Source:
http://www.whitehouse.gov/news/releases/2007/10/20071018-10.html
Homeland Security Presidential
Directive
HOMELAND SECURITY PRESIDENTIAL DIRECTIVE/HSPD-21 Subject: Public
Health and Medical Preparedness Purpose (1)
This directive establishes a National Strategy for Public Health and
Medical Preparedness (Strategy), which builds upon principles set forth
in Biodefense for the 21st Century (April 2004) and will
transform our national approach to protecting the health of the
American people against all disasters. Definitions
(2) In this directive:
(a) The term “biosurveillance” means the process of active
data-gathering with appropriate analysis and interpretation of
biosphere data that might relate to disease activity and threats to
human or animal health – whether infectious, toxic, metabolic, or
otherwise, and regardless of intentional or natural origin – in order
to achieve early warning of health threats, early detection of health
events, and overall situational awareness of disease activity;
(b) The term “catastrophic health event” means any natural or manmade
incident, including terrorism, that results in a number of ill or
injured persons sufficient to overwhelm the capabilities of immediate
local and regional emergency response and health care systems;
(c) The term “epidemiologic surveillance” means the process of actively
gathering and analyzing data related to human health and disease in a
population in order to obtain early warning of human health events,
rapid characterization of human disease events, and overall situational
awareness of disease activity in the human population;
(d) The term “medical” means the science and practice of
maintenance
of health and prevention, diagnosis, treatment, and alleviation of
disease or injury and the provision of those services to individuals;
(e) The term “public health” means the science and practice of
protecting and improving the overall health of the community through
disease prevention and early diagnosis, control of communicable
diseases, health education, injury prevention, sanitation, and
protection from environmental hazards;
(f) The term “public health and medical preparedness” means the
existence of plans, procedures, policies, training, and equipment
necessary to maximize the ability to prevent, respond to, and recover
from major events, including efforts that result in the capability to
render an appropriate public health and medical response that will
mitigate the effects of illness and injury, limit morbidity and
mortality to the maximum extent possible, and sustain societal,
economic, and political infrastructure; and
(g) The terms “State” and “local government,” when used in a
geographical sense, have the meanings ascribed to such terms
respectively in section 2 of the Homeland Security Act of 2002 (6
U.S.C. 101).
Background (3) A catastrophic health event, such
as a terrorist attack with a weapon of mass destruction (WMD), a
naturally-occurring pandemic, or a calamitous meteorological or
geological event, could cause tens or hundreds of thousands of
casualties or more, weaken our economy, damage public morale and
confidence, and threaten our national security. It is therefore
critical that we establish a strategic vision that will enable a level
of public health and medical preparedness sufficient to address a range
of possible disasters.
(4) The United States has made significant
progress in public health and medical preparedness since 2001, but we
remain vulnerable to events that threaten the health of large
populations. The attacks of September 11 and Hurricane Katrina
were
the most significant recent disasters faced by the United States, yet
casualty numbers were small in comparison to the 1995 Kobe earthquake;
the 2003 Bam, Iran, earthquake; the 2004 Sumatra tsunami; and what we
would expect from a 1918-like influenza pandemic or large-scale WMD
attack. Such events could immediately overwhelm our public health
and
medical systems.
(5) This Strategy draws key principles from the National
Strategy for Homeland Security (October 2007), the National
Strategy to Combat Weapons of Mass Destruction (December 2002), and
Biodefense for the 21st Century (April
2004) that can be generally applied to public health and medical
preparedness. Those key principles are the following:
(1)
preparedness
for all potential catastrophic health events;
(2) vertical and
horizontal coordination across levels of government, jurisdictions, and
disciplines;
(3) a regional approach to health preparedness;
(4)
engagement of the private sector, academia, and other nongovernmental
entities in preparedness and response efforts; and
(5) the important
roles of individuals, families, and communities.
