Homeland Security Watch

Today’s Washington Post includes a front-page piece on a possible breakdown of the WHO biosurveillance system that may have delayed full recognition of the Mexican outbreak from April 16 to April 24.  Please see, System Set Up After SARS Epidemic Was Slow to Alert Global Authorities. 

Some readers may want to access the WHO’s International Health Regulations.  This is the international agreement which established the biosurveillance system. Pertinent to the Washington Post‘s findings, the signatories to the IHR are to complete an assessment of the biosurveillance and response system by this coming June 15.

James Jay Carafano and Jenna Baker McNeil of the reliably rightist Heritage Foundation write, “The Centers for Disease Control (CDC) is reporting that, as of April 28, there have been 40 cases of swine flu in the United States. The spread of this flu and the associated deaths in Mexico have left Americans frightened and concerned. While these concerns have led to calls to contain the outbreak by closing the border with Mexico or instituting travel restrictions, a border-centric strategy is not an effective solution for dealing with the swine flu.”

“Instead, local health departments should focus on educating Americans about common-sense precautions individuals can take to lessen the likelihood they will be infected. Both Congress and the Department of Homeland Security (DHS) should reinforce these prudent measures rather than exacerbating fears and advocating less effective measures.”

See their complete, Strategy for Swine Flu Should focus on Common Sense, not the Border at the Heritage website.

I wonder if they pounded out this WebMemo after watching yesterday’s Senate hearing with Secretary Napolitano and Rear Admiral Shuchat.  In response to questions from Senator McCain, Dr. Shuchat was crystal clear that in her scientific judgment closing the border would not contribute in any way to containing or mitigating spread of the virus.

The simple clarity of the uniformed physician/scientist seemed to shock some of the Senators.  But when she began to explain the science behind her judgment, Dr. Shuchat was cut off.   I perceived that Secretary Napolitano — wisely — intervened to move on to other topics.

It is almost as if JJ and JB felt compelled to follow-on from where the Admiral was not allowed to go.  But whatever motivated the attention, thank you.

“A top al Qaeda commander has called on Pakistanis to rise up against the government of the nuclear-armed power where Taliban militants are fighting the army, according to a message on Islamist websites on Thursday,” Reuters is reporting.

“The 29-page article by Abu Yahya al-Libi, who is thought to be in Afghanistan and Pakistan, was dated mid-March. Pakistan’s army has been trying to fight back al Qaeda’s Taliban allies who have taken control of areas close to the capital Islamabad in north Pakistan.”

“Muslims in Pakistan, and especially their clerics, should prepare themselves and rise up to perform the duty … of fighting the Pakistani army and the rest of the apparatus that are the pillars of their tyrannical state,” al-Libi wrote.

“The criminals in the Pakistani government and its army have not only been a cover for the occupying crusader infidels in Afghanistan, they have directly helped them in committing all their crimes in Afghanistan and elsewhere,” he said.

Over the last two days Pakistani troops have made progress in their advance against Taliban forces northwest of Islamabad.  According to the Associated Press, “Security forces backed by artillery and warplanes began pushing into Buner, a district just 60 miles (100 kilometers) from Islamabad, on Tuesday after Taliban militants from the neighboring Swat Valley infiltrated the area under cover of a peace pact. On Thursday, troops ousted militants from the Ambela Pass leading over the mountains into Buner and were inching toward the north, army spokesman Maj. Gen. Athar Abbas said.” (Related coverage new this afternoon from the New York Times.)

Far to the South, ethnic violence broke out earlier today in Karachi, Pakistan’s financial capital.  Thirty-four are reported killed, and many more injured, in clashes between speakers of Urdu and Pashto. (More from the BBC.)

During his Wednesday night news conference, President Obama characterized Pakistan as “very fragile.” (More from Bloomberg) Fox News is reporting that Gen. David Petreaus, Commander of the US Central Command, perceives that the next two weeks are critical to Pakistan’s survival.

President Obama is scheduled to meet with President Zardari of Pakistan and President Karzai of Afghanistan next week at the White House.  The Washington Post reports that  the summit will focus mostly on how do reverse the unraveling of Pakistan.

