Essentials of Public Health Preparedness / Rebecca Katz

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Essentials of Public Health © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION PreparednessNOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Rebecca Katz, MPH, PhD © Jones & Bartlett Learning, LLC © JonesAssistant & Bartlett Professor Learning, LLC NOT FOR SALE OR DISTRIBUTION GeorgeNOT Washington FOR SALE University OR DISTRIBUTION School of Public Health and Health Services Washington, DC © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

79832_ch00_FM_5987.indd 1 8/24/11 9:22:38 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA 01803 978-443-5000 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC [email protected] NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION www.jblearning.com

Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC SubstantialNOT discounts FOR on SALEbulk quantities OR DISTRIBUTION of Jones & Bartlett Learning publications are availableNOT FOR to corporations, SALE ORprofessional DISTRIBUTION associa- tions, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones & Bartlett Learning via the above contact information or send an email to [email protected].

© JonesCopyright & Bartlett © 2013 by Learning, Jones & Bartlett LLC Learning, LLC, an Ascend Learning© Jones Company & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechani- cal, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner.

This publication is designed to© provide Jones accurate & Bartlett and authoritative Learning, information LLC in regard to the Subject Matter© covered. Jones It is& sold Bartlett with the Learning, LLC understanding that the publisherNOT is not FOR engaged SALE in rendering OR legal,DISTRIBUTION accounting, or other professional service. IfNOT legal advice FOR or SALE other expert OR DISTRIBUTION assistance is required, the service of a competent professional person should be sought.

Production Credits Cover Design: Kristin E. Parker Publisher: Michael Brown Rights & Photo Research Manager: Katherine Crighton Managing ©Editor: Jones Maro &Gartside Bartlett Learning, LLC Photo Research Supervisor:© Jones Anna & GenoeseBartlett Learning, LLC Editorial Assistant:NOT FOR Chloe SALEFalivene OR DISTRIBUTION Cover Image: © CaitlinNOT Mirra/ShutterStock, FOR SALE OR Inc. DISTRIBUTION Production Manager: Tracey McCrea Section and Chapter Opener Image: Courtesy of Journalist 1st Class Associate Marketing Manager: Jody Sullivan Mark D. Faram/U.S. Navy Manufacturing and Inventory Control Supervisor: Amy Bacus Printing and Binding: Malloy, Inc. Composition: Publishers’ Design and Production Services, Inc. Cover Printing: Malloy, Inc. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Library of Congress Cataloging-in-Publication Data NOT FORKatz, Rebecca SALE Lynn, OR 1973– DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Essentials of public health preparedness / Rebecca Katz. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-0-7637-7983-2 ©(pbk.) Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ISBN-10: 0-7637-7983-0 (pbk.)NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1. Public health—United States. 2. Disaster medicine—United States. 3. Public health administration—United States. 4. Civil defense readiness—United States. I. Title. [DNLM: 1. Civil Defense—United States. 2. Disaster Planning—United States. 3. Public Health Administration—United States. 4. Security Measures—United States. 5. Terrorism—prevention & control—United States. WA 295] RA445.K34© Jones 2012 & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 363.34’8—dc23NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 2011014807 6048 Printed in the United States of America 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

79832_ch00_FM_5987.indd 2 8/24/11 9:22:38 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Prologue: Essentials of Public Health Preparedness ix P©reface Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,xi LLC ANOTcknowledgments FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTIONxiii About the Author xv Abbreviations xvii © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Part I Background of the Field 1 Chapter 1 Introduction to Public Health Preparedness 3 © Jones & Bartlett Learning,Learning LLC Objectives © Jones & Bartlett Learning, LLC 3 NOT FOR SALE OR DISTRIBUTIONIntroduction NOT FOR SALE OR DISTRIBUTION 3 National Security 3 Homeland Security 4 Homeland Defense 4 Public© Jones Health & PreparednessBartlett Learning, LLC © Jones & Bartlett Learning,4 LLC DevelopingNOT FOR the SALE Public OR Health DISTRIBUTION Preparedness Workforce: Charge andNOT Careers FOR SALE OR DISTRIBUTION6 Jobs in Public Health Preparedness 6 Key Words 7 Discussion Questions 8 © Jones & BartlettReferences Learning, LLC © Jones & Bartlett Learning, LLC 9 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Part II Defining the Problem: Potential Threats 11 Chapter 2 Threats from Biological, Chemical, Nuclear, and Radiological Weapons 13 © Jones & Bartlett Learning,Learning LLC Objectives © Jones & Bartlett Learning, LLC 13 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

