The State of Biopreparedness:
Lessons for Leaders, Proposals for Progress

Overview

I would just ask you to think for a minute about the day after a biological attack occurring in Seoul or San Francisco. What is it that we're not doing that we will wish we had been doing that could have prevented that? And what is it that we weren't doing enough of or fast enough or in enough places that could have better prepared us to deal with such an attack?

- Andrew Weber, September 23, 2010

The state of biopreparedness in the U.S. is improving, but many important challenges remain.

Since 2001, federal, state, and local governments and their private sector and NGO partners have collaborated across disciplines to cultivate working relationships and build systems for preparedness, response, and recovery from biological attacks and other public health threats. Experiences with SARS, West Nile virus, hurricanes Katrina and Rita, H5N1 influenza, the 2009 earthquake in Haiti, and the H1N1 pandemic tested U.S. response plans and systems and provided important lessons that have helped strengthen systems and capabilities.

With regard to biodefense specifically, the U.S. has grown stronger in the past 10 years, but there is work that remains to be done in many realms crucial to biopreparedness-including threat assessment, detection and surveillance, countermeasure development and distribution, public health and medical response, and national recovery-all steps in the chain of resilience described by Senator Bob Graham at the conference, The State of Biopreparedness: Lessons from Leaders, Proposals for Progress (Washington, DC; September 23, 2010).

With the support of the Alfred P. Sloan Foundation (conference sponsor), the Center convened this national meeting to provide a forum for thought leaders from the public and private sectors to discuss ongoing challenges and priorities in biopreparedness and identify opportunities for improvement. Read the conference summary report for highlights.

Suggested Background Reading:

• Smallpox-The Death of a Disease: The Inside Story of Eradicating a Worldwide Killer, by D.A. Henderson. Amherst, NY: Prometheus Books; 2009.
• Hospitals Rising to the Challenge: The First Five Years of the U.S. Hospital Preparedness Program and Priorities Going Forward (Evaluation Report, March 2009). Baltimore, MD: Center for Biosecurity of UPMC. Prepared for the U.S. Department of Health and Human Services under Contract #HHSO100200700038C.
• The Next Challenge in Healthcare Preparedness: Catastrophic Health Events (Preparedness Report, January 2010). Baltimore, MD: Center for Biosecurity of UPMC. Prepared for the U.S. Department of Health and Human Services under Contract #HHSO100200700038C.
• Dispensing Medical Countermeasures for Public Health Emergencies: Workshop Summary. Institute of Medicine. Washington, DC: National Academies Press; 2008.
• Executive Order -- Medical Countermeasures Following a Biological Attack [news release]. Washington, DC: Office of the Press Secretary, The White House; December 30, 2009.
• Maximizing State and Local Medical Countermeasure Stockpile Investments Through the Shelf-Life Extension Program. Courtney B, Easton J, Inglesby TV, SooHoo C. Biosecurity and Bioterrorism. 2009;7(1)
• Getting Medicine to Millions: New Strategies for Mass Distribution. Lien O, Maldin B, Franco C, Gronvall GK. Biosecurity and Bioterrorism. 2006;4(2).
• Assessing the Legal Standard of Care in Public Health Emergencies. Hodge Jr. JG, Courtney B. JAMA. 2010;303(4):361-362.
• National Preparedness for a Catastrophic Emergency: Crisis Standards of Care. Gostin LO, Hanfling D.JAMA. 2009;302(21):2365-2366.
• Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report (Summary). Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations, Institute of Medicine. September 24, 2009.
• Draft Planning Guidance for Recovery Following Biological Incidents. U.S. Department of Homeland Security, U.S. Environmental Protection Agency. May 2009.
• Environmental Decontamination Following a Large-Scale Bioterrorism Attack: Federal Progress and Remaining Gaps. Franco C, Bouri N. Biosecurity and Bioterrorism. 2010;8(2).

Agenda

Watch Videos

Welcome and Opening Remarks

Thomas V. Inglesby, CEO and Director, Center for Biosecurity of UPMC

Biodefense—Strengthening the Chain of Resilience
Senator Bob Graham, Former Chairman, Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism; Co-Founder, The WMD Center

DHS Biodefense Programs and Priorities: Now and in the Years Ahead
Alexander Garza, Assistant Secretary for Health Affairs and Chief Medical Officer, DHS; former Director of Military Programs, ER One Institute, Washington Hospital Center

Contrasting Federal and Local Biodefense Views
Richard Falkenrath, Principal, The Chertoff Group; former Deputy Commissioner for Counterterrorism, NYPD; former Deputy Assistant to the President and Deputy Homeland Security Advisor, The White House

Panel Discussion—How Prepared Is the Nation to Dispense Medical Countermeasures Rapidly to Large Populations?