The Senate Committee on Homeland Security and Governmental Affairs met this morning to consider the nomination of Timothy Manning as FEMA Deputy Administrator for National Preparedness. 

The following is a real-time report, but due to technical difficulties is being posted after the hearing’s conclusion.  Prepared testimony should eventually be found on the Committee’s website.

In Chairman Lieberman’s opening, he emphasizes the value of linking preparedness with mitigation, response, and recovery.  He highlights the fundamental role of prevention and protection in the strategic continuum of homeland security.

In his brief opening statement, Mr. Manning says, “I believe a strong and resilient nation can only be built on a solid foundation of preparedness. I believe that through strong partnerships; between cities, counties, States, and territories, tribal governments, the federal government, the private sector and – most importantly — the American people, this is achievable.  Through a collaborative, joint process of doctrine development and implementation across all levels of government, and the furtherance of community resilience and readiness, we can overcome the missteps of the past, and the mistrust between partners that has developed in places.”  (He said it slightly differently, I am not sure about “doctrine development”  but this is pretty close.)

These two sentences are worth the kind of analysis, parsing, unpacking, and even hypter-texting that has been given the Nicene Creed.   Like the Nicene Creed, it may signal an effort to organize a capable but very diverse movement around core principles.

The Chairman follows-up with an inquiry about the Committee’s commitment to rejoining preparedness with response.  He asks, “What will you do to strengthen FEMA and especially the role of preparedness?”  Mr. Manning emphasizes that preparedness “transcends” the traditional boundaries of emergency management.  Preparedness needs to be built-into every aspect of emergency management and the homeland security disciplines.

The Chairman asks, “What is the role of the National Preparedness Directorate?”  Mr. Manning responds that it is a “peace-time activity, if you will,” that prepares professionals to 1) look past the current crisis for lessons-learned and principles to apply in the future, 2) works with responders to be better prepared for tomorrow’s threats, and 3) assumes and advocates that we are all emergency managers.  I understand that “all” to include all homeland security disciplines and the general citizenry.  But Mr Manning was not explicit in this regard.

In reference to the swine flu crisis  — then self-corrected to  H1N1 — the Chairman asks, what is the role of FEMA in managing the unfolding situation.  Mr. Manning responds that the Preparedness Directorate should match state, local, tribal and private sector partners with expertise to implement policy, strategy, and plans; as well as look at implications for the next crisis.

Senator Akaka points toward the H1N1 virus and hurricane threats, and the FEMA vacancy rate as priorities.  He then asks about how FEMA can better respond to a geographically isolated jurisdiction, such as Hawaii. Mr. Manning responds by emphasizing the FEMA role to support State and local leadership, especially through education, training, and upfront logistics planning and pre-deployment.

Senator Akaka asks about emergency preparedness plans and pandemic plans.  Mr. Manning responds that because of  investments in planning and training over the last several years we are better prepared for the pandemic threat than may be the case for any other foreseeable risk.  He also emphasizes the role of measurement in assessing how prior plans are being implemented now.  Honest  measurement and accountability will enhance readiness for dealing with future risks.

The Chairman follows-up with a question about the National Exercise Program.  He perceives the Program is not fulfilling its potential.  How can after-action and corrective-action be improved? Mr. Manning states that the evaluation phase of an exercise is what is most important.  He outlines the need for a consistent two-phase process:  a quick , meaningful flash assessment followed by a more complete and detailed full assessment.

(Full Disclosure: I consider Tim Manning a friend. In a profound disability for a blogger, I am inclined to give others the benefit of the doubt and this is especially my stance with friends.  But Tim and I occasionally differ — imagine that — and I will endeavor to engage in a rigorous appreciative inquiry regarding his leadership of a FEMA function that I consider critically important and too often neglected.)

The Senate Committee on Homeland Security and Governmental Affairs met this morning to consider the nomination of Ivan K. Fong as DHS General Counsel. The following is a real-time report, but due to technical difficulties is being posted after the hearing’s conclusion.  Prepared testimony should eventually be found on the Committee’s website.

The Committee opens with only the Chairman present, but with a full deployment of staff in the second row. It is certainly true — especially on more arcane matters of policy — that the ears, eyes, and minds of Congressional staff are crucial.  The single Senator flanked by so many staff reinforces the reality.

