HSPH is part of a national system of Centers for Public Health Preparedness established by the Centers for Disease Control and Prevention (CDC). The focus is on improving the capacity of frontline public health and health care workers to respond to bioterrorism, infectious disease outbreaks, and other public health threats and emergencies.

Under the leadership of HSPH Professor Deborah Prothrow-Stith, the Harvard Center for Public Health Preparedness (H-CPHP) was developed in 2002, with first-year funding of $1 million from the CDC. H-CPHP and 18 other Academic Centers for Public Health Preparedness are the result of a cooperative agreement between the CDC and the Association of Schools of Public Health (ASPH).

"A strong collaboration between our center, the national network of academic centers, and the state health departments is imperative in these worrisome times," said Prothrow-Stith. "We must share products, avoid duplication of efforts, and better translate knowledge into practice."

H-CPHP and the other 18 centers share information regularly through different venues, including monthly conference calls for both administrators and principal investigators of the project, as well as attendance of several meetings each year at the CDC in Atlanta.

The purpose of H-CPHP is to bridge public health practice and academe through workforce training. Work is focused on the training needs and unique challenges of potential bioterrorism threats in Maine and Massachusetts.

"The school brings academic expertise that is greatly needed," said John Auerbach, executive director of the Boston Public Health Commission, one of the center's partners.

The center's faculty members are already training workers and developing innovative materials, including videos, lectures, and PowerPoint presentations. This spring, H-CPHP is producing a locally led satellite broadcast with both Maine and Massachusetts. The distance learning strategy is expected to allow both the distribution of accurate information and the development of a network of local leadership to work with health departments.

H-CPHP has been active in Maine from the early days of preparedness planning, in part because HSPH already had a relationship with the Maine Center for Public Health (MCPH) and the state's Bureau of Health through two other unrelated projects. The relationship has been facilitated by the fact that H-CPHP co-investigator Paul Campbell serves as part-time president of MCPH and as lecturer at HSPH. His particular responsibility at H-CPHP is to advance preparedness planning in rural areas, including Maine.

"In Maine, our preparedness leaders decided that their initial top priority is enhancing the skills of a core bioterrorism team of physicians and epidemiologists, all staff members of the Bureau of Health," said Campbell.

Among the center's goals is advancement of "connectivity," or the development of "a seamless web of organizations, people, resources, and information that is best able to catch, contain, and control a bioterrorist threat," said Leonard Marcus, founding director of the Program for Health Care Negotiation and Conflict Resolution at HSPH and co-principal investigator of H-CPHP.

Connectivity is one of the knottiest problems in existing emergency plans. For example, every individual on the front lines must know whom to call, how to reach them, and what information to obtain or pass on. Yet this is far from the case at present.

The problem is being addressed under the "incident command" rubric, which is designed to establish quick leadership in emergencies and to knit disaster and medical leaders together so that all will be on the same page, regardless of discipline or institutional culture. Few will forget how the incompatibility of police and fire department radios hampered rescues in the World Trade Center attacks.

To aid in preparing the public health workforce in the event of bioterrorism, H-CPHP partners with local and national organizations such as the ASPH, Boston Public Health Commission, CDC, Maine Bureau of Health, Maine Center for Public Health, Massachusetts Department of Public Health, New England Alliance for Public Health, New England Coalition for Health Promotion and Disease Prevention, and the New England Collaborative for Public Health Preparedness.

"The educational task ahead is immense and time is short," said Jennifer Leaning, H-CPHP co-investigator and a professor in the Department of Population and International Health. "Assessing needs and the state of readiness is the first step, but the bottom line is that everyone must know something about bioterrorism, particularly at the level of emergency medicine, school nurse, and primary care physician. These practitioners, with their clinical training, can readily be taught to respond to bacterial and viral threats and taught how to deal with the added difficulty posed by malevolent use of such agents."

The training materials and videoconferences being developed at the center can be targeted to different audiences. The materials are competency-based and employ multiple training strategies.

"A mission for the center and its collaborators is to ensure that, in the case of a bioterrorist event, every individual either on the front lines or at home knows whom to call, how to respond, and where to get accurate information," said Prothrow-Stith. "As a result, our teaching methodologies and our materials are diverse, culturally appropriate, and sensitive to the specific audiences we are training."

--Richard Saltus

H-CPHP Investigator Reports on Israeli Bioterrorism Preparedness Efforts

In October 2002, and again in January 2003, fact-finding trips took Leonard Marcus, founding director of the Program for Health Care Negotiation and Conflict Resolution, to Israel--a nation repeatedly roiled by terrorist bombings. Through official interviews and talks with ordinary Israelis, Marcus found bioterrorism preparedness much more advanced than in the United States.

With lessons learned from the 1991 Gulf War and years of unpredictable suicide bombings, Israel is preparing for smallpox infections, handing out gas masks, and setting up mass decontamination centers.

"I was impressed with the amount of knowledge the average citizen has about chemical and biological warfare and what to do about it," said Marcus.

The first trip to Israel was organized with the help of Colonel Dr. Itzak Ashkenazi, who studied public health leadership at HSPH while attending the JFK School of Government. Ashkenazi is now head of the Medical Services and Supply Center at the Tel Hashomer Base, Israel Defense Forces. On the second trip, Marcus introduced CDC representative Joseph Henderson to Israeli officials. What Israeli public health officials have gleaned from the first phase of smallpox inoculations is already being used to update the Harvard Center for Public Health Preparedness' training materials.

Still, with the threat of war with Iraq looming, even Israelis are wondering how prepared they really are, said Marcus after his second visit. Now, he feels a new sense of urgency about H-CPHP's mission to ratchet preparedness to higher levels.

Marcus has written about his Israeli trips. For more information, visit http://www.state.ma.us/dph/bioterrorism/advisorygrps/bpac.htm.