✯
✯
2003 National Health Policy ✯Conference
January 22-23, 2003
J.W. Marriott
Washington, D.C.
Organizing to
Confront Terrorism:
State Perspective
Patricia Quinlisk, MD, MPH
Medical Director/State Epidemiologist
Iowa Department of Public Health
Prior to Fall of 2001
• Limited preparedness for terrorism
(primarily for biological terrorism)
• Adding potential BT diseases to
reportable diseases list
• Limited educational opportunities
• Limited federal funding, little or no state
funding
After 9/11 and Anthrax
• Became priority
• Federal funding increased substantially
• First public health infrastructure
funding in decades
• Dual purpose - BT and other diseases
(emerging diseases, food safety, etc)
• HRSA monies for hospital/medical
CDC Grant
• Purpose: “to upgrade state and local
public health jurisdictions:
preparedness for and response to
bioterrorism, other outbreaks of
infectious diseases, and other public
health threats and emergencies.”
Future: CDC Grant
• Expect this to be long term process,
Congress discussing 5-10 year
funding
• CDC: will remain constant for a
couple years, but then may decrease
State Public Health Issues
•Public health is a new partner in
homeland security and national
defense
–Public health’s role in preparedness
and response not well understood
by traditional responders
–Unfamiliar role for public health
–Public health still forgotten at times
Issues: State Public Health
• Used to dealing with assessing risk vs.
benefits to health
• But now getting conflicting risk
information
• Medical and public health professionals
asked to accept risk of vaccine, but feel at
times “out of the loop” and “not trusted”
Financial Issues
• First time for PH infrastructure $$
• Given grant-mandated core capacities
to insure preparedness
• Today priority given to smallpox, so
money taken from core capacities/
non-terrorism programs to cover
• Changing multi-use purpose to single
agent preparedness
BIOTERRORISM?
• Town of about 10,000
• Rural America
• Event occurred around election time
• Hundreds became ill
• Religious group involved
• Low mortality organism
BIOTERRORISM OR NOT?
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rural town - 10,000
- Dalles, OR
religious group involved
- Rajneeshi
low mortality organism
- Salmonella
Many exposed ~1000
Many people ill ~ 700
YES
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rural town - 10,000
- Oskaloosa, IA
religious group involved
- Knights of Columbus
low mortality organism
- Salmonella (plus)
Many exposed ~ 1000
Many people ill ~500
NO
Other Issues with Smallpox
• Coverage for liability, workman’s
comp, adverse events, family spread
• Concerns about funding phase one,
how to cover phase two and three?
• Concerns about “venturing into the
unknown” too quickly
Personnel Issues
• Personnel shortages, nurses
• CDC grant to hire epidemiologists, but
not enough new epidemiologists
• Need experienced, motivated people, but
salaries low – non-competitive
• Education outreach to medical
community necessary but difficult
• Often media front person; need training,
assistance by experts
Risk Communication Problems
• In late May/early June of 2001, three
students developed meningitis, two died
• Prophylactic antibiotics recommended
for 3,000 fellow-students, per national
guidelines
• Physician calls press conference at local
hospital, states that anyone in contact to
any student at any of the schools need
antibiotics, estimated 40,000 people
• Conflicting messages from “experts”
Community/Media Response
• “37,000 line up for drugs” headline
• School officials cancel graduation, close
schools, cancel sports events
• Downtown becomes deserted
• People state they are afraid to take
children to grocery stores, Wal-Mart, to
touch pens, eat out, etc.
• Rumors of National Guard quarantine
More Community/Media Response
• “On the heels of three local cases of
meningococcal disease comes the true
epidemic - one of fear and panic”,
stated local newspaper
• Local media notes that panic was fueled
by lack of central system for spreading of
information to the public
Bottom Line
• Public Health; a new partner needing
development in this new era
• Need good communications
• All sides need to understand each
other’s roles and trust each other
• Need to sustain Public Health
infrastructure: personnel, systems,
response capacity, training