Program Details

Practice Type:	Promising
Program Name:	Building Collaborative Capacity at the Georgia Seaports
Organization:	Coastal Health District
Web site:	www.gachd.org
Overview:	The practice Building Collaborative Capacity at the Georgia Seaports targets international travelers and addresses the issues of infectious disease evaluation and response. The goal of this project is to build collaborative capacities among agencies and private companies to strengthen the role of local public health to detect, intercept, and mitigate the potential effects of a Class A, B or C biological agent or the intentional or unintentional introduction of a disease through port activity. Currently, effective collaborative processes between public health agencies and other local, state and federal partners in port security are weak and primarily the result of informal activities. Although port security receives considerable policy attention in other areas of risk management, such as radiological detection, public health investments are relatively neglected. The goal of this project was to engage in a collaborative process to strengthen relationships between the Coastal Health District/Georgia Division of Public Health, United States Customs and Border Protection, United States Coast Guard and the Centers for Disease Control Atlanta Quarantine Station thus leading to a more effective process for detecting and responding to a microbial threat at the Georgia Ports of Savannah and Brunswick. The probability of containing a disease of public health significance depends on how quickly the disease is detected and public health measures are implemented to limit spread. This speed of the process is directly dependent on multi-agency collaboration, communication and cooperation in detecting and responding to a microbial threat. This issue is of prime importance to homeland security because of the social and economic ramifications of a disease outbreak with high morbidity and mortality that could be prevented or mitigated through rapid detection and response. The threat of Pandemic Influenza imparts urgency to this task.
Year Submitted:	2007
Responsiveness and Innovation:	There were major gaps in interagency communication, information sharing and collaboration for a unified response to a biological threat originating at the Georgia Seaports which provided an impetus to engage in a collaborative process to strengthen relationships between the Coastal Health District/Georgia Division of Public Health, United States Customs and Border Protection, United States Coast Guard and the Centers for Disease Control Atlanta Quarantine Station. To ameliorate this lack of interagency communication, a series of meetings were scheduled to collaboratively develop a process to enhance information sharing, establish open communication channels, clarify agency roles and responsibilities, strengthen relationships and develop a unified response to a bio-security threat originating at the port. The Institute of Medicine published a report entitled “Quarantine Stations at Ports of Entry” which verified that these issues are not unique, but reflected a national deficiency in the collaborative capacity of local, state and federal agencies with overlapping jurisdiction and responsibility to protect the public from the threat of infectious diseases that originate abroad. The report recognized the criticality of local public health in disease detection and response at the nation’s ports of entry to support the core mission of the Centers for Disease Control Quarantine Stations to mitigate the risks to residents of the United States posed by infectious diseases of public health significance originating abroad. Federal, state and local stakeholders must delineate each partner’s role, authority and channel of communication to minimize the risk of microbial threats of public health significance entering the United States. Interagency communication, information sharing and collaborative planning for a unified response provide a framework for reducing the morbidity and mortality resulting from such an event. A coordinated effort by all responding agencies is necessary to contain the disease and reduce or prevent unnecessary exposure and transmission of the illness to the public at large. The Quarantine Station serving the Georgia Ports Authority is located in Atlanta, Georgia and is responsible for international arrivals in Georgia, North Carolina, South Carolina, Tennessee, Alabama, Mississippi, and Louisiana. Federal isolation and quarantine is authorized for nine communicable diseases including Cholera, Diphtheria, Tuberculosis, Plague, suspected Smallpox, Yellow Fever, Viral Hemorrhagic Fevers, SARS, and Novel Influenza. Obviously, international travelers do not arrive with an attached diagnostic label, making screening procedures vital to detection and response. Also obvious, CDC quarantine officers are not immediately available to provide medical evaluation for travelers with signs and symptoms of illness, making reporting procedures vital to appropriate intervention. Federal and state laws overlap in jurisdiction and authority once an international carrier arrives in the United States leading to some confusion over the role of each agency. Preservation of the public health is the responsibility of state and local agencies, but response to an infectious disease event requires communication and collaboration among local, state and federal entities with jurisdiction and responsibility for the containment. Primary quarantine authority is a function of state health officials, but the federal government exercises authority over interstate and foreign quarantine. Challenges evident in the quarantine process led to a proposal by the Department of Health and Human Services to update the Code of Federal Regulations 42 CFR Parts 70 and 71 to strengthen the capacity to enforce regulations. Gaps, barriers and shortfalls are evident in the current legislative and practice arena for isolation and quarantine, screening procedures, and reporting process for communicable diseases at the nation’s ports. Understanding these gaps, barriers and shortfalls are the first step in collaborative development of interagency best practices to effectively address biosecurity threats at the Georgia Ports.
Agency and Community Roles:	Incident Management: An Incident Command Structure (ICS) will be established to facilitate and coordinate the initial response by multiple agencies. When this SOP is activated, the Coastal Health District, ATL QS, USCG, CBP, Georgia Division of Public Health, local Emergency Management Agency and the Georgia Office of Homeland Security-Georgia Emergency Management Agency (OHS-GEMA) will respond under a Unified Command (UC) as operational authorities. Initially, Unified Command will be established by conference call communication with USCG, CBP, ATL QS, GDPH and CHD participation. If the incident expands beyond a limited public health concern, UC will be established at the Chatham or Glynn County Emergency Management Agency Emergency Operation Center as appropriate. The Federal Bureau of Investigation will assume the role of Incident Commander if the incident involves one of the Category A diseases or a credible threat of a federal offense. A Public Health Assessment and Surveillance Team (PHAST) may be activated and deployed to the Ports of Savannah or Brunswick to conduct public health field investigation activities. The mission of the team is to perform public health assessment and surveillance, and make recommendations to the District Health Director. The team is flexible in structure and is designed to meet the demands of the incident and may include an environmentalist, epidemiologist, nurse, physician or other public health specialist as required. PHAST, assisted by Emergency Medical Services, will evaluate, treat, and arrange transport of the reported ill traveler to prevent further complications or unnecessary communicable disease exposures.
