© Copyright October 2014 STATE OF PREPARATION: Southern SLC STATES AND THE VIRUS AN ISSUE ALERT FROM THE SLC Legislative Conference

of The Council Lauren Greer, Policy Analyst of State Stephanie Noble, Research and Publications Associate overnments Southern Legislative Conference

G October 2014 Commons License courtesy Creative Photo of NIH NIAID via flickr

he World Health Organization reports that it is important for states to remain proactive in emergen- the current outbreak of the Ebola virus dis- cy response and vigilant in mitigating the risks posed by ease (EVD), which is believed to have begun in infected patients. March 2014 in , is the largest and Tmost complex outbreak of the virus since its discovery in The following provides a brief account of some of the 1976.1 It was not until August 2014, when two American efforts SLC states have taken in reaction to the Ebola vi- missionaries were flown to Emory University Hospital in rus disease, as of October 20, 2014. As governors across Atlanta after contracting the disease in Africa, that most the nation continue to meet with health officials in their Americans became aware of the outbreak. Nearly two states, the policies and efforts to combat this disease, for months later, the first diagnosis of Ebola was reported in which there is no proven treatment, undoubtedly will the United States. continue to evolve.

The diagnosis and subsequent death of this patient has Alabama led many states to reevaluate their emergency prepared- Governor Robert Bentley held a press conference on ness strategies. While the Centers for Disease Control and October 8, alongside the Alabama Department of Pub- Prevention (CDC) has issued guidance and recommenda- lic Health and the Alabama Hospital Association, to tions for healthcare providers treating Ebola patients, and announce the measures the state is taking to prepare for standards for public health preparedness in state and local possible Ebola cases.4 In addition to issuing a healthcare emergencies, it lacks the authority to enforce them.2 provider bulletin, the Department has sent toolkits to every hospital in the state, as well as paramedics and doc- Incorporating the recommendations from the CDC, ma- tors’ offices.5 The toolkits include a list of questions to ask ny states have taken steps to offer healthcare providers patients, information on how to protect staff from the with the information and tools needed to care for suspect- disease, and suggestions on the adequate care of patients. ed Ebola patients, limit exposure to others, and to educate Likewise, healthcare workers are being trained on the the public on the disease. proper protocol for isolating patients and donning and doffing protective gear.6 The state also is working to en- The CDC recently announced it would establish a rapid- sure every hospital has the basic gear necessary to stop the response team that will be deployed immediately to assist spread of Ebola, such as face-shields, and monitoring in- U.S. hospitals with a diagnosed case of Ebola.3 However, ternational students who return from West Africa.

