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Goal 5: Facilitate Recovery to Restore the Community, the Economy, and the Environment after a Bioincident

Biodefense Summit Transcript

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

​Panelists: Laura Biesiadecki, Senior Director for Preparedness, National Association of County and City Health Officials; Marc DeCourcey, Senior Vice President, U.S. Chamber of Commerce Foundation; Nicolette Louissaint, Executive Director of Healthcare Ready.

>> CICELY WATERS: So we've had a great group of panelists and moderators thus far, who have facilitated discussions about risk assessment and how it's required to inform decision making. We've talked about the need for prevention, a focus on preparedness, as well as a focus on response.

And our last panel will focus on Goal No. 5 of the strategy, which is recovery. The moderator for our fifth panel will be Mr. Gary Flory, agricultural Program Manager, Virginia Department of Environmental quality. Gary. 


>> GARY FLORY: Well, good afternoon. It is a pleasure to be here this afternoon and to have this discussion. Thank you for staying with us. I know it's late in the afternoon and it's a beautiful day out there. But we do have a great panel for you here to discuss this topic of recovery. Now, it is Goal No. 5. But the goals are not in any particular order because the reality is is that it is so important that we have within our strategy a good plan for recovery. Because without this plan for recovery, we can't get beyond and get to a place where we're back in business, we're back in our schools, we're back in our communities. It's so important.

So for example, when we have that anthrax attack on our subway systems, how do we go in and how do we get that subway system back in operation? There's a lot of components to that that are associated with recovery. How do we do the sampling that's required to make sure it's safe?

How do we do the decontamination that's required to ensure that we can safely put our children on that subway system?

So there's a lot involved.

When we have that outbreak of highly pathogenic avian influenza, it's important for us to get those farmers back in production. But to do that, there's wide numbers of things that we have to take care of how do we decontaminate that facility? How do we dispose of the mortality? We talked about that before, all of those animals that died from the disease. And just as importantly, how do we get those external markets open so that we can, again, start to be selling our agricultural products to our external customers?

So there's really a lot of issues involved. 

As we were chatting a little bit earlier with our panel, we were acknowledging the fact that we tend to not do recovery very well. You know, at the end of this process we all become exhausted. We have been through that recovery process and those that are engaged have become exhausted by all of the effort that it takes to go through that planning, that response effort.

And it also can be confusing. Because many times in reality when you're actually in the field, that line between response and recovery gets very blurry. And in fact, late response, early recovery, all sort of blends together. So it's important to try to get a handle on that.

One of the things I want to just give you an idea of is that my particular space within this biodefense area is really in the area of biological waste disposal. Also agricultural emergency response, such as transboundary animal diseases. How do we deal with depopulation, disposable, disinfection, that area. So that makes me immensely qualified to introduce to you a panel who has very, very different sets of backgrounds and knowledge and experiences. Because the reality is there's many different aspects to recovery. And we can all learn from each other.

And one of the things I do want to mention to you, if you have not taken the opportunity to look through the bios that are provided for the panelists and the speakers today, please do that. Because as moderators, we're really not able to do justice to the immense amount of knowledge and experience and the background of those people who are speaking today. So please take a moment to do that.

So now what I would like to do is I would like to go ahead and introduce to you our panel for today or at least our first speaker for that panel. And we're going to start with Laura Biesiadecki. And Laura is going to come up here and speak with us. She is the Senior Director for preparedness for the National Association of County and City Health Officials. So Laura. 


>> LAURA BIESIADECKI: Well, good afternoon. And thank you for the opportunity to speak today. And I promise it's late in the day so I'm going to try to keep this as short and sweet as possible. I'm here today on behalf of the National Association of County and City Health Officials.  We represents the 3,000 local health departments across the country. Local health departments are vital frontline resources to -- for response and recovery efforts and work closely with our Federal partners in preparedness and response planning. And when thinking about my comments for today I was reminded of a recent tabletop exercise that as a organization NACCHO undertook recently for our own continuity of operations plan. And in the exercise we tested that during an event, NACCHO could have the backups of backup systems for I.T. and HR. We had developed a communications infrastructure that allowed us to get and disseminate information out to our various stakeholders and members very quickly. And that we had identified ways that we could support our Federal partners, including participating in their own emergency operations centers.