79832_ch00_FM_5987.indd 3 8/24/11 9:22:38 PM iv Contents © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Introduction 13 Chemical Threats 13 Toxins 14 History© Jones & Bartlett Learning, LLC © Jones & Bartlett14 Learning, LLC Nuclear andNOT Radiological FOR SALE Threats OR DISTRIBUTION NOT FOR SALE OR16 DISTRIBUTION Nuclear Weapons 16 Radiological Threats 16 Biological Threats 20 Biological Agents 22 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Classification of Biological Weapons 23 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The Biological Threat 28 Key Words 29 Discussion Questions 30 References 31 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORChapter SALE 3 ORT hreatsDISTRIBUTION from Naturally OccurringNOT Disease FOR SALE OR DISTRIBUTION 33 Learning Objectives 33 Introduction 33 Evolution of Disease and Security Links 34 Defining© the Jones Link between& Bartlett Disease Learning, and Security LLC © Jones & Bartlett36 Learning, LLC Global InterconnectednessNOT FOR SALE and OR the DISTRIBUTION Spread of Disease NOT FOR SALE OR38 DISTRIBUTION Monkeypox 38 Severe Acute Respiratory Syndrome 38 HIV/AIDS 40 © JonesResponse & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC40 NOT FORKey Words SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION42 Discussion Questions 43 References 44

© JonesPar & Bartlettt III InfrastructureLearning, LLC © Jones & Bartlett Learning, LLC 45 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Chapter 4 September 11, 2001 and Its Aftermath 47 Learning Objectives 47 Introduction 47 Constitutional© Jones Framework & Bartlett and History Learning, of Federal LLC Assistance for Preparedness© Jones and & Bartlett Learning, LLC DisasterNOT Response FOR SALE OR DISTRIBUTION NOT FOR SALE OR47 DISTRIBUTION Immediate Response to 9/11 48 Post-9/11 50 Offices and Organizations: The Federal Preparedness Infrastructure 52 © Jones &Department Bartlett ofLearning, Health and LLC Human Services (DHHS) © Jones & Bartlett Learning, LLC52 NOT FORDepartment SALE OR of DISTRIBUTION Homeland Security (DHS) NOT FOR SALE OR DISTRIBUTION53 Department of Agriculture (USDA) 53 Department of Justice, Federal Bureau of Investigation (FBI) 53 Department of Defense 54 © Jones & Bartlett IntroductionLearning, toLLC the Intelligence Community© Jones & Bartlett Learning, LLC 54 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

79832_ch00_FM_5987.indd 4 8/24/11 9:22:38 PM Contents v © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Key Words 55 Discussion Questions 56 References 57 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Chapter 5 PreparednessNOT FOR SALE Plans OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION59 Learning Objectives 59 Introduction 59 National Incident Management System 60 © Jones & BartlettThe National Learning, Response LLC Framework © Jones & Bartlett Learning, LLC 62 NOT FOR SALEPresidential OR DISTRIBUTION Policy Directive 8 NOT FOR SALE OR DISTRIBUTION 64 State Preparedness 64 Discussion 64 Key Words 64 © Jones & Bartlett Learning,Discussion LLC Questions © Jones & Bartlett Learning, LLC 65 References 66 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Chapter 6 Legislation, Regulations, and Policy Guidance 67 Learning Objectives 67 Introduction 67 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Legislation 67 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Public Health Improvement Act of 2000 (Public Law 106-505) 67 USA PATRIOT Act of 2001 (Public Law 107-56) 67 Public Health Security and Bioterrorism Preparedness and Response Act of 2002 (Public Law 107-188) 68 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Smallpox Emergency Personnel Protection Act of 2003 (Public Law 108-20) 68 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The Project Bioshield Act of 2004 (Public Law 108-276) 68 Public Readiness and Emergency Preparedness (PREP) Act of 2005 (Division C of the Department of Defense Emergency Supplemental Appropriations, Public Law 109-148) 68 Pandemic and All-Hazards Preparedness Act of 2006 (Public Law 109-417) 69 © Jones & Bartlett Learning,Implementing LLC Recommendations© Jones of the 9/11 & BartlettCommission Learning, Act of 2007 LLC (Public Law 110-53) 70 NOT FOR SALE OR DISTRIBUTIONPending Legislation NOT FOR SALE OR DISTRIBUTION 70 Presidential Directives 70 Biodefense for the 21st Century (National Security Presidential Directive 33/ Homeland Security Presidential Directive 10, April 2004) 70 © JonesMedical &Countermeasures Bartlett Learning, Against WeaponsLLC of Mass Destruction© (Homeland Jones & Security Bartlett Learning, LLC NOT FORPresidential SALE Directive OR DISTRIBUTION 18, February 2007) NOT FOR SALE OR DISTRIBUTION71 Public Health and Medical Preparedness (Homeland Security Presidential Directive 21, October 2007) 71 Establishing Federal Capability for the Timely Provision of Medical Countermeasures © Jones & Bartlett FollowingLearning, a Biological LLC Attack (Executive Order© Jones 13527, &December Bartlett 2009) Learning, LLC 71 NOT FOR SALENational OR DISTRIBUTION Strategy for Countering Biological ThreatsNOT (Presidential FOR SALE Policy OR Directive DISTRIBUTION 2, November 2009) 71 Model Legislation 72 Summary 72 © Jones & Bartlett Learning,Key Words LLC © Jones & Bartlett Learning, LLC 72 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