In his opening statement, Mr. Fong notes, “The General Counsel, working through the lawyers in the Department, also helps ensure that the Department complies with applicable laws and regulations, including laws protecting civil rights, civil liberties, and privacy rights of all Americans. I share Secretary Napolitano’s commitment to protecting our security while also protecting the civil rights, civil liberties, and privacy rights of all Americans.”  There are 1700 lawyers in DHS.

The Chairman has a gracious ability to listen or appear to be listening.  He is clearly conscious of being the only Senator present.

The Chairman asks Mr. Fong about the wide-range of DHS responsibilities and to identify his priorities. Mr. Fong replies that he needs to start by learning as much as he can about the Department and developing relationships across the Department.  He will focus on security broadly and cybersecurity in particular.  He then goes on to mention H1N1 and violence along the Southwest Border as having a high profile.

The Chairman follows-up with a question about integrating the lawyers that are dispersed across the Department. Mr. Fong responds that due to a reorganization in the Bush administration, all 1700 lawyers, regardless of the component to which they are assigned, report to the General Counsel.  Mr. Fong is committed to building on this foundation to develop a fully integrated “legal department.”  He will do this through communicating a clear vision, a strategy, and key priorities.

The Chairman quotes a GAO report — and his own experience — that in the previous DHS General Counsel has complicated DHS interaction with the GAO, Office of the Inspector General, and Congressional Committees. Mr. Fong responds, “I very much believe in the role of Congressional Oversight in our constitutional system of checks and balances.”  He promises to review management procedures to, “ensure appropriate access to information.”  Later Senator Akaka, the second Senator to arrive (about thirty minutes in), emphasizes the value — and constitutional requirement — of Congressional oversight.  (Might this be the GAO report referenced?)

The Chairman turns his attention to cybersecurity.  The Chairman expresses concern about a lack of authority by US CERT to actively undertake its role in cybersecurity.  The Chairman asks how the General Counsel might help address this deficiency.  Mr. Fong responds that he will do everything he can to improve our abilities, preparedness and readiness to prevent cyberattacks.  He will review the White House 60 day cybersecurity study and review DHS legal authorities in order to make sure US CERT and other DHS components have the needed capabilities.

Senator Akaka asks about CBP searching and seizing laptops. Will Mr. Fong review current policy and regulation to better ensure the privacy interests related to such seizures? Mr. Fong responds that he looks forward to working with the Committee to find a balance of security and privacy on this matter.

Senator Akaka asks about a significant vacancy rates in the DHS General Counsel’s office.  Mr. Fong replies that it is his priority to recruit and retain top talent.  (See related recruiting notice.)

Readers of this blog are engaged in an informed and intelligent discussion of how policy can, does – and sometimes does not – influence practice.  Yesterday we began a discussion of how Homeland Security Presidential Directive-21 might be the (a?) strategic framework for response to the H1N1 virus.  I don’t perceive this discussion is completed and hope it will continue — and find new contributors — over today.

I have been given the impression that some of those involved in drafting HSPD-21 are aware of this discussion.  Please help us understand original purpose and intent.  I promise anonymity.   There is an apparent disconnect between this reasonable statement of national strategy and how we have operationalized in response to the current threat.  If this is a mistaken impression, please correct it.  If there is an explanation, it would be great to have it.   The purpose of the discussion is to inform our collective judgment in regard to how — or how not — to develop future policy and strategy.

But whether you have inside information or not, please review the H1N1 related comments made yesterday (and back to Monday).  It might be easiest to continue the discussion by accessing the series of comments already begun at: http://www.hlswatch.com/2009/04/29/swine-flu-strategic-goals-and-operational-plans/#comments

There have now been 91 laboratory confirmed diagnoses of the H1N1 virus in the United States.  There has been one fatality.  The virus has now been confirmed in ten states. The CDC provides updates at: http://www.cdc.gov/swineflu/index.htm

Yesterday the WHO increased its pandemic alert level to Phase 5, one short of a full pandemic.  There are reports that a move to six could happen later today. It is worth noting that a “pandemic” is mostly a matter of how a virus is transmitted and the geographic spread of the virus.  It does not, necessarily, reflect on the virulence of the disease.

