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Goal 5: Discussion Questions and Answers

Biodefense Summit Transcript

Panel Moderator: Gary Flory, Program Manager, Virginia Department of Environmental

>> GARY FLORY: Thank you, Nicolette. All right. So now we have the opportunity to pick the brains of our expert panel members from within the healthcare sector and the business sector. They have a lot of experience and insights that they can share with us. So again we are pointing out that we are looking to receive your input, your questions, on the same topics, the same areas, that we looked at for our other goals, as well. So we're really looking for those gaps. And we're looking for those opportunities, as well.

So with that, I would like to open it up to the audience and bring forward your questions and comments for our panel today.

And while people are moving to the microphones, I'll just point out, Governor Ridge mentioned it earlier, so we're having this conversation. And I think that is very, very important. But until we take this conversation and we move it into action, we're really not making a lot of progress. So this is really our opportunity to take some of your input and to take your questions and to put it into a form that we can have action items that we can implement. So please take this opportunity to share with us your questions and comments.

So we'll start here.

>> CHRISTY: Thank you. This is Christy. I come traditionally out of the medical research world. So the readiness side and the response side is interesting to me. I was a corpsman. So it's interesting to me as I listen. And my question to you is where is the grease at on the money flow? So I would imagine when you're responding to a disaster, the money is either there to deploy these resources or not there or sometimes it works or sometimes it doesn't or there's islands where there's nothing.

Is there the money flow coming for you guys to be responsive and deploy resources and be prepared? Is that like -- is there a threat that we need to -- there's been no talk of money here. 


>> CHRISTY: Is there a threat of that that we need to add to this conversation because I haven't heard it? 

>> NICOLETTE LOUISSAINT: I don't think that there has been a clear funding mechanism or set of mechanisms set for how recovery is continually funded. I think what we see is that from at least a healthcare and public health side oftentimes that's where philanthropy steps in. And so then you're kind of at the mercy, if you will, of what the philanthropic assessment of needs would be.

But no, I don't think that there is. I do think, on the other side, though, that for the private sector that is impacted or working to recover, that there is I think a different conversation about what recovery funding looks like for their business to get back up and running. And I think that's different than kind of how we support the overall infrastructure of the recovery process.

>> MARC DeCOURCEY: I would add so that, too, that just recently the House passed the preparedness all hazards -- Pandemic and All-Hazards Preparedness Act. And it's awaiting action of the Senate. That's not what we do at the Chamber Foundation. But our colleagues at the Chamber are highly active in this. In fact, they just signed a letter with the Alliance for Biosecurity, which is a myriad of health-interested companies including like GSK and J & J and Emergent BioSolutions. And we really feel at the Chamber on behalf of the entire business community that BARDA needs to be fully funded. That Project BioShield needs to be fully funded and reauthorized. These are the type of things that get us started and if we can head off a lot of these incidents by having full Federal funding then of course it makes the response and recovery a little bit easier.

>> LAURA BIESIADECKI: So frequently I think we hear about recovery and when an event happens, it's always -- remember, it's a marathon and it's not a sprint. And what happens is that state and local health departments are typically funded through two primary mechanisms, which is the hospital preparedness program as well as the public health emergency preparedness program. And this allows for a lot of ongoing planning and exercising activities that increase community resiliency.

But when an event actually happens, that -- everything gets taken offline. And people get engaged. And other members of the public health workforce have to get engaged. And it takes a lot more resources to respond. And typically then what happens is that in situations like ebola and zika, there has to be supplemental funding that is awarded through Congress and then eventually gets down to the state and local level. But that happens from sometimes -- God, 9 months at the absolute earliest potentially to 18 months down the road.

So you're already way into recovery. And so it's very difficult to do recovery with the funding that's available for response and planning. It has to be some sort of different type of mechanism.

>> GARY FLORY: Thank you, next question. 

