ESSENTIAL Management and Emergency Preparedness Public Health Essentials of Atlanta, Georgia Senior PublicHealthEmergency Management Professional James A.Banaski,Jr., MS,MEP, CEM Washington, DC Associate Professor Rebecca Katz, PhD,MPH Edited by Series Editor:Richard Riegelman EDITION SECOND

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6048 Printed in the United States of America 22 21 20 19 18 10 9 8 7 6 5 4 3 2 1 © f00sion/E+/Getty Contents

Prologue ...... vii PART II Defining the Problem 11 Preface...... ix New to This Edition...... xi Chapter 2 Threats from Biological, Contributors ...... xiii Chemical, Nuclear, and Radiological Weapons ...... 13 Acknowledgments...... xv Learning Objectives...... 13 About the Authors ...... xvii Introduction...... 13 About the Contributors...... xix Chemical Threats...... 14 Abbreviations...... xxi Toxins...... 14 History...... 15 Nuclear and Radiological Threats ...... 19 PART I Principles of Public Health Nuclear Weapons...... 19 Preparedness and Emergency Radiological Threats...... 19 Management 1 Biological Threats...... 22 Biological Agents ...... 26 Chapter 1 Introduction to Public Health Classification of Biological Weapons...... 26 The Biological Threat...... 28 Preparedness...... 3 Key Words...... 30 Learning Objectives...... 3 Discussion Questions...... 30 Introduction...... 3 References ...... 30 Definitions ...... 3 Chapter 3 Threats from Naturally Occurring Promote General Welfare and Provide for the Common Defense...... 3 Disease and Natural Disaster. . . . 33 National Security...... 4 Learning Objectives...... 33 Homeland Security ...... 4 Introduction...... 33 Homeland Defense...... 4 Evolution of Disease and Security Links...... 34 Public Health Preparedness...... 4 Defining the Link Between Disease and Security. . . .37 Emergency Management...... 6 Global Interconnectedness and the Threat of Public Health Preparedness and Emerging Infectious Diseases...... 38 Federalism ...... 6 Monkeypox...... 39 Developing the Public Health Preparedness Severe Acute Respiratory Syndrome...... 40 Workforce: Charge and Careers...... 6 HIV/AIDS...... 42 Jobs in Public Health Preparedness...... 7 in West Africa...... 42 Key Words...... 8 Zika...... 42 Discussion Questions...... 9 Antimicrobial Resistance...... 43 References ...... 9 Response...... 43

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Key Words...... 44 Public Health Security and Discussion Questions...... 44 Preparedness and Response Act of 2002 (Public Law 107-188)...... 72 References ...... 45 Smallpox Emergency Personnel Protection Act of 2003 (Public Law 108-20)...... 72 PART III Infrastructure 47 The Project Bioshield Act of 2004 (Public Law 108-276)...... 73 Chapter 4 9/11 and Its Aftermath...... 49 Public Readiness and Emergency Preparedness Act of 2005 (Division C of the Department Learning Objectives...... 49 of Defense Emergency Supplemental Introduction...... 49 Appropriations, Public Law 109-148)...... 73 Constitutional Framework and History of Pandemic and All-Hazards Preparedness Federal Assistance for Preparedness and Act of 2006 (Public Law 109-417)...... 74 Disaster Response...... 50 Pandemic and All-Hazards Preparedness Immediate Response to 9/11...... 51 Reauthorization Act of 2013 (Public Law 113-5).. . . 74 Implementing Recommendations of the 9/11 Post 9/11...... 53 Commission Act of 2007 (Public Law 110-53). . . . 74 Offices and Organizations—The Federal The National Defense Authorization Act for Preparedness Infrastructure...... 55 Fiscal Year 2017 (Public Law 114-328) ...... 75 Department of Homeland Security...... 55 Case Study: Passage of the Pandemic and Department of Health and Human Services...... 55 All-Hazards Preparedness Act of 2006...... 75 U .S . Department of Agriculture...... 56 Presidential Directives...... 77 Department of Justice, Federal Bureau of Biodefense for the 21st Century: National Security Investigation...... 56 Presidential Directive 33/Homeland Security Department of Defense...... 56 Presidential Directive 10 (April 2004)...... 77 Other Relevant Federal Agencies...... 58 Medical Countermeasures Against Weapons of Introduction to the Intelligence Community...... 58 Mass Destruction: Homeland Security The National Response Framework— Presidential Directive 18 (January 2017)...... 77 Public Health and Medical Response...... 60 Public Health and Medical Preparedness: Homeland Security Presidential Directive National Incident Management System...... 62 21 (October 2007)...... 77 National Response Framework...... 64 Establishing Federal Capability for the Timely Emergency Support Function #8...... 65 Provision of Medical Countermeasures Following a Biological Attack: Executive Order 13527 Who Does What...... 66 (December 2009)...... 78 Discussion...... 68 National Strategy for Countering Biological Key Words...... 69 Threats: Presidential Policy Directive 2 Discussion Questions...... 69 (November 2009)...... 78 National Preparedness: Presidential Policy References ...... 69 Directive 8 (March 2011)...... 78 Advancing the Global Health Security Agenda to Chapter 5 Legislation, Regulations, Achieve a World Safe and Secure from and Policy Guidance...... 71 Infectious Disease Threats, Executive Order (November 4, 2016)...... 79 Learning Objectives...... 71 Model Legislation...... 79 Introduction...... 71 International Law and Regulations...... 79 Public Health Emergency Preparedness Legislation Early Agreements...... 79 in the United States (Starting in 2000)...... 72 Chemical Weapons Convention...... 80 Public Health Improvement Act of 2000 Nuclear Non-Proliferation Treaty...... 80 (Public Law 106-505)...... 72 U .N . Security Council Resolution 1540...... 80 Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept Australia Group...... 81 and Obstruct Terrorism Act of 2001 Biological Weapons Convention...... 81 (Public Law 107-56)...... 72 International Health Regulations 2005...... 82 Contents v