(6)
Present public
health and medical preparedness plans incorporate the concept of
“surging” existing medical and public health capabilities in response
to an event that threatens a large number of lives. The
assumption
that conventional public health and medical systems can function
effectively in catastrophic health events has, however, proved to be
incorrect in real-world situations. Therefore, it is necessary to
transform the national approach to health care in the context of a
catastrophic health event in order to enable U.S. public health and
medical systems to respond effectively to a broad range of incidents.
(7) The most effective complex service delivery systems
result
from
rigorous end-to-end system design. A critical and formal process
by
which the functions of public health and medical preparedness and
response are designed to integrate all vertical (through all levels of
government) and horizontal (across all sectors in communities)
components can achieve a much greater capability than we currently
have.
(8) The United States has tremendous resources in
both public
and private sectors that could be used to prepare for and respond to a
catastrophic health event. To exploit those resources fully, they
must
be organized in a rationally designed system that is incorporated into
pre-event planning, deployed in a coordinated manner in response to an
event, and guided by a constant and timely flow of relevant information
during an event. This Strategy establishes principles and
objectives
to improve our ability to respond comprehensively to
catastrophic health events. It also identifies critical
antecedent
components of this capability and directs the development of an
implementation plan that will delineate further specific actions and
guide the process to fruition.
(9) This Strategy focuses on
human
public health and medical systems; it does not address other areas
critical to overall public health and medical preparedness, such as
animal health systems, food and agriculture defense, global
partnerships in public health, health threat intelligence activities,
domestic and international biosecurity, and basic and applied research
in threat diseases and countermeasures. Efforts in those areas
are
addressed in other policy documents.
(10) It is not possible to
prevent all casualties in catastrophic events, but strategic
improvements in our Federal, State, and local planning can prepare our
Nation to deliver appropriate care to the largest possible number of
people, lessen the impact on limited health care resources, and support
the continuity of society and government.
Policy (11)
It is the
policy of the United States to plan and enable provision for the public
health and medical needs of the American people in the case of a
catastrophic health event through continual and timely flow of
information during such an event and rapid public health and medical
response that marshals all available national capabilities and
capacities in a rapid and coordinated manner. Implementation Actions
(12) Biodefense for the 21st Century
provides a foundation for the transformation of our catastrophic health
event response and preparedness efforts. Although the four
pillars of
that framework – Threat Awareness, Prevention and Protection,
Surveillance and Detection, and Response and Recovery – were
developed to guide our efforts to defend against a bioterrorist attack,
they are applicable to a broad array of natural and manmade public
health and medical challenges and are appropriate to serve as the core
functions of the Strategy for Public Health and Medical Preparedness.
(13) To accomplish our objectives, we must create a firm
foundation
for community medical preparedness. We will increase our efforts
to
inform citizens and empower communities, buttress our public health
infrastructure, and explore options to relieve current pressures on our
emergency departments and emergency medical systems so that they retain
the flexibility to prepare for and respond to events.
(14) Ultimately,
the Nation must collectively support and facilitate the establishment
of a discipline of disaster health. The specialty of emergency
medicine evolved as a result of the recognition of the special
considerations in emergency patient care, and similarly the recognition
of the unique principles in disaster-related public health and medicine
merit the establishment of their own formal discipline. Such a
discipline will provide a foundation for doctrine, education, training,
and research and will integrate preparedness into the public health and
medical communities. Critical Components of Public Health
and Medical Preparedness
(15) Currently, the four most critical components of
public
health and
medical preparedness are biosurveillance, countermeasure distribution,
mass casualty care, and community resilience. Although those
capabilities do not address all public health and medical preparedness
requirements, they currently hold the greatest potential for mitigating
illness and death and therefore will receive the highest priority in
our public health and medical preparedness efforts. Those
capabilities
constitute the focus and major objectives of this Strategy.
(16) Biosurveillance:
The United States must develop a nationwide, robust, and integrated
biosurveillance capability, with connections to international disease
surveillance systems, in order to provide early warning and ongoing
characterization of disease outbreaks in near real-time.
