State Should Prepare for Public Health Emergencies

TMA Testimony: Interim Charge on State’s Preparedness for Public Health Emergencies 

House Public Health Committee
Feb. 10, 2016

Good afternoon Chair Crownover and members of the committee. I want to thank you for the opportunity to testify on the state’s preparedness for public health emergencies. I am Philip Huang, MD, MPH. I am a family physician, and I have served eight years as the health authority for Austin Travis County Health and Human Services, following many years of service at the Texas Department of State Health Services (DSHS). Prior to joining the state, I was an Epidemic Intelligence Service (EIS) Officer at the Centers for Disease Control and Prevention. I chair both the Travis County Medical Society’s Public Health Committee and the Texas Medical Association’s Committee on Infectious Diseases. I am here today on behalf of the 48,000 members of TMA and the Texas Pediatric Society.

The capacity to plan for and respond to public health emergencies is one of the most important responsibilities of local and state government and our health care system. Along with other first responders and clinical teams, our physician members are on the front lines protecting those at risk during a public health emergency. Our members have a vested interest in participating in and contributing to the state’s public health emergency preparedness planning.

A Culture of Preparedness
We appreciate the culture of preparedness that you and other elected officials have promoted and enhanced in Texas. The state has a developed infrastructure that supports state and local public health preparedness planning and response — but we can do better. We need to build on and invest further in our public health infrastructure. Public health preparedness and prevention efforts are invisible when we are doing our job, but it can be catastrophic if we haven’t invested in them adequately.

Planning and response are best accomplished locally. I have worked at the federal, state and local levels, and I can honestly tell you public health happens at the local level, and it is at the local level where there is a unique understanding of the particular factors that are needed to prevent and control a public health situation. We continue to strongly espouse the role of local leadership in preparedness, with the support of regional and state officials and resources when needed.

You have recognized the importance of data and surveillance systems such as our state immunization registry, ImmTrac, which becomes especially critical during a pandemic or infectious disease emergency. A fully functioning registry allows us to know who is immunized or who might be at greater risk in a public health emergency. We are hopeful that DSHS will roll out the new ImmTrac system by mid-year.

We will benefit from the supplemental funding you authorized to update our state’s emergency stockpiles the health care community and the public might need; and you have enhanced our laboratory services and surveillance capacity, including more epidemiology positions and other critical support that can be deployed in a public health emergency. And currently, our members and other responders and policymakers are benefiting from DSHS’ preparedness planning and education programming on high-

consequence infectious diseases. We urge you to continue to invest in these state-of-the-art programs, and we offer our support in planning and organizing such programming. 

Areas of Concern
We have previously noted areas of concern in Texas’ public health planning and preparedness that we believe need more attention. Planning and preparedness for public health emergencies are not limited to state and local agencies, personnel, and programs. Health facilities, private physicians and providers, nonprofit community-based organizations, and others — all must make up the planning and response team and network that protect our residents in a public health emergency. 

We are currently focused on the global nature and threat of emerging pathogens like Zika and how they can affect public health. As community leaders, our physicians are being asked right now by their patients and by schools, community leaders, media, and others about Zika and other potentially harmful infectious agents. This potential for infectious disease emergencies requires physician expertise in infectious disease at the state and local level and the engagement by those who practice in direct patient care. Texas was fortunate that former Commissioner of Health David Lakey, MD, was an infectious disease expert and could readily contribute to the Dallas response and management of Ebola in 2014. However, at the present time there is only one infectious disease physician at DSHS in Austin! 

But we also need broad physician expertise for other emergencies. As we’ve seen with the Zika virus disease, informed planning and preparedness also requires physician expertise in obstetrics and neonatology. We also must be prepared for other threats including bioterrorism, radiological or chemical emergencies, and other agents that could quickly harm and overwhelm any community in Texas. That’s why physician expertise in occupational safety, pediatrics, pathology, and other areas should be present at the state level and throughout Texas at regional and local public health offices and units. We strongly encourage you to review information from the Public Health Inventory of Services that DSHS is currently compiling (as required by 84th Texas Legislature) so you can assess the state’s access to multidisciplinary medical expertise currently available to respond to a public health emergency. We believe that doing so will identify some gaps that need to be addressed.

We appreciate the governor’s designation of the Task Force on Infectious Disease Preparedness and Response, and we offer our support and expertise to this diverse group. While clearly there is substantial institutional and organizational strength in the task force, we encourage you to recognize the need to include physicians who directly practice in clinical settings. The Task Force is composed almost entirely of academic, state and local representatives, but most patient interaction occurs in non-public clinic settings. Please consider including the private medical community. We also ask that this group meet openly in public to ensure transparency in the deliberations. Its recommendations will have a direct impact on the use of public health and medical resources, and physicians should have an opportunity to contribute to these discussions. 

We have a scattered and nonuniform public health system with varying levels of capacity across the state. Most Texas counties do not have a fully functioning public health department, while those with health departments or units provide different levels of services. The DSHS regional offices support dozens of counties without health departments, but they must have adequate resources to do this. We also have an important network of local health authority physicians throughout the state. We need to further support the local health authorities with additional training and support.  TMA stands ready to assist with that effort. We recommend you use the information from the Public Health Inventory of Services to assess public health preparedness capacity and gaps at the local and state levels.

Finally, I conclude by reiterating a message we frequently share — that we must have greater collaboration between public health and medicine. Local and regional preparedness can be enhanced only with the development of strong relationships among public health, state and local health care facilities, and medicine. And while it is essential to plan and prepare for public health emergencies, it is just as critical that you continue to support and enhance our current public health and prevention initiatives. Strong public health programming (e.g., high vaccination levels in state-licensed health facilities and of health care workers) will complement and ensure our preparedness for public health emergencies. Public health and physician practice are based on science and evidence-based methods that promote health, prevent disease, and/or delay or reduce disability. We must continue to work together to ensure our readiness for public health emergencies and we offer our continued support in this planning and response.

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March 08, 2017