Public Health Emergency Preparedness, 30451-30466 [05-10537]

Agencies

• Centers for Disease Control and Prevention
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 70, Number 101 (Thursday, May 26, 2005)]
[Notices]
[Pages 30451-30466]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-10537]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention


Public Health Emergency Preparedness

    Announcement Type: New.
    Funding Opportunity Number: AA154.
    Catalog of Federal Domestic Assistance Number: 93.283.
    Application Deadline: July 13, 2005.
    Notice of Award: August 31, 2005.

I. Funding Opportunity Description

    Authority: This program is authorized under 42 U.S.C. 247d-3.

    Purpose: The purpose of this program is to upgrade and integrate 
State and local public health jurisdictions' preparedness for and 
response to terrorism and other public health emergencies with Federal, 
State, local, and tribal governments, the private sector, and Non-
Governmental Organizations (NGOs). These emergency preparedness and 
response efforts are intended to support the National Response Plan 
(NRP)\1\ and the National Incident Management System (NIMS) \2\.
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    \1\ Emergency Support Function Annexes. National Response Plan. 
Available at: https://www.dhs.gov/dhspublic/interapp.editorial/
editorial_0566.xml.
    \2\ National Incident Management System https://www.fema.gov/
nims/.
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    In addition, the activities described in this cooperative agreement 
guidance are designed to develop emergency-ready public health 
departments in accord with the Interim National Preparedness Goal (NPG) 
\3\, the Interim Public Health and Healthcare Supplement to the NPG 
\4\, and the Centers for Disease Control and Prevention (CDC) 
Preparedness Goals (see below). Associated with the Interim NPG are two 
broad-gauged resources to help guide preparedness planning and 
implementation: A set of scenarios and the Target Capabilities List 
\5\. The Department of Homeland Security (DHS) developed the Interim 
NPG and the associated resources in concert with the Department of 
Health and Human Services and other agencies of the Federal Government 
as well as with representatives of State and local public health 
departments and other stakeholders. All of these documents will be 
refined and extended from time to time to capture lessons learned and 
to introduce new concepts as appropriate.
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    \3\ Interim National Preparedness Goal: https://
www.ojp.usdoj.gov/odp/docs/InterimNationalPreparednessGoal_03-31-
05_1.pdf.
    \4\ Interim Public Health and Healthcare Supplement to the 
National Preparedness Goal: https://www.hhs.gov/ophep/.
    \5\ Target Capabilities List: Version 1.0; January 31, 2005. 
U.S. Department of Homeland Security Office of State and Local 
Government Coordination and Preparedness (ATTN: Office for Policy, 
Initiatives, and Analysis) 810 7th Street, NW. Washington, DC 20531. 
Version 1.0 of the Target Capabilities List will be made available 
on the ODP Secure Portal (https://odp.esportals.com) and the Lessons 
Learned and Information Sharing network (https://www.llis.gov).
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    This announcement is only for non-research activities supported by 
the Centers for Disease Control and Prevention/Agency for Toxic 
Substances and Disease Registry (CDC/ATSDR). If research is proposed, 
the application will not be reviewed. For the definition of research, 
please see the CDC Web site at the following Internet address: https://
www.cdc.gov/od/opspoll1.htm.
    This program addresses the ``Healthy People 2010'' focus area(s) of 
public health infrastructure.
    Recipient Activities: CDC has developed Preparedness Goals designed 
to measure urgent public health system response performance parameters 
that are directly linked to health protection of the public. The 
Preparedness Goals are intended to measure urgent public health system 
response performance for terrorism and non-terrorism events including 
infectious disease, environmental and occupational related emergencies. 
For the purposes of this announcement urgent response is intended to 
indicate non-routine public health system reaction to limit possible 
mortality, morbidity, loss of quality of life, or economic damage. The 
primary intent of this cooperative agreement is to fund the active 
participation of awardees in the immediate establishment, use, and 
continuous improvement of a national system using the CDC Preparedness 
Goals to measure public health system response performance. The CDC 
Preparedness Goals are below:
    Prevent: (1) Increase the use and development of interventions 
known to prevent human illness from chemical, biological, radiological 
agents, and naturally occurring health threats.
    (2) Decrease the time needed to classify health events as terrorism 
or naturally occurring in partnership with other agencies.
    Detect/ Report: (3) Decrease the time needed to detect and report 
chemical, biological, radiological agents in tissue, food or 
environmental samples that cause threats to the public's health.
    (4) Improve the timeliness and accuracy of information regarding 
threats to the public's health as reported by clinicians and through 
electronic early event detection, in real time, to those who need to 
know.
    Investigate: (5) Decrease the time to identify causes, risk 
factors, and appropriate interventions for those affected by threats to 
the public's health.
    Control: (6) Decrease the time needed to provide countermeasures 
and health guidance to those affected by threats to the public's 
health.
    Recover: (7) Decrease the time needed to restore health services 
and environmental safety to pre-event levels. (8) Increase the long-
term follow-up provided to those affected by threats to the public's 
health.
    Improve: (9) Decrease the time needed to implement recommendations 
from after-action reports following threats to the public's health.
    The activities in this cooperative agreement guidance will be based 
on the synchronization of the Department of Homeland Security Target 
Capabilities List (TCL) with the CDC Preparedness Goals in order to 
create a preparedness framework that identifies the key needs for the 
public health community.
    The TCL was developed under the auspices of Homeland Security 
Presidential Directive 8: National Preparedness (HSPD-8). It is a 
functional, performance-focused compendium of response activities 
designed to provide State and local jurisdictions with nationally 
accepted preparedness levels of first responder capabilities. The TCL 
was developed in close consultation with Federal, State, local, and 
tribal entities and national associations, including CDC and many of 
the agency's key response partners.
    Additional Requirements: The activities outlined in the guidance 
and required for the application for funds are as follows:
    1. The existence of or current efforts to establish or participate 
in a senior advisory committee during Fiscal Year 2005 (FY05) to 
coordinate funding with the U.S. Department of Health and Human 
Services' (HHS) Centers for Disease Control and Prevention; U.S. 
Department of Health and Human Services' (HHS) Health Resource and 
Services Administration (HRSA) hospital preparedness cooperative 
agreement; and FY05 Homeland Security Grant Program Department of

[[Page 30452]]