But when we entered Stage 4 of planning exercise, that part after the WarGamesesque type of escalation where it looks like a big nuclear blowup, when we were supposed to figure out how we would get back to normal, we realized that our own plan was woefully inadequate. We hadn't thought through recovery. And we had -- and as collectively as an organization were so exhausted by the rest of the exercise that we left off thinking about recovery planning until the next afteraction review. And in this, we realized we were not dissimilar from our own membership.  NACCHO conducts an annual assessment of preparedness coordinators across the country and in it we asked what areas do you address most of your training, planning and exercise activities. While areas of medical countermeasure, community preparedness and infectious disease received most of the attention, respondents indicated that activities for CBRN, critical infrastructure protection and long-term recovery received few, if any.

And in 2017 and 2018 NACCHO conducted a landscape analysis for the purposes of attempting to assess the status of local health department recovery planning across the country. And we want to develop some strategies for how we might address the identified gaps.

As part of the analysis we conducted reviews of recovery-related documents, plans and Federal guidelines. We used FEMA's Second Edition National Disaster Recovery Framework as a measurement standard for conducting the reviews because it provides a framework for the planning and delivery of eight core recovery capabilities, including five specific recovery support functions.

What we find -- what we found, and this doesn't come as a surprise, is that due to the unique characteristics and structure of individual local health departments and jurisdictions, there is no one-size-fits-all local plan that can serve as a universal template for public health recovery planning.

We did, however, identify plans containing strong components of recovery planning that can be adapted across jurisdictions, including language describing transition from short, mid, to long-term recovery operations, including triggers that indicate transition has or should occur.

Checklists or tools that describe actions and operational roles for local health departments and partners. And planning processes and frameworks, including stakeholder engagement and suggested structures for Advisory Committees, which align to the National Disaster Recovery Framework language and structure.

We also identified some common barriers, including lack of clear roles and responsibilities. Not just for local health departments but for all stakeholders. Absence of a clear unified command structure for recovery efforts. There are strong examples for plans and framework which approach recovery from a whole community lens. However, it is difficult for a single agency to take responsibility and ownership of recovery efforts because it is so inherently collaborative. And the lack of a publicly available recovery plan examples.

We have learned that local health departments do best when they learn from each other. And support each other in planning and responding to various scenarios.

As I mentioned, one of the key challenges identified is the lack of clear roles and responsibilities with respect to recovery. Additionally, we acknowledged that the National Disaster Recovery Framework and recovery support functions do not appear to be as widely integrated in local health department plans as do the national response framework and emergency support functions.

This presents Federal, state and local stakeholders with an opportunity to better assess these gaps in adoption and implementation and provide input and guidance to address these gaps.

Currently we are working with our local health departments and our ASPR and CDC colleagues to develop a system for sharing local recovery plans and other tools to equip local health departments with resources that can help increase efficiency and inform recovery planning.

In closing, I don't think local health departments are unique in where they are in recovery planning and I'm very interested in hearing from the rest of the panel on how we can collectively bring increased attention to the importance of these recovery initiatives.

I tend to look at recovery as the so what of all the rest of the preparedness response and planning activities. Because how we bring individuals, families, communities, states, and regions back makes a statement on how -- the resilience and strengths of the nation. Thank you very much. 


>> GARY FLORY: Thank you, Laura.

All right. So next I would like to invite Marc DeCourcey to come up. He's the Senior Vice President for the U.S. Chamber of Commerce Foundation. So please join us, Marc. 


>> MARC DeCOURCEY: Thank you, Gary. And thank you to the Academy for inviting me here today and of course thank you to HHS and ASPR for being such a great partner of the Chamber Foundation. Just a little bit about the U.S. Chamber, for those of you who might not know much about it, it is the world's largest business federation.  It consists of about 1500 state and local chambers here in the U.S., 118 American Chambers of Commerce overseas. And all in it's about 3 million businesses. That's not me. I'm the Chamber Foundation.

The Chamber Foundation is the nonprofit 501(c)3 affiliate of the U.S. Chamber of Commerce. And what we do, our mission, unlike the Chambers all around the world who really exist to help companies do well, be successful, the Chamber Foundation exists to help companies do good. And we believe in the synergy between doing well and doing good in the business community.

