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October 9, 2003 Stephen
M. Apatow
FEDERAL AND STATE PROGRAMS ASKED TO PROVIDE PROGRESS REPORT REGARDING FOOT AND MOUTH DISEASE RESPONSE PLANS The National Academies of Science (Countering Agricultural Bioterrorism) identified Foot and Mouth Disease as the most important animal disease the United States must be prepared for. In the context of contingency planning, preparedness and response, we are asking the directorate level of federal, state and local programs to provide Humanitarian Resource Institute with a progress report on the current state of preparedness associated with the challenges outlined in the following assessment of the Tripartite Exercise 2000, "Observations, Comments and Lessons learned,' by the CNA Corporation, Operations Evaluation Group. Please direct correspondence to s.m.apatow@humanitarian.net We thank you for your assistance in this endeavor.
Tripartite
2000 Exercise Reports
Observations,
Comments and Lessons Learned
Overview The overall goal of Tripartite Exercise 2000 was to practice and evaluate a North American emergency response plan for Foot and Mouth Disease, focusing on communication and use of the vaccine. CNAC’s objective as observers of the exercise was to learn about interagency process for responding to an animal disease outbreak. To this end, we had an observer at each of the exercise “nodes” in the United States: Riverdale, MD, Austin, TX, and Hidalgo County, TX. We were subsequently asked by APHIS to combine our insights on the conduct of the operations at the three sites and offer critical comments in our role as observers. Our observations seemed naturally to fit into several categories. These categories comprise information management, operational policy, communications, organizational structure, vaccination decision-making, and challenging operational issues. Since communication was a primary objective of the exercise, this category is further detailed as communication within the exercise, with other agencies, or with the public and media. Likewise, the category of vaccination decision-making is divided into sections discussing policies and operations. First we summarize our observations in each category and then provide specific recommendations for further development in these areas. We also provide some comments on exercise design and conduct. The following sections discuss these issues in more detail. Information Management Issues An FMD outbreak is an information intensive problem with the need for decision makers to draw on a wide array of information from a variety of sources. This requires awareness of the need to collect, disseminate, display and explain the information in a standard manner yet specialized to the situation. We observed that some forms of information, such as task lists for players, and even geographical maps, were posted late in the exercise and not regularly updated or consulted. Further, decision makers frequently lacked information they needed during conference calls, such as epidemiological data on the spread of the disease, forms that should have accompanied samples for testing, and contact information for other countries, states, and agencies. For example, we observed a need for off-line mechanisms to provide timely data when the Logistics group at APHIS needed to know the number of at-risk animals in order to estimate resources for vaccination, but the epidemiologists were tied up in meetings. At the State level, task report sheets completed by the various players were insufficient for information processing, which highlighted an overall need for synthesis of information. TERT personnel quickly found themselves inundated with vast amounts of information at various operational levels such as the size of a swine herd near the index site, funding estimates for owner-operator indemnification, and policy statements on the use of vaccine. Although operations eventually attempted to manage this large information influx, we found that the methods and structures couldn’t keep pace with the data rate, and led to a less than ideal information picture as the exercise progressed. Recommendations -
Develop data collection structures and methodologies unique to foreign
animal disease (FAD) outbreaks, and automate data storage and retrieval
processes to the maximum extent possible.
Operational Policy Issues We found that at the operational policy level, significant uncertainty exists in areas that could be firmly established before an outbreak occurs. The primary policy issues concerned the mechanisms by which local, state, and federal disaster response agencies plug into the state and federal emergency management systems, both in terms of procuring funds as well as estimating economic loss. Another issue was recognition of who could authorize compensation for producers as well as the ability to do this quickly so as to have a “check in hand” when visiting individual farms. Exercise players at all levels of the exercise debated who had the legal authority to quarantine, depopulate and indemnify herds. For example, there was uncertainty as to whether the state of Texas needed to wait for a declaration of emergency from the U.S. Secretary of Agriculture in order to begin pre-emptive slaughter. Both State and National level players had questions regarding the timely imposition of federal quarantine on the state of Texas, and how that would be communicated and enforced. In the first two days of the on-site TERT operations, a large fraction of the time spent in conference calls between Edinburg and Austin was devoted to sometimes pointed discussions on the policy of the response effort. Edinburg and Austin personnel debated the size of the area around the index sites to depopulate, and the method and sources for owner-operator indemnification. Overall, a notable amount of communication time was spent debating concerns with these primary policy issues. Recommendations - Develop
a series of operational policies that allow “automatic” responses to occur
for a given set of achieved constraints. For example, determine
that once a confirmed diagnosis is obtained for a given case, all potentially
affected animal herds within a given radius are approved for depopulation,
with associated indemnification procedures pre-approved.