Surveillance
must use multiple modalities and an in-depth architecture. We
must
enhance clinician awareness and participation and strengthen laboratory
diagnostic capabilities and capacity in order to recognize potential
threats as early as possible. Integration of biosurveillance
elements
and other data (including human health, animal health, agricultural,
meteorological, environmental, intelligence, and other data) will
provide a comprehensive picture of the health of communities and the
associated threat environment for incorporation into the national
“common operating picture.” A central element of biosurveillance
must
be an epidemiologic surveillance system to monitor human disease
activity across populations. That system must be sufficiently
enabled
to identify specific disease incidence and prevalence in heterogeneous
populations and environments and must possess sufficient flexibility to
tailor analyses to new syndromes and emerging diseases. State and
local government health officials, public and private sector health
care institutions, and practicing clinicians must be involved in system
design, and the overall system must be constructed with the principal
objective of establishing or enhancing the capabilities of State and
local government entities.
(17) Countermeasure Stockpiling
and Distribution:
In the context of a catastrophic health event, rapid distribution of
medical countermeasures (vaccines, drugs, and therapeutics) to a large
population requires significant resources within individual
communities. Few if any cities are presently able to meet the
objective of dispensing countermeasures to their entire population
within 48 hours after the decision to do so. Recognizing that
State
and local government authorities have the primary responsibility to
protect their citizens, the Federal Government will create the
appropriate framework and policies for sharing information on best
practices and mechanisms to address the logistical challenges
associated with this requirement. The Federal Government must
work
with nonfederal stakeholders to create effective templates for
countermeasure distribution and dispensing that State and local
government authorities can use to build their own
capabilities.
(18)
Mass Casualty Care: The structure and operating principles
of
our day-to-day public health and medical systems cannot meet the needs
created by a catastrophic health event. Collectively, our Nation
must
develop a disaster medical capability that can immediately re-orient
and coordinate existing resources within all sectors to satisfy the
needs of the population during a catastrophic health event. Mass
casualty care response must be (1) rapid, (2) flexible, (3) scalable,
(4) sustainable, (5) exhaustive (drawing upon all national resources),
(6) comprehensive (addressing needs from acute to chronic care and
including mental health and special needs populations), (7) integrated
and coordinated, and (8) appropriate (delivering the correct treatment
in the most ethical manner with available capabilities). We must
enhance our capability to protect the physical and mental health of
survivors; protect responders and health care providers; properly and
respectfully dispose of the deceased; ensure continuity of society,
economy, and government; and facilitate long-term recovery of affected
citizens.
(19) The establishment of a robust disaster health
capability requires us to develop an operational concept for the
medical response to catastrophic health events that is substantively
distinct from and broader than that which guides day-to-day operations.
In order to achieve that transformation, the Federal Government
will
facilitate and provide leadership for key stakeholders to establish the
following four foundational elements: Doctrine, System Design,
Capacity, and Education and Training. The establishment of those
foundational elements must result from efforts within the relevant
professional communities and will require many years, but the Federal
Government can serve as an important catalyst for this
process.
(20) Community Resilience: The above
components
address the
supply side of the preparedness function, ultimately providing enhanced
services to our citizens. The demand side is of equal
importance.
Where local civic leaders, citizens, and families are educated
regarding threats and are empowered to mitigate their own risk, where
they are practiced in responding to events, where they have social
networks to fall back upon, and where they have familiarity with local
public health and medical systems, there will be community resilience
that will significantly attenuate the requirement for additional
assistance. The Federal Government must formulate a comprehensive
plan
for promoting community public health and medical preparedness to
assist State and local authorities in building resilient communities in
the face of potential catastrophic health events.
Biosurveillance
(21)
The Secretary of Health and Human Services shall
establish
an
operational national epidemiologic surveillance system for human
health, with international connectivity where appropriate, that is
predicated on State, regional, and community-level capabilities and
creates a networked system to allow for two-way information flow
between and among Federal, State, and local government public health
authorities and clinical health care providers. The system shall
build
upon existing Federal, State, and local surveillance systems where they
exist and shall enable and provide incentive for public health agencies
to implement local surveillance systems where they do not exist.