Pandemic Influenza Preparedness Framework. . . . . 82 Chapter 8 Natural Disasters and Global Health Security Agenda...... 85 Humanitarian Response . . . . . 121 The Functionality of International Agreements. . . . .86 Learning Objectives...... 121 Key Words...... 86 Natural Disasters...... 121 Discussion Questions...... 87 International Disaster Response...... 122 References ...... 87 Disaster Risk Reduction...... 123 PART IV Solving Problems 89 U .N . System...... 125 Case Study: Flooding in Pakistan...... 127 Chapter 6 ...... 91 World Health Organization...... 129 Sphere Project...... 131 Learning Objectives...... 91 Key Words...... 132 Introduction...... 91 Discussion Questions...... 132 The Dual Use Dilemma...... 92 References ...... 133 Mousepox and Other Research of Concern ...... 93 Case Study: The H5N1 Transmission Papers— Chapter 9 Surveillance and Attribution Reinvigorating the Dual Use Dilemma...... 95 Investigations...... 135 Select Agents...... 98 Learning Objectives...... 135 Synthetic Biology...... 99 Introduction...... 135 Global Health Security Agenda Biosafety and Policy Directives...... 138 Biosecurity Action Package and the Global Partnership Program...... 100 U .S . Government Biosurveillance Programs. . . . 138 Integration Efforts...... 140 Key Words...... 100 BioSense...... 140 Discussion Questions...... 100 National Biosurveillance Integration System...... 140 References ...... 101 Biowatch ...... 140 Global Surveillance...... 141 Chapter 7 The Research Agenda...... 103 Global Systems...... 141 Learning Objectives...... 103 When Epidemiology and Law Enforcement Come Together...... 141 Introduction...... 103 Differentiating Between Natural Basic Scientific Research...... 103 and Intentional Events...... 142 Infrastructure for Research...... 104 Attribution Assessments...... 143 High-Containment Laboratories—The Debate. . . 107 Domestic Investigations of Suspected Galveston and Boston...... 107 Biological Weapons Use...... 143 Case Study: Epidemics and Biobanking...... 109 Case Study: Amerithrax...... 144 Medical Countermeasures...... 111 International Investigations of Suspected Stockpiling and Distribution Biological Weapons Use...... 144 of Medical Countermeasures...... 112 Case Study: Investigating Cities Readiness Initiative...... 112 Chemical Weapons Use in Syria...... 145 Case Study: Research Note on Data Integration Conclusions...... 146 for Effective Response to Public Health Key Words...... 146 Emergencies...... 116 Discussion Questions...... 146 Key Words...... 118 References ...... 147 Discussion Questions...... 118 References ...... 118 vi Contents PART V Practical Applications Public Health Emergency Preparedness Cooperative Agreement...... 170 and Operations 149 Conclusions...... 172 Key Words...... 172 Chapter 10 The Preparedness Cycle. . . . . 151 Discussion Questions...... 172 Learning Objectives...... 151 References ...... 172 Introduction...... 151 The Preparedness Cycle...... 151 Chapter 13 Links to Exercises and The Planning Process...... 152 Capacity Building...... 173 Conclusions...... 156 Learning Objectives...... 173 Key Words...... 157 Introduction...... 173 Discussion Questions...... 157 Training Development Process...... 174 References ...... 157 Exercise Development Process...... 175 Conclusions...... 178 Chapter 11 Practical Applications Key Words...... 178 of Public Health Emergency Discussion Questions...... 179 Management...... 159 References ...... 179 Learning Objectives...... 159 Introduction...... 159 Chapter 14 Case Studies in Public Health The Incident Command System ...... 159 Response Operations...... 181 Incident Command System Structure...... 160 Learning Objective...... 181 Threat and Hazard Identification and Introduction...... 181 Risk Assessment...... 163 Case Study: Public Health Emergency Conclusions...... 165 Management in Guinea—Before and Key Words...... 165 After the 2014 Ebola Outbreak...... 182 Discussion Questions...... 165 Case Study: Risk Communications in a Time References ...... 165 of Zika—Conducting Community Assessments during Public Health Emergencies...... 185 Chapter 12 Developing a Public Health Discussion Questions...... 190 Emergency Operations Center. . . 167 References ...... 190 Learning Objectives...... 167 Glossary ...... 191 Introduction...... 167 List of Figures...... 195 Emergency Operations Center Development. . . . 168 List of Boxes ...... 197 Framework for a Public Health Emergency Operations Centre...... 169 List of Tables...... 199 Public Health Emergency Operations Center Index ...... 201 Network...... 170 © f00sion/E+/Getty Prologue