Homeland Security, Office for Domestic Preparedness.
    2. During the award year, awardees ability to respond to events 
will be evaluated through assessments, site visits, drills, exercises, 
and responses to real events. In year one of this cooperative 
agreement, CDC will initiate a series of drills to test components of a 
comprehensive response system. In years 2-5 of this cooperative 
agreement, CDC will require the demonstration of a broader set of 
measures that are consistent with the TCLs through full-scale exercises 
at the State and local level. Further guidance on the development and 
evaluation of exercises and drills will be forthcoming from CDC. To the 
extent possible, public health exercises should use standards set by 
the DHS Homeland Security Exercise Evaluation Program (HSEEP) as well 
as other recognized exercise programs including those used by the 
Federal Emergency Management Agency (FEMA) Emergency Management 
Institute. These exercises should test both horizontal and vertical 
integration with response partners at the local, tribal, State, and 
federal level.
    3. Awardees must ensure that funds are available to establish and 
maintain systems to collect and report on the performance measures 
described in this program announcement, including reporting on the 
achievement of performance measures by local public health entities.
    4. Awardees are expected to address the activities and outcomes 
described in this announcement through the use of cooperative agreement 
funds and coordination with other funding sources such as the Urban 
Areas Security Initiative (UASI) and the Metropolitan Medical Response 
System (MMRS) through the Department of Homeland Security. Achievement 
of these outcomes will be evaluated through drills, exercises, and 
responses to real events whenever possible.
    5. While this guidance contains instructions for CDC awardees, it 
also includes recipient activities that need to be integrated with 
those funded by the hospital preparedness cooperative agreement 
administered by HRSA. Further, CDC encourages applicants to coordinate 
activities with current relevant efforts in their jurisdictions or 
proposed under the various goals of this cooperative agreement.
    Applicants should also coordinate activities within their 
jurisdictions (i.e., at the State level), between State and local 
jurisdictions, tribes, and military installations; among local 
agencies; and with hospitals and major health care entities, including 
tribal and Public Health Service health facilities; among 
jurisdictional MMRSs, and adjacent States. If applicable, awardees 
should coordinate with neighboring provinces, tribal/First Nations 
indigenous jurisdictions and States across international borders.
    6. Public health agencies must support public health response 
functions in the context of NIMS. In accordance with HSPD-5, NIMS 
provides a consistent approach for Federal, State, and local 
governments to work effectively and efficiently together to prepare 
for, prevent, respond to, and recover from domestic incidents, 
regardless of cause, size, or complexity. As a condition of receiving 
Public Health Emergency Preparedness cooperative agreement funds, 
awardees agree to adopt and implement NIMS. In accordance with the 
eligibility and allowable uses of the cooperative agreement, awardees 
are encouraged to direct FY05 funding towards activities necessary to 
implement NIMS.
    On September 8, 2004, the former Secretary of Homeland Security, 
Tom Ridge, wrote a letter to the Governors outlining the important 
steps that State, territorial, tribal and local entities should take 
during FY05 to become compliant with NIMS.\6\
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    \6\ Available at https://www.fema.gov/doc/nims/letter_to_
governors_09082004.doc, accessed April 7, 2005.
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    In order to receive Fiscal Year 2006 (FY06) preparedness funding, 
the minimum FY05 compliance requirements described in the Secretary's 
letter must be met. Applicants will be required to certify as part of 
their FY06 cooperative agreement applications that they have met the 
FY05 NIMS requirements.
    NIMS compliance activities to be accomplished during FY05 are as 
follows:

States and Territories

     Incorporate NIMS into existing training programs and 
exercises;
     Ensure that federal preparedness funding (including the 
National Bioterrorism Hospital Preparedness cooperative agreement) 
supports State, local and tribal NIMS implementation;
     Incorporate NIMS into Emergency Operations Plans (EOP);
     Promote intraState mutual aid agreements;
     Coordinate and provide NIMS technical assistance to local 
and tribal entities; and
     Incorporate Incident Command Systems (ICS) into public 
health department, hospital, and supporting health care systems.

State, Territorial, Local and Tribal Jurisdictions

     Complete the NIMS Awareness Course: ``National Incident 
Management System (NIMS), An Introduction'' IS 700.
    This independent study course developed by the Emergency Management 
Institute (EMI) explains the purpose, principles, key components and 
benefits of NIMS. The course is available on the EMI Web page at: 
https://training.fema.gov/EMIWeb/IS/is700.asp.
     Formally recognize the NIMS and adopt NIMS principles and 
policies.
    States, territories, tribes and local entities should establish 
legislation, executive orders, resolutions, or ordinances to formally 
adopt the NIMS. Go to https://www.fema.gov/nims and see NIMS Resources 
for examples.
     Determine which NIMS requirements have already been met.
    State, territorial, tribal, and local entities have already 
implemented many of the concepts and protocols identified in the NIMS. 
However, as gaps in compliance with the NIMS are identified, States, 
territories, tribes and local entities should use existing awards to 
develop strategies for addressing those gaps.
     Develop a strategy and timeframe for full NIMS 
implementation.
    States, territories, tribes, and local entities are encouraged to 
achieve full NIMS implementation during FY05. To the extent that full 
implementation is not possible during FY05, federal preparedness 
assistance must be leveraged to complete NIMS implementation by FY06. 
By Fiscal Year 2007 (FY07), federal preparedness assistance will be 
conditioned by full compliance with the NIMS. States should work with 
tribal and local governments to develop a strategy for Statewide 
compliance with the NIMS.
     Incorporate Incident Command Systems (ICS) into public 
health department, hospital, and supporting health care systems.
    All Federal, State, territory, tribal and local jurisdictions are 
required to adopt ICS in order to be compliant with the NIMS. See NIMS 
and the Incident Command System at https://www.fema.gov/nims under NIMS 
Resources.
    During the FY 2005 budget period the Department of Health and Human 
Services will continue to work closely with the NIMS Integration Center 
to clarify NIMS requirements for public health and medical communities. 
Both HRSA and CDC will continue to provide technical assistance 
throughout this