79832_ch00_FM_5987.indd 5 8/24/11 9:22:38 PM vi Contents © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Discussion Questions 73 References 74

Part IV Solving© Jones Problems & Bartlett Learning, LLC © Jones & Bartlett75 Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Chapter 7 Biosecurity 77 Learning Objectives 77 Introduction 77 © JonesThe &Dual-Use Bartlett Dilemma Learning, LLC © Jones & Bartlett Learning, LLC78 NOT FORMousepox SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION79 The Fink Report 80 Select Agents 82 Synthetic Biology 82 © Jones & Bartlett CooperativeLearning, T LLChreat Reduction © Jones & Bartlett Learning, LLC 83 NOT FOR SALE ORKey DISTRIBUTION Words NOT FOR SALE OR DISTRIBUTION 84 Discussion Questions 85 References 86

Chapter 8 The Research© Jones Agenda & Bartlett Learning, LLC © Jones & Bartlett87 Learning, LLC LearningNOT Objectives FOR SALE OR DISTRIBUTION NOT FOR SALE OR87 DISTRIBUTION Introduction 87 Basic Scientific Research 87 Infrastructure for Research 88 © JonesHigh-Containment & Bartlett Learning, Laboratories— LLCThe Debate © Jones & Bartlett Learning, LLC90 NOT FORGalveston SALE OR and DISTRIBUTIONBoston NOT FOR SALE OR DISTRIBUTION91 Medical Countermeasures 93 Stockpiling and Distribution of Medical Countermeasures 94 Cities Readiness Initiative 94 MedKit 94 © Jones & Bartlett Learning,U.S. Postal LLC Service © Jones & Bartlett Learning, LLC 94 NOT FOR SALE OROngoing DISTRIBUTION Research Debates NOT FOR SALE OR DISTRIBUTION 94 Key Words 94 Discussion Questions 100 References 101 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Chapter 9 InternationalNOT FOR Agreements SALE OR DISTRIBUTION NOT FOR SALE10 OR3 DISTRIBUTION Learning Objectives 103 Introduction 103 Early Agreements 104 © JonesChemical & Bartlett Weapons Learning, Convention LLC © Jones & Bartlett Learning, 10LLC5 NOT FORThe Nuclear SALE NonproliferationOR DISTRIBUTION Treaty NOT FOR SALE OR DISTRIBUTION105 United Nations Security Council Resolution 1540 105 Australia Group 105 Biological Weapons Convention 105 © Jones & Bartlett InternationalLearning, LLCHealth Regulations (2005) © Jones & Bartlett Learning, LLC 106 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

79832_ch00_FM_5987.indd 6 8/24/11 9:22:38 PM Contents vii © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The Functionality of International Agreements 107 Key Words 107 Discussion Questions 108 References© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,109 LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Chapter 10 Attribution and Investigations 111 Learning Objectives 111 Introduction 111 Differentiating between Natural and Intentional Events 111 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Attribution Assessments 112 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Domestic Investigations of Suspected Biological Weapons Use 113 International Investigations of Suspected Biological Weapons Use 113 Summary 116 Key Words 116 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Discussion Questions 117 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION References 118

Chapter 11 Surveillance 119 Learning Objectives 119 Introduction© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,119 LLC PolicyNOT DirectivesFOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION121 U.S. Government Surveillance Programs 124 Integration Efforts 124 BioSense 124 © Jones & BartlettNational Learning, Biosurveillance LLC Integration System © Jones & Bartlett Learning, LLC 124 NOT FOR SALEBiowatch OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION124 Global Surveillance 125 Key Words 126 Discussion Questions 127 © Jones & Bartlett Learning,References LLC © Jones & Bartlett Learning, LLC 128 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Chapter 12 Testing Preparedness: Natural Disasters and the Public Health Response 129 Learning Objectives 129 Introduction© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,129 LLC HurricaneNOT FOR Katrina SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION131 Avian and Pandemic Influenza 135 H1N1 137 Key Words 138 © Jones & BartlettDiscussion Learning, Questions LLC © Jones & Bartlett Learning, LLC 139 NOT FOR SALEReferences OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION140

