1. Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism Jeff Levi, PhD Executive Director Trust for America’s Health

2. Chief Findings  General Progress has been made – average state scores are higher.  Progress is threatened by decreased federal funding and recession.  Issue is losing focus at federal level.  Opportunity in health reform to rethink healthy system related preparedness issues.

3. 2008 Report State Indicators  Mass Distribution – Strategic National Stockpile  Mass Distribution – Antivirals  Public Health Labs – Pickup and Delivery  Public Health Labs – Pandemic Planning  Biosurveillance  Healthcare Volunteer Liability Protection  Entity Liability Protection  Medical Reserve Corps  Food Safety – Detection & Diagnosis  Funding Commitment

4. State Results  Areas of progress: Lab capacity; pandemic and all-hazards plans; plans for distributing countermeasures; workforce; emergency communications.  Areas of vulnerability: Surge capacity (liability protections and Medical Reserve Corps coordination); 24 hour lab response; antiviral stockpiling; food safety capacity varies widely; cuts in public health funding.

5. Progress at Risk  State budget crises combined with federal cuts threatens tremendous progress since 2001.  In the coming year, according to the Center on Budget and Policy and Priorities, 33 states are facing shortfalls in their 2009 budgets and 16 states are already projecting shortfalls to their 2010 budgets.  More than 11,000 state and local public health jobs have already been cut, and another 10,000 may be cut, according to surveys conducted by state and local health departments.

6. Loss of Focus at Federal Level  Federal funding declined.  Failure to see through investment on BARDA and pandemic R&D.  Plans need to be evergreen.  States and local health depts. need more explicit guidance so all are equally prepared and do not waste resources duplicating efforts.

7. Federal and Congressional Action  Pandemic Preparedness  Funding  Build Preparedness into Health Reform  Research and Development  Legal Preparedness  Federal Food Safety Reforms

8. Pandemic Preparedness  A severe pandemic flu outbreak could result in 90 million Americans becoming sick, 2.2 million deaths, and a drop in the U.S. Gross Domestic Product of more than 5.5 percent, leading to an estimated $683 billion loss. National Strategy should be evergreen document. Congress should continue to fund pandemic preparedness: For FY10, TFAH recommends $870M in no-year funding, $350M for states. Congress should ensure oversight of PAHPA.

9. Pandemic Funding - Inconsistent 2006200720082009 Omnibus State & Local $600M (no year) $0 No Year (Vaccines, antivirals, etc.) $5B$0 $507M CDC $400M$70M$155M$156M Office of the Secretary $78M$0$75M$78M

10. Funding  Fully fund and stabilize funding for state and local capacity, hospital preparedness, pandemic influenza, BARDA. Fund PHEP grants at $1B (Omnibus was $746M) Fund hospital preparedness at $596M (Omnibus was $387M) Fund pandemic flu at $870M, and $350M for states (Omnibus was $507M with no money for states) Fund BARDA at $500M over multiple years (Omnibus was $250M)  Funding should be accountable, transparent, with outcomes-based measures.

11. Federal Funding Decline

12. Preparedness & Health Reform  Assure stable funding for strong public health infrastructure.  Build hospital preparedness and surge capacity funding into reimbursement mechanisms. The federal government should lead surge planning.  Modernize disease surveillance and incorporate preparedness into development of health IT.

13. Emergency Health Benefit  No federal mechanism exists for reimbursing providers during a public health emergency for treatment of uninsured/underinsured.  Senator Durbin (D-IL) and Rep. Lois Capps (D- CA) introduced Public Health Emergency Response Act in 110 th to enable HHS to offer temporary emergency health coverage for uninsured during a health disaster.

14. Legal Preparedness  Congress should amend Public Health Service Act to provide Federal Tort Claims Act protection to ESAR-VHP volunteers.  Congress should explore liability protection for organizations that participate in emergency response

15. Federal Food Safety Reforms  Increase resources for food functions at FDA, but pair that with long-term strategic planning and transparency from Agency.  Immediately: HHS should elevate and unify food safety functions within HHS. Should be line authority for food safety official at FDA.  Short-term: Congress should enact legislation to unify food safety functions of HHS (such as H.R. 875) and to strengthen prevention, enforcement, and surveillance capacity at FDA (multiple bills).

16. Questions?  Please contact: Jeff Levi, Executive Director jlevi@tfah.org jlevi@tfah.org Rich Hamburg, Director of Government Relations rhamburg@tfah.org rhamburg@tfah.org