Public Health Emergency - Leading a Nation Prepared
Remarks Facilitated by Cicely Waters, Director - Office of External Affairs, Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services
>> CICELY WATERS: Thank you, Gary, and our Panel 5 participants. So throughout the course of the day, we have heard some common themes and we have also considered some cross-cutting themes that should be considered when developing the implementation plan for each of the five priorities in the strategy. Some of these cross-cutting themes have been things like pediatric considerations, communications, information sharing.
What we would like to do now is to ask for your feedback for the record. Not necessarily take questions. But receive your feedback for the record on any cross-cutting themes that you think should be considered when developing the implementation plan for the strategy itself but in particular when we focus on each of the five priorities.
So we welcome those of you here in the room as well as those who are joining us via webcast to give us your thoughts on may of those cross-cutting themes we should consider when developing the strategy.
>> MONICA VADARI: Hi, Monica Vadari [phonetic], NASA Goddard Space Flight Center. First of all I want to say I'm not representing NASA. I'm a private citizen here. So thank you, everyone, all of the panelists who were speaking. This has been really awesome. And I did come here after lunch so I apologize if this was already talked about. But there's been no mention that I've seen of the space sector. And when we're talking about, you know, Space Policy Directives 1 through 4 and going to the moon in five years and the commercialization of lower earth orbit, tourism, all of that stuff, there's so much that goes into that. And it kind of opens up this whole new world of biothreats and bioterrorism. Especially talking about contamination in a closed system. So the ISS, the gateway, lunar habitats and stuff like that. No one has really kind of talked about that and no one has really kind of brought up the public and private space sector. So I just wanted to bring that up and make sure that we're talking about that when we talk about biodefense. We can't implement a biodefense policy without thinking about what that means for space. It's not a long-term thing. Like we have talked about going in the next five years. Especially when we do space policy, we have to talk about biodefense and ensure we're monitoring contamination. And when we talk about tourism in space that we're monitoring all of that, as well. So thank you.
>> CICELY WATERS: Thank you. We appreciate that feedback.
>> CASSIE CONLEY: Actually I did address that. So thank you very much for bringing it up again. Again, astrobiologist at NASA, Cassie Conley. The one area that I wanted to emphasize that was a cross-cutting theme and in fact is also relevant to the previous comments is the importance of acting internationally. This is not going -- a major response is not going to be a U.S.-only problem. It's been raised multiple times. But it really needs to be emphasized I think that we have to coordinate effectively with our global partners, both the countries that we normally coordinate with and also the ones that we don't. Because if there's an objection from a country that doesn't normally talk to us about something that's going on, that could potentially create international incidents of the kind that we really don't want to have happen.
>> CICELY WATERS: Certainly. Thank you.
>> GERRY PARKER: Gerry Parker from Texas A&M. And I just echo that last comment. And one thing I am seeing not really crystal clear how it's coming together is make some of the international development and how we redefine biodefense and maybe the global health security world and international development and this strategy. So I think that's something to consider as you take this on and really it's just echoing the last comment.
And then the other thing, it's really not a technical cross-cutting theme. But maybe a process thing to consider. So I've seen a lot of strategies, a lot of implementations planned, some of them work well, some of them, hmmm, well, maybe not quite so well. But I just offer one that I think worked well. And that was back in the '06 timeframe when there was an emergency supplemental for pan flu was the first one. So that gave you a unified budget. I haven't figured out how to do the unified budget for biodefense but that gave you a unified budget. But then there was a very detailed, I mean very detailed, implementation plan. That included 300 plus action items. Clearly identified who was in charge. What was support. Or who was lead and who was support as far as department agencies. Then there was metrics, milestones, outcomes.
And we were all held accountable for that. And a lot of my colleagues didn't like it. They thought it was White House micromanagement. You know, on and on and on.
But there was a lot accomplished because we had that very detailed and we were held accountable. The whole community. Not just the Federal Government. But at the Federal, state, local, tribal, private sector, NGO, we were an enterprise and we were held accountable so I just offer that as something to consider in what to look at at what has worked well and not so well in implementation plans. And the strategy is great. It's great to have a comprehensive strategy. It's great to have biodefense holistically, comprehensively defined. It's great. Now we got to do the hard work.