rom bioterrorism to environmental disasters health professionals, and a range of other emergency and emerging communicable disease, threats to response professionals. An impressive list of experts health now appear everywhere we look. Essen- have contributed to these case studies. Ftials of Public Health Preparedness and Emergency Essentials of Public Health Preparedness and Emer- Management, Second Edition takes an all-hazards gency Management, Second Edition assumes no prior approach to public health preparedness and emer- background in public health, yet it speaks to under- gency management, providing broad perspectives on graduate students at community colleges and 4-year the local, national, and global threats. colleges, graduate students, as well as public health Rebecca Katz, PhD, MPH, an associate profes- practitioners. sor of global health and the co-director of the Center Public health preparedness has become a corner- for Global Health Science and Security at George- stone of public health and a major undertaking of gov- town University Medical Center, Washington, D.C., ernmental public health. takes on the challenge of putting public health pre- Competencies have been developed by the Asso- paredness in the larger context of public policy and ciation of School and Programs of Public Health with national security. She brings to this challenge a wealth support and encouragement from CDC. Essentials of of background in the policy aspects of public health Public Health Preparedness and Emergency Manage- preparedness, having worked at the intersection of ment, Second Edition will help students and practi- infectious diseases and national security for the State tioners achieve these competencies. Department and the Defense Intelligence Agency. The second edition has added new materials plus This second edition has added “emergency man- new chapters and now consists of 14 chapters that agement” to its title and content and added a new comprehensively introduce the full range of topics in author, James A. Banaski, Jr., MS, MEP, CEM, who public health preparedness and emergency manage- brings hands-on emergency management experience as ment. The 14 chapters, including an abundance of case a former team lead for the Global Response Prepared- studies, should make the second edition an ideal text ness Team in the Emergency Response and Recovery for a wide range of undergraduate and graduate pub- Branch of the Centers for Disease Control and Pre- lic health courses as well as courses for first respond- vention (CDC), Atlanta, Georgia. He led a team that ers, health administrators, nurses, and other clinical works with the Ministries of Health to assist in the health professionals. development of preparedness and response programs. I am confident that you will find Essentials of Essentials of Public Health Preparedness and Emer- Public Health Preparedness and Emergency Manage- gency Management, Second Edition also includes a ment, Second Edition engaging and enlightening. I am series of case studies such as Ebola and Zika, which delighted that Essentials of Public Health Preparedness demonstrate approaches to addressing the treatment and Emergency Management, Second Edition is part of of emerging infectious diseases. Additional case stud- our Essential Public Health series. ies focus on bioterrorism, environmental disasters, and the need for a coordinated approach, involving the Richard Riegelman, MD, MPH, PhD full range of first responders, public health and clinical Series Editor, Essential Public Health

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© f00sion/E+/Getty Preface

he last 15 years have seen many changes in The first edition of Essentials of Public Health terms of how we view our security and the role ­Preparedness and Emergency Management was designed of the public health community. Infectious dis- based on a course that one of the authors (Rebecca Teases continue to emerge and reemerge around the Katz) had been teaching for 10 years. The additions of world, and the globalization of our food supply and emergency management and other changes to the text the speed and volume of international travel make us are based on student feedback, feedback from faculty all vulnerable to the emergence of a new agent. There at other schools who have used the text, and colleagues is mounting evidence that large-scale epidemics can working in this area. dramatically affect the economic, social, and security The goal of this book is to introduce students to foundations of a nation. There is an ever-evolving the field of public health preparedness and emergency threat of the terrorist use of weapons of mass destruc- management, and for the first time to combine all tion against our population, particularly the use of of the topics in this field into one single text. Public biological weapons. We are constantly reminded of health preparedness and emergency management are the devastating effects of natural disasters, particularly new concepts for many students, from the undergrad- hurricanes and fire. All of these factors have led to the uate to doctoral students. As such, the text is written emergence of the subdiscipline within public health— in a way that presupposes no previous exposure to the public health preparedness. The public health com- concepts, yet still provides enough depth for students munity plays a vital role in identifying, responding who may have more advanced knowledge. to, containing, and recovering from emergencies. It Essentials of Public Health Preparedness and is imperative that public health professionals develop ­Emergency Management, Second Edition is divided an awareness of the emerging threats, the means of into five parts: addressing those threats, security challenges inherent Part I: Principles of Public Health Preparedness in these activities, and be able to identify and work and Emergency Management with other sectors with similar responsibilities. Part II: Defining the Problem An essential component of effective public health Part III: Infrastructure preparedness and response is public health emergency Part IV: Solving Problems management and emergency operations centers. Part V: Practical Applications and Operations Responding to large-scale public health events often Part I provides an overview and background requires coordination with multiple organizations and to the field of public health preparedness. We look international entities through an emergency response at how the field has evolved and how different enti- plan, and emergency operations centers play an essen- ties have defined the discipline. We also review the tial role in coordinating an effective response. definitions and evolution of national security and Public health preparedness and emergency man- homeland security, with particular emphasis on how agement has been rapidly developing at the global, they relate to public health. Finally, we look at the federal, state, and local levels. The CDC has an entire role of the public health professional in emergency division devoted to emergency management and the preparedness, from designing policy to participating world’s gold standard public health emergency oper- in disaster response, and explore potential careers in ations centers. The World Health Organization pub- the field. lished a first-ever guidance and standards document Part II of the text begins to characterize the prob- for public health emergency operations centers, in a lems that require preparedness on the part of the pub- response to global demand from Ministries of Health. lic health community. Chapter 2 covers threats from Academia is now acknowledging this as an essential biological, chemical, nuclear, and radiological weap- area of expertise necessary for a fully developed public ons. We define these threats and review the history health workforce. of use—both intentional and accidental. The chapter

