Central Asia Regional Health Security WorkshopGeorge C. Marshall European Center for Security Studies

17-19 April 2012, Garmisch-Partenkirchen, Germany

Sharon I. Peyus and Robert C. Hutchinson Homeland Security Investigations

U.S. Immigration and Customs EnforcementU.S. Department of Homeland Security

17 April 2012

Options for Preventing Disease Transmission at Borders – What Works and

What Does Not?

Introduction

• National Strategy Options– Containment

– Resilience

• What Works

• What Does Not Work

• Issues for Consideration

• Lessons Learned – Full Scale Exercise conducted at the Miami International

Airport, Miami, Florida USA

Containment vs. Resilience

• Resilience– Is resilience politically acceptable?

– Is resilience a socially acceptable concept?

– Can resilience be achieved with education and support?

• Containment– Is containment a viable option for

your resources?

– Is containment politically acceptable?

– Is containment realistic?

• Strategy Considerations– Detecting threat

– Screening

– Stopping or slowing entry of threat

– Quarantine and isolation

– Treatment

– Monitoring

– Challenges

• Expected to delay entry of threat for minimal amount of time

• Human and civil rights considerations

• Trade and economic considerations

• Realistic expectations

Containment Model

Resilience Model

• Strategy Considerations– Detecting threat

– Screening

– Acceptance of entry

– Quarantine and isolation

– Treatment

– Monitoring

– Challenges

• Clear explanation of public responsibilities and governmental capabilities for preparedness and response

• Information sharing and planning

• Leadership

Border Control Planning Efforts

• Border Environments and Their Challenges– Marine border and seaport

– Land border

– Airport

• Authorities and Agreements– To deny entry

– To detain, quarantine, or isolate

– To arrest

– To deport

– Options when deportation is refused

– Use of force

Border Control (cont’d)

• Border Options– Surveillance

– Restriction

– Partial closure

– Full closure

• Capabilities to Enforce Options– Authorities

– Staffing and resources

– Medical resources

– Surge capacity

– Cost and benefits for each option

What Works…

• Prior investment in pandemic preparedness

• Strengthening policies

• All hazards approach

• Surveillance activities

• Logistics

What Works (cont’d)

• Close cooperation and collaboration with all stakeholders – Public / Private sectors

– Non-governmental organizations

– Whole of Society

– Foreign neighbors

• Prevention and mitigation measures (information to mitigate the impact)– Non-pharmaceutical measures (hand washing, social

distancing, school closures, stockpiling of personal protective equipment)

What Does Not Work…

• Closing borders

• Inaccurate / inconsistent messaging

• Lack of multi-sector preparedness, planning and testing

• Lack of community based involvement and cross-border cooperation

What Does Not…(cont’d)

• Lack of support from senior leaders

• No vision for long-term capacity building (improved health care programs, education programs, community development)

• Lack of investment / resources

• No continuity planning

H1N1 Border Activities

• Referring symptomatic persons to a Centers for Disease Control and Prevention (CDC) quarantine station or local public health official for evaluation

• No closure of the United States / Mexico border– Scientific evidence did not support as an effective means of

controlling the spread

– Resource intensive

– Disruption of trade and economic interests

• Monitoring incoming travelers at ports of entry

• Providing information about disease control measures

Considerations

• Previous pandemic threats and health issues have proven difficult to control in a global economy

• The speed and ease of travel often reduces the ability to identify and mitigate a threat

• Social, economic and political considerations can affect or reduce policy and strategic options

Considerations (cont’d)

• Now is the time to develop realistic and flexible strategies and plans that take into consideration the points identified

• Understand that few strategies and plans fully survive their first encounter with any quickly evolving threat / event

Full Scale Exercise

Miami International Airport

Miami, Florida

USA

Lessons Learned Part 1

Miami International Airport

• Passengers: 38,314,389

– International: 18,417,513

– Domestic: 19,896,876

• Freight Tons: 2,000,042

• Mail Tons: 30,750

• Busiest U.S. airport for cargo

• 10th busiest airport for cargo in the world

• Freight Forwarders: 1,000

• Customs Brokers: 250

• Economic Impact: $26.7 Billion

Exercise in Airport Environment

• Exercise focused on influenza like symptoms reported on an inbound international flight by the airline

• Airport utilized thermal imaging and questionnaires for compliant passengers

• Several symptomatic passengers were referred for additional screening

• Personnel from several agencies worked well together

Lessons Learned

• Additional resources would be required, but limited in the best of times from federal, state and local partners

• Screening with sufficient staffing works

• Several large aircraft would quickly overwhelm resources

Lessons Learned (cont’d)

• Challenges for containment of passengers

• The current clearance process was not designed for the inclusion of public health screening

• Response depended on no other competing challenges or reduced staffing due to illness or health concerns

Questions?

Questions

Sharon I. Peyus(Former) Director

National Incident Response Unit

speyus@ice.dhs.gov

(202) 732-0331

Robert C. HutchinsonAssistant Special Agent in Charge

Homeland Security Investigations

rchutchi@ice.dhs.gov

(305) 597-6034

Thank You

References

• Congressional Research Service, The 2009 Influenza Pandemic: An Overview, August 6, 2009. Available at www.crs.gov

• Congressional Research Service, The 2009 Influenza Pandemic: Selected Legal Issues, R40560, October 29, 2009. Available at www.crs.gov

• Congressional Research Service, Immigration Policies and Issues on Health-Related Grounds for Exclusion, Report R40570, January 6, 2011. Available at www.crs.gov

• Homeland Security Council, National Strategy for Pandemic Influenza Implementation Plan, May 2006

• Homeland Security Council, National Strategy for Pandemic Influenza, November 2005