Joseph Henderson of the CDC

How these missions might be bridged was a key issue discussed during "A Conversation with the CDC" in Snyder Auditorium on May 8. A panel of HSPH faculty and top public health professionals in New England questioned Joseph Henderson, CDC Associate Director for Terrorism Preparedness and Response.

The panelists covered a range of issues, including how schools of public health can play a role in preparedness activities, the CDC’s response to SARS, and the need for a stronger global public health network.

The event was sponsored by the Harvard Center for Public Health Preparedness (H-CPHP), one of 19 academic centers that resulted from a cooperative agreement between the CDC and the Association of Schools of Public Health. H-CPHP received first-year funding of $1 million from the CDC in 2002. Deborah Prothrow-Stith, principal investigator at H-CPHP and professor of public health practice in the Department of Health Policy and Management, moderated the panel.

Preparedness vs. Building Infrastructure?

According to Henderson, CDC funding rocketed from $50 million to $1 billion within six months after September 11th. States have received dispersals of the increased funding. Asked panelist Alfred DeMaria, assistant commissioner of the Massachusetts Department of Public Health: "Is this money to build our capacity to be responsive to a variety of threats, including bioterrorism, or is this money for very specific capacities and benchmarks?"

From left to right, panelists Anita Barry, Robert Blendon, Dora Mills, and Dean Bloom

"If we fail to do that–even if we build a solid public health infrastructure, but we don’t demonstrate proficiency in responding to events–I don’t think Congress will continue to appropriate funds at this level," he said.

How the money is spent is an important question for community public health authorities. "All disasters are local," said panelist Anita Barry, director, Communicable Disease Control, Boston Public Health Commission. She questioned, "How can [the CDC] assure that resources are available at a local level to do surveillance, education, and training, and consequence management?" she asked.

The CDC relies on state authorities to coordinate with local public health officials because there are too many local health jurisdictions for the agency to deal with directly, said Henderson. However, the CDC is developing performance programs to be used at local levels to improve proficiencies.

Measuring Success

H-CPHP is training and educating public health workers in Massachusetts and Maine. But, noted HSPH Dean Barry Bloom, there will be a "day of reckoning" in Congress when the CDC-funded academic centers will need to demonstrate that progress is being made. "How do we assess how well we’re doing within the framework of the nation, [and] also how well we are training people?" asked Dean Bloom.

The crunch will come in December, when the states’ financial reports concerning preparedness funding are due to Congress, said Henderson. Plans, achievements, and proficiencies need to be demonstrated.

"Congress is impatient because they are nervous about terrorism," Henderson said. He added. "They want to see a very big change in our public health system, and it’s our responsibility to bring that change forward."

Measuring preparedness performance is difficult because there is no definition of what is considered to be "good," said Henderson. For example, vaccinating 450,000 people against smallpox may appear to be a measure of success, but what if it is achieved at the expense of developing a plan to respond to smallpox that emerges in an emergency room, he said. Schools of public health can help define preparedness performance measures, freeing state and local authorities to direct resources to building public health infrastructure, he said.

	From left to right, moderator Deborah Prothrow-Stith with Leonard Marcus and Alfred DeMaria

Demonstrating how terrorism preparedness funding has paid off in unexpected ways at local levels was Dora Mills, HSPH alumna and director of the Maine Bureau of Health. In April, one person died and 15 others were hospitalized after drinking arsenic-laced coffee at a church in New Sweden, ME. Authorities are still investigating the incident.

"Our response was 100 times better than it would have been two years ago," said Mills.

The Maine Bureau of Health was able to have someone on site within a couple of hours to interview patients. Laboratory renovations purchased with bioterrorism funds allowed them to test quickly and safely for the toxin. Health alerts were sent to hospitals and health providers describing what they needed to know about the poisoning and what to look for in potential cases. The Bureau used Homeland Security funds to purchase antidote drugs and aggressively treat the sick to reduce the chance of long-term complications.

Moreover, health and police officials had developed a relationship through training exercises, which helped them address the poisoning incident–one that became both a public health and a homicide investigation, she said.

SARS Epidemic

Panelist and HSPH professor of health policy and management Robert Blendon observed there is a perception that the CDC has dealt with the SARS threat dramatically better than the anthrax attacks in 2001.

"What are you doing differently?" he asked Henderson. "Obviously the epidemic is different, but there is a sense that you are much more on top [of the SARS threat]. There is a different style of operation."

In both situations, responded Henderson, the agency used the best science to inform decision-making. A difference is improved clarity of roles and efficiency, under the leadership of CDC Director Julie Gerberding. A new emergency operations center at the CDC, intended to help the agency deal with multiple emergencies, has been in use during the SARS crisis. At the center, said Henderson, there is a clear concept of operation and an efficient system for dealing with incoming calls.

Gerberding is committed to communication, said Henderson, and dispersing information about SARS and other public health issues is the responsibility of Von Roebuck, senior public affairs specialist at the CDC. Roebuck described to the Snyder Auditorium audience how the CDC is targeting communication efforts to specific audiences, such as the public, the media, and Congressional offices. The agency is providing press briefings with meaningful information two or three times each week, which builds credibility, he said. The CDC has also developed a risk communication course for state health officers.

The SARS epidemic and the threat of bioterrorism has pointed to the fact that the U.S. is part of a global system, said Leonard Marcus, panelist and co-investigator of H-CPHP. Marcus has traveled to Israel twice in the past seven months to learn about its bioterrorism preparedness efforts. During the second trip, he introduced Henderson and Roebuck to Israeli officials to promote an exchange of information. At the panel discussion, Marcus asked what the CDC is doing to strengthen the global public health infrastructure.

"We’ve never looked at disease as just being a disease of the United States," said Henderson. The CDC fields hundreds of employees around the world, and distance learning technologies have increased the agency’s international presence. Prior to the war in Iraq, for example, CDC officials used video teleconferencing to train doctors in the Middle East on the diagnosis and containment of a potential smallpox attack and on use of the smallpox vaccine.

"We do recognize the global role that [the] CDC plays, and the Department of Health and Human Services, but we need more funds and resources, more attention," said Henderson. "We need a strategic plan."

To watch a webcast of "A Conversation with the CDC," visit http://www.hsph.harvard.edu/cdc/.

--RS