ix x Preface then looks at how the current threat from weapons of at the enterprise that has been built to support the mass destruction (WMD) is evaluated and returns to ­development of medical countermeasures. the role of the public health community in responding Chapter 8 focuses on the response—the systems to WMD. Chapter 3 discusses threats from naturally that have been established to coordinate and govern occurring disease and natural disasters: the historical the humanitarian response to emergencies. Chapter 9 impact of disease and natural disaster on homeland and describes the domestic and international surveillance national security, preparedness activities around the programs, and concentrates on the challenges asso- threat of naturally occurring diseases, evaluating the ciated with investigating an alleged-use event and on current threat from disease and disasters, and the pub- making an attribution assessment. This chapter also lic health and foreign policy response to these threats. explores the relationship between the Federal Bureau Part III moves from definitions and threat char- of Investigation and the public health community, acterization to a review of the infrastructure, primar- particularly as it pertains to criminal and epidemio- ily on the federal level, that has emerged in the past logical investigations. 15 years to address public health preparedness. Chap- The last section of the book, Part V, focuses on ter 4 focuses on national infrastructure for public the practical applications and operations associated health preparedness and planning. We review the cre- with public health preparedness and emergency man- ation of the National Strategy for Homeland Security agement. Chapter 10 introduces the idea of prepared- and the offices and organizations that were created in ness as a program through the preparedness cycle the aftermath of 9/11. This chapter also introduces and the idea of a deliberate planning process for pre- the reader to the Intelligence Community. We look paredness. Chapter 11 covers practical applications at the National Response Framework, with particu- of public health emergency management, explaining lar emphasis on public health and medical response the Incident Command System and the Threat and components, the National Incident Management Hazard Identification and Risk Assessment process. System, and specific plans for public health emergen- In Chapter 12, we explore the development and use cies. Finally, Chapter 5 presents the legislation, reg- of an emergency operations center. Chapter 13 cov- ulations, and policy guidance that have emerged to ers capacity development programs, such as training, address public health preparedness and to mitigate exercises, and evaluation. Chapter 14 discusses a few the threats of WMD, naturally occurring disease, and of the most recent public health responses. other disasters. We are excited to introduce a series of case studies Part IV of the book is generally categorized as that appear throughout the book, written by experts solving problems and includes a variety of approaches from across the discipline. Our hope is that these case the community has taken to address biological threats, studies bring to life some of challenges and solutions along with the challenges of each approach. Chapter 6 offered to advance public health preparedness and explores biosecurity and biosafety: defining the dual emergency management. use dilemma, how biosecurity is used to minimize This book is designed to give the reader an appre- the threat, the role of the life sciences community in ciation for the complexities of issues that must be establishing codes of conduct and self-policing scien- considered by public health professionals in design- tific publications, reviewing pathogen security efforts, ing preparedness and response plans, policies, regu- and examining emerging challenges in biosecurity. lations and legislation, and emergency management. In Chapter 7, we look at the research agenda and the We hope readers will better understand the essential infrastructure that has been built to support research role of the public health community in preparing for directly relating to biological threats. We also look and responding to security threats. © f00sion/E+/Getty New to This Edition

s mentioned in the Preface, this edition reflects case studies throughout the book, intended to provide major changes that have evolved in the field of in-depth review of issues directly related to the text. public health preparedness in the past 6 years For these case studies, we have brought in guest con- Aand brings in the essentials of emergency management. tributors. We have updated each of the chapters that These changes were made based on student feedback, have remained from the previous edition to reflect feedback from faculty at other schools who have used new developments in the field, more recent outbreaks the text, and colleagues working in this area. The most and challenges, and an ever-evolving national and obvious changes are the addition of five chapters on international system to describe and address chal- emergency management (Chapters 10–14) written lenges in public health preparedness and emergency by James A. Banaski, Jr., an emergency management management. expert from the CDC. We have also added a series of

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© f00sion/E+/Getty Contributors

Jennifer Bryning Alton, MPP Ami Patel, PhD, MPH Case Study: Passage of the Pandemic and All-Hazards Case Study: Risk Communications in a Time of Zika— Preparedness Act of 2006 (appears in Chapter 5) Conducting Community Assessments During Malaya Fletcher, MPH Public Health Emergencies (appears in Chapter 14) Case Study: Risk Communications in a Time of Erin M . Sorrell, PhD, MS Zika—Conducting Community Assessments Case Study: The H5N1 Transmission Papers— During Public Health Emergencies (appears in Reinvigorating the Dual Use Dilemma (appears in Chapter 14) Chapter 6) Ellie Graeden, PhD Claire Standley, PhD, MSc Case Study: Research Note on Data Integration for Case Study: Epidemics and Biobanking (appears Effective Response to Public Health Emergencies in Chapter 7) and Case Study: Public Health (appears in Chapter 7) Emergency Management in Guinea—Before and After the 2014 Ebola Outbreak (appears in Chapter 14)