To
the extent feasible, the system shall be built using electronic health
information systems. It shall incorporate flexibility and depth
of
data necessary to respond to previously unknown or emerging threats to
public health and integrate its data into the national biosurveillance
common operating picture as appropriate. The system shall protect
patient privacy by restricting access to identifying information to the
greatest extent possible and only to public health officials with a
need to know. The Implementation Plan to be developed pursuant to
section 43 of this directive shall specify milestones for this
system.
(22) Within 180 days after the date of this directive, the
Secretary
of Health and Human Services, in coordination with the Secretaries of
Defense, Veterans Affairs, and Homeland Security, shall establish an
Epidemiologic Surveillance Federal Advisory Committee, including
representatives from State and local government public health
authorities and appropriate private sector health care entities, in
order to ensure that the Federal Government is meeting the goal of
enabling State and local government public health surveillance
capabilities.
Countermeasure Stockpiling
and Distribution
(23)
In accordance with the schedule set forth below, the
Secretary of
Health and Human Services, in coordination with the Secretary of
Homeland Security, shall develop templates, using a variety of tools
and including private sector resources when necessary, that provide
minimum operational plans to enable communities to distribute and
dispense countermeasures to their populations within 48 hours after a
decision to do so. The Secretary of Health and Human Services
shall
ensure that this process utilizes current cooperative programs and
engages Federal, State, local government, and private sector entities
in template development, modeling, testing, and evaluation. The
Secretary shall also assist State, local government, and regional
entities in tailoring templates to fit differing geographic sizes,
population densities, and demographics, and other unique or specific
local needs. In carrying out such actions, the Secretary shall:
(a) within 270 days after the date of this directive, (i)
publish an initial template or templates meeting the requirements
above, including basic testing of component distribution mechanisms and
modeling of template systems to predict performance in large-scale
implementation, (ii) establish standards and performance measures for
State and local government countermeasure distribution systems,
including demonstration of specific capabilities in tactical exercises
in accordance with the National Exercise Program, and (iii) establish a
process to gather performance data from State and local participants on
a regular basis to assess readiness; and
(b) within 180 days after the completion of the tasks set forth in (a),
and with appropriate notice, commence collecting and using performance
data and metrics as conditions for future public health preparedness
grant funding.
(24) Within 270 days after the date of this directive, the
Secretary
of Health and Human Services, in coordination with the Secretaries of
Defense, Veterans Affairs, and Homeland Security and the Attorney
General, shall develop Federal Government capabilities and plans to
complement or supplement State and local government distribution
capacity, as appropriate and feasible, if such entities’ resources are
deemed insufficient to provide access to countermeasures in a timely
manner in the event of a catastrophic health event.
(25) The
Secretary
of Health and Human Services shall ensure that the priority-setting
process for the acquisition of medical countermeasures and other
critical medical materiel for the Strategic National Stockpile (SNS) is
transparent and risk-informed with respect to the scope, quantities,
and forms of the various products. Within 180 days after the date
of
this directive, the Secretary, in coordination with the Secretaries of
Defense, Homeland Security, and Veterans Affairs, shall establish a
formal mechanism for the annual review of SNS composition and
development of recommendations that utilizes input from accepted
national risk assessments and threat assessments, national planning
scenarios, national modeling resources, and subject matter
experts.
The results of each such annual review shall be provided to the
Director of the Office of Management and Budget and the Assistant to
the President for Homeland Security and Counterterrorism at the time of
the Department of Health and Human Services’ next budget submission.
(26) Within 90 days after the date of this directive, the
Secretary of
Health and Human Services shall establish a process to share relevant
information regarding the contents of the SNS with Federal, State, and
local government health officers with appropriate clearances and a need
to know.