>> PHYLLIS ARTHUR: Phyllis Arthur, BIO. Great presentations. Thank you very much. I wonder if the gap we might want to highlight is probably a little earlier in the process in the preparedness aspect, how much is it viable for the Chamber, businesses in a state or nationally, to be connected to the planning going on in public health? How connected are the public health folks connected to the economic development people at the State Government level who can support you in the recovery? These are the people who would go to the Governor and say, this is really affecting our tax base. Our ability of the state to get back on its feet.

I often find the public health folks are unfortunately standing alone and there are other parts of the Government that don't understand the vital role you all play in getting the state back on its feet until they are in the middle of recovery. And so maybe one of the things that NACCHO and ASO could do is better connect to some of the other parts of the State Government that are actually responsible for the economic viability of the state. So that they understand the importance of you in terms of maintaining that viability of the state.

And I think the Chamber would be the other place to do that where local businesses don't want to shut down. And they are finding out after they are in the middle of a crisis what they are supposed to do and maybe helping them know beforehand would make them an ally.

This also leads to the ability to then have funding in peacetime. If those folks understand the importance of it to their business objectives, they actually may support it. The way the Chamber supported the funding at the national level. Is because they understand the importance of it to their business solutions.

So I think there's a way to do some of these things in the earlier goals that actually help with recovery on the backend. 

>> GARY FLORY: Thank you for that. Any comments? 

>> MARC DeCOURCEY: Yeah, I agree. And I think larger companies are probably much better integrated into emergency response, whether it's from the HHS/CDC side or from the DHS/FEMA side. Smaller companies, particularly local business are not. There's no muscle memory there.

There's all kinds of storms and tornadoes and everything else that exercises this frequently. And then this actually exercises that they do. But I would submit to the state and local folks in the room, invite your local chambers into the planning process. Get them and their members involved. Because once they understand what's at risk, and it's a financial risk for them. And when they go back and look at their balance sheets, they are going to say, oh my gosh, where do I sign up to help? And I think that's what we want to cultivate.

>> NICOLETTE LOUISSAINT: I would add two things to that. One is when you look for example, just as an example, pharmacies, when you look at community pharmacies that do not have a business continuity plan, what we know is that 75% of them after a disaster will not reopen. That has been a point that we've tried to use to explain why you need a plan. And what we found is that for a lot of them the issue is that investment piece and that training and so when you are a smaller healthcare entity and you're lean on staff and lean on capabilities, making it easier to create that plan and then build those partnerships to test it is very important. But the other point that I would make is that at the state level there are certain states that are actually doing a really interesting job of thinking about either using their fusion centers or creating their business emergency operations centers to specifically allow any companies that are in the state to have a seat in their emergency response.

And I think there are a couple of states that are actually doing a very good job of connecting that business EOC function that has all of those companies with ESF #8. So with healthcare and public health. And we saw an example of one of those a couple of weeks ago.

But what we see with that is that it gives companies that are in that state a place to go to coordinate. There's only one state that I've seen so far that carries that into recovery. And that's North Carolina.

So perfect, right?

But at the same time that is a model of how that type of coordination that can be used to understand what the private sector is doing during a response can transition nicely into recovery. So it could work.

>> GARY FLORY: And just a follow-up question, you mentioned North Carolina.


>> GARY FLORY: Is that because these issues are so real and so frequent for them or are there other drivers for that? 

>> NICOLETTE LOUISSAINT: I think one of the biggest drivers in preparedness response and recovery is political investment. And making the commitment to make sure that the infrastructure is supported from the public sector perspective. And what we have seen in North Carolina is an Emergency Management director who believes that he should work with his Department of Health. And he believes that there should be a business Emergency Operation Center that is a place for healthcare to be at the table. So some of this is just political will.

>> LAURA BIESIADECKI: And I will say that I don't think all of the local health departments are necessarily comfortable with the idea of engaging with the private sector.


