Forum for Medical & Public Health Preparedness for Disaster & Emergencies and Action Collaborative. Policy Context There are many governmental agencies and private organizations charged with ensuring the Nation?s capacity to prevent and respond to the health effects that arise from disasters, both man-made and natural. While each of these stakeholders is critical in guaranteeing adequate prevention and response, their efforts must be coordinated to ensure optimal outcomes. However, the challenge arises from the diverse set of responsibilities of the primary stakeholders, the Department of Health and Human Service (HHS) and the Department of Homeland Security (DHS), and coordinating the efforts among the many other governmental agencies (federal, state, and local), industry, professional societies, foundations, academia, and other interested parties. Unfortunately, venues that bring all of these stakeholders together are limited. The NAS Forum for Medical and Public Health Preparedness began to address these issues in 2008. Aligning the responsibilities and focus of each stakeholder will greatly assist in ensuring adequate protection and response. Each stakeholder offers unique assets that must be linked in to an overall strategy. It is here where the appropriate federal agencies, including the HHS, DHS, Department of Defense, Department of Transportation, and Veterans Affairs, play a vital role in developing a National strategy and logistical support and coordinating with the private sector. The Forum for Medical and Public Health Preparedness for Disasters and Emergencies (the Forum) provides a venue where the major stakeholders may sit down together and discuss the primary issues, afford organizations the opportunity to make assessments, discuss policies, and review outcomes. These areas will focus not only on the immediate responses to disasters and public health emergencies, but also the intermediate and long term needs that arise (e.g. providing adequate shelter, food and water safety, primary care, mental health) during the recovery phase and efforts to enhance preparedness, cooperation and information sharing. The activities of the federal government, volunteer organizations, the private sector, and others in the medical preparedness, resilience, and health sciences are of increasing complexity, both in terms of technology and policy. Currently, it is difficult for the nation's medical emergency response and public and mental health systems to meet the physical and psychological needs that result from all types of disasters including terrorism and natural disasters. Unfortunately, gaps continue to exist in the following areas: (1 Global Health Security, (2) Communication and Coordination, (3) Personal and Community Resilience, and (4) Critical Infrastructure Protection. Addressing the physical, psychological, and social needs that result from various acts of terrorist events or natural disasters will therefore require universal preparedness by all systems responsible for the public's health. Preparedness, response, and recovery are required for all hazards and should include all segments of the population during each phase of the event. The research and development needs of these initiatives are immense and thus require the federal government to seek and coordinate assessment from both national and international clinical practice, as well as biomedical research communities. Such coordination will require the best advice available as federal agencies seek guidance in developing its strategic plans for advancing the practice of medical preparedness. These initiatives include scientific, technical, and workforce issues in the medical and public health arenas (infrastructure, clinical, environmental, and public health, research needs, including the development of new drugs and biologics and the collection and funding of critical data collection in a timely manner); effective training, education, and communication exercises; and evaluation of preparedness. The multiple and complex ethical issues surrounding these developing fields must also be considered. Technical Context The forum will promote open discussion of existing systems and lessons learned from previous disasters and public health emergencies and identify areas for improvement. These discussions exist across four broad categories: (1) Communication and Cooperation; (2) Personal and Community Resilience; (3) Preparedness and Infrastructure Needs; (4) Medical and Public Health Preparedness and Response; Within these areas, topics that might be on the meeting agendas of the forum include: Global Health Security Topics within this theme focus on the ongoing efforts to accelerate progress toward a world safe and secure from emerging infectious diseases and other threats. Discussions concentrate on strengthening the U.S. health care and public health systems capacity to detect, prevent, plan for, respond to, and recover from naturally occurring outbreaks and intentional or accidental releases of dangerous substances. Communication and Cooperation: Topics within this theme focus on ensuring timely communications and effective coordination within all levels of government and between government, the private sector, and the public during large-scale disasters and incidents. Discussions concentrate on ways to improve situational awareness, threat intelligence sharing, risk communication, and collaboration among multi-sector disaster response networks including public, academic, private, governmental, and non-governmental entities, (e.g., improving coordination among disaster response networks from public, academic, private, and governmental entities and stakeholder data collection, harmonization, and management during and post disasters including acute surveillance and longitudinal exposure, health effects, clinical assessment, and evaluative data sets and information; organization and sharing of open data sets and development of computational tools to analyze the datasets (data science for discovery). Personal and Community Resilience: According to the Implementation Plan for the National Health Security Strategy (2015-2018) (www.phe.gov/Preparedness/planning/authority/nhss/Documents/nhss-ip.pdf), National health security is achieved when the Nation and its people are prepared for, protected from, respond effectively to, and are able to recover from incidents with potentially negative health consequences. Topics within this theme focus on issues related to the sustained ability of an individual and a community to utilize available resources to respond to, withstand, and recover from adverse situations following a catastrophic event. Discussions concentrate on ways to enhance resilience for individuals and communities through disaster risk reduction, inclusion of health in post-disaster recovery planning efforts, working with non-traditional sectors, and exploring special considerations needed to strengthen a community after a mass casualty incident. Critical Infrastructure Protection Topics within this theme focus on the ongoing efforts to secure the assets, systems, and networks, whether physical or virtual, vital to the security, public health, and safety of the nation. Discussions center on the health care and public health sector and interdependent sector vulnerabilities, consequences of cascading and prolonged failures of infrastructure, threats from chemical, biological, radiological, nuclear, and high yield explosives, and the increasing threat and consequences of cyber-attack, (e.g., investigating steps for building the next decade of disaster preparedness and simultaneously improving the