NRF Biological Incident Annex
Last month DHS published four new annexes intended to supplement the not entirely helpful NRF. Now, I’ll admit that I’m not the biggest fan of many DHS publications and helper documents. In fact, I usually count on annexes and appendices to help clarify the morass of lingo-speak and “may’s” and “should’s” and “shall’s” that make up too much of what gets published in preparedness literature. I see them as the sort of reverse Cliff’s Notes, or “how are we going to do all that stuff we just said.” This one, though, by my criteria, is better placed in the body of the document.
I have to confess my prejudices up front. The annex confirms my understanding of the federal government’s role in a biological incident response being next to nil, except when that incident is intentional (read: terroristic) and the FBI takes over. Think I’m being overly dramatic?
State, tribal, territorial, and local governments are primarily responsible for detecting and responding to disease outbreaks and implementing measures to minimize the health, social, and economic consequences of such an outbreak.
Oh, and this, too..
The public health system, starting at the local level, is required to initiate appropriate protective and responsive measures for the affected population, including first responders and other workers engaged in incident-related activities. These measures may include mass vaccination or prophylaxis for populations at risk and populations not already exposed, but who are at risk of exposure from secondary transmission or the environment.
Aside from the Laboratory Response Network (a network of state and local labs that receive guidance and funding from the CDC), the annex describes HHS’ involvement with response as such:
HHS evaluates the incident with its partner organizations and makes recommendations to the appropriate public health and medical authorities regarding the need for [such and such].
The listed objectives that require fulfillment during a biological incident?
- Detect the event through disease surveillance and environmental monitoring.
- Identify and protect the population(s) at risk.
- Determine the source of the disease.
- Assess the public health, law enforcement, and international implications.
- Control and contain any possible epidemic (including providing guidance to State, tribal, territorial, and local public health authorities).
- Augment and surge public health and medical services.
- Identify the cause and prevent the recurrence of any potential resurgence, additional outbreaks, or further spread of disease.
- Assess the extent of residual biological contamination and conduct response, restoration, and recovery actions as necessary.
The first three are the sole dominion of the local, state and tribal health departments. In a disastrous epidemic situation, the CDC will provide ways to share information and may station epidemiologists around the hot zone, but that’s really it. I’ll give you that assessing the public health, law enforcement and interational implications falls squarely under the purview of the federal government, particularly CDC. The next two are where the rubber meets the road. I don’t think they can be done, and nothing I know of (outside the SNS) is a known commodity that the federal government provides to do such a thing. Unless they’ve got hospital beds and nurses stuffed in their back pockets (because the locals surely don’t), then there is no way to surge, there is no way to control an epidemic disaster–even when given guidance to State, tribal, territorial, and local public health authorities. I say this because the annex itself has a section on “Controlling the Epidemic,” and the only part that isn’t the sole responsibility of the states and locals is the risk communication part (which, admittedly, CDC is really good at). The last bullet is really a decon bullet, and that calls for several other ESF’s to take part, it’s an EPA action, basically.
So, out of all of those responsbilities, HHS and CDC function as supporting agencies. And that’s scary because locals and state health departments are completely overwhelmed today-right now-and an epidemic or pandemic situation will literally break that infrastructure. (I still mean to post on the section of the book, The Edge of Disaster, that focuses on the appalling public health infrastructure, I promise)
This is one of those things. We all know it to be true, we know that Agent Johnson isn’t coming on that white horse to save us. It’s just scary to see it incorporated into the nation’s response plan.
Photo credit: CDC PHIL