

Our second recommendation is that a public health emergency fund should be established and funded at a level no less than $2 billion dollars and replenished as needed, so that a meaningful response can be employed when necessary.

An existing authority was created in 1983 for a Public Health Emergency Fund (PHEF) to be available to the Secretary of the Department of Health and Human Services (HHS). However it is has never been funded to meet the needs of large-scale responses like Ebola, Zika and Pandemic Influenza. Many proposals are currently being circulated to fund such a vehicle. This is encouraging, if it is implemented at sufficient levels with appropriate triggers for use.

This funding should also allow for advance declarations to be made when we see significant outbreaks overseas, similar to pre-landfall declarations made for hurricanes under the Stafford Act. Current proposals link use of this fund to the existing criteria for declaration of a public health emergency. A declaration that was not made by the United States for Zika or Ebola. This trigger for use should be fully evaluated to ensure it is the right process, and that it would have worked for these recent responses.

Finally, public-private partnerships are frequently recommended, but rarely articulated beyond research and development, manufacturing and supply chains. While these are all critical aspects of biodefense, the private sector also has tools for optimizing communications, cost-benefit analysis in resource constrained environments, creating business intelligence systems and real-time operational dashboards, among many others.

With the New York City Department of Health and Mental Hygiene, we have been contracted to develop performance measures for preparedness and response and are integrating such private sector concepts as emergent strategy, managing uncertainty, and organizational theory.

We are engaged in a project sponsored by the biopharmaceutical and healthcare company, GSK, in partnership with Save the Children to develop community resilience coalitions focused on child-serving institutions, while integrating the work with formal emergency management and public health systems. The contribution of GSK allows work to be done that expands local preparedness, while also contributing expertise in communications to reach wider audiences and to ensure that the work being done in the communities is elevated into the national dialogue.

Both of these projects require a unique courage among public and private sector employees to invest time and resources to work across sectors, to share their knowledge, and to accept that there are good ideas and innovative practices in other fields that may use different words and different measures of success, but can solve many of the problems we face in biodefense.

For our final recommendation, we urge Congress and the Administration to embrace the wide range of benefits that can come from private sector integration with local preparedness by creating technical assistance programs that can help local communities and private sector patrons connect with each other, and to create guidance for navigation of legal hurdles such as the Federal Advisory Committee Act, antitrust regulations and other perceived barriers to collaboration. Further incentives for this kind of collaboration should also be explored.

A community’s resources are not just its’ tangible assets; it is in the ingenuity and networks of all of its people. The more seats we have at the table, the more we can grow our effectiveness and access the fiscal, intellectual and social resources that we have yet to fully capitalize on in this field of biodefense.

I will conclude by once again, expressing my sincere gratitude for the work of this panel, and the commitment you have made to hear these perspectives, and for your continued contribution toward enhancing our national biodefense capabilities.