Examining HHS’s Public Health Preparedness for and Response to the 2017 Hurricane Season

This year’s Atlantic hurricane season has been unusually devastating. Throughout September and early October, Hurricanes Harvey, Irma, Jose, and Maria tore through vulnerable communities in Texas, Florida, Puerto Rico, and the U.S. Virgin Islands, leaving trails of destruction in their wake and dealing severe blows to the health, safety, and livelihoods of the affected populations. Despite the severity of the storms and their aftermath, the U.S. federal response has proven to be uneven and ineffective, particularly for Puerto Rico and the Virgin Islands. As of this writing, for instance, many Puerto Ricans still lack electricity and access to healthcare; much of the island also suffers from food and water insecurity.

On October 24, the U.S. House Committee on Energy and Commerce hosted a hearing, “Examining HHS’s Public Health Preparedness for and Response to the 2017 Hurricane Season,” to brief lawmakers on the efforts of four agencies within the Department of Health and Human Services (HHS) – the Food & Drug Administration (FDA), the Office of the Assistant Secretary for Preparedness and Response (ASPR), the Centers for Disease Control & Prevention (CDC), and the Centers for Medicare and Medicaid Services (CMS) – around hurricane response and recovery. Witnesses included Dr. Scott Gottlieb (Commissioner, FDA), Dr. Robert P. Kadlec (ASPR), Dr. Stephen Redd (CDC), and Ms. Kimberly Brandt (CMS).

The following are a few highlights from the witnesses’ testimony:

  • HHS has sent 439 tons of medical equipment and supplies. ASPR has deployed 2,500 personnel through NDMS, who have cared for more than 15,000 patients in Puerto Rico, Texas, Florida, and the Virgin Islands. More than 200 dialysis patients have been evacuated from the Virgin Islands.
  • CDC has activated its Emergency Operations Center, currently has about 500 staff coordinating the agency’s hurricane response efforts, and has deployed 70 staff (including 30 to Puerto Rico) to aid with response and recovery, as well as federal medical stations to serve as temporary, non-acute facilities.
  • CDC is using syndromic surveillance to monitor Puerto Rico for disease outbreaks, and CDC has arranged for clinical specimens to be transported to Atlanta to be tested for priority diseases (e.g., leptospirosis, TB, rabies, influenza, and salmonella) because much of the island’s laboratory infrastructure has been destroyed.
  • Puerto Rico is the manufacturing site for many medical products, including more than 1,000 medical devices and 15 sole-source drugs (i.e., drugs not produced anywhere else). FDA is working to help these companies get their power restored, as many are currently functioning at low capacity using temporary generators. The Committee members expressed concern about the potential implications of grid insecurity for medical supply shortages, both in Puerto Rico and on the U.S. mainland.
  • Nearly 50% of Puerto Rico is covered through a CMS program. CMS is working closely with ASPR to monitor the healthcare needs of vulnerable patients (especially dialysis patients), as well as track available supplies of fuel and water. CMS has also waived and/or modified certain rules that facilitate both Medicare enrollment and patient transportation between hospitals in the affected locations.

Notably, Congressman Raul Ruiz, MD (D-CA), who recently visited Puerto Rico, offered the witnesses a series of recommendations (see below; lightly edited for clarity) for leveraging U.S. federal response capabilities more effectively to meet the needs of hurricane victims, particularly those living in remote, underserved areas:

  • Establish a clear chain of command and clarify the roles and responsibilities of the responding agencies. Is FEMA running the show? Or is it HHS, the Department of Defense, or the Puerto Rican government? Command posts should be established on the ground to facilitate decision-making and resource allocation.
  • It is crucial to get into the remotest areas affected by the hurricanes and talk to people; we will not get the full picture by staying in San Juan.
  • There appears to be a lack of clarity in the metrics being used to assess the effectiveness of the federal response. We should be discussing capacities for ensuring food, water, and grid security in relation to the overall need of residents on the island.

We will continue to track and report on federal response and recovery efforts in the weeks and months to come.