Chapter 13 From Local Preparedness to Global Governance of Disease: The Path to Security 141 © Jones & Bartlett Learning,Learning LLC Objectives © Jones & Bartlett Learning, LLC 141 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

79832_ch00_FM_5987.indd 7 8/24/11 9:22:39 PM viii Contents © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Introduction 141 Local and State Preparedness Activities 141 Laboratory and Epidemiologic Capacity 142 Communication© Jones & Bartlett Learning, LLC © Jones & Bartlett144 Learning, LLC HospitalNOT Preparedness FOR SALE OR DISTRIBUTION NOT FOR SALE 14OR5 DISTRIBUTION Community Resilience 145 Response 145 Challenges for Local and State Entities 145 Funding 145 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Workforce 147 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Preparedness Authorities 147 Quarantine 148 From Local to Global 150 Key Words 150 © Jones & Bartlett DiscussionLearning, Questions LLC © Jones & Bartlett Learning, LLC 151 NOT FOR SALE ORReferences DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 152 Glossary 153 Index 157 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC List of FiguresNOT FOR SALE OR DISTRIBUTION NOT FOR SALE167 OR DISTRIBUTION List of Boxes 169 List of Tables 171 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

79832_ch00_FM_5987.indd 8 8/24/11 9:22:39 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Prologue: Essentials of Public © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONHealth PreparednessNOT FOR SALE OR DISTRIBUTION

Public Health is no longer exclusively about promoting health preparedness and response plans, policies, regulations, and and preventing disease; it is now about protecting health legislation. as well. From bioterrorism© Jones to environmental& Bartlett Learning, disasters and LLC The text concludes with© Jones a look at& what Bartlett can be Learning, learned LLC emerging communicableNOT disease, FOR threatsSALE to OR health DISTRIBUTION now appear from recent experiences. PandemicNOT FOR influenza SALE and OR Hurricane DISTRIBUTION everywhere we look. Essentials of Public Health Preparedness Katrina represent two episodes that help illustrate the wide takes an all-hazards approach to public health preparedness, range of interventions and policies that are needed to protect providing broad perspectives on local, national, and global health. They also illustrate the essential roles that the public threats.© Jones & Bartlett Learning, LLC health community© Jones plays& Bartlett in preparing Learning, for and responding LLC to NOTProfessor FOR KatzSALE takes OR on DISTRIBUTIONthe challenge of putting public securityNOT threats. FOR SALE OR DISTRIBUTION health preparedness in the larger context of public health Essentials of Public Health Preparedness assumes no prior education and public policy. She brings to this challenge a background in public health preparedness, yet it speaks to wealth of background in the policy aspects of public health the needs of undergraduate students, graduate students, and preparedness, having worked at the intersection of infectious public health practitioners. Public health preparedness has © Jones & Bartlettdiseases andLearning, national security LLC for the Defense Intelligence© Jones become & Bartlett a cornerstone Learning, of public LLC health and a major undertak- NOT FOR SALEAgency, OR the DISTRIBUTION Joint Military Intelligence College, and theNOT De- FORing ofSALE governmental OR DISTRIBUTION public health. Public health preparedness partment of State. Rebecca Katz builds on an exceptional content is increasingly being integrated into public health education background at Swarthmore (BA), Yale (MPH), and education at the undergraduate, as well as graduate levels. Princeton (PhD). New competencies are been developed by the Association Essentials of Public© Jones Health Preparedness & Bartlett focuses Learning, on public LLC of School of Public Health© with Jones support & andBartlett encouragement Learning, LLC policy but does notNOT stop there. FOR Dr. SALE Katz goes OR on DISTRIBUTION to describe from Centers for Disease NOTControl FOR and Prevention. SALE OR Essentials DISTRIBUTION the operational aspects of public health preparedness. She of Public Health Preparedness will help students and practi- reviews the experience of September 11, 2001 and the recom- tioners fulfill these competencies. mendations of the 9/11 Commission, exploring the framework I’m confident that you will find this book engaging and and institutions being built on these recommendations. Once enlightening. I’m delighted that Essentials of Public Health Pre- the© Jonesreader has & understood Bartlett theLearning, basics, she turnsLLC her attention paredness© Jonesis now a part& Bartlett of our Essential Learning, Public Health LLC series. toNOT solving FOR problems. SALE In ORdoing DISTRIBUTION this she develops in the reader NOT FOR SALE OR DISTRIBUTION an appreciation of the complexities of the issues that must Richard Riegelman, MD, MPH, PhD be considered by public health professionals in designing Series Editor, Essential Public Health

