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Johns Hopkins Center for Health Security, CDC create checklist for strengthening health sector resilience to high-consequence infectious diseases

New report makes recommendations for improving preparedness and response based on lessons learned from Ebola cases in four U.S. cities

Center News


June 21, 2017 – Researchers from the Johns Hopkins Center for Health Security and the U.S. Centers for Disease Control and Prevention have developed an evidence-informed checklist that outlines action steps for medical and public health officials to assess and strengthen the resilience of their community’s health sector to high-consequence infectious disease (HCID) events.

The checklist bridges a planning gap in building resilience to HCID events by offering comprehensive guidance on recommended improvements to the interconnected preparedness and response capabilities of the public, private, and community organizations that comprise local health sectors. Other HCID resilience efforts currently underway focus exclusively on specific aspects of HCID preparedness and response, like clinical treatment guidelines or biocontainment units, rather than the broad range of entities and operations that comprise the health sector response.

“One of the key findings of our research is the diversity of people who end up being involved in a response and how interrelated they are, including many who never expected to be involved,” said Eric Toner, M.D., senior associate at the Center and the project’s principal investigator. “Therefore, many more stakeholders must participate in planning, and they are eager for firsthand information from others who have experienced an HCID event.”

Toner produced the checklist with Center Senior Associates Tara Kirk Sell, Ph.D., and Monica Schoch-Spana, Ph.D.; Senior Analyst Matthew Shearer, MPH; Analyst Diane Meyer, R.N., MPH; and former Research Assistant Hannah Chandler. CDC coauthors were Erin Thomas Echols, Ph.D., applied research fellow in the office of public health preparedness and response; Dale Rose, Ph.D., associate director for science in the division of emergency operations; and Eric Carbone, MBA, Ph.D., director of the office of applied research in the office of public health preparedness and response. The project was supported by funding from the CDC.

The team’s full report, “Health Sector Resilience Checklist for High-Consequence Infectious Diseases—Informed by the Domestic US Ebola Response,” analyzes the firsthand experience of handling confirmed cases of Ebola virus disease in four U.S. cities (Atlanta, Dallas, New York, and Omaha) and identifies challenges and solutions to both common and unique problems faced by these cities, in particular highlighting unanticipated issues. The checklist is derived from these salient lessons learned and broadened to cover similar HCIDs, which the authors define as novel in the affected community, moderately to highly contagious, not easily controllable by medical countermeasures or non-pharmaceutical interventions, moderately to highly lethal, and a cause of significant public concern. Smallpox, SARS, MERS, and H5N1 influenza A are examples of other HCIDs.

Health sector resilience requires the collective commitment of individuals and organizations responsible for HCID preparedness and response at the state and local level. The checklist makes recommendations of value to all of these stakeholders, including healthcare systems and facilities, public health departments, emergency medical services, public and private diagnostic laboratories, elected officials, law enforcement, academia, and community-based organizations that represent affected populations.

“Our goal is to provide clear direction for leaders so they can take a proactive approach to building and maintaining health sector resilience in advance of an HCID event in their community,” said Toner.

Overarching resilience actions are grouped in the following checklist categories:

  • Planning and preparedness
  • Leadership
  • Creative flexibility/adaptability
  • Command structure
  • Public trust
  • Managing uncertainty
  • Crisis and emergency risk communication

The report also includes specific checklists for public health agencies, healthcare organizations, EMS, and elected officials.

The detailed findings in the report, along with the resilience checklist, are the result of more than a year of research and analysis. The team examined peer-reviewed publications, media reports, commentary, after-action reports, and other pertinent documents related to the domestic impact and management of the 2013-16 West Africa Ebola epidemic. They interviewed more than 70 people in total from Atlanta, Dallas, New York, Omaha, and the CDC who treated confirmed cases of Ebola or served in another relevant role during the response. In addition, they convened focus groups of health sector stakeholders in Dallas and New York to continue discussions of important issues identified during the interview process. As a final step, the team brought together an advisory group of subject matter experts to discuss the relevance and scope of the preliminary findings and further refine the recommendations.

This report is a companion project to a previously published health sector resilience checklist for natural disasters based on New York’s experience with Hurricane Sandy.

About the Johns Hopkins Center for Health Security:
The Johns Hopkins Center for Health Security works to protect people from epidemics and disasters and build resilient communities through innovative scholarship, engagement, and research that strengthens the organizations, systems, policies, and programs essential to preventing and responding to public health crises. The Center is part of the Johns Hopkins Bloomberg School of Public Health and is located in Baltimore, Md.

Project Contact:
Eric Toner, M.D.

Project Materials:
Health Sector Resilience Checklist for High-Consequence Infectious Diseases—Informed by the Domestic US Ebola Response (PDF)