public health infrastructure and addressing how existing public health systems and infrastructure can be strengthened while simultaneously moving forward to meet disaster response needs of the future). Disaster Research Response Action Collaborative The Forum will convene an Action Collaborative on Disaster Science, based on the receipt of additional supporting funds from NIH and other sponsors to: 1) foster improved processes and platforms for developing and implementing needed time-critical data collection and research in response to disasters (?Science Preparedness?); 2) identify evidence-based mechanisms and opportunities for conducting and sharing information gathered from public health research during disasters; 3) engage cross-sector stakeholders in development, refinement, and promotion of disaster research opportunities and best practices; 4) provide a venue to support the development and maintenance of a rapid response mechanism for the National Academies to continue to meet sponsor needs for convening, idea generation and information sharing during the initial stages of a public health emergency. Activities of the Action Collaborative may include1) outlining and defining processes for conducting research (particularly research involving human subjects and at-risk populations) quickly following a disaster to avoid missing critical data; 2) ensuring community engagement and IRB/ethical considerations in disaster research. 3) defining processes for expanding and enhancing a coordinated network of disaster researchers; 3) assembling data collection, research, and best practice resources (or any other substantive products for the first year); 4) exploring appropriate venues to support the development and maintenance of a rapid response mechanisms for the National Academies and other platforms or forums to continue to meet sponsor needs for convening, generating ideas, and sharing information during the initial, as well as later stages of a public health emergency. Since 2008, the forum has held numerous meetings and workshops and published a number of documents regarding the issues listed above. Task Description: The National Academies of Science, Engineering and Medicine (NAS)) established a Forum on Medical Preparedness for Disasters and Emergencies (the ?Forum?) in 2008. Forums are designed to provide its members with a venue for exchanging information and presenting individual views, and allow a structured opportunity for dialogue and discussion while scrutinizing critical and possibly contentious scientific and policy issues. Representatives from government, industry, academia, and other interested parties are expected to serve on the Forum, which will convene two to three times a year to confer on subject areas of mutual interest and concern. At its meetings, the Forum identifies and discusses emerging scientific research and policy required to improve the Nation's medical preparedness and resilience to acts of terrorism and/or natural disasters, as well as issues in the coordination of federal, state, local, public, and private medical preparedness and resilience activities. The Forum sponsors workshops as an additional mechanism for informing forum meetings and discussions. The Forum may also commission individually-authored papers. Forum discussions or workshops or other formats of meetings, may lead to proposals for specific studies by units of The National Academies resulting in institutional reports. Such studies, if undertaken, will be conducted independently and at arm?s length from the Forum and in accordance with all institutional policies and procedures governing such study activities. All activities of the Forum will be conducted in accordance with institutional guidelines described in Roundtables: Policy and Procedures. In addition, with funding from NIH and possibly other sponsors, will support a Disaster Research Action Collaborative as an additional activity of the Forum. For the past several years, NIH and others have sponsored a Standing Committee on Medial and Public Health Research during Large-Scale Emergency Events. After discussion with the sponsors and NASEM, it was decided to move from the Standing Committee to an Action Collaborative under the Forum. The Action Collaborative will work on outlining and defining processes and procedures for conducting research following disasters as described above. Expertise The Forum?s membership includes over 30 individuals, chosen for their professional and policymaking perspectives, as well as their scientific or public policy credentials. Expertise includes government technical program management; medical operations in support of homeland security; biotechnology/bioengineering; strategic planning; threat assessment; toxicology; environmental health and geosciences; bioinformatics; national public health and emergency management and response; epidemiology; molecular biology; state/local public health; health care; risk communication; first responders; bioethics; nursing; pharmacotherapeutics, medical countermeasure planning and response, workforce education and training, health disparities and community engagement, data science and bioethics. Representatives of federal research and regulatory agencies are appointed by virtue of the positions they hold. Additional experts are invited to participate in particular discussions on an ad hoc basis. Each sponsor sends a primary representative and is welcome to also send ?alternate? members. Currently Ms. Stacey J. Arnesen, NLM (Florence Chang, alternate) Barbara Mulach, NIAID, and Dr. Aubrey Miller, NIEHS, serve as NIH representatives to the forum. The Action Collaborative will include members, chosen for their professional expertise in developing, conducting, and promoting disaster-related research as well as their general scientific and/or disaster medicine/public health/emergency management credentials. Expertise may include grant management (e.g., as a Principal Investigator), emergency management, homeland security, environmental health and geosciences, toxicology, behavioral/psychosocial/mental health, data science/ bioinformatics, health care, public health, public policy, risk communications, health disparities and community engagement, and human subjects research/bioethics. Work plan The type of work that a forum, such as the Forum on Medical and Public Health Preparedness for Disasters and Emergencies, with mixed Federal, academic, not-for-profit, and industry for-profit participation can engage in include: meetings and workshops on topics of interest to Forum members; symposia held for the purpose of informing Forum members more widely about medical and public health preparedness, response, and resilience consistent with Forum interests and discussions. The Forum can also serve as a locus for informing each of its members of the views and plans of other members about approaches to problems and work on holding public events. Specific activities will be organized according to the following tasks: 1. Forum Meetings. Forum Meetings will be held two or three times a year. They will be open or closed as needed and attended by NAS staff and Forum members. 2. Workshops or Other Activities Sponsored by the Forum. The Forum will consider the use of several mechanisms to convene experts on topics in which it needs to be informed. Examples of activities include workshops and active collaborations. The Projected Costs shown at the end of the proposal includes funding for these activities. 3. Individually authored summary documents or proceedings of the Forum's workshops and symposia may be published by NAP or posted on the internet.
