In order to respond accordingly in the midst of large-scale biological events such as a terrorist attack or natural disaster, public and private organizations need to coordinate, but on Wednesday public health experts at a Blue Ribbon Study Panel on Biodefense meeting cited obstacles that highlight the nation’s vulnerabilities.
The bipartisan panel was created in 2014 in order to issue recommendations to improve U.S. biodefense strategies, and Wednesday’s meeting at the University of Miami focused on assessing the ability of state, local, territorial and tribal governments to respond to major biological threats.
Hosted by panel members Donna Shalala, former Secretary of Health and Human Services, and former U.S. Rep. Jim Greenwood, officials made the case that putting in place a comprehensive public health system that is able to respond before a true biological disaster strikes is critical. The panel released a key report in 2015, A National Blueprint for Biodefense: Leadership and Major Reform Needed to Optimize Efforts, that highlighted gaps in the nation’s capabilities and recommended changes to U.S. biodefense policies.
In an op-ed appearing in the Miami Herald on Jan. 15, Shalala wrote that during a large biological event, “I know that the federal government would move resources to affected areas throughout the United States. But those resources are already too few, and the federal government does not respond quickly to multiple locations in distress.”
She added, “Even if the contents of the Strategic National Stockpile are effective against a fast-moving and deadly infectious disease, continued reductions in funding for the stockpile do not make it a sole solution we can depend on.”
One notion that was driven home during a panel discussion was that although public trust exists that communities are able to respond to public health threats, resources are stretched thin. Education is lacking, and some of the systems set up to aid the nation in times of crisis are hamstrung by outdated thinking.
For example, emergency medical services (EMS) is one segment of public health services that face challenges. James Robinson, assistant chief of the Denver Health Paramedic Division, noted how much trust the public puts in EMS services, yet emphasized how unbalanced their state of actual preparedness can be, and drew a direct line between their example and the state of biopreparedness nationwide.
“The public trusts that we’re going to be able to handle it on the big day,” Robinson said. “And unfortunately, I think that’s not the case currently. As I went through the recommendations for the report, it’s very analogous to the state of EMS in this country. We have greatly varying levels of readiness in this country, and greatly varying levels of effectiveness among EMS in this country. Our capacity levels, our ability to make an effective response, is probably not where we want it to be currently.”
Robinson pointed to a patchwork system through the country and a lack of national unity on the issue. Thus, various areas possess wholly different capabilities, scopes of practice and delivery models.
In the case of EMS, there are also challenges presented by its financing model. “Part of that is EMS are considered suppliers of health care,” Robinson said. “All we can do is provide transport and be reimbursed for that. That relegates EMS to really a commodity and that’s reflected in federal EMS doctrine as it relates to preparedness.”
Sounding a warning bell, he noted that this leads to an outcome elected officials rarely want to hear: a need to discuss the level of preparedness people have paid for. Robinson pointed out that not every individual is going to get the level of care he or she expects on a daily basis, and much less so in a crisis situation.
Nicolette Louissaint, director of the nonprofit Healthcare Ready, implied greater opportunity could be found in the private sector.
Referring to her organization’s time on the ground in the wake of Hurricane Harvey, the California wildfires and others, she said, “What we saw is the private sector’s ability not just to provide medicines as donation, or funding, but really step in as partners and find innovative, rapid-fire solutions on the ground.”
And those quick solutions are necessary in a crisis. Through polls instituted by Healthcare Ready, Louissaint said that the majority of patients were found to be able to go two or three days before needing access to a pharmacy or hospital. Patients are split on where they think ultimate responsibility for that lies, indicating the need for a shared community response — and that is an area of the supply chain Louissaint said could really use growth.