1. Enter Title of Presentation on Master Slide 1 Department of Health and Human Services (DHHS) Overview of FY04 DHHS Cooperative Agreements on Public Health (CDC) and Hospital (HRSA) Emergency Preparedness and Response William Raub, PhD Principal Deputy Assistant Secretary Office of Public Health Emergency Preparedness 14 January 2005

2. Enter Title of Presentation on Master Slide 2 Office of Public Health Emergency Preparedness (OPHEP)  To ensure sustained public health and medical readiness for our communities and our nation against: Bioterrorism Other Infectious disease outbreaks Other public health threats and emergencies Goal

3. Enter Title of Presentation on Master Slide 3 CDC Cooperative Agreements for Public Health Emergency Preparedness and Response CDC Focus Areas  Preparedness Planning/Readiness Assessment  Surveillance and Epidemiological Capacity  Biological Laboratory Capacity  Chemical Laboratory Capacity  Communications and Information Technology  Risk Communication  Education and Training

4. Enter Title of Presentation on Master Slide 4 CDC Cooperative Agreements for Public Health Emergency Preparedness and Response CDC Funding History Allocations since September 11, 2001:  FY02 ~ $949.70 million  FY03 ~ $1.04 billion  FY04 ~ $849.59 million  FY02-04 total ~ $2.84 billion

5. Enter Title of Presentation on Master Slide 5 HRSA Cooperative Agreements for Hospital Emergency Preparedness and Response. HRSA Priority Areas Regional Hospital Surge Capacity Beds, Personnel, Equipment Isolation capacity Mental health services Trauma/burn care Emergency Medical Services Linkages to Public Health Hospital Laboratories Surveillance & Patient Tracking Education and Preparedness Training Exercises

6. Enter Title of Presentation on Master Slide 6 HRSA Cooperative Agreements for Hospital Emergency Preparedness and Response HRSA Funding History Allocations since September 11, 2001:  FY02 ~ $125 million  FY03 ~ $498 million  FY04 ~ $498.00 million  FY02-04 total ~ $1.121 billion

7. Enter Title of Presentation on Master Slide 7 Public Health and Hospital Preparedness and Response Cooperative Agreements CDC/HRSA Combined Funding History Combined Allocations since September 11, 2001:  FY02 ~ $1.07 billion  FY03 ~ $1.53 billion  FY04 ~ $1.34 billion  FY02-04 Grand-total ~ $3.9 billion

8. Enter Title of Presentation on Master Slide 8 Public Health and Hospital Preparedness and Response Cooperative Agreements FY04 Cross-Cutting Activities  To ensure that selected CDC and HRSA supported preparedness activities are coordinated and integrated at the state and local levels  Cross-cutting section identical in both CDC and HRSA guidance documents  Responses were to be identical whether submitting for CDC or HRSA funding

9. Enter Title of Presentation on Master Slide 9 Public Health and Hospital Preparedness and Response Cooperative Agreements Six Cross-Cutting Critical Benchmarks Incident Management Joint Advisory Committee Laboratory Connectivity Laboratory Data Standards Jointly Funded Health Department/Hospital Activities Preparedness for Pandemic Influenza

10. Enter Title of Presentation on Master Slide 10 Public Health and Hospital Preparedness and Response Cooperative Agreements Eight Cross-Cutting Activities Surveillance Coordination with Indian Tribes Populations with Special Needs Planning for Psychosocial Consequences Education and Training Academic Health Centers Involvement IT System Interoperability Border States (Mexico and Canada)

11. Enter Title of Presentation on Master Slide 11 Public Health and Hospital Preparedness and Response Cooperative Agreements CDC/HRSA FY04 Funding Formulas Eligible Applicants (N = 62) and Formulation of Funding Allocations:  Each of the 50 States and Puerto Rico received a base amount + an amount equal to its proportional share of the nation’s population  The District of Columbia received two times the base amount + an amount equal to its proportional share of the nation’s population  The nation’s three largest Municipalities (New York City, Los Angeles County and Chicago) received a base amount + an amount equal to its proportional share of the nation’s population  The Commonwealth of the Northern Mariana Islands and the Territories of American Samoa, Guam and the U.S. Virgin Islands received a base amount + an amount using a population- based formula  The Federated States of Micronesia and the Republics of Palau and the Marshall Islands received a base amount + an amount using a population-based formula

12. Enter Title of Presentation on Master Slide 12 The Cities Readiness Initiative  End: Prevent mass mortality and morbidity from diseases for which antibiotics are an appropriate medical countermeasure.  Means: Mass distribution and dispensing of antibiotics provided by the CDC-based Strategic National Stockpile  Strategy: Address potential threat from aerosolized Bacillus anthracis

13. Enter Title of Presentation on Master Slide 13 Bacillus anthracis: A Long-Standing Threat (1)  Lends itself to terrorist use  Spore form (vegetative state) can be made into a powder with some difficulty  N.B.: 2001 Mailings; USPS BDS System

14. Enter Title of Presentation on Master Slide 14 Bacillus anthracis: A Long-Standing Threat (2)  Ubiquitous; easy to obtain  Easy to grow in large quantities  Easy to work with surreptitiously

15. Enter Title of Presentation on Master Slide 15 Slurry of B. anthracis Spores: New Twist on Old Threat  Dispersal as aerosol with commercially available equipment  B. thuringensis sprayed for pest control  Plume can cover many square miles

16. Enter Title of Presentation on Master Slide 16 Connecting the Dots (1)  Terrorists have ready means to expose densely populated areas to aerosolized B. anthracis spores.  Those who inhale an infectious dose will be at high risk for inhalational anthrax.

17. Enter Title of Presentation on Master Slide 17 Connecting the Dots (2)  The appearance of symptoms of inhalational anthrax will be the first indication that someone has inhaled an infectious dose.  The first cases of inhalational anthrax are likely to occur within 48 hours.

18. Enter Title of Presentation on Master Slide 18 Connecting the Dots (3)  Untreated, inhalational anthrax is 90% fatal.  Even with intensive care, survival is 50% at best.  A hundred cases could overwhelm the healthcare system of a typical large city.

19. Enter Title of Presentation on Master Slide 19 Connecting the Dots (4)  A large outdoor release of aerosolized B. anthracis spores could put hundreds of thousands (and possibly millions) of people at risk.  With healthcare facilities overwhelmed, fatalities could number in the tens of thousands.

20. Enter Title of Presentation on Master Slide 20 Connecting the Dots (5)  Mass chemoprophylaxis is the only means to prevent catastrophic loss of life following such an exposure.  Given the characteristics of the anthrax organism, the entire at-risk community should receive chemoprophylaxis as soon as possible after exposure.

21. Enter Title of Presentation on Master Slide 21 CRI Objective Provide Antibiotics to At-Risk Population – Which Could be the Entire Metropolitan Area Plus Commuters and Transients – Within 48 Hours of Decision to Do So

22. Enter Title of Presentation on Master Slide 22 CRI Significance  How well we implement CRI may be the difference between life and death for tens of thousands of people.  We have a moral imperative to explore every potential modality for mass chemoprophylaxis.