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In His Words: Dr. Robert Kadlec, Assistant Secretary for Preparedness and Response

In His Words: Dr. Robert Kadlec, Assistant Secretary for Preparedness and Response

In December, at the National Healthcare Coalition Preparedness Conference, Dr. Robert Kadlec, the newly confirmed Assistant Secretary for Preparedness and Response (ASPR) laid out his vision for the Office of the ASPR and the Hospital Preparedness Program. Attendees came away impressed with his bold vision, directness, and sense of humor. And based on the phone calls and emails to my office from coalition leaders and state preparedness gurus, they also came away seeking clarity– seeking a bit more information.

So, I reached out to Dr. Kadlec through ASPR Public Affairs, and to his credit, he agreed to work with me to deliver this Q&A for you. The questions were developed jointly, but the answers are all his.

What do you see as the biggest challenges the health sector facing in biodefense?

One of our biggest challenges is keeping up with the ever-increasing array of health security threats we face. The 21st century threat environment is more complex than ever – from infectious diseases with the potential to cause a pandemic, such as the H7N9 influenza virus, to state and non-state actors that have shown an interest in and willingness to use chemical, biological or nuclear weapons on our homeland, to cyber threats and severe weather events. Healthcare providers and systems need to stay informed and be trained and ready to manage potentially catastrophic health consequences from these diverse threats. However, funding to support our nation’s healthcare readiness has declined steadily.  On any given day, our nation’s medical system performs at near capacity and as efficiently as possible, which makes it difficult to develop surge within the healthcare system. Since most of healthcare is largely privately run, we need to better engage healthcare leaders in building readiness for 21st century threats. There needs to be a business case for readiness. This past hurricane season, I witnessed heroic efforts from our EMS, healthcare providers and volunteers, Disaster Medical Assistance Teams and healthcare systems as they responded to the devastating impacts of hurricanes Maria, Harvey, and Irma. That type of engagement is crucial to our efforts.

What is your vision for healthcare preparedness?

My vision for healthcare preparedness is a national healthcare system that is trained, equipped and ready to provide high quality care for patients impacted by 21st century threats. Building readiness and response capacity for these threats is a national security imperative. In order to move us toward that vision, I have four main priorities. The first is strong leadership, including providing clear policy direction, improving our threat awareness, and securing adequate resources. The second is to create a national disaster health care system, which I talked about at the 2017 health care coalition conference. The third is to build a better medical countermeasures capability to make effective vaccines, drugs, and other medical supplies that would be needed in disasters and could be rapidly deployed to save lives and protect Americans. The fourth is to ensure that we have strong nation-wide public health security capabilities to guarantee that we can detect disease earlier, diagnose disease faster and treat people. It’s a work in progress and we’ve taken many steps toward that end state.

How would a national disaster healthcare system work?

With a national disaster healthcare system, I envision a tiered regional system built on local healthcare coalitions and trauma centers that integrates medical response capabilities, including federal facilities from VA and DOD, as well as emergency medical services (EMS). This system would expand specialty care expertise in trauma and chemical, biological, radiological, nuclear, and explosive agents and coordinate medical response through mutual aid across states, tribal nations, local governments, territories and regional jurisdictions. A national disaster healthcare system also would incentivize the healthcare system to integrate measures of preparedness into daily standards of care.

What is your opinion on all states receiving HPP funding vs. reducing the number of states eligible to apply for the HPP cooperative agreement?

During the 2017 healthcare coalition conference, I described my vision for a national disaster healthcare system. State and local health departments, hospitals and healthcare coalitions as a whole are essential in that vision. Healthcare preparedness begins with hospitals and coalitions being able to perform the competencies described in the recent HPP guidance, some of which the CMS preparedness rule requires. Part of my responsibility is to find ways to maximize the use of the available funds and to identify how to use them most effectively.

We do not yet have final appropriations for this fiscal year, although the House bill would maintain the current funding level for HPP. As appropriated funding has decreased steadily since 2005, HPP proactively has considered options to the current funding formula to maximize the impact of available funds. One option under consideration is to use evidence-informed, risk-based formula, recognizing that some states may receive reduced funding in some of those formulas.  That certainly is not ideal, and ASPR is working to prevent that from occurring. Additionally, HPP has taken steps to make more funds available to healthcare coalitions by reducing the administrative burden for awardees and implementing caps on direct costs of awardees. ASPR staff will continue to work with our HHS partners, the executive branch, and our Congressional colleagues to inform them of the HPP budget impacts on state and local healthcare preparedness in order to continue the work that began in 2002. Most importantly, ASPR will continue to work with our state and local partners to communicate our intentions and receive input from those tasked with the mission of healthcare readiness.