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Acknowledgments

From Rebecca Katz: From James A. Banaski, Jr.: This book is based on a class I taught for many years I would like to publicly thank my colleagues from at George Washington University’s School of Public the CDC for their kind input and encouragement as Health and Health Services (Washington, D.C.)—a I wrote chapters for this book. Specifically, I would class I inherited in 2006 from Brian Kamoie. So, I like to thank Kim ­Hanson, Luis Hernandez, Jennifer continue to thank Brian for his foresight and efforts Brooks, Mike ­Gerber, and Mark Anderson, whose in designing this class and for trusting me to build on guidance and critiques have made this a better book. the foundation he provided. I thank all of the students Thank you to Claire Standley and Erin M. Sorrell, true who have provided helpful comments on the text over professionals that I have had the pleasure of working the years. I thank my colleagues at Georgetown Cen- with in many different capacities. Thank you Emily ter for Global Health Science and Security for their Harris, who is the reason this book looks coherent. I support while I worked on this book, specifically would also like to thank my wife, Kim, and my chil- Claire Standley for research assistance on Chapter 5 dren, Ashley and Avery, for allowing me to sacrifice and Aurelia Attal-Juncqua for research assistance on family time in order to do something I have always Chapter 4. Many, many thanks to Emily Harris, who wanted to do. And last, but certainly not least, Dr. provided exceptional, detailed assistance in making Rebecca Katz. Thank you for inviting me to be a part this book happen. I am also thankful to Jennifer Alton, of this project. I have always wanted to do something Claire Standley, Erin M. Sorrell, Ellie Graeden, Malaya like this and you made it happen. Fletcher, and Ami Patel for generously contributing case studies to this edition. And to Jim Banaski for being willing to come on board this project and share his fantastic expertise with us. Most importantly, I thank my family—Matt, Olivia, and Benjamin—for their love and support.

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About the Authors

Rebecca Katz, PhD, MPH is an associate professor James A. Banaski, Jr., MS, MEP, CEM is the team lead of global health and the co-­director of the Center for for the Global Response Preparedness Team in the Global Health Science and Security at Georgetown Emergency Response and Recovery Branch, Division University Medical Center (­Washington, D.C.). She is of Global Health Protection, Center for Global Health also an affiliate faculty in the ­Georgetown University at the CDC in Atlanta, Georgia. He leads a team that School of Foreign Service and the McCourt School of works with Ministries of Health to assist in the devel- Public Policy. Prior to joining ­Georgetown Univer- opment of preparedness and response programs to sity in 2016, she spent 10 years in the Department of help them meet their requirements under the Inter- Health Policy and Management at the Milken Insti- national Health Regulations (2005) to detect, respond tute School of Public Health at George ­Washington to, and report public health threats of international University. She is trained in epidemiology, demogra- concern. Before coming to the CDC, he worked with phy, , global health, and public policy. Since the U.S. Army North, conducting training and exer- 2007, she has focused her research on the implemen- cises for the Weapons of Mass Destruction Civil Sup- tation of the International Health Regulations, health port Teams. Previous to that, he served as a training diplomacy, and public health preparedness policy. specialist at the U.S. Army Chemical School at Fort Since September 2004, she has been a public health Leonard Wood, Missouri. He has served in numerous scientist and expert consultant at the U.S. Department public health emergencies, including H1N1, numer- of State. She currently supports the Biological Policy ous hurricanes, the Deepwater Horizon oil spill, the Staff in the Bureau of International Security and Non- American Samoa Tsunami response, the Japan Earth- proliferation. She has been with this office since it was quake and Tsunami response, the Joplin, Missouri created in 2010, and works primarily on the Biological tornado relief, and the worldwide Ebola response in Weapons Convention and provides content and pol- Sierra Leone and Liberia. icy expertise on emerging and pandemic threats. Mr. Banaski is an 11-year veteran of the U.S. Army Dr. Katz has an undergraduate degree in polit- Chemical Corp and served in various locations in the ical science and economics from Swarthmore Col- United States, Europe, and the Middle East. lege (Swarthmore, Pennsylvania), a master’s in public Mr. Banaski has a dual bachelor of science degree health from (New Haven, Connecti- in environmental science and biology from Drury cut), and PhD from (Princeton, University (Springfield, Missouri) and a master of New Jersey). science degree in environmental management from Webster University (Webster Groves, Missouri). He also holds a Master Exercise Practitioner certification from the Department of Homeland Security and the Certified Emergency Manager designation from the International Association of Emergency Managers.

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© f00sion/E+/Getty About the Contributors