79832_ch00_FM_5987.indd 9 8/24/11 9:22:39 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

79832_ch00_FM_5987.indd 10 8/24/11 9:22:39 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Preface © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

The last decade has seen many changes in terms of how we Public Health Preparedness is divided into four parts: view our security and the role of the public health community. Part I: Background of the Field There is an ever-evolving threat of the terrorist use of weap- © Jones & Bartlett Learning, LLC Part II: Defining the ©Problem: Jones Potential & Bartlett Threats Learning, LLC ons of mass destruction against our population, in particular NOT FOR SALE OR DISTRIBUTION Part III: InfrastructureNOT FOR SALE OR DISTRIBUTION the use of biological weapons. Infectious diseases continue to Part IV: Solving Problems emerge and reemerge around the world, and the globalization of our food supply and the speed and volume of international Part I provides an overview and background to the field travel make us all vulnerable to the emergence of a new agent of public health preparedness. We look at how the field has anywhere© Jones in the& Bartlett world. Learning, LLC evolved,© as Jones well as &how Bartlett different Learning,entities have LLCdefined the NOTThere FOR is mounting SALE ORevidence DISTRIBUTION that large-scale epidemics subdiscipline.NOT FORWe also SALE review ORthe definitions DISTRIBUTION and evolution can dramatically affect the economic, social, and security of national security and homeland security, with particular foundations of a nation. We are constantly reminded of the emphasis on how they relate to public health. Finally, we look devastating effects of natural disasters, particularly hurricanes at the role of the public health professional in emergency pre- © Jones & Bartlettand earthquakes. Learning, All of these LLC factors have led to the emergence© Jones paredness—from & Bartlett Learning, designing policy LLC to participating in disaster NOT FOR SALEof a new OR subdiscipline DISTRIBUTION within public health—public healthNOT FORresponse—and SALE OR explore DISTRIBUTION potential careers in the field. preparedness. The public health community plays a vital role Part II begins to characterize the problems that require in identifying, responding to, containing, and recovering from preparedness on the part of the public health community. emergencies. It is imperative that public health professionals Chapter 2 covers threats from biological, chemical, nuclear, develop an awareness of the emerging threats, the means of and radiological weapons. We define these threats and re- addressing those threats,© Jones and the & security Bartlett challenges Learning, inherent LLC view the history of use—both© Jones intentional & Bartlettand accidental. Learning, The LLC in these activities andNOT that FOR they be SALE able to ORidentify DISTRIBUTION and work chapter then looks at howNOT the current FOR threatSALE from OR weapons DISTRIBUTION with other sectors with similar responsibilities. of mass destruction (WMDs) is evaluated and returns to the Public health preparedness is a new discipline, but it has role of the public health community in responding to WMD. been rapidly developing at the federal, state, and local levels. Chapter 3 discusses threats from naturally occurring disease Academia© Jones is &now Bartlett acknowledging Learning, this as anLLC essential area of and natural© Jones disasters: & Bartlettthe historical Learning, impact of LLCdisease and expertiseNOT FOR necessary SALE for aOR fully DISTRIBUTION developed public health work- naturalNOT disaster FOR on homelandSALE OR and DISTRIBUTION national security, pre- force. The goal of this book is to introduce students to the paredness activities around the threat of naturally occurring field of public health preparedness. The book presupposes no diseases, evaluation of the current threat from disease and previous exposure to the concepts, yet provides enough depth disasters, and the public health and foreign policy response for students who may have advanced knowledge. to these threats. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