With the exception of  Mexico, where there have been at least 176 fatalities, the disease is usually presenting mild symptoms.  “This virus doesn’t have anywhere near the capacity to kill like the 1918 virus,” which claimed an estimated 50 million victims worldwide, said Richard Webby, a leading influenza virologist at St. Jude Children’s Research Hospital in Memphis,”  reports the Los Angeles Times. But clearly the Mexican cases, the novelty of this flu strain, and the possibility of further mutation are cause for significant concern.

According to  WHO, “The situation continues to evolve rapidly. As of 18:00 GMT, 29 April 2009, nine countries have officially reported 148 cases of swine influenza A/H1N1 infection. The United States Government has reported 91 laboratory confirmed human cases, with one death. Mexico has reported 26 confirmed human cases of infection including seven deaths. (HLSwatch note: These official numbers are often lagging indicators due to rigorous laboratory confirmations.) The following countries have reported laboratory confirmed cases with no deaths – Austria (1), Canada (13), Germany (3), Israel (2), New Zealand (3), Spain (4) and the United Kingdom (5).”

Since Sunday we have seen quite a bit of John Brennan.  In this Tuesday picture he is briefing the spanking-new Secretary of Health and Human Services.  We can guess the topic of conversation.

Mr. Brennan is the Special Assistant to the President for Homeland Security and Counterterrrorism.   He also holds the title of Deputy National Security Advisor. Mr. Brennan is a long-time intelligence professional who played a prominent role on candidate Obama’s national security team.

The sudden emergence of the H1N1 virus highlights a security domain distinct from the traditional NSC portfolio.  The hydra-like challenges of recent days have obscured — perhaps delayed — but have certainly informed the final draft of the report ordered by Presidential Study Directive 1. 

I hope Mr. Brennan keeps both of his titles.  As I have argued elsewhere, the lessons of this current challenge should be reflected in a reformed and strengthened HSC staff that is effectively coordinated, but remains helpfully distinct from the NSC.

DHS has released a transcript of the opening statement that Secretary Napolitano made this morning to the Senate Homeland Security and Governmental Affairs Committee.  (The transcript of the more formal prepared testimony can be found in a prior post.)

The web-based transcript of the Secretary’s daily news briefing on H1N1 has not been posted as of 8:30 pm (eastern).  Today she was joined by the new Secretary of Health and Human Services.  Since I cannot point you to the full transcript, following are three excerpted paragraphs:

I know there have been some calls to close the border. I want to address that directly. First of all, it is important to know that we are making all of our decisions based on the science and the epidemiology as recommended to us by the Centers for Disease Control. The CDC, the public health community, and the World Health Organization [WHO] all have said that closing our nation’s borders is not merited here, that the focus, the public health focus, should be on mitigating the impact of this virus. And so we are following those recommendations now… 

Many parents across the country are concerned about school closures, and President Obama spoke about this earlier today. The Centers for Disease Control has recommended that schools with confirmed cases of H1N1 virus or schools with suspected cases linked to a confirmed case consider closing on a temporary basis. Some schools have already followed that advice. The best thing parents can do right now is to make sure you have a contingency plan in place so that you’ve made arrangements to care for your child in the event of a school closure

This is also a good reminder for businesses to think about contingency planning as well.  As I said, we’re going to be working through this for a while. You have to anticipate what happens if you have employees who are parents. The schools have closed. The employees need to stay home. How do you continue with your business operations? And so all of us should be dusting off our business contingency plans, looking at things such as telecommuting and the like so that operations keep on going.

The web-link to Secretary Napolitano’s comments at the news briefing is now available.

Rather than asking how he did over the last 100 days, how did we do?

Despite Chris Bellavita’s thoughtful skepticism regarding the liturgy of threat-vulnerability-consequence-risk, I find it a helpful thinking tool.  If we apply this framework to the last 100 days of homeland security, what does it tell us?

