1. Central Asia Regional Health Security Workshop George C. Marshall European Center for Security Studies 17-19 April 2012, Garmisch-Partenkirchen, Germany Sharon I. Peyus and Robert C. Hutchinson Homeland Security Investigations U.S. Immigration and Customs Enforcement U.S. Department of Homeland Security 17 April 2012 Options for Preventing Disease Transmission at Borders – What Works and What Does Not?

2. Introduction National Strategy Options –Containment –Resilience What Works What Does Not Work Issues for Consideration Lessons Learned –Full Scale Exercise conducted at the Miami International Airport, Miami, Florida USA

3. Containment vs. Resilience Resilience –Is resilience politically acceptable? –Is resilience a socially acceptable concept? –Can resilience be achieved with education and support? Containment –Is containment a viable option for your resources? –Is containment politically acceptable? –Is containment realistic?

4. Strategy Considerations –Detecting threat –Screening –Stopping or slowing entry of threat –Quarantine and isolation –Treatment –Monitoring –Challenges Expected to delay entry of threat for minimal amount of time Human and civil rights considerations Trade and economic considerations Realistic expectations Containment Model

5. Resilience Model Strategy Considerations –Detecting threat –Screening –Acceptance of entry –Quarantine and isolation –Treatment –Monitoring –Challenges Clear explanation of public responsibilities and governmental capabilities for preparedness and response Information sharing and planning Leadership

6. Border Control Planning Efforts Border Environments and Their Challenges –Marine border and seaport –Land border –Airport Authorities and Agreements –To deny entry –To detain, quarantine, or isolate –To arrest –To deport –Options when deportation is refused –Use of force

7. Border Control (cont’d) Border Options –Surveillance –Restriction –Partial closure –Full closure Capabilities to Enforce Options –Authorities –Staffing and resources –Medical resources –Surge capacity –Cost and benefits for each option

8. What Works… Prior investment in pandemic preparedness Strengthening policies All hazards approach Surveillance activities Logistics

9. What Works (cont’d) Close cooperation and collaboration with all stakeholders –Public / Private sectors –Non-governmental organizations –Whole of Society –Foreign neighbors Prevention and mitigation measures (information to mitigate the impact) –Non-pharmaceutical measures (hand washing, social distancing, school closures, stockpiling of personal protective equipment)

10. What Does Not Work… Closing borders Inaccurate / inconsistent messaging Lack of multi-sector preparedness, planning and testing Lack of community based involvement and cross- border cooperation

11. What Does Not …(cont’d) Lack of support from senior leaders No vision for long-term capacity building (improved health care programs, education programs, community development) Lack of investment / resources No continuity planning

12. H1N1 Border Activities Referring symptomatic persons to a Centers for Disease Control and Prevention (CDC) quarantine station or local public health official for evaluation No closure of the United States / Mexico border –Scientific evidence did not support as an effective means of controlling the spread –Resource intensive –Disruption of trade and economic interests Monitoring incoming travelers at ports of entry Providing information about disease control measures

13. Considerations Previous pandemic threats and health issues have proven difficult to control in a global economy The speed and ease of travel often reduces the ability to identify and mitigate a threat Social, economic and political considerations can affect or reduce policy and strategic options

14. Considerations (cont’d) Now is the time to develop realistic and flexible strategies and plans that take into consideration the points identified Understand that few strategies and plans fully survive their first encounter with any quickly evolving threat / event

15. Full Scale Exercise Miami International Airport Miami, Florida USA Lessons Learned Part 1

16. Miami International Airport Passengers: 38,314,389 –International: 18,417,513 –Domestic: 19,896,876 Freight Tons: 2,000,042 Mail Tons: 30,750 Busiest U.S. airport for cargo 10 th busiest airport for cargo in the world Freight Forwarders: 1,000 Customs Brokers: 250 Economic Impact: $26.7 Billion

17. Exercise in Airport Environment Exercise focused on influenza like symptoms reported on an inbound international flight by the airline Airport utilized thermal imaging and questionnaires for compliant passengers Several symptomatic passengers were referred for additional screening Personnel from several agencies worked well together

18. Lessons Learned Additional resources would be required, but limited in the best of times from federal, state and local partners Screening with sufficient staffing works Several large aircraft would quickly overwhelm resources

19. Lessons Learned (cont’d) Challenges for containment of passengers The current clearance process was not designed for the inclusion of public health screening Response depended on no other competing challenges or reduced staffing due to illness or health concerns

20. Questions? Questions

21. Sharon I. Peyus (Former) Director National Incident Response Unit speyus@ice.dhs.gov (202) 732-0331 Robert C. Hutchinson Assistant Special Agent in Charge Homeland Security Investigations rchutchi@ice.dhs.gov (305) 597-6034 Thank You

22. References Congressional Research Service, The 2009 Influenza Pandemic: An Overview, August 6, 2009. Available at www.crs.govwww.crs.gov Congressional Research Service, The 2009 Influenza Pandemic: Selected Legal Issues, R40560, October 29, 2009. Available at www.crs.gov www.crs.gov Congressional Research Service, Immigration Policies and Issues on Health-Related Grounds for Exclusion, Report R40570, January 6, 2011. Available at www.crs.govwww.crs.gov Homeland Security Council, National Strategy for Pandemic Influenza Implementation Plan, May 2006 Homeland Security Council, National Strategy for Pandemic Influenza, November 2005