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input of both a broad range of State health department individuals and local health department individuals. And then we have an advisory committee, and that advisory committee is actually made up of several individuals in this room. Ms. Mencer sits on the advisory committee. Major General Whitney, Mr. Wall, Mr. Greer and Agent Airy have been involved in the work of the committee. So, again, we are trying to really get some coordination between our different agencies and make sure that the one knows what the other is doing and has input into those activities.

The grant, as you see in my notes, is divided into six focus areas. These focus areas are funded separately. They deal with specific readiness preparations, that is, the writing of the plans, the exercising of those plans, and training. They also deal with surveillance and epidemiology, which is the ability to detect and respond to an event quickly. So if there is a bioterrorism event, we will know about it as soon as possible, and we can control it quickly and prevent spread.

There's also a laboratory part of this grant that will go specifically to help us upgrade our laboratory capacity so we can better identify, more quickly identify, agents of bioterrorism at the State level. We also want to upgrade local laboratory capabilities.

There's also a section that deals with information technology, obviously an important issue that runs through every part of terrorism prevention and response. And we are dealing not only with actually connecting people and making sure they have good communication technology, but protecting that information and making sure that our information is secure.

We found out with the anthrax event, I think, that risk communication or the ability of public officials and public health officials to communicate information quickly and accurately, is very important and can really mean the difference in an event between quick control and not-so-quick control of an event. We need to make sure that we have better training in risk communication in our public health and public official levels so that we can provide information in the best way possible to the public.

The last area of focus in our grant is training and education. Obviously we have a huge number of not only public health people but also hospital staff to whom this is a relatively new issue, and we have a lot of training to do about the issue, about how we respond to this issue, importantly, how we work with all our different partners here, which public health staff are not as accustomed to working with as it should be, probably. We are getting better at working with our partners and knowing who those partners are, but that's still an area of need to do some training and education in.

My final point that I would make with these funds is that they are intended to increase our infrastructure in public health. And I think in order to do that, a 1-year grant is not going to work. We need to hire personnel and have training that is very long-term. And to do that well, I think these funds, obviously, need to be longer than 1 or 2 years to actually improve our infrastructure in a long-term way. So I thank you for your time and attention, and I'd be happy to take questions.

[The prepared statement of Dr. Miller follows:]

8/21/2002

Dr. Miller

Summary

Public Health Preparedness and Response for Bioterrorism
Colorado Department of Public Health and Environment

Federal Funding from the

Centers for Disease Control and Prevention and Health Resources and Services
Administration

U.S. Department of Health and Human Services

Colorado's Grant Applications for Public Health Bioterrorism Preparedness and Hospital Preparedness were prepared in response to President George W. Bush's initiative and federal legislation that provided funds to foster bioterrorism preparedness among state and local health departments and hospitals. In a January 31, 2002 letter, Secretary Tommy G. Thompson directed each state governor to review and approve the state's applications, which was done prior to the submission of the applications in April, 2002. The content of each application is discussed in further detail below.

Colorado's Hospital Preparedness Grant

The Hospital Preparedness grant was developed by Colorado Department of Public Health and Environment with oversight by a Hospital Preparedness Advisory Committee. The Committee consists of representatives from the fields of emergency medical services, emergency management, rural health, veterans affairs, Indian health, public health, providers, the Metropolitan Medical Response System, law enforcement, and is chaired by the President of the Colorado Health and Hospital Association.

These grant funds are provided through the Department of Health and Human Services,
Health Resources and Services Administration (HRSA) to upgrade the preparedness of
Colorado's hospitals and collaborating entities (pre-hospital/emergency medical systems
and community health clinics) for bioterrorism response.

Hospital Grant Award

The State was awarded $1.9 million, which is being delivered in two phases: The Phase One funds ($383,267) were awarded in March, 2002 to develop the infrastructure of the program, including the Hospital Preparedness Advisory Committee and a hospital needs assessment survey. The grant supports 1.75 staff positions (1.0 staff position for a program director, 0.25 staff for a medical director, and 0.50 staff for an administrative assistant); 54% of the Phase 1 funds will be combined with the Phase 2 funds and distributed directly to hospitals and other entities. The Phase two funding ($1.5 million) is expected to arrive in late September. More than 80% of these funds will be distributed directly to the hospitals and other entities, based on the identified needs from the Phase One needs assessment. The Hospital Preparedness Advisory Committee will prioritize the

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identified needs and items will be purchased in bulk, where possible, then distributed to hospitals as appropriate. These funds cover the time period up to March 31, 2003.