[[Page 30453]]

process to assist to awardees in meeting 2005 requirements.
    7. Competency-based education of public health workers, clinicians, 
and others critical to emergency response should be planned and 
implemented based on needs identified through assessments and/or 
evaluations of performance. Awardees are expected to continue to 
support preparedness education and training activities needed to 
successfully achieve targeted outcomes and preparedness goals. 
Development, delivery, and evaluation of competency-based preparedness 
education should be done in conjunction with Centers for Public Health 
Preparedness (CPHP), and academic experts in other schools of public 
health, medicine, nursing, and academic health science centers.
    Prior to planning development of new preparedness education courses 
or training programs to meet identified needs, efforts should be taken 
to identify and utilize existing education programs that have been 
evaluated for learning effectiveness (e.g. as evidenced by measured 
knowledge gained through pre- and post-tests, self-assessed learner 
competence, and/or skill demonstrations.) Resources such as learning 
management systems ((e.g. TrainingFinder Real-time Affiliate Integrated 
Network (TRAIN)) and other preparedness educational inventories ((e.g. 
Centers for Public Health Preparedness (CPHP) Resource Center)) can 
help facilitate the identification of existing preparedness educational 
programs that can be accessed, adopted, and adapted for local use, 
which will result in less duplication and more efficient use of 
available funds.
    8. During the award year, awardees are expected to implement 
capable, interoperable information systems that support public health 
preparedness. PHIN Preparedness defines functional requirements in the 
areas of Early Event Detection, Outbreak Management, Countermeasure and 
Response Administration, Partner Communications and Alerting, and 
Connecting Laboratory Systems. All awardees are expected to develop 
information technology systems that are compliant with PHIN and begin 
to initiate the PHIN Preparedness certification process (further 
guidance on this process can be found at https://www.cdc.gov/phin/
certification) during this cooperative agreement cycle. PHIN 
certification will ensure that systems have the capabilities necessary 
(``functional requirements'') to share data and work together (``Key 
Performance Measures--KPM's'') in order to implement a national network 
of capable public health preparedness systems. Certification is based 
upon the system requirements and specification guides found at https://
www.cdc.gov/phin. Self-assessment tools are available for all 
functional areas and the alerting KPMs at https://www.cdc.gov/phin/
certification.
    Awardees may choose to meet the system requirements and 
specifications by: building or enhancing their own systems, purchasing 
commercial solutions, or using CDC developed systems and services. The 
requirements documents and specification guides include the details of 
what needs to be implemented in grantee systems to meet these needs. 
Some awardees may choose to use CDC developed software and services 
either as their final solutions or as bridge solutions until their own 
systems meet the requirements and specifications and are certified. The 
CDC has software and services available to cover all of the PHIN 
Preparedness functional areas, but the CDC is committed to working with 
awardees to help support solutions from any viable software solutions 
providers. The implementation of the PHIN Preparedness functional 
requirements will usually require several software systems to cover all 
of the functional areas, but in some circumstances, awardees may 
implement a single system that covers more than one functional area. 
Each PHIN Preparedness functional area can be certified separately. 
While CDC systems will undergo certification themselves, if CDC 
software and services are used in the awardee environment some 
components will require certification in the environment they are 
implemented.
    9. CDC requires documentation with the cooperative agreement 
application that describes the process used by the State health 
department to engage local health departments to reach consensus, 
approval, or concurrence for the proposed use of non-earmarked 
cooperative agreement funds. Non-earmarked cooperative agreement funds 
are those funds not designated for urban areas (e.g. Cities Readiness 
Initiative (CRI)), Early Warning Infectious Disease Surveillance 
(EWIDS), currently established Level 1 Chemical laboratories, or other 
specialty activities as defined in the guidance. The description should 
bear evidence that local health department officials have been engaged 
in the cooperative agreement application process and at least a 
majority, if not the total, approves or concur with the application 
itself. This evidence may be demonstrated by:
    a. The consensus of a majority of local health officials whose 
collective jurisdictions encompass a majority of the State's 
population;
    b. The recommendation of the President of the State Association of 
County and City Health Officials (SACCHO) if a majority of local health 
officials whose collective jurisdictions encompass a majority of the 
State's population agree with the SACCHO's decision; or
    c. Any other alternative method agreed to by the State Health 
Official and a majority of local health officials whose collective 
jurisdictions encompass a majority of the State's population.
    State applicants will be required to submit a list of concurring 
local health departments and a brief description of the process used to 
engage local health departments to reach consensus, approval, or 
concurrence for the proposed use of funds. In addition, State 
applicants will be required to provide signed letters of concurrence 
upon request.
    10. CDC requires documentation with the cooperative agreement 
application that describes the process used by the State health 
department to engage the following entities in preparedness and 
response activities: American Indian tribal governments, Tribal 
organizations representing those governments, tribal epidemiologic 
centers, or Alaska Native Villages and Corporations located within 
their boundaries.
    11. State awardees are expected to ensure the preparedness of major 
population centers within each State either through the provision of 
funding to the population centers to ensure their capability to perform 
the outcomes and activities described and/or (for those States with a 
centralized public health system that does not fund local health 
agencies) by directly achieving the performance outcomes and completing 
the required activities described in this cooperative agreement 
announcement in those population centers. State awardees are expected 
to report on the relevant performance measures (see Appendix 4) for the 
following population centers. Some of the performance measures will be 
reported on by each local public health agency (through the State) in 
the jurisdiction; others will require the local agencies to work 
collaboratively to develop an integrated response. In those cases, 
reporting will be done through the State for the region as a whole (see 
Appendix 4).

[[Page 30454]]