So we help them, all of these companies, with their social impact and optimize what they can do to improve society. And in one instance, around health and disaster, we have programming. That I wanted to share a little bit with you and then also get into the gaps, some of the highlights, as well as the initiatives that we see from our perspective that's happening out there.

So the Chamber Foundation, we have programming around disasters when bad things happen. Sorry. When bad things happen we coordinate the business community to respond. Both respond philanthropically but also respond operationally because they have many business continuity plans in place, as you might imagine. They have resources at their disposable.

So we have coordination calls with the responders. A lot of times it may be with FEMA. Or DHS. If it's in the health space like ebola we coordinate with CDC. We have we coordinate with ASPR. And we bring in hundreds of companies on these calls so they have better situational awareness of what's going on and how they can best help.

We have online resources, as well, that we push out to companies and push out to our local chambers about how they can be more resilient before, during and also after an event. And we have a disaster Help Desk. This is for small businesses. As you might imagine, they don't have rapid response teams or asset protection teams in place like a lot of large organizations and companies. And what they are able to do is they can call us and we can send them to the right resources. So it's an 888 number that I can share with you afterwards if you like. Also you can get to it from our Website.

So that's what we do. We do events, as well, to bring awareness to issues around resilience. Our biggest event of the year is in July. It will be Year 8 doing it with FEMA, DHS and U.S. Northern Command around not public-private partnerships but because we're the Chamber it's private-public partnerships. And we can share more information with you on that, as well.

So some of the gaps that I've seen that we hear from our companies. One is around if you want to haves a robust recovery, you have to have a resumption of commerce. And that probably doesn't surprise you coming from the U.S. Chamber. But when we think about it, people need to get back to work. They need to be able to purchase goods. They need to be able to take care of their families. But they can only do so in a safe environment and they rely on public health to tell them when it's safe. They rely on public health to have the consumers know when it's safe.

So what we want to do is we want to be able to work with public health to figure out when it is that commerce can resume. And businesses will be there at the ready.

Another gap that we see is around supply chain. Now, I think a lot of you have -- remember the Japanese earthquake and tsunami. The biggest story that came out of that was about chips. Silicon chips weren't being processed, manufactured, transported out of Japan. So that was inconvenient. And an economic loss. But it just meant you couldn't use your tablet.

There was another story that MIT uncovered around General Motors. They didn't have anyone in the affected area. They lost no factories. But within two weeks after the earthquake and tsunami they had 16 factories down around the world. And that's because they couldn't get the parts. Because you can't build a car without all the parts.

And we also saw most recently after Hurricane Maria. Hurricane Maria, there was a shortage of pharmaceuticals. Shortage of mid devices. Shortage of IV bags. And it took a year for the IV bags to restock just because the supply chain was at risk.

So we're going to get to some other things when I get to sit down and take your questions. But one of the new initiatives I did want to highlight that we found is really interesting and we were part of this for a while is the National Health Security Preparedness Index. It was originally started by CDC. It was taken over by the Robert Wood Johnson Foundation.

And essentially it is ranking and rating states as well as the country as a whole on its health security. And you can go to their Website and check it out. They revise it every year. And we think it's important tool for businesses to be able to understand where they can deploy resources and where it's needed the most.

So with that I will pass it back to you, Gary. And be delighted to take your questions in a minute. 


>> GARY FLORY: Thank you, Marc. I appreciate those comments. All right. So next up we have Nicolette Louissaint and she is the Executive Director of Healthcare Ready. And Nicolette, please join us. 


>> NICOLETTE LOUISSAINT: Good afternoon, everyone. It's a pleasure to be here. Thank you to the organizers, the Academies, and ASPR for having this important summit and for inviting me to provide remarks. I am here to speak on behalf of Healthcare Ready. For those of you who do not know who we are, we are a national nonprofit that has been in existence for about 13 years now. We are a true public-private partnership established by the pharmaceutical supply chain across the supply chain to work with our Government partners across public sector in both Emergency Management and public health. Recognizing the role that the healthcare supply chain plays in protecting patients after disasters.

And so with that in mind, I think about this issue of recovery from a range of perspectives. But really using the traditional Emergency Management term of being a whole of community restoration effort and thinking about how from the supply chain perspective it requires science and medicine. It also requires logistics and distribution. And finally, a clear understanding of how we're going to actually be able to engage our provider community in order to really restore operations.