>> LAURA BIESIADECKI: And Nicolette just recently facilitated a panel where we had representatives from CVS Health, national CVS Health, national Walmart and representatives from state and local health departments. And the woman who sat on the panel from the state and local health department said, I didn't know why I should be up here. Until I talked to some of my members and they said, yeah, you should be up there and you should say, I'm uncomfortable being up here. Because that will begin to open up the conversation.

And so -- and that representative was from North Carolina. So even the most advanced state that we're talking about is still uncomfortable talking about these public-private partnerships. But I think that the session when you heard from Jason Jackson from Walmart, he was very open that he wants all of his local box stores engaged with the community to do this work. But it really is what does each side bring to the table? And that conversation has to happen in order for both sides to get something out of it.


>> MALE SPEAKER: All right. Thank you, thanks for opening up this discussion and for those answers right there, those were great. I'll push you a little further maybe.

We saw earlier when I was showing investments in the four columns there, silos, we see that prevention and recovery are hugely underrepresented or undersupported. And in many ways I think recovery is just the circle back to prevention.

So I just want to get your thoughts, if you have some suggestions, for implementation of the strategy about how recovery is not just to get us back to where we were before the disaster happened. But maybe so the next one won't happen. So build in some prevention. Can we do better in recovery and we're not just getting us back there?

And also kind of the lessons learned. I think I picked up from what you were saying it's like the people doing recovery probably have a lot of insights to do better prevention and response. And so if you have suggestions of how to make that really happen instead of having specialists in recovery and specialists in prevention and they don't talk to each other. But how could we switch that up? Do we move people around? Force mandate rotation through different activities? I'm just trying to think outside the box and from your experience as to what might help.

>> GARY FLORY: Thank you.

>> NICOLETTE LOUISSAINT: Absolutely. So I'll take the easy one first. I think the idea that you can be a specialist in preparedness and not do response makes no sense to me. Similarly I think building silos across the Emergency Management life cycle and making partial investments in piece of it creates a partial framework that leaves us with amazing capabilities and a portion of our critical function that falls apart as soon as we transition to the next phase.

So investing in building specialists at portions of the life cycle. Or frankly, organizations and core functions that are only able to be functioning in those pieces is not a sound investment, either. And I hope that I'm among friends so I won't get run out of the room for saying that. But I do think that's a part of the question is how do we think about this as more of a continuum and a true cycle as opposed to defined steps? Because it's just not the case.

And I think in the same way that we think about the blurred line between response and recovery, I think there's also a blurred line between preparedness and response, depending on the nature of the event. So we do have to look at it as a continuum. We have to think about how we're fully resourced to handle that continuum. But I think the other point -- and I wonder about this from a policy perspective -- is how we define resilience. Because I do think that -- and I think we just need to define it for one. But I think that there are investments that are happening through the frame of resilience that some of them, if you look at them, are really about the transition from recovery back to steady state, back to that kind of mitigation and preparedness posture.

But there are others that are trying to be all encompassing of the entire life cycle. So it makes it difficult to determine what the strategies for investment are. And I think that that's kind of across the entire funding landscape. So whether that be public investment, private investment, philanthropic. That is starting to blur the lines a little bit possibly in a good way. But it could use some definition and some structure so that we're doing it in a way that actually bolsters the entire system and not just a part of it.

>> MARC DeCOURCEY: Yeah I would add something different because you covered it really well. That -- not to get into too much human psychology but in order to keep people focused on something, you have to be able to speak to them emotionally and we did some research utilizing IBM's Watson where we were actually taking sentiment on the web, public sentiment, around disasters. And what moved people to stay engaged in the conversation.

And it wasn't numbers and really hard science type of -- and math. It was stories. It was stories about people. And once that sinks in, you don't have that huge dropoff like people don't care anymore about recovery. Actually they care a lot about it. But it's how you talk to them.

And look, the media has to be a partner in this. Whether they like it or not. To help I think public health in this instance and emergency response and managers in another to keep the focus on the people who still need the help. Because once you do, there's a lot more interest. And I think money will follow, too. 

