Responding to agricultural bioterrorism that uses pathogenic agents that can be communicated from animals to humans—zoonotic diseases—will require coordination among groups with diverse responsibilities and at different levels of government. And both human and animal health threats must be addressed. To understand the required response, staff from RAND, the Georgia Division of Public Health, and the Rollins School of Public Health conducted a series of tabletop exercises on public health preparedness in six health districts across Georgia, as well as an exercise at the state level. The goal of the project was to develop and pilot-test exercises that could be used throughout Georgia to explore interaction and coordination among public health and other organizations in responding to a scenario that involved intentional introduction of avian influenza in commercial poultry operations in the context of an already significant human influenza season.
The district-level exercises took one day each to complete, and each dealt with a different biological threat. The state-level exercise was conducted over two days. The first day examined the district public health response to a hypothetical unexplained outbreak of influenza-like illness in poultry workers who had reported that poultry at their place of work were ill. On the second day, local public health and response officials joined state officials in an exercise simulating an escalation of events requiring increased state involvement and coordination.
All the exercises reinforced a number of lessons already broadly appreciated, including the need to address workforce and surge-capacity issues in the public health and health care sectors, and the need to successfully reach vulnerable populations (such as non-English speakers) during response efforts. The exercises also yielded a number of other important lessons:
- Carrying a local-level exercise through to the state level was valuable. Local participants could observe decisionmaking after they "handed off" responsibility to a higher level of government; state officials learned how issues are addressed at the local level before they come to the state level.
- Involving many of the agencies in designing the exercise increased the relevance and realism of the exercise, and it helped ensure that all relevant organizations could participate in decisionmaking at the exercise, increasing the value of the effort.
- Different organizations within the state had different priorities and different assumptions about how operations in a large-scale event would be managed.
- At both the local and state levels, it was not fully clear what agency had lead responsibility for declaring an emergency and invoking incident command procedures.
- State-level actors may lack the information necessary to make use of locally driven resources and planning for a health crisis.
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