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                                    Biowatch\*\ or UASI
              State                     (05) cities                           Associated MSA
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Arizona..........................  Phoenix.............  Phoenix-Mesa-Scottsdale, AZ
California.......................  Anaheim.............  Los Angeles-Long Beach-Santa Ana, CA
                                   Long Beach..........  Los Angeles-Long Beach-Santa Ana, CA
                                   Los Angeles.........  Los Angeles-Long Beach-Santa Ana, CA
                                   Oakland.............  San Francisco-Oakland-Fremont, CA
                                   Sacramento..........  Sacramento Arden-Arcade Roseville, CA
                                   San Diego...........  San Diego-Carlsbad-San Marcos, CA
                                   San Francisco.......  San Francisco-Oakland-Fremont, CA
                                   San Jose............  San Jose-Sunnyvale-Santa Clara, CA
                                   Santa Ana...........  Los Angeles-Long Beach-Santa Ana, CA
Colorado.........................  Denver..............  Denver-Aurora, CO
Delaware.........................  Philadelphia........  Philadelphia-Camden-Wilmington, PA-NJ-DE
District of Columbia.............  Washington/NCR......  Washington-Arlington-Alexandria, DC-VA-MD
Florida..........................  Jacksonville........  Jacksonville, FL
                                   Miami...............  Miami-Fort Lauderdale-Miami Beach, FL
                                   Tampa...............  Tampa-St. Petersburg-Clearwater, FL
Georgia..........................  Atlanta.............  Atlanta-Sandy Springs-Marietta, GA
Hawaii...........................  Honolulu............  Honolulu, HI
Illinois.........................  Chicago.............  Chicago-Naperville-Joliet, IL-IN-WI
                                   St. Louis...........  St. Louis, MO-IL
Indiana..........................  Indianapolis........  Indianapolis, IN
                                   Chicago.............  Chicago-Naperville-Joliet, IL-IN-WI
                                   Cincinnati..........  Cincinnati-Middletown, OH-KY-IN
                                   Louisville..........  Louisville, KY-IN
Iowa.............................  Omaha...............  Omaha-Council Bluffs, NE-IA
Kansas...........................  Kansas City.........  Kansas City, MO-KS
Kentucky.........................  Louisville..........  Louisville, KY-IN
                                   Cincinnati..........  Cincinnati-Middletown, OH-KY-IN
Louisiana........................  Baton Rouge.........  Baton Rouge, LA
                                   New Orleans.........  New Orleans-Metairie-Kenner, LA
Massachusetts....................  Boston..............  Boston-Cambridge-Quincy, MA-NH
Maryland.........................  Baltimore...........  Baltimore-Towson, MD
                                   Washington DC.......  Washington-Arlington-Alexandria, DC-VA-MD
Michigan.........................  Detroit.............  Detroit-Warren-Livonia, MI
Minnesota........................  Minneapolis.........  Minneapolis-St. Paul-Bloomington, MN-WI
Missouri.........................  Kansas City.........  Kansas City, MO-KS
                                   St. Louis...........  St. Louis, MO-IL
Nebraska.........................  Omaha...............  Omaha-Council Bluffs, NE-IA
North Carolina...................  Charlotte...........  Charlotte-Gastonia-Concord, NC-SC
New Hampshire....................  Boston..............  Boston-Cambridge-Quincy, MA-NH
New Jersey.......................  Jersey City.........  New York-Northern New Jersey-Long Island, NY-NJ-PA
                                   Newark..............  New York-Northern New Jersey-Long Island, NY-NJ-PA
                                   Philadelphia........  Philadelphia-Camden-Wilmington, PA-NJ-DE
Nevada...........................  Las Vegas...........  Las Vegas-Paradise, NV
New York.........................  Buffalo.............  Buffalo-Niagara Falls, NY
                                   New York............  New York-Northern New Jersey-Long Island, NY-NJ-PA
Ohio.............................  Cincinnati..........  Cincinnati-Middletown, OH-KY-IN
                                   Cleveland...........  Cleveland-Elyria-Mentor, OH
                                   Columbus............  Columbus, OH
                                   Toledo..............  Toledo, OH
Oklahoma.........................  Oklahoma City.......  Oklahoma City, OK
Oregon...........................  Portland............  Portland-Vancouver-Beaverton, OR-WA
Pennsylvania.....................  Philadelphia........  Philadelphia-Camden-Wilmington, PA-NJ-DE
                                   Pittsburgh..........  Pittsburgh, PA
                                   New York............  New York-Northern New Jersey-Long Island, NY-NJ-PA
South Carolina...................  Charlotte...........  Charlotte-Gastonia-Concord, NC-SC
Texas............................  Austin\*\...........  Austin-Round Rock, TX
                                   Arlington...........  Dallas-Fort Worth-Arlington, TX
                                   Dallas..............  Dallas-Fort Worth-Arlington, TX
                                   Fort Worth..........  Dallas-Fort Worth-Arlington, TX
                                   El Paso\*\..........  El Paso, TX
                                   Houston.............  Houston-Baytown-Sugar Land, TX
                                   San Antonio.........  San Antonio, TX

[[Page 30455]]

 
Virginia.........................  Washington DC.......  Washington-Arlington-Alexandria, DC-VA-MD
Washington.......................  Seattle.............  Seattle-Tacoma-Bellevue, WA
                                   Portland............  Portland-Vancouver-Beaverton, OR-WA
Wisconsin........................  Chicago.............  Chicago-Naperville-Joliet, IL-IN-WI
                                   Milwaukee...........  Milwaukee-Waukesha-West Allis, WI
                                   Minneapolis.........  Minneapolis-St. Paul-Bloomington, MN-WI
----------------------------------------------------------------------------------------------------------------
\*\ Biowatch only.

    12. CDC will work with awardees and partner agencies ((including 
National Association of County and City Health Officials (NACCHO), 
Association of State and Territorial Health Officials (ASTHO), Council 
of State and Territorial Epidemiologists (CSTE), Association of Public 
Health Laboratories (APHL), DHS, and FEMA)) to build on these initial 
activities and develop performance-based metrics within the next six 
months that will measure all aspects of preparedness as outlined in the 
CDC Preparedness Goals and the TCLs. They will be developed with the 
understanding that wherever possible these activities can be 
demonstrated through performance in drills, exercises, or real events. 
Additional activities will include gap analysis, economic modeling, 
continuous improvement and data collection/evaluation from exercises 
and real events as well as piloting the developed metrics. Required 
critical tasks and performance measures will be updated in each project 
year as public health learns more about measuring preparedness. In 
addition, CDC will be developing targets for those measures that do not 
currently have them based on research over the coming year.
    13. As Stated in the FY04 guidance, awardees should provide a copy 
of the complete pandemic influenza plan for the jurisdiction to HHS 
Office of Public Health Emergency Preparedness (OPHEP) via CDC Division 
of State and Local Readiness' Management Information System (DSLR-MIS). 
Awardees of this cooperative agreement should collaborate with 
influenza programs to maximize the impact of funds and efforts, reduce 
duplication, and coordinate activities including drills and exercises. 
Detailed information concerning the development of influenza pandemic 
preparedness plans is available in the document Pandemic Influenza: A 
Planning Guide for State and Local Officials, version 2.1 available at 
https://www.hhs.gov/nvpo/pubs/pandemicflu.htm.