Threats

There are plenty.  The President has already declared 19 major disasters.  There was an unprecedented Red River crest. As drought deepens the prospect of wildfire worsens. Hacker attacks have substantially increased.  This year’s hurricane forecast, thankfully, leans toward the historic mean. But some insist the long-term forecast is apocalyptic. Our self-declared adversaries continue at-large and are increasingly active. The potential for terrorist attack persists. The likelihood of such an attack almost certainly increases with each passing day. The surprising emergence of the H1N1 virus suggests how, in so many ways, our risks can swiftly shift

Vulnerabilities

Again, more than we can list: Lots of old infrastructure; lemming-like relocation of population to areas especially susceptible to hurricane, earthquake, flood, drought, and wildfire; increasing concentration and interdependence of power, food, and water supplies; recently many have been feeling especially vulnerable regarding our economic system.

I will add another vulnerability not usually in the top ten: We have not found nor crafted an effective way to communicate about intentional threats.  See the dust-up regarding “man-made disasters,” followed by controversy regarding possible right-wing extremism. Prior and similar cases can be recalled. In each case there are serious issues that might have benefitted from hearing and discussion.  Instead we stood by while – or perhaps contributed to – a barrage of preconceived fears, accusations, clichés, and other forms of self-justification from all sides. The noise drowned out most chances of advancing anyone’s understanding.

Discouraged from meaningfully exploring our doubts, many are inclined to one of two extremes. The optimists among us tend toward hopeful denial. Our pessimists prepare grimly to respond.  Prevention, mitigation and proactive resilience — which most agree are worth the investment — require a shared sense of reality that, so far, escapes us.  

We would be less vulnerable if we could be less prickly and considerably more magnanimous in listening to others. This would — at least — allow the conversation to get started.

Consequence

Map our threats to our vulnerabilities and the resultant interweaving of nodes and networks reminds me of Bartolomeo’s map of hell.  What I have observed from the last 100 days — and well before  – is  that too many are too quick to lose a sense of shared relationship, mutual respect, and simple patience to listen to one another.  This tendency is increasing the consequences we face from a variety of catastrophic possibilities.

Map of Hell by Bartolomeo di Fruosino, c.1420

Risk

There is a formula that some use to calculate risk.  It is rendered as follows:

Likelihood = Threat / Vulnerability (for example, I live on top of a mountain, my vulnerability to flood is so low as to practically negate the threat. My vulnerability to fire amplifies that threat).  Risk = Likelihood * Consequences.

We can often adjust our vulnerabilities much more easily than our threats.  If the vulnerability I have identified above is accurate, one of the most effective means of reducing our risk is to communicate carefully, clearly, and courageously while listening to the communications of others with an authentic effort to understand. By reasoning together we can reduce the likelihood of harm.

One hundred days ago, the new President said, “On this day, we gather because we have chosen hope over fear, unity of purpose over conflict and discord.  On this day, we come to proclaim an end to the petty grievances and false promises, the recriminations and worn-out dogmas that for far too long have strangled our politics.  We remain a young nation.  But in the words of Scripture, the time has come to set aside childish things.”

We still have some maturing to do.

(The Department of Homeland Security has released its own report entitled, 100 days of Homeland Security. A less tranquil take on the same 100 days is offered by James Jay Carafano of the Heritage Foundation.)

The World Health Organization has increased its pandemic alert  to Phase 5, one short of a full pandemic at Phase 6.  According to the WHO website, phase 5 is announced when human-to-human transmission has occurred in at least two countries.  “While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.”  At 5:15 pm (eastern) the WHO website was still referencing Phase 4.  This has been superceded.

There is a related report from the BBC.

DHS has released the Secretary’s prepared testimony for this morning’s Senate Homeland Security and Government Affairs Committee hearing.  The filed testimony is almost always more formal and detailed than the oral testimony (rough coverage of her actual remarks follows in the next post below).

