FORUM ON MEDICAL AND PUBLIC HEALTH PREPAREDNESS FOR DISASTERS AND EMERGENCIES AND ACTION COLLABORATIVE ON DISASTERS/PUBLIC HEALTH EMERGENCY RESEARCH

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 as exemplified by the recent SARS COV-2 global pandemic and increasingly frequent and severe natural disasters including heatwaves, hurricanes, and wildfires across the nation. While each of these stakeholders is critical in guaranteeing adequate prevention, response and recovery, efforts must be coordinated to foster functional strategies, communications, and collaborations to ensure optimal outcomes improving the health and well-being of our communities. Challenges arise, however, 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. Aligning the responsibilities and focus of each stakeholder greatly assists in ensuring adequate protection and response. Each stakeholder offers unique assets that must be linked 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") began to address these issues and coordination of stakeholders in 2008. 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 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 areas of medical and public health preparedness, resilience, and recovery are of increasing complexity, both in terms of technology and policy. Currently, it is difficult for the nation's medical emergency response, public health and mental health systems, and health research enterprise to meet the rapidly increasing and diverse medical and health challenges that result from all types of disasters including terrorism and natural disasters. Unfortunately, gaps continue to exist. Addressing the physical, psychological, and social needs, especially among at-risk population (e.g., pregnant and lactating women, children and adolescents, elderly, individuals with disabilities and pre-existing conditions, communities of color, and worker subpopulations) that result from various disasters will therefore require universal preparedness by all systems responsible for the public's health and well-being. 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 to promote and coordinate needed scientific assessments and capacity building across the nation and with international partners. Such coordination will require the best advice available as federal agencies seek guidance in developing its strategic plans for advancing medical and public health preparedness, response, and recovery to disasters. 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 evaluations of preparedness and post-disaster performance. 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. The upcoming FY2024 will consider opportunities to address four broad categories: (1) Digital Technology and Health Security, (2) Advancing Preparedness, (3) Expanding Access, and (4) Climate Change and Cascading Events. Within these areas, topics that might be on the meeting agendas of the forum include: Digital Technology and Health Security Topics within this theme focus on advancing digital technology and artificial intelligence as it relates to health security. Exploration of health preparedness for radiation, nuclear and chemical exposures and crisis standards of care will also be leveraged. Advancing Preparedness Topics within this theme focus on the Behavioral and Social Science aspects of preparedness. Discussions will concentrate on ways in which these scientific fields can advance the nation's preparedness across all hazards and populations. Expanding Access Topics within this theme focus on expanding access to care/services to tribal communities, and other at-risk populations. Discussions will focus on leveraging preparedness experiences and opportunities for equitable reach to these vulnerable communities across the disaster cycle. Climate Change and Cascading Events Topics within this theme focus on cascading events related to climate change. Dissemination of declarations and the evolution of the Stafford Act will be discussed. Action Collaborative on Disaster/Public Health Emergency Research The Forum will continue to convene an Action Collaborative on Disaster/Public Health Emergency Research (the "Action Collaborative") based upon the receipt of additional supporting funds from NIH and other sponsors. Recent efforts to respond to the COVID-19 crisis and the multiple increasing national disasters highlights the critical need to develop improved U.S. capacity for pre-, during- and post-event research and science. For this year the Action Collaborative will strive to further our collective capacity for timely disaster and public health research, especially with respect to at-risk populations and improvements in disaster data science. Focused interests and activities of the Action Collaborative may include 1) outlining and defining processes for designing and conducting research, particularly transdisciplinary research involving vulnerable and at-risk populations, 2) ensuring community engagement and IRB/ethical considerations in disaster research. 3) defining processes for expanding and enhancing a coordinated network of disaster researchers across the U.S. and globally; 4) facilitating platforms, exchanges, and processes for data collection, harmonization, integration, and warehousing research, 5) 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, and 6) promoting improved processes for developing, coordinating, and implementing the federal and academic research enterprise in response to disaster and public health emergencies, especially improving timeliness to avoid missing critical data. The Action Collaborative convenes in-person and/or virtual meetings and workshops which significantly influence the field of disaster science. For example, the hybrid 2022 landmark Pediatric Disaster Science Symposium convened academic, clinical and community stakeholders, along with subject matter experts, to scope perspectives, information and scientific needs related to disasters affecting child populations. Discussions focused around prioritization of pediatric disaster science foci, opportunities for alignment and synergy of scientific efforts, capacity building around evidence-based practices and scientific discovery to improve outcomes of children. Development and implementation of relevant virtual or in-person workshops or hybrid meetings may be pursued during this period of performance.