79832_ch00_FM_5987.indd 11 8/24/11 9:22:39 PM xii Preface © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Part III moves from definitions and threat characteriza- Chapter 9 focuses on the role of treaties in prevention tion to a review of the infrastructure, primarily on the federal of WMD and how international agreements have been used level, that has emerged in the past decade to address public to address public health threats. Chapter 10 concentrates on health preparedness. Chapter 4 focuses on the immediate the challenges associated with investigating an alleged use © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC response to September 11, 2001, and the 9/11 Commission event and on making an attribution assessment. We explain findings. We review the NationalNOT Strategy FOR SALE for Homeland OR DISTRIBUTION Se- microbial forensics, present the caseNOT study FOR of a domesticSALE ORin- DISTRIBUTION curity and the offices and organizations that were created vestigation of alleged biological weapons use, and discuss in the aftermath of 9/11. This chapter also introduces the the international mechanisms available for investigating sus- reader to the intelligence community. Chapter 5 presents the pected chemical and biological weapons use. This chapter preparedness© Jones plans that & were Bartlett created Learning, in response to LLC evolving also explores the© relationship Jones & between Bartlett the FederalLearning, Bureau LLC of threats. WeNOT look atFOR the National SALE ResponseOR DISTRIBUTION Framework—with Investigation andNOT the public FOR health SALE community, OR DISTRIBUTION particularly as particular emphasis on public health and medical response it pertains to criminal and epidemiological investigations. components, the National Incident Management System, and In Chapter 11, we turn our attention to biosurveillance specific plans for public health emergencies. Finally, Chapter and discuss the domestic and international surveillance pro- 6 presents the legislation, regulations, and policy guidance grams, as well as the federal entities, tasked with and engaged © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC that have emerged to address public health preparedness and in these efforts. Chapter 12 provides several case studies of NOT FORto mitigate SALE the ORthreats DISTRIBUTION of WMD, naturally occurring disease, NOTpublic FOR health SALE preparedness OR DISTRIBUTION and response. We look at pre- and other disasters. paredness activities around avian influenza (H5N1); response Part IV of the book is generally concerned with solving activities around pandemic influenza (H1N1); and response problems, and it includes a variety of approaches the com- mechanisms for natural disasters, including Hurricane Ka- munity has taken to address ©biological Jones threats, & Bartlett along with Learning, the trina LLC and the Haiti earthquake. The© final Jones chapter, & ChapterBartlett 13, Learning, LLC challenges of each approach.NOT Chapter FOR 7 explores SALE biosecurity: OR DISTRIBUTION takes the reader from the local preparednessNOT FOR level SALE to global OR DISTRIBUTION defining the dual-use dilemma, determining how biosecurity governance of disease. This chapter looks at the role of local is used to minimize the threat, examining the role of the life preparedness activities, quarantine as part of preparedness sciences community in establishing codes of conduct and self- and response, and global governance as it pertains to infec- policing scientific publications, reviewing pathogen security tious diseases and public health emergencies of international efforts, and© examiningJones & synthetic Bartlett biology Learning, as a threat LLC to secu- concern. © Jones & Bartlett Learning, LLC rity. In ChapterNOT 8,FOR we look SALE at the ORresearch DISTRIBUTION agenda and which This book isNOT designed FOR to give SALE the reader OR DISTRIBUTIONan appreciation agencies are engaged in supporting basic scientific research of the complexity of issues that must be considered by public that directly relates to biological threats. We also look at the health professionals in designing preparedness and response enterprise that has been built to support the development of plans, policies, regulations, and legislation. I hope readers will © Jonesmedical & Bartlett countermeasures Learning, and at theLLC proliferation of biosafety ©better Jones understand & Bartlett the essential Learning, role of the LLC public health com- NOT FORlevel 3 SALE and level OR 4 laboratories. DISTRIBUTION NOTmunity FOR in preparing SALE forOR and DISTRIBUTION responding to security threats.

79832_ch00_FM_5987.indd 12 8/24/11 9:22:39 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Acknowledgments © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

This book is based on a class I teach at The George Washing- of this book. I thank my colleagues for their support while I ton University School of Public Health and Health Services—a worked on this book, and I thank my team of research assis- class I inherited in ©2006 Jones from Brian & Bartlett Kamoie. SoLearning, I first thank LLC tants without whom I would© Jones be lost, including& Bartlett Sarah Learning, Elrod, LLC Brian for his foresightNOT and FOR efforts SALE in designing OR thisDISTRIBUTION class and Jacqueline Miller, Adeela Khan,NOT Jordan FOR Chapman,SALE OR and DISTRIBUTIONDaniel for trusting me to build on the foundation he provided. I Bachmann. Most important, I thank my family—Matt, Olivia, thank the class for their helpful comments on earlier drafts and Benjamin—for their love and support.

79832_ch00_FM_5987.indd 13 8/24/11 9:22:39 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

79832_ch00_FM_5987.indd 14 8/24/11 9:22:39 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION About the Author © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Rebecca Katz, PhD, MPH, is an assistant professor of health telligence College, and spent several years as a public health policy and emergency medicine at The George Washington consultant for The Lewin Group. Since 2004, Dr. Katz has University School of© Public Jones Health & Bartlett and Health Learning, Services. Her LLC been a consultant to the ©Department Jones & of Bartlett State, working Learning, on LLC research is focusedNOT on public FOR health SALE preparedness OR DISTRIBUTION and the issues related to the BiologicalNOT WeaponsFOR SALE Convention, OR DISTRIBUTION avian interface between infectious diseases and national security. and pandemic influenza, and disease surveillance. She is the Since 2007, the primary focus of her research has been on the co-editor of the 2nd edition of the Encyclopedia of Bioterror- domestic and global implementation of the Revised Interna- ism Defense, and author or co-author of more than 30 papers, tional Health Regulations. She previously worked on biologi- book chapters, and policy briefs. Dr. Katz received her un- cal© warfareJones counterproliferation & Bartlett Learning, at the Defense LLC Intelligence dergraduate© Jones degree &in Bartlettpolitical science Learning, and economics LLC from Agency,NOT FOR was an SALE Intelligence OR DISTRIBUTIONResearch Fellow at the Center SwarthmoreNOT College, FOR SALE an MPH OR from DISTRIBUTION Yale University, and a for Strategic Intelligence Research in the Joint Military In- PhD in public affairs from Princeton University.