Jennifer Bryning Alton, MPP leads Bavarian Nordic’s Scholar, and conducted capacity assessments at district U.S. public policy and government affairs activities, hospitals in Ghana. including policy development, lobbying, public affairs, An epidemiologist and emergency planner, her alliance development, and trade association manage- interests include global health security, mixed meth- ment. She is also a board member for the Alliance for ods research, and integrating emergency management Biosecurity, a coalition of biopharmaceutical compa- with routine public health functions through train- nies and academic partners working to ensure medical ings and exercises. Fletcher is committed to overcom- countermeasures are available to protect public health ing the traditional boundaries of public health and and enhance national health security. She previously emergency management and translating findings into worked in the U.S. Senate as public health policy direc- evidence-based policies. She is a member of the tor for Senator Richard Burr on the Health, Education, Advisory Board for the Systems-Level Mass Fatality Labor, and Pensions Committee, where she led the Preparedness Study at the University of California’s development and negotiation of policy and legislation Philip R. Lee Institute for Health Policy Studies (San on public health issues, and successfully shepherded the ­Francisco, CA). She is also an Emerging Leaders in bipartisan Pandemic and All-Hazards Preparedness Act Biosecurity Initiative fellow with the Johns ­Hopkins into law in 2006, transforming the country’s prepared- Center for Health Security (Baltimore, MD). She ness for health security threats. She also worked at the received an MPH in epidemiology and a Global Health U.S. Department of Health and Human Services, where Certificate from Columbia University(New York) in she was selected as a presidential management fellow 2012. She also has a bachelor’s in microbiology and in the Office of the Assistant Secretary for Budget and Certificate in Health Care Organizations & Society received the Secretary’s Distinguished Service Award. from Arizona State University (Tempe, AZ). She holds a master of public policy degree from the Luskin School of Public Affairs (University of ­California, Ellie Graeden, PhD is the founder and CEO of Talus Los Angeles, CA) and a bachelor’s degree from Whittier Analytics, a small research and consulting firm that College (Whittier, CA). specializes in translating complex, computational, and scientific analysis into useful data for decision Malaya Fletcher, MPH serves as the Global Migra- makers. She earned a in biology from the tion & Monitoring Coordinator for the Philadelphia Massachusetts Institute of Technology (Cambridge, Department of Public Health (PDPH), where she MA), where she held a National Science Foundation focuses on emerging infectious disease surveillance Graduate Research Fellowship. She has a bachelor of and travel health. She currently oversees the agency’s science in microbiology from Oregon State University Zika education activities. In this capacity, she was (Corvallis, OR). Across her research and consulting the lead planner for Philadelphia’s first Community career, she has built a unique approach to data anal- Assessment for Public Health Emergency Response, ysis, visualization, and computational modeling that which is used to evaluate the efficacy of the agency’s informs policy and practical decision-­making. Her Zika media campaign. Prior to her current position, past projects have included efforts in support of Fed- she served as the public health preparedness planner eral Emergency Management Agency to identify and at PDPH, where her primary responsibilities included characterize the models used for emergency manage- regional coordination for the Philadelphia–Camden– ment and in support of the White House National Wilmington Metropolitan Statistical Area, radiological Security Council to coordinate data-driven decision-­ incident planning, and medical countermeasure pro- making for public health emergencies. She has, in curement. Outside of Philadelphia, she has worked in addition, led teams funded by the Bill and Melinda pandemic flu planning for Washington State Schools, Gates Foundation to develop and deploy public health researched maternal–child health in India as a Boren models for local use in the developing world, built a

xix xx About the Contributors data and analysis platform for the CDC pandemic in the Office of Cooperative Threat Reduction’s Bios- flu response, and developed an integrated flood risk ecurity Engagement Program at the Department of analysis and community resilience investment plan- State, where she also worked as an American Asso- ning method funded by the Department of Homeland ciation for the Advancement of Science’s science and Security’s Science and Technology Directorate. technology policy fellow. She worked on foreign assis- tance activities in sub-Saharan Africa, the Middle Ami Patel, PhD, MPH is presently a senior epide- East, and North Africa. miologist at CSL Behring (King of Prussia, PA). She Dr. Sorrell was a postdoctoral fellow both at Eras- previously spent 9 years as a CDC career epidemi- mus Medical Center (Rotterdam, The Netherlands) ology officer (CEFO) for the PDPH. In her role as a and the University of Maryland (College Park, MD). CEFO, she managed PDPH’s Acute Communica- Her research focused on the molecular mechanisms of ble Disease Program and its team of 15 epidemiolo- interspecies transmission, primarily focusing on avian gists, disease surveillance investigators, and program to human transmission of H2, H7, H9, and H5 influ- assistants in their conduct of routine surveillance, enza A viruses. She received her master’s and doctor- outbreak investigations, educational outreach efforts ate in virology from the University of Maryland and a and training, and special studies for over 60 enteric, bachelor’s in animal science from Cornell University ­vaccine-preventable, vector-borne, respiratory virus (Ithaca, NY). and healthcare-associated viral hepatitis diseases/con- ditions along with emerging infections. Claire Standley, PhD, MSc is an assistant research Dr. Patel began her career with the CDC in 2002 professor within the Center for Global Health Science at the National Institute of Occupational Safety and and Security at Georgetown University, with a primary Health (Pittsburgh, PA). She then joined the CDC’s faculty appointment in the Department of Interna- Epidemic Intelligence Service (EIS) in 2005, where she tional Health. Her research focuses on the analysis of was assigned to the Virginia Department of Health. health systems strengthening and international capac- After completing EIS in 2007, she became a CEFO. ity building for public health, with an emphasis on She received her master of public health in 2002 and prevention and control of infectious diseases in both a doctorate in epidemiology in 2005 from the Univer- humans and animals, as well as public health emer- sity of Pittsburgh’s Graduate School of Public Health gency preparedness and response. (Pittsburgh, PA). She maintains an active interest in Prior to joining Georgetown University, Dr. teaching and mentoring students, and is an instructor Standley was a senior research scientist at The George at Thomas Jefferson University’s School of Population ­Washington University Milken Institute School of Health and Philadelphia College of Osteopathic Med- Public Health, and also served as an American Asso- icine (Pittsburgh, PA). ciation for the Advancement of Science’s science and technology policy fellow at the Department of State, Erin M. Sorrell, PhD, MS is an assistant research where she supported programs for laboratory capac- professor in the Department of Microbiology and ity building, disease surveillance, and cooperative Immunology and a member of the Center for Global research across the Middle East, sub-­Saharan Africa, Health Science and Security at Georgetown University and the Lower Mekong. (Washington, D.C.). Her work focuses on developing Dr. Standley has broad and multidisciplinary partnerships across the U.S. government, interna- training across the life sciences, including an under- tional organizations, and ministries around the world graduate degree in natural sciences (zoology) from to identify elements required to support health sys- the University of Cambridge (Cambridge, UK); a mas- tems strengthening and laboratory capacity building ter’s in biodiversity, conservation, and management for disease detection, reporting, risk assessment, and from the University of Oxford (Oxford, UK); a PhD response. Her research uses evidence-based approaches in genetics (with a focus on biomedical parasitology) to determine gaps and identify capacities for effective from the University of Nottingham (Nottingham, global health programs and policies. UK), as part of a joint program with the Natural His- Previously, Dr. Sorrell was a senior research sci- tory Museum of London. She served as a postdoctoral entist at The George Washington University’s Milken research associate at Princeton University (Princeton, Institute School of Public Health in the Department of NJ), where she examined the dynamics between dis- Health Policy and Management (Washington, D.C.). ease, biodiversity, and public health, working at field Prior to joining the university, she was a senior analyst sites in Tanzania and Costa Rica. © f00sion/E+/Getty Abbreviations

