The Office of the Assistant Secretary for Preparedness and Response (ASPR) led the development of the National Health Security Review (NHSR) which describes progress that the nation has made—and its persistent challenges—in strengthening national health security over the past four years. The NHSR 2010-2014 uses the strategic objectives and priorities described in the National Health Security Strategy 2010-2014
and the NHSS Implementation Plan 2012-2014
as the standards for evaluation. The NHSR findings informed development of National Health Security Strategy and Implementation Plan 2015-2018.
Overarching Findings of NHSR
The inaugural NHSS 2010-2014 set forth two goals for national health security: 1) Build community resilience; and 2) strengthen and sustain health and emergency response systems. Since 2010, progress has been made in achieving both of these goals. The greatest improvement has been seen in these areas:
- Integration of public health, healthcare and emergency management systems
- Planning at the federal, state, and local levels
- Building national health security workforce capabilities, including development of core competencies for the disaster medicine and public health workforces and competency-based training courses
- Coordination within government and between government and the private sector, through such means as the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE)
- Strengthening community resilience, including a national policy focus on informed and empowered individuals and communities
Summary of Progress on the Cooperative Agreements: Hospital Preparedness Program and Public Health Emergency Preparedness
The Hospital Preparedness Program (HPP) and Public Health Emergency Preparedness (PHEP) and the HPP cooperative agreements, administered by HHS’ Centers for Disease Control and Prevention (CDC) and the Office of the Assistant Secretary for Preparedness and Response (ASPR), respectively, are key federal investments in national health security and have catalyzed progress. The programs provide both financial and technical support to states, territories, and major metropolitan areas to strengthen public health and medical response systems and enhance community preparedness.
An important strength of the programs has been their adaptability. In place since 2002, they have continually evolved as needs have changed and the evidence base for national health security has increased. Since 2009, the programs have improved in several areas described below.
- Program Alignment: in 2012 following alignment of the two programs, HPP and PHEP awarded grants jointly for the first time, encouraging cooperation between health care and public health systems while increasing efficiency in grant administration, technical assistance, and data management.
- Technical Assistance: both programs have launched initiatives to help awardees improve, measure and sustain progress toward achieving national health security capabilities.
- Capability Development: public health preparedness and health care preparedness capabilities were developed and in alignment with the National Response Framework core capabilities. Awardees are required to assess their annual progress toward achieving and enhancing health security capabilities.
- Measure Development and Deployment: the suite of program measures has evolved and matured over time moving from a focus on capacities to a greater focus on capabilities, providing information on a community’s ability to carry out specific disaster-related activities.
Summary of Progress by NHSS 2010-2014 Strategic Objectives
Objective 1: Foster Informed, Empowered Individuals and Communities. There has been an increased policy focus on informed and empowered individuals and communities, and many efforts demonstrate broader community engagement and improved stakeholder uptake of crucial preparedness information. Community resilience is now widely understood to be a central organizing element for national health security and has been incorporated into programs, policies, and planning at all levels.
Objective 2: Develop and Maintain the Workforce Needed for National Health Security. Progress has been made in identifying core competencies for the disaster medicine and public health workforce, developing and delivering competency-based training courses, and quantifying the number of staff and volunteers available. The number of volunteers has increased with more than 200,000 volunteers in Medical Reserve Corps (MRC) unites and over 260,000 in the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP).
Objective 3: Ensure Situational Awareness. Ongoing efforts have helped clarify key definitions and concepts, including distinguishing situational awareness from biosurveillance for human health. The ability to provide strategic warning has improved, and systems for fostering situational awareness have proven successful in several major incidents. Laboratory capability has also increased. Between 2009 and 2011, more than 90% of Laboratory Response Network (LRN) laboratories passed proficiency testing in identifying biological agents. In 2012, laboratory surge capacity in the event of an attack on the food supply achieved target goals of 2,500 radiological and 2,100 chemical samples per week.
Objective 4: Foster Integrated, Scalable Healthcare Delivery Systems. Healthcare organizations have become better integrated with community medical, public health, behavioral health, human services, emergency management, public safety, and other organizations. Regional planning alliances and healthcare coalitions have proliferated, and many have conducted training together. Guidance, tools, and templates have been developed to strengthen surge capacity and to help states and localities establish crisis standards of care.