Local Caches of Antiviral Drugs

    Certain antiviral drugs are efficacious in countering influenza 
virus and could be the sole initial medical countermeasure against a 
pandemic strain until an effective vaccine is available. The H5N1 avian 
strain currently circulating widely in Asia has been shown to infect 
humans and cause significant mortality and morbidity; and the virus 
could trigger an influenza pandemic if it were to undergo genetic 
changes that enhance its transmissibility from person to person. One 
commonly available drug, Oseltamivir, has been shown to be effective 
against the current H5N1 strain. Because worldwide production capacity 
for antiviral drugs faces significant limitations, the Department of 
Health and Human Services is working to create a mechanism whereby it 
and its State and local public health partners might acquire and pre-
deploy predictable quantities of antiviral drugs during the next 
several years.
    The Hospital Bioterrorism Cooperative Agreement of the Health 
Resources and Services Administration (HRSA) includes a Critical 
Benchmark for hospital-based pharmaceutical caches. This provision 
provides a means for jurisdictions to amass appropriate quantities of 
antiviral drugs as a first line of protection for the staff of 
hospitals and other healthcare entities as well as their most 
critically ill patients. Such action could be one of the most important 
steps toward maintaining an effective healthcare infrastructure during 
an influenza pandemic.
    Hospital-based pharmaceutical caches also could house antiviral 
drugs to protect public health professionals, another critical part of 
the human resources needed to combat an influenza pandemic. Funds 
allocated through the CDC bioterrorism cooperative agreement could be 
used to acquire appropriate quantities of antiviral drugs for storage 
within the hospital-based caches funded by the HRSA cooperative 
agreement. When and as needed, the drugs could be released to the 
public health department for it to dispense to its staff. This 
arrangement would be analogous to the way some jurisdictions have 
implemented the CHEMPAK program (containerized sets of nerve-agent 
antidotes)--i.e., using CDC funds to acquire materiel, using HRSA funds 
to offset costs of storing it, and planning to release the materiel 
when and as needed to those authorized to use it in accord with an 
established Concept of Operations.
    Awardees requesting to use cooperative agreement funds for the 
purchase of antiviral drugs for these caches must specify the quantity 
and cost as part of the budget application.
    14. Awardees participating in the FY04 CRI will continue to do so 
in FY05 (the second year of the pilot initiative). The guidelines for 
CRI can be found in Appendix 3.
    Application Content: What follows is the outline to be used to 
develop the application for funds. It was derived from a combination of 
many resources: past guidance, input from State and local public health 
partners, subject matter expertise within technical program areas of 
CDC, priorities from HHS, CDC priorities, documentation from DHS's TCL, 
DHS's Universal Task List (UTL), and HSPD-8.
    The outline is arranged in the following manner:
    CDC Goals--Draft CDC Preparedness Goals that form a framework for 
public health activities surrounding preparedness. This cooperative 
agreement is one activity among many that will contribute to meeting 
the Preparedness Goals.
    Outcomes--The outcomes are Statements that were developed with 
State and local input from public health and homeland security. They 
were created in relation with HSPD-8 and are a comprehensive 
description of the major roles and capabilities needed to respond to an 
event of significance. Version 1 of the TCL contained 36 capabilities. 
For year one of this guidance, we singled out those capabilities that 
had a significant public health component. In some cases, we added 
language to the capabilities to

[[Page 30456]]

create a public health focused outcome. A comprehensive budget where 
each allocation is linked to an outcome should be submitted with the 
application through the DSLR MIS.
    Required Critical Tasks--The critical tasks were obtained from the 
TCL. In most cases, the public health specific critical tasks 
associated with an outcome were listed. Language was added or modified 
to make the required critical task more specific to public health. In 
addition, program requirements specific to CDC and this cooperative 
agreement were added as sub-bullets under the required critical tasks 
to assure that each applicant addressed plans to continue 
implementation of the activities in the next cooperative agreement 
cycle.
    Performance Measures--The performance measures are defined as 
leading indicators that will allow a national ``snapshot'' to show how 
the preparedness and response activities, and the associated resources, 
aid in making a public health system that responds more quickly and 
comprehensively in a public health emergency.
    Applicants will be required to address each critical task (using 
the DSLR-MIS) by providing an explanation of their current capability 
to perform this task and proposing activities for this budget year to 
enhance performance on each critical task. In addition, applicants will 
be asked how they currently evaluate or plan to evaluate their ability 
to perform each of the critical tasks.
    After award, CDC Project Officers and technical experts will 
monitor the progress of each awardee in accomplishing the activities 
set forth and approved in the plan submitted.

CDC Preparedness Goal 1: Prevent

    Increase the use and development of interventions known to prevent 
human illness from chemical, biological, radiological agents, and 
naturally occurring health threats.
Outcome 1A: All Hazards Planning
    Emergency response plans, policies, and procedures that identify, 
prioritize, and address all hazards (using the 15 National Planning 
Scenarios 7 8 9 10 as a guide to identify or recognize the 
roles and responsibilities for each jurisdiction/agency) across all 
functions. All plans are coordinated at all levels of government and 
address the mitigation of secondary and cascading emergencies.
---------------------------------------------------------------------------