In regard to the policy-with-practice focus we have been attempting, following are some quick excerpts:

“DHS’ role in addressing the threat of this flu outbreak is clear: The Homeland Security Act instructs the Secretary of Homeland Security to lead the Department as a focal point for the federal government regarding crises and emergency planning. Under Homeland Security Presidential Directive 5 (HSPD-5), the Secretary of Homeland Security is the Principal Federal Official (PFO) for domestic incident management, which includes responding to large-scale medical emergencies. Under the National Response Framework, the Department of Health and Human Services (HHS) has the lead for public health and medical services, which include assessing public health and medical needs, conducting disease surveillance, providing public health and medical information, developing vaccines, and managing health, medical, and veterinary equipment and supplies. As part of HHS’ response, HHS’ Centers for Disease Control and Prevention (CDC) has responsibility for identifying and tracking the spread ofthe disease, conducting epidemiological investigations and laboratory tests, managing the Strategic National Stockpile (SNS) and providing SNS medicines and medical supplies to states, and communicating health-related information to the government, the media, the public, and others…”

“In our response, we are moving according to plans and protocols in the National Pandemic Strategy and Implementation Plan (PI) to effectively address an outbreak of this kind. We have taken action to get in front of this not just based on what’s going on today, but on what could happen four months from now. We are prepared, and we are constantly evaluating the facts to ensure that we have a plan ready to be executed no matter how the threat evolves.”

“Indeed, this is a threat for which DHS and other levels of government have been preparing for a long time. While Governor of Arizona, I served as the co-chair of the National Governors Association panel on pandemic flu preparedness. I was able to see first-hand and help guide collaboration among states, DHS, HHS, and the CDC in preparing for potentially dangerous flu outbreaks. These preparedness exercises are now coming into great use, and the strong partnerships that formed as a result are now serving the American people well as we collaborate extensively across levels of government to mitigate this public health threat…”

Beginning at 10:05 am this morning Secretary Napolitano and Rear Admiral Anne Shuchat M.D. of the Centers for Disease Control are testifying before the Senate Committee on Homeland Security and Governmental Affairs.  (If you have a broadband connection, you can access the webcast.)

The following is a real-time posting.  I intend to restrict my attention to the broader policy-with-practice nexus on which this blog is attempting to focus.  Later today I will post media coverage of the hearing.

Chairman Lieberman opens by saying, “This is a case when the government was prepared for the crisis.”   He emphasizes the Secretary of Homeland Security has been given authority, by statute and presidential directive, to serve as the federal government’s  emergency manager. 

The Chairman quickly reviews a history of relevant law-making and policy-making.  In particular he highlights the  National Strategy for Pandemic Influenza Implementation Plan.

Senator Collins, the ranking Republican, highlights the importance and role of the Biomedical Advanced Research and Development Authority.  She also raises concerns regarding bio-surveillance, distribution of countermeasures, and interagency communication/collaboration.

Secretary Napolitano repeats that the Secretary of  Homeland Security is the Principal Federal Officer for Domestic Incident Management (as per HSPD-5, but she did not make this specific cite).  She says, “At the Department of Homeland Security we are moving ahead in accord with planning and frameworks that have been in place for many years.”

The Secretary clarifies that, “statutory authority exists to close specific ports, but not the border as a whole.”  But in the current case, such action would not be scientifically justified.

Dr. Shuchat gives substantial attention to the Strategic National Stockpile and an emergency use authority.  The admiral referenced a variety of preparedness activitities that have been engaged, but she is not specific. As a result of these efforts  she says,” at no time in our nation’s history have we been as well-prepared as we are today.”

Dr. Shuchat began, I think, to explain how prior plans and studies to deal with Avian Flu did contemplate containment strategies (very roughly analogous to closing the border).  But those plans and studies anticipated very early identification of human-to-human transmission in an isolated location (not analogous to the current situation).  But Senator McCain did not recognize where she was going.

Responding to the admiral’s assertion that she cannot foresee the need to close the border, the Chairman may be confusing social-distancing tactics from a containment strategy.  The Secretary responds to both Senator McCain and the Chairman attempting to take the issue off the table.

The question of medical mutual aid agreements is raised.  These exist.  They have been created at the state and regional levels. But Dr. Shuchat cautions that prior planning — and the prospect of a wide-spread epidemic – may cause  communities to be unwilling to share and medical professionals may be reluctant to relocate.

Information on school closures and related social-distancing options  is being distributed.  CDC is inclined to defer to local judgment on this matter.  The Secretary says this has been a topic of conversation with governors and mayors.