79832_ch00_FM_5987.indd 15 8/24/11 9:22:40 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

79832_ch00_FM_5987.indd 16 8/24/11 9:22:40 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Abbreviations © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

AI avian influenza CREATE Center for Risk and Economic Analysis of ALERT Center of Excellence for Awareness and Terrorism Events ©Location Jones of &Explosives—Related Bartlett Learning, Threats LLC CRI Cities Readiness© Jones Initiative & Bartlett Learning, LLC APHIS AnimalNOT andFOR Plant SALE Health InspectionOR DISTRIBUTION Service CS chlorobenzylidenemalononitrileNOT FOR SALE OR DISTRIBUTION ARS acute radiation syndrome CTR Cooperative Threat Reduction ASPH Association of Schools of Public Health CW chemical warfare/chemical weapons ASPR Assistant Secretary for Preparedness and CWC Chemical Weapons Convention © Jones & BartlettResponse Learning, LLC CWS © JonesChemical & Bartlett Warfare Learning, Service LLC NOTBARDA FOR SALEBiomedical OR AdvancedDISTRIBUTION Research and DEA NOT FORDrug SALE Enforcement OR DISTRIBUTIONAgency Development Authority DHHS Department of Health and Human Services BEP Biological Engagement Program DHS Department of Homeland Security BSL biosafety level DIA Defense Intelligence Agency BT bioterrorism © Jones & Bartlett Learning, LLC © JonesDMAT & Bartlett Learning,Disaster Medical LLC Assistance Team BW biological warfare/biological weapons NOT FOR SALE OR DISTRIBUTION NOT FORDNI SALE OR DISTRIBUTIONDirector of National Intelligence BWC Biological and Toxin Weapons Convention DoD Department of Defense C2I Center of Excellence in Command, Control and Interoperability DOS Department of State CAMRA Center for Advancing Microbial Risk DTRA Defense Threat Reduction Agency ©Assessment Jones & Bartlett Learning, LLCEEE Eastern ©Equine Jones Encephalitis & Bartlett Learning, LLC CBRN chemical,NOT FOR biological, SALE radiological, OR DISTRIBUTION and EIS EpidemicNOT Intelligence FOR Service SALE OR DISTRIBUTION nuclear EO Executive Order CBRNE chemical, biological, radiological, nuclear, ESF Emergency Support Function and explosive FAA Federal Aviation Administration CDC Centers for Disease Control and Prevention © Jones & Bartlett Learning, LLC FAZD © JonesNational & Bartlett Center forLearning, Foreign Animal LLC and NOTCIA FOR SALECentral OR Intelligence DISTRIBUTION Agency NOT FORZoonotic SALE Disease OR DISTRIBUTION Defense CN chloroacetophenone FBI Federal Bureau of Investigation COE Centers of Excellence FDA Food and Drug Administration CONUS Continental United States FEMA Federal Emergency Management Agency © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

