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Monday, December 6th, 2021

Joint Johns Hopkins, CDC checklist for disease response reveals diverse, complex involvement needed to ready public health sector

Eric Toner

Joint efforts from university and federal researchers have prepared a checklist designed to help strengthen communities against infectious disease outbreaks – and what they’ve learned is it’s a messy web to navigate.

The report was prepared against the backdrop of the 2014 Ebola crisis, with researchers and analysts from both the Johns Hopkins Center for Health Security and the U.S. Centers for Disease Control and Prevention. It was supported by CDC funding, with the aim of improving preparedness and response during high-consequence infectious disease events, such as smallpox, SARS, MERS, and H5N1 influenza A.

What it found was a complex array of public, private and community organizations required for any outbreak incident – many whom might not realize their need in such events, or might present unwillingness to cooperate. The checklist breaks the topic down into a series of critical areas and addresses each one’s role in a crisis. Chiefly, these involved: planning and preparedness, leadership, creative flexibility, command structures, the public trust, managing uncertainty and communication.

An optimal response to such outbreaks, the report notes, involves a robust and resilient public health capacity, with established protocols that cover a range of event types. Local leadership is vital to implementation of such responses, largely because many federal agencies like the CDC can rarely provide support unless explicitly requested by the state.

Local leadership, in turn, finds itself mired in a variety of involved parties.

“I think one of the things that struck me most on this project is the wide diversity of individual organizations that find themselves involved in responding to a crisis,” Dr. Eric Toner, the project’s principal investigator and a senior associate at the Johns Hopkins Center for Health Security, said in an interview with Homeland Preparedness News. “We think of emergency preparedness at the local level with involving people in hospitals, EMS…but there’s so many other people who end up getting involved, who never anticipated they would get involved, so they’re not planned for.”

The big message is, he said, that even if people in the health sector don’t think they’re part of emergency management, in a crisis they probably will be. One of the best things people in the health sector can do, consequently, is to get involved early.

Otherwise, “They may get drafted into a response whether they anticipate it or not,” Toner said.

Raising Awareness
One particularly important observation in the report noted: “Fear of the unknown, particularly in the context of changing and, often, conflicting information, can trigger highly emotional public responses.”

As a result, effective communication and general awareness are critical to preserving the public health. Unfortunately, blockades to those seemingly simple needs come from both governmental and human tendencies. Organizations can put out all the information they want, but as Toner put it, people have a natural tendency toward denial.

“They think: this can’t happen to us, these things only happen to someone else,” Toner said. “That’s a normal, human reaction—but it’s not logical.”

Health organizations therefore find themselves needing to play the part of the continual reminder, especially in the face of what Toner called “silos.” Silos are a chronic issue, wherein various elements of public health might not want to work with those in emergency management, or various divisions therein. Integration is key, Toner notes, but there are both structural and cultural resistances in the field to working outside familiar “tribes.”

“It’s differences in language, attitudes, ways of looking at the world,” Toner said. “So even when you get people in a room working together, these cultural differences come out. It can be a bit tribal at times. They feel comfortable working with people from their own structure and distrustful of people from other sectors.”

The Funding Question
A consistent question with public health preparedness remains that of funding. The budget proposed by the president includes massive cuts to organizations and labs dedicated to health preparedness.

While this checklist mostly pertained to local level involvement, Toner said unequivocally that passage of President Donald Trump’s budget as proposed would devastate the nation’s preparedness for terrorism and disease at all levels.

“The cuts that have already been made over the years have greatly affected our ability to respond to disasters,” Toner said. “The draconian cuts proposed would make our country much more vulnerable. They make us completely vulnerable, not more secure.”

States, he noted, would see funding for hospital preparedness slashed, and their ability to react to any disasters – bioterrorism, certainly, but also things like tornadoes and hurricanes – would be hamstrung.

“This certainly sets a new precedent, a new low for funding proposals that are inconsistent with our national security priorities,” Toner said. “On the other hand, it has been my experience over the decade that these things change suddenly. The next big crisis that hits would probably be followed by a big boost of money. This happens pretty frequently. Budgets get slashed, then there’s a crisis, then there’s a truckload of money that gets dumped.”