A ”decision-to-vaccinate”  is an entirely separate decison from the decision to  produce a vaccine. The Senators, the Secretary, and Dr. Shuchat all emphasize the importance of recognizing that these are very discreet issues… and need to be kept that way.  Evidently this was not the case with the Ft. Dix swine flu incident in 1976.

Senator Pryor asks the Secretary about possible lessons-learned.  While she concurs that lessons will be learned, she chooses not to respond directly.  She explains, “right now we are too much, in it.” (her emphasis)

11:34 -  I have a professional commitment that can no longer be delayed. Readers who are monitoring are invited to use the comment function to highlight other policy-with-practice aspects of the hearing.

2:00 pm – The hearing’s focus on virus-basics, closing-the-border, and vaccine production probably reflect where many citizens have concerns.  The Senator’s questions and statements provided another opportunity for raising awareness and educating the public.

I understand — but regret — Secretary Napolitano’s demurring on the opportunity to discuss early lessons-learned.   Anything she said in this setting and at this time would have been amplified beyond recognition.  But Senator Pryor was right to ask the question.  Here’s hoping the Secretary and many others are keeping notes for future reference.

The Secretary’s formal prepared testimony has now been released and provides helpful information on our policy-with-practice focus.  See next post above.

————————————

Eileen Sullivan with the Associated Press is also filing real-time: Napolitano asserts strong federal flu response and a more extensive follow-on story under the same headline.

Yesterday Secretary Napolitano confirmed some of our speculations and observations regarding the policy framework currently being implemented.

During her late afternoon news briefing the Secretary explained, “By Friday we were beginning to assemble the information, inform the inter-agency team that would need to work this issue over the weekend. And under HSPD-5 [Homeland Security Presidential Directive 5], I was designated as the principal federal official, and we began—that whole process was well underway as we worked throughout the weekend.”

Otherwise, I cannot — yet —  find any official documents or even semi-official statements regarding the operational plan per se.  Not surprisingly these kind of “inside-baseball” questions are not — yet – being asked.   Today the Secretary will testify before the Senate Homeland Security and Governmental Affairs Committee.   Her prepared  testimony may be a good source for this kind of information.

Can we discern the operational plan from behavior? In October 2007 Homeland Security Presidential Directive 21: Public Health and Medical Preparedness was released.   This was intended to set out the strategy and principal operational steps, “to plan and enable provision for the public health and medical needs of the American people in the case of a catastrophic health event through continual and timely flow of information during such an event and rapid public health and medical response that marshals all available national capabilities and capacities in a rapid and coordinated manner.”

I don’t know that anyone in the Homeland Security Council staff, DHS, or elsewhere has even glanced at this artifact of the Ancien Regime. But a quick review suggests they might have.  The HSPD argues, “the four most critical components of public health and medical preparedness are biosurveillance, countermeasure distribution, mass casualty care, and community resilience.”

In regard to biosurveillance, there is some controversy. Some of the key concerns have been set out in comments made on this blog in recent days (especially see the comments to this prior post). Basically it comes down to “what did you know, and when did you know it.” But there is also also a claim that investment in enhanced biosurveillance specifically paid off in this case (see editorial note at end of this prior post). What can be stated confidently is that since Tuesday April 14, the US biosurveillance system has been on high alert, and as far as we can tell seems to be operating effectively.

The second critical component is Countermeasures Distribution.  During yesterday’s news briefing the Secretary emphasized in her opening statement, “I issued a public health emergency declaration. That permitted today the—an emergency authorization that allows the FDA [U.S. Food and Drug Administration] to proceed to permit things like Tamiflu to be used for populations that they otherwise wouldn’t be used for—in this case, for example, very, very young children…  We are in the process of activating our national stockpile of antiviral drugs. The priority is placed on states that have been affected, as well as states along the border. And antivirals already are on the way to some of these states. All states will have access to the national stockpile and full deployment is expected by the third of May.” According to plan? 

