In one of her first interviews since her appointment to lead the Centers for Disease Control and Prevention, Julie Gerberding, M.D., told Modern Healthcare late last month that the agency has made major strides since Sept. 11 in communicating with providers.
Gerberding said aside from its primary duties to assist in delivering medical supplies and vaccines during a terrorism attack, the CDC has launched a work group that will develop and disseminate information to meet the needs of clinicians and administrators. "We know we have the most subject-matter experts in areas relevant to terrorism, whether it's biological, chemical or radiation," she said. "We're putting together the information and making it available for (providers) to use in whatever way fits into their planning process."
Last week in Washington, lawmakers took steps to strengthen the nation's healthcare and public health systems by approving plans for a federal Homeland Security Department, which will coordinate various health-related and bioterrorism-prevention functions, including overseeing all preparedness activities related to biological, chemical, nuclear or other terrorist attacks.
"We think the development of that department is a very logical step," Gerberding said. "We're very optimistic because we're at the table and are participating in how this will actually get implemented."
But she added that while the heightened focus on bioterrorism prevention will require careful coordination at the CDC, the agency is also using the investment in terrorism preparedness and response to enhance activities that also serve the overall public health agenda.
"We have a very decayed public health infrastructure at all levels-at the local level, the state level and at the CDC," Gerberding said. "We are rebuilding that, and the investments in public health preparedness that were made this year are not one-time investments. We expect this to be ongoing support that will be sustained over at least the next several years, and we can use that ongoing investment to continue to build and enhance these programs."
The U.S. House passed its version of the homeland security bill by a vote of 295-132. The Senate is scheduled to vote on its version of the legislation after an August recess.
The proposed $37 billion agency would control several public health-related activities to improve state, local and hospital preparedness previously carried out by HHS, including control of the national pharmaceutical stockpile to be deployed to states and providers in the event of a national emergency.
The House's bill also would give the new department authority over research, development and distribution of the nation's smallpox vaccine and transfer authority of the National Disaster Medical System and the Metropolitan Medical Response System from HHS to a newly created undersecretary for emergency preparedness and response. The National Disaster Medical System is a partnership among federal, state and local governments and the private sector to provide medical services after a disaster that overwhelms local healthcare resources.
The House's version of the Homeland Security bill also proposes that the president create a 100-member National Council of Emergency Responders composed of hospital workers, emergency personnel and top law enforcement and fire department officials.
If passed, the new legislation also would require HHS Secretary Tommy Thompson to create a coordinated response strategy in collaboration with the secretary for homeland security and develop "specific benchmarks and outcome measurements for evaluating progress" toward meeting public health priorities and preparedness goals among local, state and federal partners.
Gerberding took over leadership of the CDC in May after serving as acting principal deputy director of the $6.8 billion agency, which she guided through last fall's anthrax attacks.
She said the CDC is roughly a year into its own $1 billion program to renovate and replace the agency's crumbling infrastructure, starting with reconstruction of its laboratory network.
"We have to keep the message out there that it's not a quick fix," Gerberding said. "We have had years of neglect and it's going to take some time to get things back to optimal shape to meet the needs of the century we're in now."
Gerberding said the CDC has made "major inroads to being prepared" since the events of last September, and is moving swiftly in its efforts to support the information needs of clinicians and first responders by developing content and an information distribution system to help providers identify suspect diseases.
"I like to talk about the `golden triangle' of response, which is basically the interface between the clinicians and laboratory (workers), the local public health officer and the healthcare facility or plan," Gerberding said. "You have to engage all three of those components in order for this to work, and the most relevant connectivity to target right now is making sure that every clinician who sees patients on a primary care or emergency basis recognizes the basic syndromes that are associated with terrorism threats."
Gerberding said the clinician must have a strong relationship with the hospital and other local providers to determine whom to call if consultation is needed, what diagnostic tests to use, and how to alert the local or state public health official that they have a concern.
"If we can accomplish those three things among our clinicians," she said, "we will have the best detection system money can buy."
The American Hospital Association and American Medical Association as well as other provider groups have been "superb partners" in terms of helping the CDC shape information content and making sure it gets delivered to the organizations' members, she said.
The communication is critical because the response to any kind of an attack will be local, Gerberding said. Each state's designated bioterrorism coordinator will work with the healthcare delivery system, managed-care plans, and clinicians preparing for such an event.
"Our goal at the CDC is to do everything we can to support the preparation and response capacity at the local level, but we're not going to go in and dictate," she said. "We trust that hospitals will make decisions about what's going to work best in their jurisdiction."