(27) Within 180 days after the date of this directive,
the
Secretary of Health and Human Services, in coordination with the
Secretaries of State, Defense, Agriculture, Veterans Affairs, and
Homeland Security, shall develop protocols for sharing countermeasures
and medical goods between the SNS and other Federal stockpiles and
shall explore appropriate reciprocal arrangements with foreign and
international stockpiles of medical countermeasures to ensure the
availability of necessary supplies for use in the United States.
Mass
Casualty Care (28)
The Secretary of Health and Human Services, in
coordination with the
Secretaries of Defense, Veterans Affairs, and Homeland Security, shall
directly engage relevant State and local government, academic,
professional, and private sector entities and experts to provide
feedback on the review of the National Disaster Medical System and
national medical surge capacity required by the Pandemic and
All-Hazards Preparedness Act (PAHPA) (Public Law 109-417) .
Within
270 days after the completion of such review, the Secretary shall
identify, through a systems-based approach involving expertise from
such entities and experts, high-priority gaps in mass casualty care
capabilities, and shall submit to the Assistant to the President for
Homeland Security and Counterterrorism a concept plan that identifies
and coordinates all Federal, State, and local government and private
sector public health and medical disaster response resources, and
identifies options for addressing critical deficits, in order to
achieve the system attributes described in this Strategy.
(29)
Within
180 days after the date of this directive, the Secretary of Health and
Human Services, in coordination with the Secretaries of Defense,
Veterans Affairs, and Homeland Security, shall:
(a) build upon the analysis of Federal facility use to
provide enhanced medical surge capacity in disasters required by
section 302 of PAHPA to analyze the use of Federal medical facilities
as a foundational element of public health and medical preparedness;
and
(b) develop and implement plans and enter into agreements to integrate
such facilities more effectively into national and regional education,
training, and exercise preparedness activities.
(30) The Secretary of Health and Human Services shall lead
an
interagency process, in coordination with the Secretaries of Defense,
Veterans Affairs, and Homeland Security and the Attorney General, to
identify any legal, regulatory, or other barriers to public health and
medical preparedness and response from Federal, State, or local
government or private sector sources that can be eliminated by
appropriate regulatory or legislative action and shall, within 120 days
after the date of this directive, submit a report on such barriers to
the Assistant to the President for Homeland Security and
Counterterrorism.
(31) The impact of the “worried well” in
past
disasters is well documented, and it is evident that mitigating the
mental health consequences of disasters can facilitate effective
response. Recognizing that maintaining and restoring mental
health in
disasters has not received sufficient attention to date, within 180
days after the date of this directive, the Secretary of Health and
Human Services, in coordination with the Secretaries of Defense,
Veterans Affairs, and Homeland Security, shall establish a Federal
Advisory Committee for Disaster Mental Health. The committee
shall
consist of appropriate subject matter experts and, within 180 days
after its establishment, shall submit to the Secretary of Health and
Human Services recommendations for protecting, preserving, and
restoring individual and community mental health in catastrophic health
event settings, including pre-event, intra-event, and post-event
education, messaging, and interventions.
Community
Resilience
(32)
The Secretary of Health and Human Services, in
coordination
with
the Secretaries of Defense, Veterans Affairs, and Homeland Security,
shall ensure that core public health and medical curricula and training
developed pursuant to PAHPA address the needs to improve individual,
family, and institutional public health and medical preparedness,
enhance private citizen opportunities for contributions to local,
regional, and national preparedness and response, and build resilient
communities.
(33) Within 270 days after the date of this
directive,
the Secretary of Health and Human Services, in coordination with the
Secretaries of Defense, Commerce, Labor, Education, Veterans Affairs,
and Homeland Security and the Attorney General, shall submit to the
President for approval, through the Assistant to the President for
Homeland Security and Counterterrorism, a plan to promote comprehensive
community medical preparedness.