AAR/IP after action report/improvement plan COMINT communications intelligence AI avian influenza CONOPs concept of operations AMR antimicrobial resistance COOP Continuity of Operations ANSS Agence National de Securité Sanitaire CPG Community Preparedness Guide AoR Area of Responsibility CR dibenzoxazepine APHA American Public Health Association CRI Cities Readiness Initiative APHIS Animal and Plant Health Inspection CS chlorobenzylidenemalononitrile Service CSTE Council of State and Territorial APHL Association of Public Health ­Epidemiologists Laboratories CTICC Cyber Threat Intelligence Integration ARS acute radiation syndrome Center ASPPH Association of Schools and Programs CTR Cooperative Threat Reduction of Public Health CW chemical warfare/chemical weapons ASPR Assistant Secretary for Preparedness CWC Chemical Weapons Convention and Response CWS Chemical Warfare Service ASTHO Association of State and Territorial CYBINT Cyber Intelligence Health Officers DDII Deputy Director of National Intelli- BAA Broad Agency Announcement gence for Intelligence Integration BARDA Biomedical Advanced Research and DDMA District Disaster Management Agency Development Authority DEA Drug Enforcement Administration BSL biosafety level DHHS Department of Health and Human BSWG Biosecurity Working Group Services BT bioterrorism DHS Department of Homeland Security BW biological warfare/biological weapons DIA Defense Intelligence Agency BWC Biological and Toxin Weapons DNI Director of National Intelligence Convention DOD Department of Defense DOE Department of Energy CASPER Community Assessment for Prepared- DOS Department of State ness and Emergency Response DRC Disaster Recovery Centers CBD Convention on Biological Diversity DRR Disaster Risk Reduction CBRN chemical, biological, radiological, and DURC Dual Use Research of Concern nuclear CDC Centers for Disease Control and ECDC European Union Center for Disease Prevention Prevention and Control CD-ROM Compact Disk-Read Only Memory EEE Eastern equine encephalitis CERT Community Emergency Response EIS Epidemic Intelligence Service Team ELINT Electronic Intelligence CIA Central Intelligence Agency EM Emergency Management CN chloroacetophenone EMC Erasmus Medical Center CNLEB Cellule de Coordination de la riposte EMT Emergency Medical Teams contra la maladie à virus Ebola EO Executive Order COE Centers of Excellence EOC Emergency Operations Center

xxi xxii Abbreviations

EOC-NET Emergency Operations Centre HSPD Homeland Security Presidential Network Directive EPA Environmental Protection Agency HSS Health and Human Services EPI-X Epidemic Information Exchange HUMINT Human Intelligence ERC Emergency Relief Coordinator ERF Emergency Response Framework IA Office of Intelligence and Analysis ESF Emergency Support Function (DHS) ESFLG Emergency Support Function IAEA International Atomic Energy Agency Leadership Group IAP Incident Action Plan IASC Inter-Agency Standing Committee FAA Federal Aviation Administration IBC Institutional Biosafety Committee FAO Food and Agriculture Organization IC Intelligence Community of the United Nations ICS Incident Command System FBI Federal Bureau of Investigation IDSR Integrated Disease Surveillance and FDA Food and Drug Administration Response FELTP Field Epidemiology Laboratory IHR International Health Regulations Training Program IMS Incident Management System FEMA Federal Emergency Management INR Bureau of Intelligence and Research Agency (DOS) FESAP Federal Experts Security Advisory INTERPOL International Criminal Police Panel Organization FETP Field Epidemiology Training Program IO international organization FININT Financial Intelligence IOM International Organization for FIRESCOPE Firefighting Resources of California Migration Organized for Potential Emergencies IPAPI International Partnership on Avian FISINT Foreign Instrumentation Signals and Pandemic Influenza Intelligence IRD Institut de recherche pour le FSE Full Scale Exercise dévelopment FSS Federal Security Service IRF Integrated Research Facility FY Fiscal Year IRFC International Federation of Red Cross and Red Crescent Societies G8 Group of 8 GEOINT Geographic Intelligence JEE Joint External Evaluation Tool GHSA Global Health Security Agenda JIC Joint Information Center GISN Global Influenza Surveillance Network JIM Joint Investigative Mechanisms GISRS Global Influenza Surveillance and Response System KGB Komitet Gosudarstvennoy GOARN Global Outbreak Alert and Response Bezopasnosti Network GOF gain-of-function GPHIN Global Public Health Information LRN Laboratory Response Network Network LSD Lysergic acid diethylamide GPP Global Partnership Program MASINT Measurement and Signature HAN Health Alert Network Intelligence HC Humanitarian Coordinator MCM Medical Countermeasures HELP Senate Committee on Health, MERS Middle East Respiratory Education, Labor and Pensions Syndrome HPAI highly pathogenic avian influenza MIC methyl isocyanate HPP Hospital Preparedness Programs MOU Memorandum of Understanding HSEEP Homeland Security Exercise and MPH Master of Public Health Evaluation Program MSEHPA Model State Emergency Health Powers Act Abbreviations xxiii