    \7\ Frequently Asked Questions: HSPD 8/National Planning 
Scenarios/Targeted Capabilities List. Available at: https://
www.ojp.usdoj.gov/odp/assessments/hspd8.htm.
    \8\ Homeland Security Presidential Directive 8 https://
www.whitehouse.gov/news/releases/2003/12/print/20031217-6.html.
    \9\ Homeland Security Presidential Directive 5 https://
www.fas.org/irp/offdocs/nspd/hspd-5.html.
    \10\ Homeland Security Grant Program--FY 2005. Available at: 
https://www.ojp.usdoj.gov/odp/docs/fy05hsgp.pdf.
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    Required Critical Tasks: (1) Support incident response operations 
according to all-hazards plan
    (2) Improve regional, jurisdictional, and State all-hazard plans 
(including those related to pandemic influenza) to support response 
operations in accordance with NIMS and the National Response Plan.\11\
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    \11\ Guide for All-Hazard Emergency Operations Planning: State 
and Local Guide 101. Federal Emergency Management Agency. April 
2001. https://www.fema.gov/pdf/rrr/slg101.pdf.
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    (a) Increase participation in jurisdiction-wide self-assessment 
using the National Incident Management System Compliance Assessment 
Support Tool \12\ (NIMCAST).
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    \12\ National Incident Management System Compliance Assessment 
Support Tool (NIMCAST). https://www.fema.gov/nimcast/index.jsp.
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    (b) Agency's Emergency Operations Center meets NIMS incident 
command structure requirements to perform core functions: coordination, 
communications, resource dispatch and tracking and information 
collection, analysis and dissemination.
    (3) Increase the number of public health responders who are 
protected through Personal Protective Equipment (PPE), vaccination or 
prophylaxis
    (a) Have or have access to a system that maintains and tracks 
vaccination or prophylaxis status of public health responders in 
compliance with Public Health Information Network (PHIN) Preparedness 
Functional Area Countermeasure and Response Administration \13\
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    \13\ Public Health Information Network (PHIN) Preparedness 
Requirements https://www.cdc.gov/phin/.
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    (4) Increase and improve mutual aid agreements, as needed, to 
support NIMS-compliant public health response.
    (5) Increase all-hazard incident management capability by 
conducting regional, jurisdictional and State training to:
    (a) Include the Emergency Management Independent Study Program, IS 
700, ``National Incident Management System: An Introduction \14\'' in 
the training plan for all staff expected to report for duty following 
activation of the public health emergency response plan and/or staff 
who have emergency response roles documented in their job descriptions.
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    \14\ Emergency Management Independent Study Program , IS 700, 
National Incident Management System, An Introduction. https://
www.training.fema.gov/EMIWeb/IS/IS700.asp.
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    (6) Provide support for continuity of public health operations at 
regional, State, tribal, local government, and agency level.
    Measures: (1) Percent of public health employees who have emergency 
response roles documented in their job descriptions that are trained in 
Incident Management.
    (2) Time to organize a NIMS-compliant medical and public health 
operations functional area \15\ with hospitals that supports:
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    \15\ The CNACorporation. Medical Surge Capacity and Capability: 
A Management System for Integrating Medical and Health Resources 
During Large-Scale Emergencies. Prepared under Contract Number 233-
03-0028 for the Department of Health and Human Services. Alexandria, 
Virginia: August 2004. Available at: https://www.cna.org/documents/
mscc_aug2004.pdf.
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     incident epidemiological profiling
     pre-hospital care
     medical care
     mental health
     hazard threat/disease containment
     mass casualty care
     (Target: 3 hours from plan activation)
    (3) Time from request for mutual aid to acknowledgement that 
request has been approved.
    (4) Time to complete the notification/alerting of the initial wave 
of personnel to staff emergency operations (Target: 60 minutes).
    (5) Time to have initial wave of personnel physically present to 
staff emergency operations (Target: 90 minutes from notification).

CDC Preparedness Goal 2: Prevent

    Decrease the time needed to classify health events as terrorism or 
naturally occurring in partnership with other agencies.
Outcome 2A: Information Collection and Threat Recognition
    Locally generated public health threat and other terrorism-related 
information is collected, identified, provided to appropriate analysis 
centers, and acted upon as appropriate.
    Required Critical Tasks: (1) Increase the use of disease 
surveillance and early event detection systems.
    (a) Select conditions that require immediate reporting to the 
public health agency (at a minimum, Category A agents).
    (b) Develop and maintain systems to receive disease reports 24/7/
365.
    (c) Have or have access to electronic applications in compliance 
with PHIN Preparedness Functional Area Early Event Detection to 
support:

[[Page 30457]]

     Receipt of case or suspect case disease reports 24/7/365.
     Reportable diseases surveillance.
     Call triage of urgent reports to knowledgeable public 
health professionals.
     Receipt of secondary use health-related data and 
monitoring of aberrations to normal data patterns.
    (d) Develop and maintain protocols for the utilization of early 
event detection devices located in your community (e.g., BioWatch).
    (e) Assess timeliness and completeness of disease surveillance 
systems annually.
    (2) Increase sharing of health and intelligence information within 
and between regions and States with Federal, local and tribal agencies.
    (a) Improve information sharing on suspected or confirmed cases of 
immediately notifiable conditions, including foodborne illness, among 
public health epidemiologists, clinicians, laboratory personnel, 
environmental health specialists, public health nurses, and staff of 
food safety programs.
    (b) Maintain secret and/or top secret security clearance for the 
State health official, local health officials, preparedness directors, 
and preparedness coordinators to ensure access to sensitive information 
about the nature of health threats and intelligence information \16\.
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    \16\ HHS Guidance: https://198.102.218.46/doc/
Security%20Class%20Guide.doc.
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    (3) Decrease the time needed to disseminate timely and accurate 
national strategic and health threat intelligence.
    (a) Maintain continuous participation in CDC's Epidemic Information 
Exchange Program (Epi-X)\17\.
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    \17\ Epidemic Information Exchange Program (Epi ``X) https://
www.cdc.gov/epix/.
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    (b) Participate in the Electronic Foodborne Outbreak Reporting 
System (EFORS) by entering reports of foodborne outbreak investigations 
and monitor the quality, completeness or reports and time from onset of 
illnesses to report entry \18\.
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    \18\ Electronic Foodborne Outbreak Reporting System (EFORS) 
https://www.cdc.gov/foodborneoutbreaks/info_healthprofessional.htm.
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    (c) Perform real-time subtyping of PulseNet \19\ tracked foodborne 
disease agents. Submit the subtyping data and associated critical 
information (isolate identification, source of isolate, phenotype 
characteristics of the isolate, serotype, etc) electronically to the 
national PulseNet database within 72 to 96 hours of receiving the 
isolate in the laboratory.
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    \19\ PulseNet https://www.cdc.gov/pulsenet/.
---------------------------------------------------------------------------

    (d) Have or have access to a system for 24/7/365 notification/
alerting of the public health emergency response system that can reach 
at least 90% of key stakeholders and is compliant with PHIN 
Preparedness Functional Area Partner Communications and Alerting.
    Measures: (1) Time to receive confirmed case reports of immediately 
notifiable conditions by public health agency (includes Biowatch and 
Biohazard Detection Systems (BDS)).
    (2) Time for State to notify local/tribal or local/tribal to notify 
State of receipt of a suspicious or confirmed case report of an 
immediately notifiable condition (Target: one hour from receipt).
    (3) Time to have a knowledgeable public health professional answer 
a disease report call and begin taking the report 24/7/365 (Target: 15 
minutes or less).
    (4) Percent of sub-typing data submitted to PulseNet within 72-96 
hours of receiving isolate in the laboratory.
Outcome 2B: Hazard and Vulnerability Analysis
    Jurisdiction-specific Hazards are identified and assessed to enable 
appropriate protection, prevention, and mitigation strategies so that 
the consequences of an incident are minimized.
    Required Critical Tasks: (1) Prioritize the hazards identified in 
the jurisdiction hazard/vulnerability assessment for potential impact 
on human health with special consideration for lethality of agents and 
large population exposures within 60 days of cooperative agreement 
award.
    (2) Decrease the time to intervention by the identification and 
determination of potential hazards and threats, including quality of 
mapping, modeling, and forecasting.
    (3) Decrease human health threats associated with identified 
community risks and vulnerabilities (i.e., chemical plants, hazardous 
waste plants, retail establishments with chemical/pesticide supplies).
    (4) Through partners increase the capability to monitor movement of 
releases and formulate public health response and interventions based 
on dispersion and characteristics over time.
    Measures: (1) Time to recommend public health courses of action to 
minimize human health threats identified in the jurisdiction's hazard 
and vulnerability analysis (Target: 60 days from identification of risk 
or hazard).