THE SOUTHERN OFFICE OF THE COUNCIL OF STATE GOVERNMENTS PO Box 98129 | Atlanta, Georgia 30359 SERVING THE SOUTH ph: 404/633-1866 | fx: 404/633-4896 | www.slcatlanta.org Florida Guard and Department of Transportation. Meanwhile, Governor Rick Scott has maintained communication the state’s Department of Health and Hospitals has distrib- with Governor Rick Perry as their states learn uted information on identifying symptoms of Ebola, the lessons on proper containment. Governor Scott’s office Department of Education is circulating guides for schools, also is coordinating preparedness efforts with the De- and the Department of Corrections is briefing wardens on partment of Transportation, the Agency for Healthcare identification, transportation, and containment.12 Administration, and Department of Health. The state’s Department of Health has issued guidelines to business- On October 15, the Board of Secondary and Elementary es, colleges, healthcare facilities, and emergency medical Education approved emergency rules granting local su- services, while the Agency for Healthcare Administration perintendents the authority to close schools in the event has identified hospitals with the appropriate treatment of any actual or imminent threat to public health or safety kits and isolation facilities and has distributed informa- that may result in loss of life, disease, or injury.13 A stu- tion and training on containment protocols.7 dent or staff member also may be removed from a school if reliable evidence or information suggests he or she has a Georgia communicable disease, which may be considered a threat On October 20, Governor Nathan Deal signed an ex- to others in the school. ecutive order to create the Ebola Response Team. The 14-member team, chaired by Public Health Commission- Mississippi er, Dr. Brenda Fitzgerald, comprising health, education, The Department of Health issued an Ebola virus hospital and public safety representatives from around the state, preparedness guide and the head of the State Emergen- including Emory University Hospital. The Ebola Re- cy Operations Center and state health officer, Dr. Mary sponse team is tasked with reviewing the state’s protocols, Currier, briefed the governor on the steps the Depart- and assessing procedures and best practices in prepara- ment has taken to prepare.14 8 tion for the potential spread of the Ebola virus disease. North Carolina Kentucky Joined by Health and Human Services Secretary Aldona The Department for Public Health has developed a pack- Wos, Governor Pat McCroy held a news conference Oc- age of materials, called “Out of Africa,” which is intended tober 13, to discuss the steps the state has taken to prepare to help hospitals, public health agencies, and healthcare for a possible Ebola diagnosis. The Department of Health organizations with Ebola preparedness.9,10 The materi- and Human Services’ Division of Public Health has been als include Guidelines for the Initial Management of Patients working with public health partners and healthcare pro- in Emergency Departments with Suspected Ebola Virus Dis- viders since July to prepare for the possibility of Ebola in ease to help healthcare personnel manage suspected cases their state.15 The Department is actively monitoring the of Ebola and care for those patients in a manner that will state’s largest hospitals for cases of Ebola using a network limit further exposure to the virus by other patients and of hospital-based public health epidemiologists.16 The personnel.11 Carolinas Poison Center has established an Ebola hotline where concerned residents can receive information and Louisiana ask questions about the disease.17 Governor Bobby Jindal met with the Unified Command Group* and the Governor’s Office of Homeland Security On October 11, Durham County Department of Public and Emergency Preparedness (GOHSEP) on October 1 to Health, in conjunction with Diaspora Alliance NC, held an discuss the state’s readiness to deal with a possible Ebola Ebola education event for the West African community outbreak. GOHSEP is coordinating efforts with the Coast in Durham.18 The event was designed to increase aware- ness and encourage communication and trust with public * The state Unified Command Group (UCG) is a strategic decision-mak- health workers. The community was updated on the cur- ing body, established by executive order of Governor Bobby Jindal, to rent situation in West Africa and information was shared establish a unified and coordinated approach to emergency manage- ment in the state for emergencies and in day-to-day operations. The about what is known about the disease, its transmission, role and duties of the UCG are codified in La. Rev. Stat. §29:725.6. and management. Discussions also included the prepared-

2 STATE OF PREPARATION: SLC STATES AND THE EBOLA VIRUS TIMELINE OF SELECTED EVENTS September 25, 2014 1976 Dr. Sacra is released from Nebraska Med- Facts about Ebola ical Center after being deemed virus-free Ebola first discovered in present-day Ebola virus is not spread through Democratic Republic of Congo September 26, 2014 ● Casual contact March 19, 2014 goes to Texas Pres- byterian Health Hospital in Dallas with ● Air Ebola outbreak begins in West Africa a reported fever. He is later sent home ● Water July 27, 2014 with antibiotics and Tylenol ● Food grown or legally purchased in American missionaries Dr. September 28, 2014 and Nancy Writebol are reported to have the U.S. Duncan returns to Texas Presbyterian contracted the virus while while helping Health Hospital by ambulance Ebola patients in Monrovia, How do you get the Ebola virus? September 30, 2014 July 31, 2014 Direct contact with The CDC confirms that Duncan has been Brantly and Writebol receive a dose of an diagnosed with Ebola experimental drug, which would later be 1 named ZMapp October 2, 2014 sick with or has died from Ebola. (blood, vomit, urine, feces, sweat, August 2, 2014 American cameraman Ashoka Mukpo contracts Ebola while providing free- semen, spit, other uids) Brantly is flown from Liberia to Atlanta, lance work in Liberia for several Ameri- Georgia, for treatment at Emory Univer- Objects contaminated with the can news outlets sity Hospital virus (needles, medical equipment) August 5, 2014 October 6, 2014 Infected animals (by contact with Mukpo arrives at Nebraska Medical Cen- Writebol is flown from Liberia to Atlanta, blood or uids of infected meat) ter in Omaha for Ebola Treatment, for a Georgia, for treatment at Emory Univer- blood transfusion from Dr. Brantly sity Hospital Early Symptoms August 19, 2014 October 8, 2014 Thomas Eric Duncan dies from the Ebo- Writebol is discharged from Emory Uni- Ebola can only be spread to others after la virus at Texas Health Presbyterian Hos- versity Hospital symptoms begin. Symptoms can appear pital in Dallas from 2 to 21 days after exposure. August 21, 2014 October 12, 2014 ● Fever ● Stomach pain Brantly is discharged from Emory Uni- Nurse Nina Pham is diagnosed with the versity Hospital ● Headache ● Unexplained bleeding Ebola virus after treating Duncan at Tex- Diarrhea or bruising September 3, 2014 as Health Presbyterian Hospital in Dal- ● American missionary Dr. Richard Sacra las; also for a blood transfusion from Dr. ● Vomiting ● Muscle pain is diagnosed with Ebola, despite only Brantly treating patients in a maternity ward in October 15, 2014 Monrovia, Liberia Nurse Amber Vinson is diagnosed with September 5, 2014 the Ebola virus after treating Duncan Ebola only spreads Sacra is flown from Liberia to Omaha, Ne- at Texas Health Presbyterian Hospital when people are sick. in Dallas and is flown from Dallas to At- braska, for treatment at Nebraska Medi- A patient must have cal Center, where he will receive a blood lanta for treatment at Emory University Hospital symptoms to spread transfusion from Dr. Brantly the disease to others. September 9, 2014 October 16, 2014 MONTH An unnamed patient arrives at Emory Uni- Pham is flown from Dallas to Bethesda, S M T W T F S After 21 days, if an Maryland, for treatment at the National 1 2 3 4 5 versity Hospital in Atlanta after contract- 6 7 8 9 10 11 12 exposed person does ing Ebola while working for the World Institutes of Health 13 14 15 16 17 18 19 20 21 22 23 24 25 26 not develop symptoms, Health Organization in Source: “Ebola in America: Timeline of the Dead- 27 28 29 30 31 they will not become ly Virus,” ABC News Online, October 17, 2014, sick with Ebola. September 20, 2014 http://abcnews.go.com/Health/ebola-america- Thomas Eric Duncan arrives in Dallas, timeline/story?id=26159719 (accessed October Texas, from Liberia 17, 2014).