My office will continue to look for proven ways to improve state healthcare readiness by engaging and funding state and other public and private partners when necessary to build the readiness the country needs for 21st century threats. To be clear, however, I do not want to make a blanket statement that rules out consideration of HPP funding options that exclude some states. With the threats our nation faces, ASPR must retain all the tools necessary to carry out our mission of protecting the American people.

As I move forward in addressing national health security issues, my staff and I are looking at innovative approaches to healthcare preparedness that may involve new organizational constructs and stronger partnerships with public and private sector partners to improve readiness and maximize existing HPP funds.

Do you see a role for states in healthcare preparedness?

Absolutely. State agencies are essential partners in preparedness and response. Public health capabilities are mostly state functions—detection, surveillance, epidemiology and lab capacity. States have situational awareness across their jurisdiction, such as vaccination rates and vulnerable populations. States also must coordinate medical countermeasures distribution and dispensing, license healthcare providers, and play a critical role in linking capabilities together across the state.

In addition to HPP or PHEP grants, ASPR always has and will continue to work with states to improve their readiness to respond to disasters. Our relationship with states takes various forms. Our regional staff works closely with state health and emergency management offices. Under the authority of the National Response Framework, ASPR also directly supports states requests for assistance. Our staff also works diligently to assist states in recovery efforts under the guidance of the National Disaster Recovery Framework. The success we jointly share depends on strong federal-state partnerships.

It is important to keep in mind, too, that the entirety of HHS works closely with states during response and recovery efforts. CMS provides waivers that enable the delivery of care to Medicare beneficiaries impacted by disasters. SAMHSA works with state and local health departments to make behavioral health services available. Our colleagues at CDC provide support for public health, environmental health, worker safety, and lab capacity. These are just a few examples of HHS organizations working with states, tribes, and territories in support of the federal efforts.

As we consider models for funding preparedness, it is incumbent upon ASPR to consider options that enable us to engage all our partners effectively. We believe that private partners are interested in greater engagement and can provide innovative solutions to some of the threats we face. ASPR’s Biomedical Advanced Research and Development Authority (BARDA) serves as a model in this regard. BARDA has been successful in partnering with private industry to develop medical countermeasures. In the past 10 years, 30 unique products developed in BARDA’s public-private partnerships have achieved FDA approval.

What do you see as the healthcare coalition’s role in response?

At their core, healthcare coalitions are response entities. The whole point of planning, training, and preparing together is to respond as a coalition. Coalitions should be able to provide quality care to people seeking healthcare during an event and have properly trained staffs to manage the medical consequences of 21st century threats. Coalitions should ensure a reliable supply chain, including sharing resources necessary to ensure patient demands. Coalitions should be integrated into other response systems within their communities, especially with emergency management, EMS, fire, law enforcement and public health and be able to maintain coordination throughout a response. Importantly, coalitions should communicate with the community such that patients and their families understand where to seek care in the event of a disaster. We’ve seen fantastic examples this year of healthcare coalitions responding to recent train accidents, mass shootings, and hurricanes.

Are you considering dividing the HPP-PHEP combined FOA?

Beginning July 2019, ASPR’s Office of Acquisitions Management, Contracts and Grants will manage the administration of grants management functions currently managed by the CDC Office of Grants Services.  ASPR will develop and publish a HPP Funding Opportunity Announcement and CDC will develop and publish a PHEP Notice of Funding Opportunity. Recipients will continue to submit one application for HPP and one application for PHEP through Grant Solutions just as they do now. Both ASPR and CDC are committed to making this administrative transition minimally disruptive to our recipients. We expect this change to improve customer service from both ASPR and CDC. This transition does not change HPP-PHEP programmatic alignment. We still believe that the program alignment between HPP and PHEP is imperative to realize progress toward U.S. public health and medical preparedness and response capabilities. ASPR and CDC will work diligently to be sure the guidance, application process, and schedules for both programs remains aligned to continue to reduce awardee burden, increase efficiency, and improve the state of national preparedness.

Karl Schmitt, MPA

Karl Schmitt, MPA


Karl is the Passionate Founder & CEO of bParati. He is on a mission to build a national network of effective, sustainable healthcare coalitions. More...

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