CDC Preparedness Goal 3: Detect/Report

    Decrease the time needed to detect and report chemical, biological, 
radiological agents in tissue, food, or environmental samples that 
cause threats to the public's health.
Outcome 3A: Laboratory Testing
    Potential exposure and disease will be identified rapidly, reported 
to multiple locations immediately, and accurately confirmed to ensure 
appropriate preventive or curative countermeasures are implemented. 
Additionally, public health laboratory testing is coordinated with law 
enforcement and other appropriate agencies.
    Required Critical Tasks: (1) Increase and maintain relevant 
laboratory support for identification of biological, chemical, 
radiological and nuclear agents in clinical (human and animal), 
environmental, and food specimens 20, 21, 22
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    \20\ CDC: Emergency Preparedness and Response--Lab Issues. 
https://www.bt.cdc.gov/labissues/.
    \21\ National Lab Training Network https://www.phppo.cdc.gov/
nltn/default.aspx.
    \22\ Sentinel (Level A) lab protocols https://www.asm.org/Policy/
index.asp?bid=6342.
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    (a) Develop and maintain a database of all sentinel (biological)/
Level Three (chemical) labs in the jurisdiction using the CDC-endorsed 
definition that includes:
     Name.
     Contact information.
     BioSafety Level.
     Whether they are a health alert network partner.
     Certification status.
     Capability to rule-out Category A and B bioterrorism 
agents per State-developed proficiency testing or College of American 
Pathologists (CAP) \23\ bioterrorism module proficiency testing.
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    \23\ College of American Pathologists (CAP) https://www.cap.org/
apps.cap. portal?--nfpb= rue&--pageLabel=home--page.
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     Names and contact information for in-State and out-of-
State reference labs used by each of the jurisdiction's sentinel/Level 
Three labs.
    (b) Test the competency of a chemical terrorism laboratory 
coordinator and bioterrorism laboratory coordinator to advise on proper 
collection, packaging, labeling, shipping, and chain of custody of 
blood, urine and other clinical specimens.
    (c) Test the ability of sentinel/Level Three labs to send specimens 
to a confirmatory Laboratory Response Network (LRN) laboratory on 
nights, weekends, and holidays.
    (d) Package, label, ship, coordinate routing, and maintain chain-
of-custody of clinical, environmental, and food specimens/samples to 
laboratories that

[[Page 30458]]

can test for agents used in biological, chemical, and radiological 
terrorism.
    (e) Continue to develop or enhance operational plans and protocols 
that include:
     Specimen/samples transport and handling.
     Worker safety.
     Appropriate Biosafety Level (BSL) working conditions for 
each threat agent.
     Staffing and training of personnel.
     Quality control and assurance.
     Adherence to laboratory methods and protocols.
     Proficiency testing to include routine practicing of LRN 
validated assays as well as participation in the LRN's proficiency 
testing program electronically through the LRN Web site.
     Threat assessment in collaboration with local law 
enforcement and Federal Bureau of Investigations (FBI) to include 
screening for radiological, explosive and chemical risk of samples.
     Intake and testing prioritization.
     Secure storage of critical agents.
     Appropriate levels of supplies and equipment needed to 
respond to bioterrorism events with a strong emphasis on surge 
capacities needed to effectively respond to a bioterrorism incident.
    (f) Ensure the availability of at least one operational Biosafety 
Level Three (BSL-3) facility in your jurisdiction for testing for 
biological agents. If not immediately possible, BSL-3 practices, as 
outlined in the CDC-NIH publication ``Biosafety in Microbiological and 
Biomedical Laboratories, 4th Edition'' (BMBL), should be used (see 
MACROBUTTON HtmlResAnchor www.cdc.gov/od/ohs) or formal arrangements 
(i.e., Memorandum of Understanding (MOU)) should be established with a 
neighboring jurisdiction to provide this capacity.
    (g) Ensure that laboratory registration, operations, safety, and 
security are consistent with both the minimum requirements set forth in 
Select Agent Regulation (42 CFR part 73) and the U.S. Patriot Act of 
2001 (Pub. L. 107-56) and subsequent updates.
    (h) Ensure at least one public health laboratory in your 
jurisdiction has the appropriate instrumentation and appropriately 
trained staff to perform CDC-developed and validated real-time rapid 
assays for nucleic acid amplification (Polymerase Chain Reaction, PCR) 
and antigen detection (Time-Resolved Fluorescence, TRF).
    (i) Ensure the capacity for LRN-validated testing and reporting of 
Variola major, Vaccinia and Varicella viruses in human and 
environmental samples either in the public health laboratory or through 
agreements with other LRN laboratories.
    (2) Increase the exchange of laboratory testing orders and results.
    (a) Monitor compliance with public health agency (or public health 
agency lab) policy on timeliness of reporting results from confirmatory 
LRN lab back to sending sentinel/Level Three lab (i.e., feedback and 
linking of results to relevant public health data) with a copy to CDC 
as appropriate.
    (b) Comply with PHIN Preparedness Functional Areas Connecting 
Laboratory Systems and Outbreak Management to enable: (a) the linkage 
of laboratory orders and results from sentinel/Level Three and 
confirmatory LRN labs to relevant public health (epi) data and (b) 
maintenance of chain of custody.
    Measures: (1) Percentage of LRN biologic and chemical laboratories 
that demonstrate proficiency in:
     Confirming Category A agents in human clinical specimens 
(proficiency in accordance with CDC's Laboratory Response Network (LRN) 
proficiency testing program)
     Confirming Category A agents in food samples.
     Confirming the identity of and further characterizing 
(e.g., assessment of toxin production, serotyping, phage typing, and 
DNA ``fingerprinting'') Salmonella (including Salmonella Typhi), 
Shigella species, Shiga toxin-producing E. coli and pathogenic vibrios 
isolated from FOOD samples.
     Confirming Category A agents in environmental samples.
     Confirming chemical agents in human clinical specimens.
    (2) Time following initiation of an epidemiological investigation 
to begin obtaining or directing the acquisition of samples/specimens 
for laboratory analysis to support epidemiological investigation, as 
needed (Target: 60 minutes).
    (3) For clinical specimens, environmental samples and samples of 
potentially contaminated food collected by public health personnel in 
an emergency, time to:
     Send clinical specimens to a reference laboratory within 
the LRN when an incident may involve an infectious biological agent 
(Target: within 60 minutes of collection).
     Send clinical specimens to the CDC or CDC-designated State 
laboratory when an incident may involve a hazardous chemical agent 
(Target: within 180 minutes of collection).
     Send environmental samples to a reference laboratory 
within the LRN when the incident requires biological or chemical 
characterization of an incident scene (Target: within 60 minutes of 
collection).
     Send potentially contaminated food samples to a reference 
laboratory within the LRN or coordinate with Food Emergency Response 
Network (FERN), as appropriate, when the incident might involve food 
contaminated with a biological or chemical agent \24\ (Target: within 
60 minutes of collection).
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    \24\ Abrin, Acids and bases, Aconites, actinomycin type protein 
synthesis inhibitors, Adamsite, Aflatoxin, amanitin toxin (Amanita 
phalloides), Anatoxin B, Any potent carcinogens or teratogens (e.g. 
benzo[a]pyrene, accutane), Arsenic compounds, Azides, Barium salts, 
Cancer chemotherapeutic agents, Carbamates, cardioactive glycosides, 
Colchicine, Copper and arseno-copper compounds, Corrosives 
(permanganate, chromate, etc), Cyanides, Cycloheximide, Digoxin, 
Dioxin, Ergot alkaloids, Ethylene glycol, Fluoroacetate salts, 
Hallucinogens (PCP, LSD, myristosin, others), Ipecac/emetine, Lead 
compounds, Mercury compounds, Methanol, Microcystins, Nicotine, 
Organochlorine pesticides, Organophosphate pesticides, Paraquat, 
Pentachlorophenol and dinitrophenols, Ricin, Rotenone, Sodium 
nitrite, Strychnine, Superwarfarins, Tetramine, Tetrodotoxin, 
Thallium salts.
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CDC Preparedness Goal 4: Detect/Report