STATE OF PREPARATION: SLC STATES AND THE EBOLA VIRUS 3 Emory University Hospital healthcare workers take in an Ebola patient. Photo courtesy of The Speaker via flickr Creative Commons License. ness measures in place in North Carolina, the CDC, and The drills are aimed at ensuring the proper protocol is Durham County, and what to do if a family member is followed at all entry points into the healthcare system, visiting the United States from one of the affected areas. not just the emergency room. Additionally, local harbor pilots, who guide every ship into the Port of Charleston, Oklahoma have been briefed on the proper procedures to handle Governor Mary Fallin held a meeting with cabinet mem- ships coming into the Port that have recently visited bers, mayors, and public health, safety, and transportation West African countries. officials at the state capitol to address the state’s ongoing preparations for a potential Ebola case. The state’s Depart- Tennessee ment of Health has issued alerts and guidelines to hospitals The Department of Health’s Emergency Prepared- in the state.19 ness Program issued a situation manual with scenarios, checklists, and resource guides, as well as instructions on South Carolina donning and doffing personal protective equipment, to The Senate Medical Affairs Committee held a special hospitals in the state.22 The Department of Health also has meeting October 9, to discuss the state’s level of pre- published examples of successful public health protocols paredness to handle the arrival of a patient suffering used to contain Ebola in and Senegal. from Ebola, should that occur.20 Legislators at the hear- ing heard about the state’s actions and resources from Texas Catherine Templeton, director of the Department of On October 6, Governor Rick Perry issued an executive Health and Environmental Control.21 During the hear- order for the creation of the Texas Task Force on Infec- ing, legislators learned that hospitals in South Carolina tious Disease Preparedness and Response to address the have begun conducting drills in all areas of the hospital, state’s readiness to handle contagious diseases, like Ebo- with “patients” reporting recent travel to West Africa. la.23 The 17-member Task Force comprises executives

4 STATE OF PREPARATION: SLC STATES AND THE EBOLA VIRUS Colorized electron micrograph of Ebola virus particles. A Nicotiana benthamiana plant used to make ZMapp. Photo courtesy of NIH NIAID. Photo courtesy of Chandres via Creative Commons license.