Communication within the exercise Issues As in most operations that involve participants at multiple venues, communications in Tripartite 2000 were critical for the spread of information and general conduct of the operations. Although participants had multiple redundant communication paths (primarily phone, e-mail, and fax) the most important communications occurred almost exclusively on the telephone in conference calls involving personnel at multiple sites. Voice communications, though timely, are subject to misinterpretation, and aren’t particularly well suited to discussions involving complex data without supporting documentation. For example, requests for explanation of data during the conference calls indicated a need to have an epidemiologist available for conference calls. This has the advantage of the expert being in the room, but also the disadvantage that the epidemiologist is not able to assist with outbreak traceouts or forecasting at the same time. We also found that a lack of supporting documentation and written forms of communication hindered the responders in accomplishing mission objectives. Recommendations -
Develop an “official” communications structure with tailored formats for
the transmission of FAD-related information. Ensure multiple redundant
paths exist for the transmission of communications, and that each message
be uniquely identified with source, recipient, and time information.
These information communication structures should be developed in concert
with the data collection methodologies discussed earlier.
Communication with other agencies Issues Effective communication with other government agencies and organizations potentially has a tremendous impact on identifying and halting the spread of the disease. Given the possibility that bioterrorism was the cause of the outbreak, USDA could be involved with both crisis and consequence management. This would require effective communication among law enforcement responders such as OIG and FBI. APHIS’s own bioterrorism / disaster group was not observed to be a player in the exercise though they are reportedly a necessary link for management of an intentional outbreak. Similarly, the establishment of quarantine necessitates communication with customs officials, and late notification raises questions on the efficacy of banning exports early in the exercise. At the State level, responders were unsure who had responsibility to notify other states. The TERT lacked even the names and contact information of local agencies with whom they might collaborate in a real-world outbreak. Though communication was clearly stated as a primary focus of this exercise, our observations highlighted the need for communication plans at all levels of the response. Recommendations -
Identify other agencies that are potential contributors of information
and resources during a FAD outbreak, such as animal health experts, department
of health, port authorities, customs officials, and various wildlife agencies.
Communication with the public Issues There is a need to disseminate cautious yet accurate information when only a presumptive diagnosis is available, as well as a responsibility to respond authoritatively to public media inquiry. Similarly, industry representatives need to have credibility in the information they are receiving, particularly with what is being distributed to trading partners. At the National and State levels, public affairs personnel would likely be inundated with tasks and may need to request help, such as phone banks for a hotline, setting up press conferences, or assisting with updating frequently-asked-questions lists. As local teams respond to the disease by collaborating with other agencies, news of the outbreak will begin to spread up to the national media. Though the Incident Coordinator stated a high priority on messages for the public and industry, this was somewhat lost as a focus of the exercise. Recommendations -
Identify and prioritize the information that must be released to the public
and ensure that it is accurate.
Organizational Structure Issues Organizing a group of people to manage, contain, and ultimately eliminate a FAD outbreak is not a simple task. An operation in this manner comprises several important operational facets, including epidemiology, diagnosis and inspection, depopulation and disposal, surveillance, appraisal, and vaccination, to name a few. The responders arise from various organizations and specialties, potentially complicating their assimilation into a single team at an Emergency Operations Center. At APHIS we observed that the Emergency Management Leadership Team did not play as a group in the exercise, though several of the constituents were present. This group, who would serve as staff and advisors to the CVO and coordinate efforts from their various agencies, may be especially important in a real-life outbreak when the CVO could be in downtown Washington, DC, headquarters dealing with various hot political issues. We also found reluctance on the part of participants to perform within a well-defined “chain of command” as well as reluctance of the Incident Coordinators to utilize their authority during the exercise, resulting in defused task accountability. At the state and local level, the TERT was organized into three main sections, each of which was further divided into teams. The teams fulfilled the operational missions discussed above, as well as other technical and administrative support functions. This allowed personnel to be assigned into teams related to their area of expertise. However, we found that this organization along functional lines could at times hinder information sharing from team to team, foster duplication of effort, and inhibit accountability. This resulted in less than optimal group meetings. Recommendations -
Develop an organization that reflects a well-defined chain of command,
emphasizing task assignment and accountability.
Vaccination Decision-making (policies) Issues A primary focus of both the exercise and its preceding orientation was the Vaccine Decision Tree. Though a vaccine decision team was tasked with discerning whether the U.S. should utilize vaccination as an outbreak control measure, in the end, the actual decision was made in a meeting at APHIS with the entire, multi-disciplinary group. It was unclear whether this was for educational and training purposes of all those involved, or was needed because the vaccination decision team had difficulty gathering all the data needed to make a confident recommendation. While the vaccine decision team could gather information and make a recommendation on whether to vaccinate, the team did not seem prepared to handle the “hot” political issues that might arise. The chosen option of “strategic vaccination” was not included in the Decision Tree. At the cross-team meeting, the group decided that the outbreak could not be subdued by stamping out only, and that wide use of pre-emptive slaughter created too high a demand for slaughtering facilities. While vaccination was considered possible, the group decided to only vaccinate herds in certain strategic “rings” around the infected locations, rather than with a sweeping vaccination program for the entire region or state. However, once it is determined that resources are not sufficient for full vaccination, the decision tree leads to the endpoint of “no OIE freedom status.” Attempting to avoid this outcome, the possibility of “strategic vaccination” was put forth. At the state level, players were concerned and confused over their role in the vaccination decision and when it might be “too late” to use vaccination as a method of subduing the outbreak. We observed that Texas officials requested 75,000 doses of vaccine prior to APHIS deciding whether or not to vaccinate. Due to the break in communications between the Texas responders and APHIS headquarters, the uncertainty over the role of Texas officials in this decision process was exacerbated. Recommendations -
Delineate the role of the Vaccination Decision Team regarding the recommendation
to use vaccine, versus the actual decision-making responsibility.