MTA Material Transfer Agreement OCHA Office for Coordination of Humanitarian Affairs NACCHO National Association of County and OFDA Office of Foreign Disaster Assistance City Health Officials OHCHR Office of the High Commissioner NAM National Academy of Medicine for Human Rights NAS National Academies of Science OIE Organization for Animal Health NATO North Atlantic Treaty Organization OPCW Organization for the Prohibition of NBACC National Biodefense Analysis and Chemical Weapons Countermeasures Center OPHPR Office of Public Health Prepared- NBIC National Biosurveillance Integration ness and Response Center OSINT Open Source Intelligence NCPC National Counterproliferation Center OTA Office of Technology Assessment NCSC National Counterintelligence and Security Center P3 Prevent 3 NCTC National Counterterrorism Center PAHPA Pandemic and All Hazards NDAA National Defense Authorization Act Preparedness Act NDMA National Disaster Management PDD Presidential Decision Directive Authority PDMA Provincial Disaster Management NDMS National Disaster Medical System Agency NEP National Exercise Program PDPH Philadelphia Department of Public NGA National Geospatial-Intelligence Health Agency PEPFAR U.S. President’s Emergency Plan NGO nongovernmental organization for AIDS Relief NHSS National Health Security Strategy PETS Pets Evacuation and NIAID National Institute of Allergy and Transportation Standards Act Infectious Diseases PHAC Public Health Agency of Canada NIC National Intelligence Council PHEIC Public Health Emergency of NIH National Institutes of Health International Concern NIMS National Incident Management PHEM Public Health Emergency System Management NOAA National Oceanic and Atmospheric PHEMCE Public Health Emergency Medical Association Countermeasures Enterprise NORAD North American Aerospace Defense PHEOC Public Health Emergency Command Operations Center NPS National Pharmaceutical Stockpile PHEP Public Health Emergency NPT Nuclear Non-proliferation Treaty Preparedness NRC Norwegian Refugee Council PHPR Public Health Preparedness and NRF National Response Framework Response NRO National Reconnaissance Office PIO Public Information Officer NRP National Response Plan PIP Framework Pandemic Influenza NSA National Security Agency Preparedness Framework NSABB National Science Advisory Board PNAS Proceedings of the National for Biosecurity Academy of Science NSC National Security Council PREP Public Readiness and Emergency NSD National Security Directive Preparedness Act NSDD National Security Decision Directive PPD Presidential Policy Directive NSPD National Security Presidential PS chloropicrin Directive NSPM National Security Presidential RFC Reconstruction Finance Memorandum Corporation NSS National Security Strategy xxiv Abbreviations

SARS Severe Acute Respiratory USA PATRIOT Uniting and Strengthening Amer- Syndrome ica by Providing Appropriate Tools SENAH National Service for Humanitarian Required to Intercept and Obstruct Action Terrorism SEPA Smallpox Emergency Personnel USAID U.S. Agency for International Protection Act Development SIGINT Signals Intelligence USAMRIID U.S. Army Medical Research Insti- SITREP Situation Report tute for Infectious Diseases SMART Simple, Measurable, Achievable, USC United States Code Realistic, Task Oriented USDA U.S. Department of Agriculture SNS Strategic National Stockpile USNORTHCOM U.S. Northern Command SOP standard operation procedure USG U.S. Government STD sexually transmitted disease UTL universal task list UTMB University of Texas Medical Branch T2 trichothecene mycotoxtin UW University of Wisconsin TB tuberculosis TCL target capabilities list VECTOR State Research Centre for Virology TECHINT Technical Intelligence and Biotechnology TFAH Trust for America’s Health VEE Venezuelan Equine Encephalitis THIRA Threat and Hazard Identification and Risk Assessment WASH Water, Sanitation and Hygiene TOPOFF Top Officials WEE Western Equine Encephalitis WFP World Food Programme UNDP U.N. Development Programme WHA World Health Assembly UNHCR United Nations High Commis- WHO World Health Organization sioner for Refugees WMD Weapons of Mass Destruction UNICEF U.N. Children’s Fund WRS War Research Service UNMAS U.N. Mine Action Service WWI World War One UNSCR U.N. Security Council Resolution WWII World War Two UNSGM U.N. Secretary-General’s Mechanism