from the health and human services, environmental Tulane professor of microbiology and immunology, Dr. quality, housing and community affairs, emergency man- Robert Garry, has been awarded $2.9 million by the Na- agement, public safety, transportation, and education tional Institutes of Health to develop a rapid diagnostic departments and university faculty in the fields of pub- finger-prick test for the Ebola virus.26 Currently, it can lic health preparedness and response, infectious animal take hours or days before being detected in humans. The diseases, immunology, epidemiology, virology, and bio- finger-prick test will allow healthcare workers to quickly defense.24 The Task Force initially will focus on hospital test patients for Ebola proteins and respond more quickly preparedness and the potential role of improved rap- if isolation is needed. It also will reduce the risk healthcare id diagnostics. The Task Force is set to testify at the state workers face by eliminating the need to use long-nee- capitol October 23, and will release its first report of rec- dled syringes when drawing blood from Ebloa-infected ommendations by December 1, with a second report by patients. In September 2014, the FDA granted emergen- February 1, 2015. cy authorization to the Department of Defense to use a similar finger-prick test, which examines viral genomes, West Virginia in U.S. military labs. Dr. Garry expects that his device, The Kanawha-Charleston and Putnam County depart- which is still in testing, also will be granted emergency ments of health formed an Ebola preparedness task force authorization. to coordinate efforts among the counties and service pro- viders to handle the potential of an Ebola diagnosis. The The National Institutes of Health and the National Insti- task force, with representatives from local hospitals, tute of Allergy and Infectious Diseases (NIAID) are leading emergency medical services, and health and fire depart- efforts to develop and expedite the testing and production ments around the area, has worked to develop a systems of Ebola treatments and vaccines. approach to Ebola containment, identifying current prac- tices and needs in the event of an Ebola case in the state.25 Kentucky BioProcessing in Owensboro, Kentucky, has been contracted by the San Diego-based company Mapp Research & Development: Biopharmecutical to produce the experimental medicine Current Progress in Ebola ZMapp.27 ZMapp, which is made using a tobacco plant compound, has seen promising results in Canadian labo- Detection and Treatment ratory testing, but was untested on humans prior to being Because there currently is no proven treatment for the administered to the two American missionaries at Emory Ebola virus disease, the best weapon to curtail the out- University Hospital. Kentucky BioProcessing has tem- break remains early detection and diagnosis. porarily halted all other work to focus entirely on the

STATE OF PREPARATION: SLC STATES AND THE EBOLA VIRUS 5 production of ZMapp and will hire more staff in an effort The Economic Costs of to expedite federal approval from the U.S. Food and Drug Administration. In addition to announcing an 18-month, the Ebola Outbreak $24.9 million contract with Mapp to accelerate devel- Collectively, state actions and research developments opment of the drug, the U.S. Department of Health and also will help alleviate a secondary impact of the Eb- Human Services also is in talks with Caliber Biotherapeu- ola outbreak, which extends beyond the borders of tics in Texas about producing ZMapp. West Africa. Beyond the doleful consequences of the Ebola outbreak in terms of the loss of life and those Two additional drugs being considered by NIAID were stricken by the disease, financial analysts and oth- developed in North Carolina. BioCryst Pharmaceuticals er experts have attempted to stitch together an es- timate of the potential impact on the global econ- in Research Triangle Park plans to begin testing its drug, omy. A report recently released by the World Bank 28 BCX4430, on humans early next year. Chimerix of Dur- estimated a potential worst-case scenario economic ham has developed a second potential drug, , cost of $32.6 billion to the global economy by the end which has shown promising results with its ability to sup- of 2015, a staggering figure by any standard. Experts press Ebola virus cells in cultures. Limited testing has also have honed in on the economic cost of fear as be- indicated the drug is safe for humans; although a broader ing particularly pernicious, a development that might evaluation of the drug is expected in the coming months. exceed actual medical costs. For instance, these ex- perts indicate that serious economic consequences Conclusion result “when consumers and businesses react by re- ducing flights on airplanes, changing vacation plans While the actions taken by these 12 SLC states are not ex- or altering business connections in a globally interde- haustive of Ebola preparations in our region, they provide pendent world.” 29 Notably, the stock prices of airlines, a snapshot of the first steps for prevention of a nation- including United and American, dropped as investors al Ebola outbreak. With recent reports from Texas that became anxious about reduced air traffic. two nurses have tested positive for Ebola, presumably af- ter providing medical care to the patient who became our nation’s first Ebola casualty, it is likely safe to assume that these will not be the last actions taken by SLC states to combat this deadly virus. As we continue to learn more about the disease and its treatment, SLC states will play a vital role in preventing the spread of infection and the ul- timate prospect of global eradication.

Hartsfield-Jackson Atlanta International Airport. CDC Director Tom Friedan in full protective gear. Photo courtesy of Dan Betts via flickr Creative Photo courtesy of CDC Global. Commons License.