• Brooke Courtney, Associate, Center for Biosecurity of UPMC, Moderator
• Greg Burel, Director, Division of Strategic National Stockpile, U.S. Centers for Disease Control and Prevention (CDC)
• Michelle Larson, Supervisor, Resource Management and Tracking Unit, Minnesota Department of Health
• David Starr, Director, Countermeasures and Response Unit, Office of Emergency Preparedness and Response, New York City Department of Health and Mental Hygiene

The United Kingdom Strategy for Biodefense
John Tesh, Deputy Director, Capabilities, UK Civil Contingencies Secretariat

Panel Discussion—Crisis Standards of Care: How Can We Save the Most Lives and Limit Suffering in a Catastrophic Disaster?

• Eric Toner, Senior Associate, Center for Biosecurity of UPMC, Moderator
• Dan Hanfling, Special Advisor, Emergency Preparedness and Response, Inova Health System; Clinical Professor, Department of Emergency Medicine, George Washington University
• James G. Hodge, Jr, Lincoln Professor of Health Law and Ethics, Sandra Day O'Connor College of Law and Fellow, Center for the Study of Law, Science and Technology, Arizona State University

Presentation by Kathleen Sebelius, Secretary, Department of Health and Human Services

Panel Discussion—Preparing to Decontaminate After an Anthrax Attack: What Are the Important Steps Ahead?

• Crystal Franco, Associate, Center for Biosecurity of UPMC, Moderator
• Peter Jutro, Deputy Director for Science and Policy, National Homeland Security Research Center, Environmental Protection Agency
• Joseph Donovan, Senior Vice President, Beacon Capital Partners; Building Owners and Managers (BOMA) National Preparedness Committee

DoD Biodefense Challenges and Accomplishments
Andrew C. Weber, Assistant to Secretary of Defense for Nuclear and Chemical and Biological Defense Programs, DoD

White House Views on Biopreparedness
Richard Hatchett, Director for Medical Preparedness Policy, White House National Security Staff (off the record)

Concluding Remarks
Thomas V. Inglesby, CEO and Director, Center for Biosecurity of UPMC

Speakers
 

Greg Burel

Director, Division of Strategic National Stockpile, U.S. Centers for Disease Control and Prevention (CDC)
 

Anita Cicero, JD

COO and Deputy Director, Center for Biosecurity of UPMC
 

Brooke Courtney, JD, MPH

Associate, Center for Biosecurity of UPMC
 

Joseph Donovan

Senior Vice President, Beacon Capital Partners; Building Owners and Managers (BOMA) National Preparedness Committee
 

Richard Falkenrath, PhD

Principal, The Chertoff Group; former Deputy Commissioner for Counterterrorism, New York City Police Department; former Deputy Assistant to the President and Deputy Homeland Security Advisor, The White House
 

Crystal Franco, MPH

Associate, Center for Biosecurity of UPMC, Moderator
 

Alexander Garza, MD, MPH

Assistant Secretary for Health Affairs and Chief Medical Officer, DHS; former Director of Military Programs, ER One Institute, Washington Hospital Center
 

Senator Bob Graham

Former Chairman, Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism; Co-Founder, The WMD Center
 

Dan Hanfling, MD

Special Advisor, Emergency Preparedness and Response, Inova Health System; Clinical Professor, Department of Emergency Medicine, George Washington University
 

Richard Hatchett, MD

Director for Medical Preparedness Policy, White House National Security Staff
 

James G. Hodge Jr., JD, LLM

Lincoln Professor of Health Law and Ethics, Sandra Day O'Connor College of Law and Fellow, Center for the Study of Law, Science and Technology, Arizona State University
 

Thomas Inglesby, MD

Chief Executive Officer and Director, Center for Biosecurity of UPMC
 

Peter Jutro, PhD

Deputy Director for Science and Policy, National Homeland Security Research Center, Environmental Protection Agency
 

Michelle Larson, MPA

Supervisor, Resource Management and Tracking Unit, Minnesota Department of Health
 

Kathleen Sebelius, MPA

Secretary, Department of Health and Human Services
 

David Starr, MIA

Director, Countermeasures and Response Unit, Office of Emergency Preparedness and Response, New York City Department of Health and Mental Hygiene
 

John Tesh

Deputy Director, Capabilities, UK Civil Contingencies Secretariat
 

Eric Toner, MD

Senior Associate, Center for Biosecurity of UPMC, Moderator
 

Andrew C. Weber, MS

Assistant Secretary of Defense for Nuclear, Chemical, and Biological Defense Programs, DoD
 

Attendees