    Improve the timeliness and accuracy of information regarding 
threats to the public's health as reported by clinicians and through 
electronic early event detection in real time to those who need to 
know.
Outcome 4A: Health Intelligence Integration and Analysis
    To produce timely, accurate, and actionable health intelligence or 
information in support of prevention, awareness, deterrence, response, 
and continuity planning operations.
    Required Critical Tasks: (1) Increase source and scope of health 
information.
    (2) Increase speed of evaluating, integrating, analyzing for, and 
interpreting health data to detect aberrations in normal data patterns.
    (3) Improve integration of existing health information systems, 
analysis, and distribution of information consistent with PHIN 
Preparedness Functional Area Early Event Detection, including those 
systems used for identification and tracking of zoonotic diseases.
    (4) Improve effectiveness of health intelligence and surveillance 
activities \25\.
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    \25\ Updated Guidelines for Evaluating Public Health 
Surveillance Systems https://www.cdc.gov/mmwr/preview/mmwrhtml/
rr5013A1.htm.
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    (5) Improve reporting of suspicious symptoms, illnesses, or 
circumstances to the public health agency.
    (a) Maintain a system for 24/7/365 reporting cases, suspect cases, 
or unusual events consistent with PHIN Preparedness Functional Area 
Early Event Detection.

[[Page 30459]]

    (6) Increase number of local sites using BioSense for early event 
detection.
    Measures: (1) Percent of local public health agencies using 
BioSense or other integrated early event detection systems.
    (2) Percent of desired non-traditional public health data sources 
that are currently part of early event detection system (e.g., HMO 
encounter data, over-the-counter pharmaceutical sales).

CDC Preparedness Goal 5: Investigate

    Decrease the time to identify causes, risk factors, and appropriate 
interventions for those affected by threats to the public's health.
Outcome 5A: Public Health Epidemiological Investigation
    Potential exposure and disease will be identified rapidly, reported 
to multiple locations immediately, investigated promptly, and 
accurately confirmed to ensure appropriate preventive or curative 
countermeasures are implemented. Additionally, public health 
epidemiological investigation is coordinated with law enforcement and 
other appropriate agencies including tribal and federal agencies.
    Required Critical Tasks:
    (1) Increase the use of efficient surveillance and information 
systems to facilitate early detection and mitigation of disease.
    (2) Conduct epidemiological investigations and surveys as 
surveillance reports warrant.
    (3) Coordinate and direct public health surveillance and testing, 
immunizations, prophylaxis, isolation or quarantine for biological, 
chemical, nuclear, radiological, agricultural, and food threats.
    (4) Have or have access to a system for an outbreak management 
system that captures data related to cases, contacts, investigation, 
exposures, relationships and other relevant parameters compliant with 
PHIN preparedness functional area Outbreak Management.
    Measures: (1) Time to initiate epidemiologic investigation after 
initial detection of a deviation from normal disease/condition patterns 
or a positive ``hit'' from an early detection device (Target: 3 hours 
from initial detection).
    (2) Time from initial detection of a deviation from normal disease/
condition patterns, initial report, or positive ``hit'' from an early 
detection device to initiation of intervention (e.g., dissemination of 
protective action guidance, treatment)

CDC Preparedness Goal 6: Control

    Decrease the time needed to provide countermeasures and health 
guidance to those affected by threats to the public's health.
Outcome 6A: Emergency Response Communications
    A continuous flow of critical information is maintained among 
emergency responders, command posts, agencies, and government officials 
for the duration of the emergency response operation.
    Required Critical Tasks: (1) Decrease the time needed to 
communicate internal incident response information.
    (a) Develop and maintain a system to collect, manage, and 
coordinate information about the event and response activities 
including assignment of tasks, resource allocation, status of task 
performance, and barriers to task completion.
    (2) Establish and maintain response communications network.
    (3) Implement communications interoperability plans and protocols.
    (4) Ensure communications capability using a redundant system that 
does not rely on the same communications infrastructure as the primary 
system.
    (5) Increase the number of public health experts to support 
Incident Command (IC) or Unified Command (UC).
    (6) Increase the use of tools to provide telecommunication and 
information technology to support public health response.
    (a) Ensure that the public health agency has ``essential service'' 
designation from their telephone provider and cellular telephone 
provider.\26\
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    \26\ Government Emergency Telecommunications Service. Accessed 
March 8, 2005 https://gets.ncs.gov/.
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    (b) Ensure that the public h