Risk Awareness (34)
The
Secretary of Homeland Security, in coordination with the Secretary of
Health and Human Services, shall prepare an unclassified briefing for
non-health professionals that clearly outlines the scope of the risks
to public health posed by relevant threats and catastrophic health
events (including attacks involving weapons of mass destruction), shall
coordinate such briefing with the heads of other relevant executive
departments and agencies, shall ensure that full use is made of
Department of Defense expertise and resources, and shall ensure that
all State governors and the mayors and senior county officials from the
50 largest metropolitan statistical areas in the United States receive
such briefing, unless specifically declined, within 150 days after the
date of this directive.
(35) Within 180 days after the date of
this
directive, the Secretary of Homeland Security, in coordination with the
Attorney General, the Secretary of Health and Human Services, and
the
Director of National Intelligence, shall establish a mechanism by which
up-to-date and specific public health threat information shall be
relayed, to the greatest extent possible and not inconsistent with the
established guidance relating to the Information Sharing Environment,
to relevant public health officials at the State and local government
levels and shall initiate a process to ensure that qualified heads of
State and local government entities have the opportunity to obtain
appropriate security clearances so that they may receive classified
threat information when applicable.
Education and Training
(36)
Within 180 days after the date of this directive, the
Secretary
of Health and Human Services, in coordination with the Secretary of
Homeland Security, shall develop and thereafter maintain processes for
coordinating Federal grant programs for public health and medical
preparedness using grant application guidance, investment
justifications, reporting, program performance measures, and
accountability for future funding in order to promote cross-sector,
regional, and capability-based coordination, consistent with section
201 of PAHPA and the National Preparedness Guidelines developed
pursuant to Homeland Security Presidential Directive-8 of December 17,
2003 (“National Preparedness”).
(37) Within 1 year after the date
of
this directive, the Secretary of Health and Human Services, in
coordination with the Secretaries of Defense, Transportation, Veterans
Affairs, and Homeland Security, and consistent with section 304 of
PAHPA, shall develop a mechanism to coordinate public health and
medical disaster preparedness and response core curricula and training
across executive departments and agencies, to ensure standardization
and commonality of knowledge, procedures, and terms of reference within
the Federal Government that also can be communicated to State and local
government entities, as well as academia and the private
sector.
(38) Within 1 year after the date of this directive, the
Secretaries
of Health and Human Services and Defense, in coordination with the
Secretaries of Veterans Affairs and Homeland Security, shall establish
an academic Joint Program for Disaster Medicine and Public Health
housed at a National Center for Disaster Medicine and Public Health at
the Uniformed Services University of the Health Sciences. The
Program
shall lead Federal efforts to develop and propagate core curricula,
training, and research related to medicine and public health in
disasters. The Center will be an academic center of excellence in
disaster medicine and public health, co-locating education and research
in the related specialties of domestic medical preparedness and
response, international health, international disaster and humanitarian
medical assistance, and military medicine. Department of Health
and
Human Services and Department of Defense authorities will be used to
carry out respective civilian and military missions within this joint
program.
Disaster Health System
(39) Within 180 days
after the
date of this directive, the Secretary of Health and Human Services
shall commission the Institute of Medicine to lead a forum engaging
Federal, State, and local governments, the private sector, academia,
and appropriate professional societies in a process to facilitate the
development of national disaster public health and medicine doctrine
and system design and to develop a strategy for long-term enhancement
of disaster public health and medical capacity and the propagation of
disaster public health and medicine education and training.
(40)
Within 120 days after the date of this directive, the Secretary of
Health and Human Services shall submit to the President through the
Assistant to the President for Homeland Security and Counterterrorism,
and shall commence the implementation of, a plan to use current grant
funding programs, private payer incentives, market forces, Center for
Medicare and Medicaid Services requirements, and other means to create
financial incentives to enhance private sector health care facility
preparedness in such a manner as to not increase health care costs.