Objective 5: Ensuring Timely and Effective Communications.
New platforms for communication between government and the public during incidents are being created, and the use of social media and mobile applications by state and local public health departments has grown. The Integrated Public Alert and Warning System (IPAWS)
now covers most of the United States, and many states have developed communication interoperability plans.
Objective 6: Promote an Effective Countermeasures Enterprise.
The Public Health Emergency Medical Countermeasures Enterprise (PHEMCE)
guides coordination among government agencies and between the governmental and private sectors. The federal government has made substantial investments in medical countermeasure (MCM) advanced research, development, and procurement, and MCM coverage is being expanded to better protect children, pregnant women, and other at-risk individuals. States and localities have improved their ability to receive, distribute, and dispense MCMs. Federal investments in MCM development have resulted in new MCMs, new uses for existing MCMs, and the development of several entirely new, FDA-approved drugs with biodefense, CBRN, and infectious disease applications.
Federal investments in MCM development have resulted in new MCMs, new uses for existing MCMs, and the development of several entirely new, FDA-approved drugs with biodefense, CBRN, and infectious disease applications. For example, FDA approved an anthrax antitoxin, developed with Project BioShield support, in 2012 and a new antitoxin for botulism in 2013. The Project BioShield Act, enacted in 2004, authorizes expedited procurement, streamlined personnel appointments, expedited peer review, biomedical countermeasures procurement, emergency use of medical countermeasures, and other biodefense activities
Objective 7: Ensure Prevention or Mitigation of Environmental and Other Emerging Threats to Health.
Surveillance, laboratory, and risk assessment capabilities have advanced. Multiple efforts have been made to improve food safety, decrease antimicrobial resistance, and control and mitigate zoonoses. The release of an Executive Order and National Strategy on Combating Antibiotic-Resistant Bacteria
by the White House in 2014 identifies combating the rise of antibiotic resistance as a top national security and public health priority. The strategy outlines priorities and coordinates investments to prevent, detect, and control outbreaks of resistant pathogens recognized by CDC as urgent or serious threats
Objective 8: Incorporate Post-Incident Health Recovery into Planning and Response. The federal government has incorporated recovery into national policy and doctrine, and agencies have expanded their capacity to provide technical assistance. Humanitarian agencies such as the American Red Cross continue to play an essential role in recovery. Organizations are increasingly supporting research in this area, to include several which are currently conducting research on incident recovery and advance science preparedness following Superstorm Sandy.
Objective 9: Work with Cross-Border and Global Partners to Enhance National, Continental, and Global Health Security.
Federal agencies have strengthened interagency coordination, communication, and collaboration, and the U.S. government is reporting compliance with the World Health Organization’s (WHO) International Health Regulations (IHR 2005) and working with global partners to help other countries build their core capacities. To accelerate progress toward global health security, the United States, working with at least 30 partner countries, launched the Global Health Security Agenda
Objective 10: Ensure that All Systems that Support National Health Security Are Based on the Best Available Science, Evaluation, and Quality Improvement Methods. Both governmental and nongovernmental stakeholders are improving the evidence base for national health security by promoting research. Multiple sectors have collaborated to develop prioritized research agendas and improve the evidence base for national health security. .
Persistent Challenges Identified by NHSR
Despite the nation’s progress toward achieving health security, numerous challenges remain:
- Reductions in the resources available to improve health security, particularly in workforce and practice-based research, threaten the sustainability of progress
- Engaging and coordinating the full range of stakeholders, especially non-federal stakeholders, in national health security can be challenging
- The science of evaluation in national health security is still relatively new; therefore, the nation’s ability to use quantitative data to objectively assess progress and identify barriers and facilitators is limited
By statute, a review of progress towards achieving national health security as well as remaining challenges is due to Congress every four years. The next NHSR will be developed in 2017. However, progress will be reviewed on an annual basis that involves collecting, analyzing and integrating both qualitative and quantitative data and information from available sources, such as the National Health Security Preparedness Index, Trust for America’s Health reports, the National Snapshot of Public Health Preparedness, and HPP and PHEP performance measures.