TFAH 2011 Ready or Not Report: Preparedness Suffering from Funding Cuts

In December 2011, Trust for America's Health (TFAH) released Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism. This year's report, supported by the Robert Wood Johnson Foundation, highlights potential declines in preparedness due to federal and state budget cuts to important programs that detect and respond to bioterrorism, disease outbreaks, and natural disasters.

Now in its ninth year, the report provides independent analysis of progress and vulnerabilities in public health preparedness. Previous reports had shown that, although major gaps remained, significant improvements were made in the nation's ability to prevent, diagnose, and respond to health emergencies after 2001. However, since the economic crisis hit, cuts to budgets and staff at the local, state, and federal levels have begun to eat away at this progress. ¹

“We're seeing a decade's worth of progress eroding in front of our eyes,” said Jeff Levi, Executive Director of TFAH. “Preparedness had been on an upward trajectory, but now some of the most elementary capabilities—including the ability to identify and contain outbreaks, provide vaccines and medications during emergencies, and treat people during mass traumas—are experiencing cuts in every state across the country.” Mel Kohn, State Health Officer and Public Health Director of the Oregon Health Authority, stated, “We have reached the point where our ability to do this work will be seriously compromised, with life and death consequences.” ²

Key findings from the report:

• Fifty-one cities, located in 40 states, are at risk for elimination of Cities Readiness Initiative funds, which support the ability to rapidly distribute and administer vaccinations and medications during emergencies.

The report also includes a series of recommendations to improve America's preparedness:

• Assure dedicated funding and strengthen the public health preparedness core capabilities;

Tara Kirk Sell

Outcomes of the 7th Review Conference on the Biological and Toxin Weapons Convention

When the Biological Weapons Convention (BWC) entered into force on March 26, 1975, it signified the culmination of post–World War II efforts to bolster the Geneva Protocol's ban on bacteriological methods of warfare, and it became the first multilateral disarmament treaty banning the production of an entire category of weapons. The BWC has successfully expanded to include 165 states parties, but implementation challenges remain. In line with Article XII of the convention, the states parties convene every 5 years to review the BWC's operation, relevant scientific and technological developments, and progress toward verification of state adherence to the articles of the convention. ¹

On December 5, 2011, the 165 states parties gathered in Geneva for the 7th BWC review conference. Leading up to the conference, the White House and the U.S. Department of State had taken steps to establish U.S. priorities and build consensus among other states parties. Notably, at a 2009 intersessional meeting, Under Secretary of State for Arms Control and International Security Affairs Ellen Tauscher announced preliminary U.S. priorities along with the President's National Strategy for Countering Biological Threats. ² Building off these previous efforts, Secretary of State Hillary Clinton addressed the conference on December 7 to announce a 3-fold focus moving forward: ³

1. Strengthen implementation of the convention.

Based on the final declaration and recommendations and decisions, the U.S. appears to have been largely successful in integrating their priorities into the BWC's implementation strategy for the next 5 years. ⁴ The U.S. hopes to champion confidence-building measure (CBM) efforts as an alternative to binding verification protocols. To that end, Secretary Clinton announced a new Bio-Transparency and Openness Initiative, which will feature a U.S.-hosted forum to discuss biological threats as well as bioresearch programs, and tours of U.S. biodefense facilities. The conference also agreed to establish an electronic database system to facilitate the exchange of CBMs among states parties.

Despite this incremental progress, several challenges and conflicts arose during discussions. Many states parties voiced financial concerns as the ongoing global economic downturn threatens many countries' ability to budget resources for BWC goals. Russia and the European Union continue to press for legally binding verification protocols, while the U.S. continues to contend that meaningful verification cannot be achieved through static verification protocols given the dual-use nature of most life science technology. Moreover, U.S. efforts to allow for a more “nimble” implementation process by permitting decision making at annual intersessional meetings were met with some resistance and did not proceed. ⁵

Article X of the BWC, which stipulates the promotion of peaceful uses of biological science and technology, continues to draw focus from states parties moving forward. In an effort to increase engagement and participation in the BWC, the capable parties agreed to provide technical assistance and support to other countries for the development of beneficent life science products such as vaccines and drugs to treat infectious diseases. Furthermore, implementation efforts will emphasize efforts to detect and respond to infectious disease events. ⁴ The BWC appears to increasingly parallel the goals of the International Health Regulations and the efforts of the World Health Organization. In doing so, the BWC will likely continue to be relevant to all states parties as it promotes constructive applications of the biosciences and global health security.

Samuel Wollner

HHS Releases Global Health Strategy to Advance International Health Efforts

On January 12, 2012, the U.S. Department of Health and Human Services (HHS) released its Global Health Strategy, outlining HHS's commitment to improving the health of all nations as a means of promoting and protecting the health of Americans. The strategy underscores the HHS role as a key contributor to global health efforts included in the Global Health Initiative, the National Security Strategy, and the National Strategy for Countering Biological Threats. ¹

As introduction to the strategy document, Secretary of HHS Kathleen Sebelius emphasized the importance of “global public health in realizing not only our own diplomatic and security goals, but also the goals of other nations…to improve the health and well-being of people throughout the world to help make a safer and more secure world community.” Secretary Sebelius asserted that the efforts of HHS and the U.S. government to improve global health will also “afford the [U.S. the] opportunity to prevent and detect coming health crises domestically and abroad, a greater ability for us to learn from other nations' success, and more sustainable health systems that effectively protect and secure health.” ¹

According to the strategy document, HHS approaches global health activities through several core operating principles, including:

• emphasizing prevention;

The strategy includes 3 main goals that are supported by 10 critical objectives, all of which are intended to guide agencies in HHS to advance global health activities. The 3 goals outlined in the strategy aim to improve the health of all nations: ¹

1. Protect and promote the health and well-being of Americans through global health action.

In support of the 3 global health goals, HHS further outlined 10 critical objectives and priority actions to guide and advance agency work in global health: ³

1. To enhance global surveillance to detect, control, and prevent diseases and health concerns;

HHS's Global Health Strategy recognizes that to advance global health, a coordinated U.S. government approach is needed, in addition to collaboration and cooperation with multilateral organizations, other national governments, and civil society and nongovernmental organizations. Key partners in the U.S. government include the U.S. Agency for International Development, the Department of State, the Department of Defense, and other departments engaged in global efforts to improve nutrition, environmental health, development, health security, and food security. HHS also continues to work with more than 190 national ministries of health and scientific and regulatory agencies and many health-related multilateral organizations, such as the World Health Organization, the United Nations Children's Fund, the World Bank, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. ¹

Nidhi Bouri