There is not yet much mass media discussion of Mass Casualty Care. But we can see and hear signs of preparation.  For example, Winchester, Virginia health officials held a public meeting to confirm readiness and communicate confidence.  According to the Winchester Star, “Health officials say they are prepared for any cases of swine flu that might be diagnosed in the area.  The Lord Fairfax Health District and Winchester Medical Center have plans in place to isolate anyone diagnosed with the illness and to maintain necessary services should an outbreak occur.”   The HHS Agency for Healthcare Research and Quality has conducted several educational and planning events precisely to prepare for mass casualty care.  HHS has also developed a Medical Surge Capacity and Capability Handbook.  But, not surprisingly, a June 2008 report by the GAO found potential problems.

I hope Winchester’s self-assessment is accurate and reflective of most others.  I also hope we don’t have a real-world test. 

Community Resilience was identified by HSPD-21 as the fourth critical component.  The White House directive explains, “Where local civic leaders, citizens, and families are educated regarding threats and are empowered to mitigate their own risk, where they are practiced in responding to events, where they have social networks to fall back upon, and where they have familiarity with local public health and medical systems, there will be community resilience that will significantly attenuate the requirement for additional assistance.”

Yesterday Secretary Napolitano reported, “The Department of Homeland Security is conducting conference calls with state public health and homeland security officials on a daily basis to discuss developments related to swine flu, and I’ve reached out to the governors of each of the states where a confirmed case has arisen… We are reaching out to the private sector to make sure that they are preparing, and to inform them of the latest actions we are taking. It’s important that they be thinking ahead about what they would do should this erupt into a full-fledged pandemic, which it has not yet, by the way.”

Similar quotes could be generated from CDC, Governors, Mayors, and others.  Is there enough being done?  Is it possible too much is being done?  If we over-do this, will the public be resistant to risk readiness for future pandemic threats?  What’s the right balance?

For the purpose of identifying  key elements of the policy-and-practice nexus, is HSPD-21 a fundamental document or –  if the document is unknown to current decision-makers — are the principles and priorities articulated in HSPD-21 being efffectively implemented?  Are you observing gaps in either the principles or the implementation?

There are now 64 laboratory confirmed diagnoses of the H1N1 virus in the United States.  The first US death, a Texas infant, has been reported. But among the cases identified to date most have had mild symptoms similar to seasonal flu.   The CDC updates the number of cases and provides additional background at: http://www.cdc.gov/swineflu/index.htm 

Spread of the virus has now been confirmed in Canada, New Zealand, United Kingdom, Spain, Israel, and Germany.  Suspected cases have been identified in Australia, South Korea, three Latin American nations, and seven member-states of the European Union.

The World Health Organization is, as this is being written, convening a scientific review of the current situation.

Until today Mexico was the only nation to have seen fatalities related to the virus.  While there are seven confirmed deaths, 159 are suspected to have died from the disease in Mexico. There are some reports that the rate of death has slowed in Mexico.

On Tuesday, Dr Richard Besser, Acting Director of the Centers for Disease Control and Prevention, said,  ”As we continue to investigate cases here, I expect that we will see deaths in this country.”  At 8:10 am this morning, the President confirmed the first US death related to H1N1.   The President also encouraged US school officials and other local leaders to begin making plans if it becomes prudent to close schools and other transmission nodes.

Each year approximately 13,000 residents of the United States die from complications related to seasonal flu.  The worldwide estimate is between 250,000 – 500,000.  Most of these fatalities are among the elderly.  

In Mexico, “the majority of the… people believed to have died from the virus here were between 20 and 40 years old, according to Mexican Health Secretary Jose Cordova, who says they are not sure why this is hitting a normally strong group… Some doctors have argued that the virus may actually provoke strong symptoms in those with the most powerful immune systems, leading to their deaths,” according to the Telegraph.

The CDC has made available a transcript of it’s Tuesday media briefing.  DHS has made available a transcript of the DHS Secretary’s briefing where she was joined by the Secretary of Agriculture and US Trade Representative.

Secretary Napolitano delivered her second daily briefing on swine flu.  Today she was joined by the President’s Special Assistant for Homeland Security and Counterterrorism, the Secretary of Agriculture,  and the United States Trade Representative.  The DHS press office has provided a transcript of the full briefing: http://www.dhs.gov/ynews/releases/pr_1240965057737.shtm

The Los Angeles Times has a related story headlined, Swine flu thrusts Napolitano into the spotlight.