Public Health Emergency Preparedness Cooperative Agreements (CDC) Hospital Preparedness Program (ASPR - PHSSEF) FY 2017 Labor HHS Appropriations Bill

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1 Public Health Emergency Preparedness Cooperative Agreement (CDC) Hospital Preparedness Program (ASPR - PHSSEF) FY 2017 Labor HHS Appropriations Bill Public Health Emergency Preparedness (CDC) Hospital Preparedness Program (ASPR) FY2015 FY2016* FY2017 President FY2017 TFAH $653,024,000 $660,000,000 $660,000,000 $675,000,000 $254,555,000 $254,555,000 $254,555,000 $300,000,000 *In FY2016, Congress combined the PHEP and All Other State & Local Capacity lines Public Health Emergency Preparedness Cooperative Agreements (CDC) Background: The recent Ebola and Zika outbreaks have demonstrated that we cannot become complacent in the face of public health emergencies. In 2015, state and local health departments responded to crises like the Flint water contamination, extreme weather, wildfires, outbreaks of HIV, measles, Legionnaire s and other infectious diseases, and mass shootings. Each of these required a public health response. The Public Health Emergency Preparedness (PHEP) program at the Centers for Disease Control and Prevention (CDC) is the only federal program that supports the work of health departments to prepare for and respond to all types of disasters, including bioterror attacks, natural disasters, and infectious disease outbreaks. PHEP grants support 62 grantees to develop 15 core public health capabilities, including in the areas of public health laboratory testing, health surveillance and epidemiology, community resilience, countermeasures and mitigation, incident management, information management, and surge management. The grants fund nearly 4,000 state and local public health preparedness staff positions. The funds have supported the development of nearly 75 percent of state, local and territorial electronic disease surveillance systems, 81 percent of the cost to develop the state and local emergency management capability such as local emergency operations centers, and 80 percent of the public health risk communication capability. 1 Impact: Many of the response systems and infrastructure states use to respond to public health emergencies would not exist without PHEP funding. Over the past three years PHEP awardees 1 HHS, FY 2017 CDC Justification of Estimates for Appropriations Committees. 1

2 have improved capacity in nearly all high priority public health preparedness capabilities. 2 The largest investments focused on public health surveillance and epidemiological investigation, laboratory testing, community preparedness, information sharing, and emergency operations coordination. Percentage of PHEP Awardees with Developed Public Health Emergency Response Systems: Before 9/11 and Current Status Primary or Alternate EOC in Place Health Care & Public Health Coordina@on Risk Communica@ons MCM Points of Dispensing Sites Current Status Before 9/11 Source: Centers for Disease Control and Prevention, Division of State and Local Readiness, 2015 In order to help awardees address gaps, CDC works with the jurisdiction on technical assistance plans, including consultation across CDC. CDC has also established a Capacity Building Branch to design systematic approaches and solutions to address commonly occurring gaps that require more broad capacity-building assistance. With the additional funding it received in FY16, CDC plans to allocate a small increase to all awardees and begin implementing recommendations from the PHEP program review including the establishment of a two-year pilot program to promote state and local public health informatics workforce development. Recent accomplishments of the PHEP program include: MERS-CoV Response: Investments from PHEP enabled the Florida Bureau of Public Health Laboratories to test suspected MERS specimens and used the Laboratory Information Management System to report to CDC. The Tampa lab confirmed the second U.S. case of MERS and worked around the clock to test more than 130 additional samples to ensure there was no domestic transmission. Nationally, all Laboratory Response Network Laboratories received emergency use authorization for Ebola and MERS assays to increase preparedness for those diseases. Public health laboratories must meet certain standards to receive PHEP funding. Programs in Georgia, Massachusetts and Indiana also conducted contact tracing of individuals exposed to MERS. Indiana HIV Outbreak: In response to the HIV and hepatitis C outbreaks among people who inject drugs in rural Indiana, the state activated its emergency operations center to investigate and respond. PHEP investments helped the state plan and exercise for such an event, including the Incident Command System structure that was used to coordinate with other state agencies to help identify infected people and connect them care. West Virginia Train Derailment: In 2015, a train derailed and leaked crude oil into the Kanwha River and Armstrong Creek, causing fires, explosions and potentially 2 CDC, 2016 National Snapshot of Public Health Preparedness. 2