6 STATE OF PREPARATION: SLC STATES AND THE EBOLA VIRUS Endnotes 1. World Health Organization, “Ebola virus disease fact sheet,” http://www.who.int/mediacentre/factsheets/fs103/en/ (accessed October 14, 2014). 2. Centers for Disease Control and Prevention, “Top 10 Ebola Response Planning Tips: Ebola Readiness Self-Assessment for State and Local Public Health Officials,” http://www.cdc.gov/vhf/ebola/outbreaks/preparedness/planning-tips-top10.html (accessed October 14, 2014). 3. “U.S. sets up rapid-response team for Ebola; Dallas nurse improves,” Reuters, October 15, 2014, http://www.reuters.com/article/2014/10/15/us- health-ebola-usa-idUSKCN0I31Q620141015 (accessed October 15, 2014). 4. “Ebola hasn’t surfaced in Alabama but state ready, Gov. Bentley says,” AL.com, October 8, 2014, http://www.al.com/news/index.ssf/2014/10/gov_ robert_bentley_on_ebola_vi.html (accessed October 14, 2014). 5. Alabama Department of Public Health, “Ebola Virus Disease: Healthcare Providers,” http://www.adph.org/ebola/Default.asp?id=6785 (accessed October 14, 2014). 6. “Governor Bentley explains Alabama’s preparedness for Ebola,” KAIT 8 Online, October 10, 2014, http://www.kait8.com/story/26741592/ alabama-is-prepared-for-ebola (accessed October 14, 2014). 7. Florida Department of Health, “Ebola Guidance: Public Health and Medical Providers,” http://www.floridahealth.gov/diseases-and-conditions/ ebola/guidance/medical-provider1.html (accessed October 14, 2014). 8. Office of the Governor, “Deal: Team to combat risks of Ebola should the need arise,” October 20, 2014, http://gov.georgia.gov/press- releases/2014-10-20/deal-team-combat-risks-ebola-should-need-arise (accessed October 20, 2014). 9. Kentucky Health Alerts, “Ebola Information for Health Professionals,” http://healthalerts.ky.gov/Pages/EbolaInformationforHealthProfessionals. aspx (accessed October 15, 2014). 10. “Kentucky health agency develops Ebola preparedness information for hospitals, others,” Lexington Herald-Leader Online, October 12, 2014, http://www.kentucky.com/2014/10/12/3477665_kentucky-health-agency-develops.html?sp=/99/164/329/&rh=1 (accessed October 14, 2014). 11. Kentucky Department for Public Health, “Guidelines for the Initial Management of Patients in Emergency Departments with Suspected Ebola Virus Disease,” October 8, 2014, http://healthalerts.ky.gov/SiteCollectionDocuments/Ebola%20-%20Guidelines%20for%20EDs.pdf (accessed October 14, 2014). 12. Louisiana Department of Health and Hospitals, “Ebola Preparedness in Louisiana,” http://www.dhh.state.la.us/index.cfm/page/1974 (accessed October 15, 2014). 13. “BESE approves emergency Ebola policies for public schools,” The Advocate Online, October 16, 2014, http://theadvocate.com/ news/10532055-123/bese-approves-emergency-ebola-policies (accessed October 16, 2014). 14. Mississippi State Department of Health, “Ebola Virus Disease Hospital Preparedness Resources Guide, October 3, 2014,” http://www.msdh.state. ms.us/msdhsite/index.cfm/14,5979,389,154,pdf/MSDH_Ebola_Hospital_Preparedness.pdf (accessed October 14, 2014). 15. North Carolina Department of Health and HumanServices, “NCDHHS Ebola Information,” http://www.ncdhhs.gov/ebola/ (accessed October 15, 2014). 16. Associated Press, “McCrory, Wos outline NC preparations for Ebola,” News & Observer Online, October 13, 2014, http://www.newsobserver. com/2014/10/13/4231405_mccrory-wos-outline-nc-preparations.html?sp=/99/102/105/135/&rh=1 (accessed October 15, 2014). 17. “NC opens hotline for Ebola questions,” 13 News Now Online, October 14, 2014, http://www.13newsnow.com/story/news/local/north- carolina/2014/10/14/nc-opens-hotline-for-ebola-questions/17237501/ (accessed October 15, 2014). 18. “Durham public health officials address Ebola concerns,” The Herald-Sun Online, October 11, 2014, http://www.heraldsun.com/news/localnews/ x532296737/Durham-public-health-officials-address-Ebola-concerns (accessed October 15, 2014). 19. Oklahoma State Department of Health, “Surveillance and Preparedness for Ebola Virus Disease in Oklahoma,” http://www.ok.gov/health/ Organization/Office_of_Communications/News_Releases/Situation_Updates/Surveillance_and_Preparedness_for_Ebola_Virus_Disease/ (accessed October 14, 2014). 20. “How is SC prepared to deal with Ebola?,” The State Online, October 9, 2014. http://www.thestate.com/2014/10/09/3734646/how-is-sc-prepared-to- deal-with.html?sp=/99/205/&ihp=1 (accessed October 14, 2014). 21. South Carolina Department of Health and Environmental Control, “Health Alerts and Notifications: Ebola,” http://www.scdhec.gov/Health/ FHPF/HealthAlertsNotifications/ebola/ (accessed October 15, 2014). 22. Tennessee Department of Health, “Information on Ebola Virus Disease,” http://health.state.tn.us/Ceds/ebola.htm (accessed October 14, 2014). 23. Rick Perry, “Relating to the creation of the Texas Task Force on Infectious Disease Preparedness and Response,” Executive Order 79, October 6, 2014, http://governor.state.tx.us/news/executive-order/20193 (accessed October 15, 2014). 24. Office of the Governor, “Gov. Perry Names Dr. Brett Giroir to Lead Texas Task Force on Infectious Disease Preparedness and Response,” October 6, 2014, http://governor.state.tx.us/news/press-release/20194/ (accessed October 15, 2014). 25. “Local health officials form Ebola task force,” The Charleston Gazette Online, October 7, 2014, http://www.wvgazette.com/article/20141007/ GZ01/141009410 (accessed October 15, 2014). 26. “Tulane researchers race to develop rapid Ebola finger-prick test,” The Times-Picayune Online, October 13, 2014, http://www.nola.com/health/ index.ssf/2014/10/tulane_researchers_race_to_dev.html (accessed October 14, 2014). 27. “Company puts sole focus on Ebola drug,” USA Today Online, October 13, 2014, http://www.usatoday.com/story/news/nation/2014/10/13/ebola- -production-boosted/17204487/ (accessed October 14, 2014). 28. “U.S. health experts consider Ebola treatments developed in NC,” News & Observer Online, October 14, 2014, http://www.newsobserver. com/2014/10/14/4232943_us-health-experts-consider-ebola.html?sp=/99/102/105/135/&rh=1 (accessed October 14, 2014). 29. “Calculating the Grim Economic Costs of Ebola Outbreak,” New York Times Online, October 13, 2014, http://dealbook.nytimes.com/2014/10/13/ calculating-the-grim-costs-of-ebola/?_php=true&_type=blogs&module=Search&mabReward=relbias%3Aw%2C%7B%221%22%3A%22RI%3A10%22%7D&_r=0 (accessed October 14, 2014).