>> CICELY WATERS: Absolutely. Thank you.
>> KAVITA BERGER: Hi, I'm Kavita Berger from Gryphon Scientific. I just want to make a few comments one is to go back to something that was said at the beginning of the day which was that this is a whole society issue. We talked a lot about what the Government can do, what the public health sectors can do. But we also have the academic sectors, the industry. We have now community labs and people getting involved through crowd -- Kickstarter and others that are crowd funding sources. So this entire landscape that we find ourselves in potentially is a lot bigger than what we found ourselves to when we think about only the agents that we have spent a lot of time focusing on.
So if the idea is to broaden to different sectors, I would argue that we should really try and think about how best to do that and how to make them partners in the whole effort. Not just people who follow rules or whatever.
And part of that is also the scientific community. I think Nicolette mentioned it at the very end. But there's more than just national scientists. We have engineers. We've got social scientists. Part of what we learned through ebola was through cultural anthropology and other social science fields. Behavior and social energy and all of those fields can play a major role in being able to implement and really see a lot of the strategy, the objectives, be followed through.
And I guess just two more very quick comments. One is on emerging biotech. We tend to get really scared of it. And we tend to use it for defensive means. What capabilities can we afford? But if it's used in another means, then we're all all of a sudden really scared. We should really be proactive and think through what that bioeconomy looks like, think through what the emerging tech looks like. Think through what are things we don't need to worry about right now or even in the near future. And things we probably want to spend a little bit more time focusing on.
Regardless of whether it touches a pathogen or a toxin. And I have now forgotten my last one so thank you.
>> CICELY WATERS: Thank you.
>> CHRIS FRECH: Hi, good afternoon, Chris Frech with Emergent BioSolutions and Co-Chair for the Alliance for Biosecurity. And certainly coming from the business side of the public-private partnership on the measurement development and manufacturing piece, there's certainly a need for certainty and clarity as well as early engagement and communication in developing the strategies in terms of how we both develop as well as stockpile and maintain these countermeasures in terms of preparedness and response.
>> CICELY WATERS: Thank you.
>> FEMALE SPEAKER: So I totally agree onto think internationally as was mentioned. But to also to act locally. Delivery is common to each of those goals we have. Local delivery. To get that last mile. To those individuals on the local side. So that's very important.
And part of that is education, which is common to all. And communication. And the fine balance of the social media that can be used for good or bad. And I think those are common to all of those groups.
>> CICELY WATERS: Thank you for your feedback.
>> HONGDA CHEN: Hongda Chen from USDA National Institute of Food and Agriculture. First of all, I commend to the organizers in putting this wonderful session together and the greater discussion panel presentation exchange with the audience.
And now it's towards the end of the day. And I thought that there may be a deficiency in coverage from what I heard today and that is to -- it's the recognition of a broader spectrum of vulnerability in the entire food system. I'm so glad to see that the audience and then the panel recognized the importance for agriculture and the foods. The coverage on the animal production industry and the plant production.
However, the -- at the farm gate, that's not the end of the supply chain. There are many, many vulnerable points from the farm gate to consumer. And hence, I see the engagement of the food industry and the whole spectrum, retailer, market, consumption, home, all of these are important aspects in the biodefense. And I didn't hear that today.
And so I make this suggestion for the consideration. Maybe it's already covered and I just didn't hear it. Thank you.
>> COREY MEYER: Hi I'm Corey Meyer from Gryphon Scientific. One of the cross-cutting capabilities that I didn't hear discussed too much today is biosurveillance so this capability is relevant to basically all of the goals, risk assessment, early detection of outbreaks, during a response to track progress. We have a lot of biosurveillance systems in the U.S. and internationally operating at many different levels. Some have specific functions. Some have multiple functions. Some talk to each other. Some don't.
So given that complex biosurveillance landscape, just I think it will take some careful thought to think about how to optimize the use of the systems and expand them across the full risk assessment, prevent, detect, respond, recovery perspective to achieve the goals of the strategy.
>> MALE SPEAKER: Capitalization, sustainability. I'm almost 60. I'm worn out.
>> MALE SPEAKER: My colleagues are worn out. Venture Capital Community finds vouchers to be uncompelling. Be and we hoped so much that they were going to make a difference.