>> LAURA BIESIADECKI: And even from a slightly different perspective, I'm really responding to this kind of continuous quality improvement loop that is a disaster life cycle. But there's another piece of emerging kind of science and approach to this, which is the idea of disaster risk reduction. And in that you are preventing or planning the disaster by better anticipating the risks and then planning to the anticipated risks. And there are several projects that are going on in Puerto Rico and U.S. VI right now that will help them address, look at their hazard vulnerability assessments, and then really begin to figure out how they can build in structure, their communities differently, after the event so they are better prepared and more resilient if another event occurs.

>> GARY FLORY: Thank you. And next question.

>> FEMALE SPEAKER: So I enjoyed everything that was said. And I must say, building the infrastructure is very important. The grade and the Internet connectivity and getting the medicines to the people and so on. But I also think mental health is very, very important. People get shocked by these incidences, especially children who are affected. And those are very long-lasting effects. And my name, by the way, is Barbara Fernandez and I'm from the NBSB. And we did a report on children and their resiliency and how they have to be looked after.

Is there something special being made for children in the recovery effort? Do you all know? Because that was not addressed.

>> LAURA BIESIADECKI: So I will say that there's some unique aspects to children. And we just got back from doing a special meeting on trying to have response and recovery in families. And going back to it brings to mind going back to the discussion of funding. Mental health recovery funding is rather unique. Because you can -- that turns into -- it's a totally different financing structure out of a totally different Government agency. And that transition to how you can pick up mental health benefits and mental health recovery plan is not real clear to me. Nor do I think to a lot in the field. And it's continually a struggle.

And I don't think enough has been done for children. And that's constantly -- we're constantly working with AAP and constantly being reminded by the pediatricians that not enough is being done for children. And so I think there's a renewed focus and we can -- and particularly with the focus that ASPR is now taking with the regional disaster healthcare systems on developing annex for children that we might see that evolve into the future.

>> MARC DeCOURCEY: And I would just add quickly because I know we're short on time is it's not just kids who are at risk, it's adults, as well. Particularly if you take a look at adults in the workplace. There is a huge rise in absenteeism and presenteeism post event and if you're an employer and you understand that, it's in your best interest as that employer to take care of your employees and come up with the resources both before, during and after that can help them out so that they can get back to work and everyone can get back to normal.

>> GARY FLORY: Thank you we have one minute left so we'll take your last question or comments for us.

>> MALE SPEAKER: I'm thinking how to make this quick. Capitalization and preparation comes up in every lessons learned analysis post outbreak or disaster event. You mentioned Puerto Rico. One might compare to Houston. I mean, we've been through this so many times. ACIP has this lovely mechanism of vaccines for children which takes it all out of the political sphere. And allows decisions made by an established non-partisan fact-based Review Board.

The other thing that I've heard repeatedly is the potential value if we had a response fund both for event occurrence as well as recovery. So that we can kind of -- this appropriations life cycle, that adds six, eight months. That's peoples' lives. They are dead. They are moved. Whatever. Right?

So -- but how in this political climate do we create a contingency fund? I don't know the answer to that. But I feel intuitively that the solution that was developed for the vaccines for children problem seems to be working. And maybe there's some lessons there that we can apply to this bigger problem. 

>> GARY FLORY: Thank you for that. And we have 30 seconds perhaps left. Do you want to -- sorry, Nicolette, you have something you want to say and I want you to get to it.

>> NICOLETTE LOUISSAINT: Sure. I think it's possible. I also wouldn't overstate the -- I've often seen the concern about competition that happens post disaster that is not real. I would say as it pertains to the actual administration of medicines and healthcare in that post disaster context. So I think it's worth assessing if the -- if that is a core problem, if that is the need that actually needs to be addressed. And is the barrier. Or if it's more of an administrative barrier or a logistics barrier, which I think is actually more likely. At least in the short-term recovery phase. But great point. 

​>> GARY FLORY: Laura, Marc, Nicolette, thank you so much for sharing your valuable insights. We really appreciate it. It's very valuable.