Public Health Emergency - Leading a Nation Prepared
In addition to seasonal influenza, which causes 290,000-650,000 deaths worldwide annually, influenza viruses with pandemic potential are of global concern. Pandemic strains of influenza emerge unpredictably and can cause even more extensive morbidity and mortality than seasonal strains. Influenza vaccines limit morbidity and mortality; however, changes in circulating viruses require that vaccines be formulated and administered annually, and do not convey protection against emerging subtypes. On September 19, 2019, the White House issued
Executive Order 13887 on Modernizing Influenza Vaccines in the United States to Promote National Security and Public Health. HHS—through efforts across Biomedical Advanced Research and Development Authority (BARDA), a component of ASPR; CDC; NIH; and the Food and Drug Administration (FDA)—has prioritized the development of rapidly available influenza vaccines that offer greater protection. This work is complex and requires cutting-edge science and an iterative, multi-year interagency process.
For example, the National Institute of Allergy and Infectious Diseases (NIAID), which is a component of NIH, leads HHS’s work in developing a universal influenza vaccine that would eventually protect against all influenza viruses and launched the first clinical trial of a universal vaccine candidate. CDC’s systems provide the scientific basis for vaccine virus selection for each year’s seasonal influenza vaccine, as well as for pandemic influenza vaccine stockpiling.
In addition to vaccines, antiviral drugs are available for prophylaxis and treatment of influenza infection. The federal government supports research on anti-influenza therapies to reduce the human costs of seasonal influenza epidemics, to mitigate potential influenza pandemics before vaccines can be developed and made available, and to increase the public’s access to antiviral drugs.
To safeguard people in America from seasonal and pandemic influenza, HHS agencies have madeprogress in influenza treatment and prevention:
From 2016 through 2018, a large, multistate outbreak of hepatitis A swept the United States. Hepatitis A is a vaccine-preventable, contagious liver disease that is usually contracted by consuming contaminated food or water. By November 2018, Michigan alone had seen 907 cases, 728 hospitalizations, and 28 deaths.
To combat this outbreak, health department staff funded by CDC’s Public Health Emergency Preparedness (PHEP) program worked with state communicable disease and immunization programs to decrease the amount of time to report new cases, conduct public health follow-up investigations, and provide public information. The immunization programs of local health departments increased vaccination outreach and, as of November 2018, provided more than 250,000 doses of hepatitis A vaccine in areas affected by the outbreak. To prepare for and support these activities, Michigan uses PHEP funds for a community health emergency coordination center, which enables coordination of efforts among multiple program areas across the department. When an emergency occurs, the pre-established relationships between preparedness staff and experts who provide services to high-risk populations allow more rapid response to incidents.
All of these activities, made possible through years of building preparedness capacity and partnerships with program areas, have positive outcomes. Michigan, for example, has reported a consistent decline in the number of new cases each month since December 2017, demonstrating the utility of PHEP support across yet another response/public health event.
Led by the NSC staff, the Department of State (DOS), HHS, DHS, DOD, and the Department of Transportation coordinated the adoption of a Federal Aero-Medical Evacuation Notification protocol, identifying roles and responsibilities to coordinate evacuation of U.S. citizens and other specified individuals, who have been exposed to or infected by a HPID, to appropriate treatment facilities within the United States from both overseas and within the United States. The protocol addresses federal coordination with SLTT public health officials. In addition, DOS coordinates with DOD on acceptance of an upgraded Generation 2 Containerized Bio-Containment System to improve biosecurity and safety during the aeromedical evacuation of such patients and to mitigate the risk to responders from HPID outbreaks.
DOD has also performed the first in-human testing of the now FDA-licensed vaccine used in the Democratic Republic of the Congo (DRC) Ebola outbreaks, in which, as of 2019 more than 90,000 people have been vaccinated. DOD also performed significant numbers of preclinical/animal studies with Ebola virus to evaluate trial samples for this vaccine across the globe. Additionally, DOD implemented its Agile Medical Paradigm strategic framework to optimize MCM delivery by including policy and technology-based solutions to address the root causes of MCM development inefficiencies, as well as indicators for assessing solution execution progress.
Overall, DOD’s investment and broad portfolio in global health and infectious disease research, including contributions to combating AMR, provided foundational information, infrastructure, and subject matter expert and partnership networks to rapidly respond to unanticipated biothreats and protect Americans from the dangers that these biothreats pose.
The EPA has a primary role in providing emergency response for natural, accidental, and intentional incidents. For certain bioincidents, EPA assists in determining the extent of contamination and risk-based cleanup levels, decontamination, and waste management, as seen following the attacks on 9/11.
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