And in reality I think it's been mentioned a couple of times. But the Emergency Management life cycle does show this neat smooth transition from response to recovery. And it makes it look like it is a very smooth and clear glide path from one to the other. But we all know that that's not the case. And so I would offer that our ability to really be successful in recovery really depends on how well we do response. And our ability to really achieve something in Goal 5 is going to be dependent on how well we do on Goal 4.

And recovery is a lot more nebulous. Laura talked about the differences between how we use emergency support functions and recovery support functions. I think that's a really important point. Because the frameworks are not clear. And the leads are not clear.

And so what we see is that there will be a need to actually sustain the level of engagement and coordination that we have started to attain on emergency response in recovery, if we are to be successful. But it does make it more complex. It is easier to do that type of coordination in a short time point. But when you're talking about short, mid, long-term recoveries that could go for decades, it is harder to sustain that type of coordination. And so I think we do have to think about the structures that are in place to support that.

From the healthcare and public health perspective, recovery does require the ability for healthcare to continue to address the acute event specific needs while also thinking about how to care for those with chronic care needs. Especially considering the vulnerable and medically fragile. So there will be a sustained surge in thinking about how we sustain healthcare. And being able to do both at the same time is critically important. 

The landscape also compounds because the requirements in healthcare and public health demand that we're going to have to think about how to do this in a continually strained environment. I think we have begun to talk about that. But really understanding how we learn from healthcare and learn from the private sector about what they can do and are doing well and figure out how to create an enabling environment to sustain that and support that strain -- support in that time of strain, is also very important.

And so with the time I have left I just want to make a few points with somewhat I would call necessary realism about what it takes to be able to do this type of recovery well. And so for my three points, I want to focus first on critical infrastructure and the healthcare landscape.

We do talk about critical infrastructure protection from a response perspective. But it is also vitally important that we think about how to carry over that critical infrastructure protection framework from response to recovery. Healthcare infrastructure is going to be the delivery vehicle on which public health depends. And what we know is that 90% of it or more is really owned by the private sector. So it's not enough for us to just think about as appropriate incorporating the private sector in the plans. The private sector really does need to be at the table, involved in not just response planning but recovery planning. They are going to be a vital part of how we're actually able to deliver this care in the long term.

But also we have to think about how we build that common operating picture. The system that we depend on for response is built in our existing infrastructure. And with that vast and varied landscape we have both a challenge and an opportunity. We have hospitals but we also have ancillary care. We're starting to talk about how to incorporate ancillary care into response. We have to do a better job with thinking about it in recovery.

Pharmacies, dialysis centers, Community Health Centers, the list goes on. That's an opportunity for potential enhanced capabilities. But also a risk as it pertains to the levels of partnership and coordination that's going to be responsible for sustaining that type of healthcare delivery across those systems.

The second point I would make is on the supply chain. We have started to talk about it. But I would like to remind everyone that there is one global health supply chain. So as we talk about how the supply chain is going to play a role in recovery, we often focus upstream on manufacturing, which is critically important. But we also have to remember the other components of the supply chain, as well. Logistics and distribution, dispensing are all going to be very important, especially in recovery. And we have to think about how those components that are responsible for those functions are going to play out in the delivery and movement of medical countermeasures as well as routine medical pharmaceutical and medical supplies.

I offer that as one of my last points healthcare recovery will essentially rise and fall on our ability to enable supply chain to enable operations. Less exciting concepts like access and re-entry which we deal with every day are actually examples of how we do work with state and locals but that is going to be a critical consideration. My last point is actually on dependencies. So I think there was a point made earlier thinking about the other critical infrastructures in which healthcare and public health depend.

Building partnerships with our partners in the energy, telecommunications, water sectors, understanding how we're going to work with them not just on response but also recovery are going to be critical for how we actually are able to sustain that recovery. What we found is that some of the lessons learned from natural disaster responses have allowed us to begin to do that better. But we still have a ways to go.

I think that recovery is very complex. And as we have seen, there are a number of gaps that remain. And establishing clear leads across recovery functions and efficient recovery is going to require true all hands on deck approach and community recovery is going to depend on the stability of the economy and the key services that makes healthcare such a critical part of ensuring continuity of care. And supporting economic recovery after an event.

So with that, I'm eager to take any questions you may have. Thank you.