Costs and Expenditures:	The cost incurred by all agencies will be monitored and annotated routinely. Their submission for reimbursement will be coordinated through the Unified Command Finance Section if there is a state or federally declared disaster.
Implementation:	There were major gaps in interagency communication, information sharing and collaboration for a unified response to a biological threat originating at the Georgia Seaports which provided an impetus to engage in a collaborative process to strengthen relationships between the Coastal Health District/Georgia Division of Public Health, United States Customs and Border Protection, United States Coast Guard and the Centers for Disease Control Atlanta Quarantine Station. To ameliorate this lack of interagency communication, a series of meetings were scheduled to collaboratively develop a process to enhance information sharing, establish open communication channels, clarify agency roles and responsibilities, strengthen relationships and develop a unified response to a bio-security threat originating at the port. The Institute of Medicine published a report entitled “Quarantine Stations at Ports of Entry” which verified that these issues are not unique, but reflected a national deficiency in the collaborative capacity of local, state and federal agencies with overlapping jurisdiction and responsibility to protect the public from the threat of infectious diseases that originate abroad. The report recognized the criticality of local public health in disease detection and response at the nation’s ports of entry to support the core mission of the Centers for Disease Control Quarantine Stations to mitigate the risks to residents of the United States posed by infectious diseases of public health significance originating abroad. Federal, state and local stakeholders must delineate each partner’s role, authority and channel of communication to minimize the risk of microbial threats of public health significance entering the United States. Interagency communication, information sharing and collaborative planning for a unified response provide a framework for reducing the morbidity and mortality resulting from such an event. A coordinated effort by all responding agencies is necessary to contain the disease and reduce or prevent unnecessary exposure and transmission of the illness to the public at large. The Quarantine Station serving the Georgia Ports Authority is located in Atlanta, Georgia and is responsible for international arrivals in Georgia, North Carolina, South Carolina, Tennessee, Alabama, Mississippi, and Louisiana. Federal isolation and quarantine is authorized for nine communicable diseases including Cholera, Diphtheria, Tuberculosis, Plague, suspected Smallpox, Yellow Fever, Viral Hemorrhagic Fevers, SARS, and Novel Influenza. Obviously, international travelers do not arrive with an attached diagnostic label, making screening procedures vital to detection and response. Also obvious, CDC quarantine officers are not immediately available to provide medical evaluation for travelers with signs and symptoms of illness, making reporting procedures vital to appropriate intervention. Federal and state laws overlap in jurisdiction and authority once an international carrier arrives in the United States leading to some confusion over the role of each agency. Preservation of the public health is the responsibility of state and local agencies, but response to an infectious disease event requires communication and collaboration among local, state and federal entities with jurisdiction and responsibility for the containment. Primary quarantine authority is a function of state health officials, but the federal government exercises authority over interstate and foreign quarantine. Challenges evident in the quarantine process led to a proposal by the Department of Health and Human Services to update the Code of Federal Regulations 42 CFR Parts 70 and 71 to strengthen the capacity to enforce regulations. Gaps, barriers and shortfalls are evident in the current legislative and practice arena for isolation and quarantine, screening procedures, and reporting process for communicable diseases at the nation’s ports. Understanding these gaps, barriers and shortfalls are the first step in collaborative development of interagency best practices to effectively address biosecurity threats at the Georgia Ports.
Sustainability:	Based on the collaborative process it is clear that effective disease detection and control is dependant upon a unified response by many local, state and federal entities as well as private partnerships with industry. The CDC Quarantine Station bears primary responsibility at the federal level, but it is unable to achieve its mission without a collaborative network of partner agencies and other community stakeholders. The challenge lies in the sustainability of this collaborative network and institutionalizing and formalizing the processes so that it does not depend on key individuals for success. The role of local public health is to support the operations of the Centers for Disease Control Quarantine Stations. The overlapping functions of local, state and federal public health to perform bio-security planning, surveillance, information sharing, assessment and response unite local, state and federal entities in protecting the population from microbial threats. Local public health provides the on-scene component for state and federal agencies in performing disease assessment, investigation and mitigation. Local public health has a responsibility to maintain a collaborative network of partner agencies and other community stakeholders for open communication, cooperation and information sharing. These relationships provide the portal through which the effectiveness of the ATL QS can be expanded at the local level.
Lessons Learned:	Compliance with disease reporting regulations for governmental and private industry workers is challenging in several respects: Identification of all stakeholders involved was not initially known. Knowledge of the mandates, regulations and mission of each stakeholder was not known. Vessel Masters, port industry and governmental workers may be unaware of disease reporting regulations. Straightforward notification policies and procedures to facilitate reporting were not in place. Confusion exists over which agency to notify and what circumstances should be reported. Workers may lack training to recognize, detect, report and respond to naturally occurring or bioterrorism disease events. Workers may lack expertise in identifying high risk health issues that demand urgent public health intervention. Education of all stakeholders is difficult because so many different entities from both the private and public sector are involved. Economic pressures to keep commerce moving and avoiding any delays in port are a barrier to reporting uncertain circumstances. The lack of a clearly defined protocol exacerbates these issues.

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