High-profile diseases such as Ebola and Zika grab headlines, but state health policymakers know that emergency preparedness begins long before the first news stories — or symptoms — appear. Preparedness and response often includes cross-sector work that addresses the intersections between public health infectious disease strategy and state Medicaid and emergency management policies. At the nexus of federal policy and local concern, state health policymakers are well-positioned to lead prior to, and during, health emergencies.
The recently announced Centers for Medicare & Medicaid Services funding opportunity to support Zika prevention and treatment activities could help state health departments invest in public health infrastructure that would position them well to respond to the next crisis when it occurs.
As concern about Zika virus continued deep into autumn, state leaders from Texas, Pennsylvania, and Florida spoke at the 2016 NASHP State Health Policy Conference about their strategies for preparing for and responding to public health emergencies and infectious disease outbreaks. They shared tips for navigating messaging challenges, especially when communicating with a restive and worried public. Panelists also noted the importance of robust public health infrastructure and cross-agency collaboration in developing and refining preparedness and outbreak investigation strategies.
- Communicate clearly, consistently, and credibly.
According to state leaders, communicating with the public and sharing facts and techniques for minimizing risk is central to preparing for and addressing outbreaks and emergencies. Texas honed its disease investigation and response practices in the crucible of the Ebola crisis. The first patient to be diagnosed in the U. S. with Ebola came to a Dallas hospital in September 2014, according to the CDC. Shortly thereafter, a healthcare worker who cared for the patient contracted Ebola. The state’s experience with this very high-profile situation informed its strategy for responding to Zika and other infectious diseases. The public health risks of confusion and panic, and the importance of having clear lines of communication and a flow of accurate, consistent, and timely information to the public and decision-makers were key lessons Texas learned in the aftermath of Ebola. Texas put this knowledge into practice in its Zika response by continually publishing health alerts and regular updates on Zika case counts.
Florida also relied on media to share accurate and up-to-date information and to enlist the public’s help in fighting Zika transmission. At the time of writing, Florida Department of Health continues to publish daily Zika updates, as well as the department’s process for Zika testing and investigation. Educational campaigns such as “Be a Hero. Spill the Water!” use social media and advertising to enlist residents’ help in preventing the spread of Zika by reducing mosquito breeding areas.
The Pennsylvania Governor’s Office broadcast on Facebook a July 2016 Zika Town Hall meeting with the state’s departments of health and environmental protection. Pennsylvania also continues to update its Zika web page.
- Cultivate Collaboration and Partnerships.
One Texas official noted the importance of collaborating with federal, state, and local partners when planning for and responding to emergencies. For example, Texas Medicaid covers insect repellent and other Zika-related items for some populations, the federal CDC provided expertise and nationwide coordination, and local officials were instrumental to mounting an on-the-ground response.
A Florida official reported that robust partnerships are integral to the state’s Zika response. The Florida Department of Health refers pregnant women to the Healthy Start Coalition for care coordination and assistance applying for Medicaid if applicable. Infants born with Zika also receive support from the Department’s Early Steps program, which has local offices and partners statewide.
Pennsylvania engaged cross-sector partners such as the March of Dimes and blood banks, as well as targeting communications to healthcare providers. Because the state did not have an existing birth defects registry, the March of Dimes’s birth defect surveillance was a helpful complement to the state’s disease monitoring and reporting infrastructure.
All three states acknowledged the importance of engaging local officials in emergency planning and response. State leaders have worked with local health departments, local mosquito control and environmental protection entities, local elected officials, and other community leaders in responding to Zika. An effective local engagement infrastructure is especially important for states such as Texas with a system of local control that grants considerable autonomy to local public health entities.
- Develop and Maintain a Robust Public Health Infrastructure.
Robust public health data collection, monitoring, and laboratory testing capacity help states respond with agility to crises such as Zika. Florida’s birth defects registry, which has been operational since 1999, includes reportable conditions such as microcephaly that are potentially associated with Zika. The fact that this infrastructure was already in place permitted Florida to establish their baseline rate of microcephaly, which in turn helped the department monitor the possible impact of Zika on that rate.
States also identified the testing capacity and capabilities of their state laboratories as another key infrastructure element that supports emergency response. States that could test for Zika in-house—and had the capacity to meet the demand—were largely spared the delays and backlogs that could result when specimens have to be sent for out-of-state testing.
The Pennsylvania Department of Health built on the mosquito surveillance that the state’s department of environmental protection conducted for West Nile Virus. The existing cross-agency relationship between the two departments and the previous mosquito surveillance assisted the state with monitoring the potential for the disease to spread. The state law requiring infectious disease reporting was also broad enough to include Zika, which helped with surveillance efforts.
As these three tips show, state leaders can build upon existing communications, partnerships, and infrastructure capabilities to prepare for the challenges of the future, whatever form they take.