Hospital Grant Criteria

The grant criteria require: 1) identification of the needs of hospitals and other entities for bioterrorism readiness; 2) development of regional plans to accommodate a minimum of 500 victims, including identification of pharmaceutical needs, identification of specialty care patient needs (pregnant women, children, immuno-compromised persons, and elderly persons); and 3) provision of training. To maximize funding, this program is working in collaboration with the Public Health Bioterrorism Preparedness grant staff and with other agencies throughout the State that are developing bioterrorism response plans with other federal funding sources.

Colorado's Public Health Bioterrorism Preparedness Grant

Colorado's plan was developed by a Planning Group comprised of 10 staff from the Colorado Department of Public Health and Environment and 11 representatives from local health departments and local public health nursing groups, with input and oversight from a multi-disciplinary Bioterrorism Advisory Committee. The Committee was formed by supplementing the Governors' Expert Emergency Epidemic Response Committee with additional representatives from the areas of mental health, occupational health, emergency medical services, rural health, police and fire department workers, and community health centers.

The federal grant funds available for public health preparedness total $14.6 million for the time period June 2002 through August 2003. These funds are apportioned by formula to six focus areas, summarized below. Each focus area also contains one or more "Critical Benchmarks” which are activities that the Department was required to complete at the time of the grant submission (April 15, 2002). Among these benchmarks was the appointment of Dr. Ned Calonge to serve as the Executive Director of the State Bioterrorism Preparedness and Response Program. The federal public health bioterrorism grants were awarded to each state and several cities in the nation using a base plus per capita formula. The grants are intended to build public health infrastructure so that the public health system will be better able to respond to bioterrorism and other public health threats and emergencies.

Of the funds allotted, a total of $2.3 million has recently been made available to county and regional public health agencies in the state to provide immediate funds for addressing issues of training and preparedness planning and response.

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Focus Area A: Preparedness Planning and Readiness Assessment $3.3 million

Grant criteria involve: 1) assessing current capacity and developing, enhancing and maintaining public health leadership, expertise and workforce necessary to address bioterrorism, other outbreaks of disease, and other public health emergencies; 2) developing and testing coordinated preparedness and response plans, and 3) developing and testing a plan for deployment of the National Pharmaceutical Stockpile.

Colorado funds will be used to fund 11 new staff in local health departments and related regions for planning and exercises, coordinated with five staff (2.5 new, and including a currently funded position in the Colorado Office of Preparedness, Security and Fire Safety) at the state level. Additional funds will support preparedness assessment, planning and exercise activities, and equipment purchases such as personal protective equipment necessary for response to a bioterrorism event. Statewide and regional multidisciplinary conferences are planned (the first is occurring October 7 and 8, 2002) to provide training to a broad constituency. Approximately $1.7 million is provided to local public health agencies.

Focus Area B: Surveillance and Epidemiology Capacity $3.0 million

Grant criteria involve developing, enhancing, supporting and testing the epidemiologic infrastructure to 1) rapidly detect a terrorist event, 2) rapidly and effectively investigate, respond to and control the consequences of a terrorist event, and 3) respond to other naturally occurring disease outbreaks and public health threats (to provide evidence of preparedness). Additional criteria involve strengthening working links between responding areas (public health, health care and law enforcement).

Colorado funds will be used to fund 13 new epidemiologists at the local level for outbreak and event detection, investigation, response and consequence management, coordinated with four staff (two new) at the state level. Additional funds will support improvements to existing reporting systems, development of new surveillance systems, and support other activities to meet grant criteria. Approximately $1.5 million is provided to local public health agencies.

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Focus Area C: Laboratory Capacity-Biologic Agents $1.9

Grant criteria involve !) developing a state-wide laboratory services program to support response to bioterrorism, other infectious disease outbreaks, and other public health threats and emergencies and 2) ensure adequate laboratory infrastructure to identify potential biologic agents from a bioterrorism event.

Colorado funds will be used to improve communication between public health and other types of laboratories, improve the level of six local public health department labs to detect biological bioterrorism agents, and to expand the capabilities of the state laboratory. Laboratory security features will also be improved. Seven positions are funded in this area, including 3.5 new staff to support coordination, training and expanded capabilities. Approximately $500,000 is provided to laboratories at the local level.

Focus Area E: Health Alert Network/Communications and Information
Technology

$1.7 million

Grant criteria involve 1) insuring connectivity among event participants with high-speed Internet access, 2) developing a method of emergency communication for event participants, 3) protecting data and information systems, and 4) securing electronic exchange of public health information.

Colorado funds will be used to provide high-speed Internet access to all local public health venues, to provide Health Alert Network access to the same venues, and to evaluate, purchase and implement a communication system for use in the event of a bioterrorism attack. Funds will also be used to assure the security of our communication system. Three new state staff will join 0.5 existing staff to meet these goals.

Approximately $900,000 is provided to local health agencies to support connectivity and communication needs.

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