79832_ch00_FM_5987.indd 17 8/24/11 9:22:40 PM xviii Abbreviations © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION FSU Former Soviet Union NIMS National Incident Management System GDD Global Disease Detection NIEHS National Institute of Environmental Health GOARN Global Outbreak Alert and Response Sciences Network© Jones & Bartlett Learning,NINDS LLC National Institute© of JonesNeurological & BartlettDisorders Learning, LLC and Stroke HSEEP HomelandNOT Security FOR Exercise SALE and Evaluation OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Program NIU National Intelligence University HSPD Homeland Security Presidential Directive NORAD North American Aerospace Defense HUMINT human intelligence Command IA Office of Intelligence and Analysis (DHS) NORTHCOM Northern Command © Jones & Bartlett Learning, LLC NPS ©National Jones Pharmaceutical & Bartlett Stockpile Learning, LLC IAEA NOT FORInternational SALE Atomic OR EnergyDISTRIBUTION Agency NOT FOR SALE OR DISTRIBUTION IARPA Intelligence Advanced Research Projects NRF National Response Framework Activity NRO National Reconnaissance Office IBC Institutional Biosafety Committee NRP National Response Plan IC intelligence community NSA National Security Agency © JonesIHR & Bartlett InternationalLearning, Health LLC Regulations © NSABBJones & BartlettNational Learning, Science Advisory LLC Board for NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION IO international organization Biosecurity IOM Institute of Medicine NSD National Security Directive IMINT imagery intelligence NSDD National Security Decision Directive INR Bureau of Intelligence and Research (DOS) NSPD National Security Presidential Directive © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC IRF Integrated Research Facility NTSCOE National Transportation Security Center of NOT FOR SALE OR DISTRIBUTION Excellence NOT FOR SALE OR DISTRIBUTION MASINT Measurement and Signature Intelligence OSINT Open Source Intelligence MDR-TB multiple-drug-resistant tuberculosis OSTP Office of Science and Technology Policy MIC methyl isocyanate OTA Office of Technology Assessment MPH Masters in Public Health © Jones & Bartlett Learning, LLC PACER ©National Jones Center & Bartlett of the Study Learning, for Preparedness LLC MSEHPA Model State Emergency Health Powers Act NOT FOR SALE OR DISTRIBUTION NOTand FOR Catastrophic SALE Event OR Response DISTRIBUTION NAS National Academies of Science PAHPA Pandemic and All-Hazards Preparedness Act NBACC National Biodefense Analysis and PDD Presidential Decision Directive Countermeasure Center PEPFAR U.S. President’s Emergency Plan for AIDS NBIC National Biosurveillance Integration Center Relief © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NCFPT National Center for Food Protection and PHEIC Public Health Emergency of International NOT FOR SALE OR DISTRIBUTIONDefense NOT FOR SALEConcern OR DISTRIBUTION NCI National Cancer Institute PHEMCE Public Health Emergency Medical NCIX National Counterintelligence Executive Countermeasures Enterprise NCPC National Counterproliferation Center PHS Public Health Service NCTC National Counterterrorism© Jones & BartlettCenter Learning,PNAS LLC Proceedings of the© National Jones Academy & Bartlett of Learning, LLC NDMS National DisasterNOT MedicalFOR SALESystem OR DISTRIBUTION Sciences NOT FOR SALE OR DISTRIBUTION NGA National Geospatial-Intelligence Agency PPD Presidential Policy Directive NGO nongovernmental organization PREP Public Readiness and Emergency Preparedness Act NHSS National Health Security Strategy PS chloropicrin NIAID © JonesNational & Bartlett Institute of Learning, Allergy and Infectious LLC © Jones & Bartlett Learning, LLC NOT FORDiseases SALE OR DISTRIBUTION RCE NOTRegional FOR Center SALE of Excellence OR DISTRIBUTION [for biodefense and emerging infectious diseases] NIC National Intelligence Council SARS severe acute respiratory syndrome NIC National Integration Center SEPA Smallpox Emergency Personnel Protection NIH National Institutes of Health Act © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

79832_ch00_FM_5987.indd 18 8/24/11 9:22:40 PM Abbreviations xix © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION SIGINT Signals Intelligence USC United States Code SNS Strategic National Stockpile USDA U.S. Department of Agriculture SSC Special Security Center USPS U.S. Postal Service START National© Jones Consortium & Bartlett for the StudyLearning, of LLC UTL universal© task Jones list & Bartlett Learning, LLC NOTTerrorism FOR and SALE Responses OR to TerrorismDISTRIBUTIONUTMB UniversityNOT of Texas FOR Medical SALE Branch OR DISTRIBUTION T2 trichothecene mycotoxin VEE Venezuelan Equine Encephalitis TB tuberculosis WEE Western Equine Encephalitis TCL Target Capabilities List WHA World Health Assembly ©TECHINT Jones & BartlettTechnical IntelligenceLearning, LLC WHO © JonesWorld & Bartlett Health Organization Learning, LLC NOTUNSCR FOR SALEUnited OR Nations DISTRIBUTION Security Council Resolution WMD NOT FORweapon SALE of mass OR destruction DISTRIBUTION UNSGM United Nations Secretary General’s WRS War Research Service Mechanism WWI World War I USAID United States Agency for International Development WWII World War II © Jones & BartlettUSAMRIID Learning,U.S. Army LLC Medical Research Institute for© JonesXDR-TB & Bartlett Learning,extremely drug-resistant LLC tuberculosis NOT FOR SALE OR DISTRIBUTIONInfectious Diseases NOT FOR SALE OR DISTRIBUTION USA PATRIOT Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

79832_ch00_FM_5987.indd 19 8/24/11 9:22:40 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

79832_ch00_FM_5987.indd 20 8/24/11 9:22:40 PM