Vaccination Decision-making (operations) Issues Intertwined with the policy and decision-making issues surrounding vaccination are a number of technical and operational concerns. For example, we observed a lack of consensus on determining the percentage of animals that need to be vaccinated in order to slow the outbreak, with player recommendations ranging from 33% to 85%. Though one participant at APHIS spent a significant amount of time concentrating on obtaining animal identification tags, in the end the tags would have arrived long after the actual task of vaccination had begun. We also observed uncertainty regarding the composition and workload of vaccination teams. Organizing the vast amount of resources and personnel required for the actual task of vaccination would likely require the combined efforts of a number of staff members focused solely on logistics of the effort. We observed that FADDL was overwhelmed by the multiple roles laboratory personnel would assume in a real-life outbreak. FADDL was inundated with tasks ranging from prioritized testing of FMD samples, deciding whether to use the vaccine, ordering, receiving and distributing the vaccine. Other critical issues such as escorting tissue samples and vaccine and maintaining proper documentation were acknowledged but not fully addressed. Recommendations - Establish
guidelines for the percentage of animals that would need to be vaccinated
in order to slow the spread of the outbreak, including variables such as
whether cattle, swine or sheep/goats are being vaccinated and whether single
or double-dosing is planned.
Challenging Operational Issues Issues Though the focus of Tripartite 2000 at APHIS was expressly on communication and decision-making for vaccination, challenging operational issues were evident throughout the exercise. Similarly the TERT faced a number of challenging operational issues. While it may be true that no straightforward solutions exist for these issues, it would seem prudent to analyze these issues closely and develop policies and operational approaches to address them, before an outbreak occurs. Challenging issues affecting all nodes of the exercise included the possibility of bioterrorism and notification of authorities responsible for crisis management, various legal issues concerning slaughter of animals and compensation, and technical issues such as TERT and APHIS using different definitions for surveillance zones and even different units (km vs mi) to measure the “rings” around an index case. Other issues directly involved policies and communication among the different nodes such as providing timely compensation to producers to ease efforts in stamping-out the outbreak as early as possible, quarantine and how this was communicated to jurisdictions within Texas, and depopulation of animals on problematic sites. While the players at APHIS were reminded that the focus of the exercise was on communication rather than operations, dealing with these challenging issues was directly linked to the players ability to communicate among the various levels of response. Recommendations Develop
policies and/or operational approaches for the following issues:
Exercise Design Issues Tripartite Exercise 2000 facilitated communication among the players at APHIS as well as the Tripartite nations, and brought together the TERT structure in an operational context for the first time. Although the exercise should be considered a success, we found that improvements could be made in exercise design. The difference in timelines between the National and State / Local nodes of the exercise made it seem as if Texas players were responding to a separate emergency. The timeline at the APHIS node became too accelerated, and didn’t allow sufficient time to respond to exercise injects. In place of direct communication with Texas, the model controllers played the “field” role for questions regarding spread of the disease. However, the controllers were not able to answer other “field” questions regarding Texas’ response to the outbreak, such as how quarantine was enforced. Overall the exercise was highly structured, and eliminated the ability of player actions to influence the future course of events. Recommendations - Investigate
a less structured exercise format that allows more free-play and player
influence.
Exercise Conduct Issues While in many respects Tripartite 2000 was a successful exercise, development of a regular training exercise program should include improvements in exercise conduct. At APHIS, the lack of a final “hot-wash” may have repressed useful comments and feedback that could get lost in the delay to compiling a written exercise report. Though the exercise allowed TERT personnel to react in a realistic environment, in the early portion of the exercise, many of the players were somewhat confused as to the expectation for “real” contacts they should make with other TERT personnel and other agencies (this confusion abated as the exercise progressed). Many of the players, although highly competent in their areas of expertise, were acting in roles for which they hadn’t been trained. Confusion at each node concerning exercise play in other nodes created difficulty for players to make decisions due to inability to obtain necessary information from responders at other levels. Recommendations - To
the extent possible, define in general terms, what types and courses of
actions players should take in the course of the exercise.
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