(41) Within 180 days after the date of this directive, the
Secretary
of Health and Human Services, in coordination with the Secretaries of
Transportation and Homeland Security, shall establish within the
Department of Health and Human Services an Office for Emergency Medical
Care. Under the direction of the Secretary, such Office shall
lead an
enterprise to promote and fund research in emergency medicine and
trauma health care; promote regional partnerships and more effective
emergency medical systems in order to enhance appropriate triage,
distribution, and care of routine community patients; promote local,
regional, and State emergency medical systems’ preparedness for and
response to public health events. The Office shall address the
full
spectrum of issues that have an impact on care in hospital emergency
departments, including the entire continuum of patient care from
pre-hospital to disposition from emergency or trauma care. The
Office
shall coordinate with existing executive departments and agencies that
perform functions relating to emergency medical systems in order to
ensure unified strategy, policy, and implementation.
National
Health Security Strategy
(42) The PAHPA requires that the Secretary of Health and
Human Services
submit in 2009, and quadrennially afterward, a National Health Security
Strategy (NHSS) to the Congress. The principles and actions in
this
directive, and in the Implementation Plan required by section 43, shall
be incorporated into the initial NHSS, as appropriate, and shall serve
as a foundation for the preparedness goals contained therein.
Task
Force and Implementation Plan
(43)
In order to facilitate the implementation of the policy outlined in
this Strategy, there is established the Public Health and Medical
Preparedness Task Force (Task Force). Within 120 days after the
date
of this directive, the Task Force shall submit to the President for
approval, through the Assistant to the President for Homeland Security
and Counterterrorism, an Implementation Plan (Plan) for this Strategy,
and annually thereafter shall submit to the Assistant to the President
for Homeland Security and Counterterrorism a status report on the
implementation of the Plan and any recommendations for changes to this
Strategy.
(a) The Task Force shall consist exclusively of the
following members (or their designees who shall be full-time officers
or employees of the members’ respective agencies):
(i) The Secretary of Health and Human Services, who
shall serve as Chair;
(ii) The Secretary of State;
(ii) The Secretary of Defense;
(iii) The Attorney General;
(iv) The Secretary of Agriculture;
(v) The Secretary of Commerce;
(vi) The Secretary of Labor;
(vii) The Secretary of Transportation;
(viii) The Secretary of Veterans Affairs
(ix) The Secretary of Homeland Security;
(x) The Director of the Office of Management and Budget;
(xi) The Director of National Intelligence; and
(xii) such other officers of the United States as the Chair of the Task
Force may designate from time to time.
(b) The Chair of the Task Force shall, as appropriate to deal with
particular subject matters, establish subcommittees of the Task Force
that shall consist exclusively of members of the Task Force (or their
designees under subsection (a) of this section), and such other
full-time or permanent part-time officers or employees of the Federal
Government as the Chair may designate.
(c) The Plan shall:
(i) provide additional detailed roles and
responsibilities of heads of
executive departments and agencies relating to and consistent with the
Strategy and actions set forth in this directive;
(ii) provide additional guidance on public health and medical
directives in Biodefense for the 21st Century; and
(iii) direct the full examination of resource requirements.
(d) The Plan and all Task Force reports shall be developed in
coordination with the Biodefense Policy Coordination Committee of the
Homeland Security Council and shall then be prepared for consideration
by and submitted to the more senior committees of the Homeland Security
Council, as deemed appropriate by the Assistant to the President for
Homeland Security and Counterterrorism.
General Provisions (44) This directive:
(a) shall
be implemented consistent with
applicable law and the authorities of executive departments and
agencies, or heads of such departments and agencies, vested by law, and
subject to the availability of appropriations and within the current
projected spending levels for Federal health entitlement programs;
(b) shall not be
construed to impair or otherwise affect the
functions of the Director of the Office of Management and Budget
relating to budget, administrative, and legislative proposals; and
(c) is not intended,
and does not, create any rights or
benefits, substantive or procedural, enforceable at law or in equity by
a party against the United States, its departments, agencies,
instrumentalities, or entities, its officers, employees, or agents, or
any other person.