Conditions of squalor, which may be found in a refugee settlement or on the streets of a third world country, appear to be rapidly increasing in certain places in the United States over the past several years. This phenomenon is evident not only in a growing number of cities in California – including San Francisco, Oakland, San Jose, Los Angeles, and San Diego – but in cities in Oregon, Washington State, Colorado, and elsewhere. During the past several years, similar signs of deteriorating conditions have also become increasingly evident in New York City and Washington, D.C.
While the mission of the Strategic National Stockpile (SNS) has not changed since Congress established this national repository of emergency medicines and supplies, public health events in the United States during the past 20 years have led to a dramatic expansion of the scope of the stockpile’s capabilities. Originally focused on protecting Americans from bioterrorist threats surrounding the year 2000, or Y2K, the stockpile has grown and evolved to a greater than $8 billion enterprise that contains more than just medical countermeasures (MCMs) for biological and chemical threats. The mission authorized is broad enough to encompass virtually any threat to national health security, and the progress SNS has made operationally lends it to encompassing a continually evolving landscape of risks that might be mitigated.
In any disaster, there is a cost beyond the immediate mortality figures following a disaster due to a lack of proper medical supplies and treatment in mass care shelters. The Centers for Disease Control and Prevention publishes a weekly “Morbidity and Mortality Weekly Report,” which serves as a clearinghouse for epidemiological reports submitted by state health departments. However, a public health method must go beyond the death tolls and rates and estimate the years of life lost for people who were without medications and treatments (like dialysis) for extended periods of time during and following disasters.
Transitioning from public sector emergency management for a large city to emergency management for a private sector hospital is not easy. The fundamentals of emergency preparedness are the same, but the hospital setting has unique challenges. Each day, there are different numbers of people within the hospital. Some days, the occupants exceed hospital capacity during normal operating conditions. There is no set vulnerable population as the demographics of the population changes hourly. Having a large turnover of people in the hospital because of appointments, outpatient surgeries, visitors, and vendors makes preparedness efforts more challenging.
In today’s emergency response landscape, public health jurisdictions across the United States rely on the Strategic National Stockpile (SNS) when incidents prove large enough or severe enough to deplete medicines and supplies needed to protect communities. In just 20 years, the SNS – now managed by the U.S. Department of Health and Human Services’ (HHS) Assistant Secretary for Preparedness and Response (ASPR) – has grown to a $7 billion enterprise poised to respond to a variety of public health threats. These threats include anthrax, botulism, smallpox, plague, tularemia and viral hemorrhagic fevers, as well as emerging infectious diseases, pandemic influenza, natural disasters, and other chemical, biological, radiological, and nuclear incidents. Although predicting the future of any program is challenging, the SNS has evolved from humble beginnings to a formidable component of national security.
In 2017, the U.S. Department of Health and Human Services declared a public health emergency related to the opioid crisis. Indeed, overdoses and deaths from opioids have skyrocketed over the past decade. In 2017, deaths from opioids were six times higher than in 1999. Opioids impact the quality of life and longevity, as well as have tremendous social and economic impacts on communities throughout the United States. The Centers for Disease Control and Prevention has stated that the total economic burden of prescription opioid misuse costs over $78 billion per year.
With the myriad of threats that communities prepare for, influenza pandemic is consistently at the top of the priority list. In recent years, strains such as H7N9 and H1N1 have caused concern among health officials. It is no mystery why, considering the 1918 influenza pandemic – which infected over 500 million individuals around the world and caused tens of millions of deaths. Domestic Preparedness Advisor Andrew Roszak recently had the opportunity to sit down with one of the world’s leading pandemic experts, Dr. Lisa Koonin. Dr. Koonin recently retired from a 30-plus year career at the U.S. Centers for Disease Control and Prevention. She was one of the leads for pandemic influenza preparedness and response efforts.
The healthcare industry has numerous supply chain challenges as it strives to meet patient and facility needs during routine operations as well as during small and large surge events. The current process has gaps that need to be filled. However, there is a possible solution.
In a world of increasingly complex and dangerous threats facing the United States – threats such as emerging infectious diseases, terrorist organizations, state actors, and extreme weather events – the Strategic National Stockpile (SNS) stands tall as a robust and reliable federal resource ready to respond. On 1 October 2018, in an effort to better align the stockpile with other federal medical countermeasure response efforts, the U.S. Department of Health and Human Services (HHS) shifted oversight and operational control of the SNS from the Centers for Disease Control and Prevention (CDC) to the HHS Assistant Secretary for Preparedness and Response (ASPR).
Public health emergencies, including infectious disease and natural disasters, are issues that every community faces. To address these threats, it is critical for all jurisdictions to understand how law can be used to enhance public health preparedness, as well as improve coordination and collaboration across jurisdictions. As sovereign entities, tribal nations have the authority to create their own laws and take the necessary steps to prepare for and respond to public health emergencies. Thus, legal preparedness for tribal nations is crucial to public health response.