The industry, my clients, look at this sector. And they say, you've got to be kidding. You know.
I can see this boom-bust cycle is -- it's destructive. If you build -- if you try to build a business and a business plan or an ADM, and it runs for three to five years. And you put your heart and soul into it. And you got a great big facility. And you put all of this great thinking and have done all of this cool innovation. And then you have to sell it off to a Japanese company because you can't sustain it, how is that helping anybody? And then they take it and they go and do small job flexible manufacturing. You know it's no longer available for the Government. It's now been offshored basically. I mean this is just one case study.
The landscape is full of skeletons. The valley of death here, I don't know that we have made it better. Maybe we have made it worse. There's a lot of aversion to touching this sector now. Because of these boom-bust cycles.
And when I read this plan, I said, oh, that's lovely. Interesting they are kicking up defense now to a higher level. I'm not quite sure how that's going to work that we're going to make it at that level.
That didn't sound to me like a recipe for effective decision making. But that's just me.
But I didn't see anything about capitalization sustainability. And as somebody who has been in all of these sectors, academic, Government, NGOs, I look at this and I go, another set of words that are lovely words, I'm glad to see them finally here. But where is the beef?
So that's kind of I think a lot of my colleagues look at this and until we see capitalization and sustainability addressed, there's going to be a lot of wariness to touching this again. Because too many people have been burned.
Now, Emergent is a great case study. Emergent has a cash cow. Because that vaccine half lifes out and it's got to be reupped. It's got to be restocked and they get a nice chunk of change every few years because they have to refill the stockpile. So it's sustainable.
But for most of us, we don't have that. And now look what happens. Emergent is able to pick up all kinds of, you know, the wounded at a bargain rate because they are the only ones kind of left standing with the capitalist load.
So until we figure out a way to do this and vouchers and these kinds of incentives, the investment community doesn't find it that compelling. So that's my cross-cutting. Thank you for listening.
>> CICELY WATERS: We appreciate that. Thank you.
>> MALE SPEAKER: I would just like to reiterate what two previous speakers said about behavior change, education, and I think that's -- I'm hearing that all through today across the themes, this importance of people to understand the seriousness of this. People aren't willing to invest in this. People aren't blah blah blah.
So I don't know if we call that SBC, social and behavioral change. Maybe that upsets people. Maybe education is more palatable. But whatever we call it, I think across those themes if there's intentional effort made with some milestones about how do we get that message out. And maybe I think there's an interagent -- I don't work for the Federal Government. There's an interagency group that's actually looking at modeling and behavior change related to health and pandemics. Maybe that's an easy first start to charge that interagency group with exploring applications and the private sector. I know Coca-Cola is really good at getting me stimulated to buy something I don't really need.
So -- well, maybe that wasn't fair. I mean, I love Coke. But they got me to think that. So I think in that private sector there's some -- there's communication skills that could be brought to bear in getting the messaging out. And then curriculum development for elementary school, for secondary, primary. So we get -- 10 years from now, 15 years from now, adults will all be thinking the way we're talking about thinking now. And that's more of a long-term strategy. But those are things to start with now about free curriculum that school teachers can use. To not scare kids.
>> CICELY WATERS: Absolutely.
>> MALE SPEAKER: But to get them comfortable being prepared. How to prevent. What to do in responding. Just some ideas.
>> CICELY WATERS: Absolutely agree. Thank you.
>> NEIL WALLEN: Neil Wallen from the National Strategic Research Institute. One of the thoughts I've had as we have been discussing the various stages and the various grouping of questions was Weick and Sutcliffe's work on high reliability organizations? And I think the five elements that they have identified that make organizations strong, able to meet the challenges and resilient when they are faced with high risk are some elements that we should really look at as we move from just a Biodefense Strategy to the implementation of that. So I throw that out as a recommendation. I think it fits in every sector of what we have talked about today. And again, that's the five elements of the high reliability organization. And Weick and Sutcliffe's work I think is phenomenal in that are.
>> CICELY WATERS: Thank you for that.
Thank you, all. And we certainly appreciate your attention, your feedback throughout the course of today. Because that is what this meeting was all about.
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