3 contaminating the area s water. PHEP funded staff and resources were used in the response, including laboratory testing, the Public Health Alert System to notify staff and provide critical information to residents and hospitals, and emergency operations support. The emergency response helped the health department manage the response and provide clean water and information to 2,000 impacted residents. Montana Oil Spill: The Dawson County (Montana) Health Department relied on PHEPsupported planning, training and exercising to respond to an oil spill into the Yellowstone River, which was the main drinking water source for 6,000 residents. The health department developed a point of dispensing to distribute drinking water, activated an emergency notification system, and conducted extensive community outreach to ensure residents were protected. L.A. Ebola Preparedness: Los Angeles County Department of Public Health credits PHEP with providing the foundation for its Ebola preparation, including supporting the Acute Communicable Disease Control program, expanding testing for high-risk agents and maintaining essential public health services. LA County developed a model of Ebola response that sending dedicated health assessment and specimen collection teams to a suspected patient s home rather than transporting the patient to the hospital, causing less disruption to healthcare delivery and ensuring patient and responder safety. When there was a suspected case, the program coordinated with the patient, local fire and police, emergency medical services, communications, and Ebola treatment center physicians to conduct the in-home assessment, collect specimens, and return laboratory test results within 3 hours. The evaluation serves as a model for future public health responses. Recommendation: TFAH recommends $675 million for the Public Health Emergency Preparedness Cooperative Agreements in FY17. Awardees are currently conducting jurisdictional risk assessments, and the increase would help all jurisdictions address vulnerabilities identified in that process. FY17 funds would also support informatics positions in health departments to support CDC surveillance strategy metrics and advance health information sharing technologies. Hospital Preparedness Program (ASPR) Background: The Hospital Preparedness Program (HPP), administered by the Assistant Secretary for Preparedness and Response (ASPR), provides funding and technical assistance to every state and territory to prepare the health system to respond to and recover from a disaster. HPP is building the capacity of healthcare coalitions (HCCs) - regional collaborations between healthcare organizations, providers, emergency managers, public sector agencies, and other private partners - to meet the disaster healthcare needs of communities. Healthcare coalitions roles include conducting exercises and trainings, providing situational awareness across the system, sharing resources, and leading scenario planning. The grants support nearly 500 healthcare coalitions with 24,000 participating facilities from across the health system, an increase of 47 percent in membership since ASPR supports coalitions to develop key capabilities, including health system preparedness and recovery, emergency operations coordination, information sharing, medical surge and responder safety. HCCs work together to ensure each member has the needed medical equipment, real-time information, communication systems, and personnel to respond to an emergency, resulting in improved response and recovery 3

4 and decreased reliance on federal medical assets during disasters. Most jurisdictions receive no other federal or state support for health system preparedness. Impact: In an impact survey of awardees, ASPR found that HPP support has been critical in helping coalitions develop health system preparedness, ensure health care worker safety, coordinate emergency operations, conduct exercises and training, share information, and build medical surge, but found gaps remain in areas such as health system recovery and crisis standards of care. Ninety percent of the HPP budget goes to state grants, with additional funding supporting technical assistance to state and local communities, the Emergency Care Coordination Center, the Science Healthcare Preparedness Evaluation and Research Branch, advanced registration of healthcare volunteers, the Division of Recovery, and the Critical Infrastructure Protection Branch. Recent events have shown the program s impact: Ebola: During 2014 and 2015, HPP has supported efforts to prepare the healthcare system for Ebola virus, including developing a national strategy and education plan. HPP released guidance, training documents and checklists for health facilities and conducted webinars for healthcare workers. Pennsylvania Train Derailment: During the 2015 Pennsylvania Amtrak derailment, the Pennsylvania Department of Health and regional healthcare coalitions coordinated to ensure coalition members had needed medical equipment and supplies, real-time information, communication systems, and appropriate personnel. HPP-supported systems sent out notifications of emergency room capacity to coalition members within a half hour, tracked and triaged patients, and distributed patients to regional hospitals. 3 Papal Visit: HPP also prepares for major events, such as the Pope s visit to the U.S. The Southeast Pennsylvania Health Care Coalition prepared its hospitals for a potential disaster, for an influx of patients due to visitors to the area, and to continue ongoing operations without disruption. HPP enabled 17 transplants across New Jersey, Delaware and Pennsylvania to occur despite the high profile event. 4 Mississippi Tornado: In 2014, a tornado ripped through rural Winston County, MS, significantly damaging Winston Medical Center, requiring evacuation of 40 hospital patients, 112 nursing home residents and 100 new patients injured by the tornado. Relying on coalition partners and a state-wide, web-based resource tracking tool, hospital personnel and the Mississippi State Department of Health Disaster Team ensured safe transport of patients, including a record of care, to other nearby facilities. 5 HPP appropriations have decreased from $426 million in FY10 to $255 million in FY16, including a $100 million cut one-third in FY14. ASPR s analysis found that funding reductions have resulted in capabilities taking longer to achieve and an inability to sustain the 3 HHS, HPP in Action: Amtrak Train Derailment, Philadelphia, PA. 4 HHS, HPP in Action: Papal Visit Preparations. 5 Mississippi Hospital Preparedness Program press release, Winston: An Emergency Preparedness Success Story. Sept 4,

5 progress that has been made, including in areas such as planning, exercises, planning for at-risk individuals, management of supplies, and preparedness training. Recommendation: TFAH recommends $300 million for FY17 for HPP. FY17 marks the beginning of the new project period, which will shift the focus of the program from supporting establishment of healthcare coalitions to ensuring they are ready to respond to emergencies. 5