STATE OF PREPARATION: SLC STATES AND THE EBOLA VIRUS 7 THE SOUTHERN OFFICE OF THE COUNCIL OF STATE GOVERNMENTS REGIONAL VIEW NATIONAL REACH

his report was prepared by Policy Analyst Lau- Florida, Georgia, Kentucky, Louisiana, Mississippi, Missouri, ren Greer with research assistance from Research North Carolina, Oklahoma, South Carolina, Tennessee, Tex- and Publications Associate Stephanie Noble for as, Virginia and West Virginia. the Human Services & Public Safety Committee of The SLC’s six standing committees provide a forum which Tthe Southern Legislative Conference (SLC) of The Council of allows policymakers to share knowledge in their area of ex- State Governments (CSG), under the chairmanship of state pertise with colleagues from across the South. By working Representative Joni L. Jenkins of Kentucky. together within the SLC and participating on its committees, The mission of The Council of State Governments’ Southern Southern state legislative leaders are able to speak in a dis- Legislative Conference is to foster and encourage intergov- tinctive, unified voice while addressing issues that affect their ernmental cooperation among its 15-member states. In large states and the entire region. measure, this is achieved through the ongoing work of the The Southern Office was opened in Atlanta in 1959. Initially Conference’s six standing committees and supporting groups. charged with serving all three branches of state government, Through member outreach in state capitols, policy research, the duties of the Office have evolved to providing services member delegations to points of interest, meetings and fly- primarily to the more than 2,400 legislative members and ins, staff support state policymakers in their work to build a staff of its 15-state region. SLC members are appointed by stronger region. the leadership of the 30 legislative chambers in the South. Founded in 1947, the Southern Legislative Conference is a The SLC Annual Meeting has grown to become the larg- member-driven organization and the largest of four region- est regional gathering of state legislators in the country al legislative groups operating under The Council of State and attracts the largest audience of any of the CSG region- Governments and comprises the states of Alabama, Arkansas, al conferences.