Susan Fanelli

Where were you on 9/11? Were you part of the emergency response?
I was working for an investment management educational firm and preparing for international travel. I was in the office very early that morning and turned the television on to see the events unfolding live. I was not part of public health or the response activities but felt the very real impact of these events on the private sector.

What was your introduction to public health preparedness? How did you get involved with PHEP?

I got involved in public health emergency response in 2003. Coming from the private sector, which was very busy, I Iooked for a state position that would be fast paced. I was not disappointed.

After being hired at the California Department of Public Health (CDPH) Emergency Preparedness Office, I received a 17-page letter from CDC. It listed all the deficiencies in the California Public Health Emergency Preparedness Program. These deficiencies included the need for a state-of-the-art emergency operations center. As part of the leadership team, we advanced the program by increasing the size of the staff from a handful to nearly 100 staff in the Emergency Preparedness Office. We also had many more staff across the department work on the various PHEP focus areas.

What do you do on a day-to-day basis related to PHEP activities?
Currently, I provide oversight and direction as part of our executive team in the Director’s Office to our Emergency Preparedness Office. I co-lead the COVID-19 response for CDPH. During planning and response efforts, I also serve in a liaison/subject matter expert role with our Health and Human Services Agency, the Governor’s Office of Emergency Services, and the Governor’s Office.

State public health areas of oversight include coordination of public health emergency preparedness and response efforts and funding across California. CDPH provides guidance, planning, exercise, and support functions to allied agencies, local governments, emergency medical services organizations, and other public health organizations throughout the state. I am lucky to support the efforts of an amazing team of multidisciplinary employees. They include public health professionals, emergency response personnel, infectious disease specialists, grant and contract managers, and others.

Over your career, what changes have you seen in PHEP? How has public health preparedness evolved?

PHEP played an important role in improving the health and well-being of California’s communities. The events of 9/11 prompted public health and emergency response planning to include bioterrorist actions, medical operations training, health alert networks, risk communications, and other crisis response preparedness needs.

The role of preparedness and response expanded during the COVID-19 pandemic and with increases in other major hazards, such as large-scale wildfires, drought, and other climate change-related hazards, increasing infectious disease outbreaks, chemical disasters, and other public health threats. During the pandemic, public health maintained its core responsibilities while engaging in an emergency response at a scale never experienced before.

The biggest change I have seen during responses is the expectation that public health will always be at the table, which wasn’t always the case. In California, we added the Public Health and Medical Operations annex to the State Emergency Plan due to the role of state and local public health in response. Public health preparedness and response now functions as its own program with its own responsibilities.

The second biggest change is the bringing together of public health and medical response through the intersection of PHEP and ASPR’s Hospital Preparedness Program (HPP) funds. Now the coordination of public health and health care is embedded in the system. Local and state public health play a key role in reducing impacts to the health care delivery system.

How has PHEP supported preparedness in your jurisdiction? What’s the most significant impact PHEP has made in terms of your jurisdiction’s ability to respond to a public health threat?

In California, PHEP supports preparedness and response capability across 58 counties and 61 local health departments that serve a population of roughly 40 million. PHEP allowed every local health jurisdiction to build their ability for preparedness and response.

Funding, such as the PHEP cooperative agreement, supported California’s success in preparedness and response. The ability to prepare for and respond to public health and medical disasters contributed toward a better prepared California.

CDPH works with local health departments, health care coalitions, and other stakeholders to meet the requirements of the PHEP work plan. Together we collaborate on the development and testing of emergency preparedness plans, ensure preparedness for medical countermeasure distribution, and team together to conduct epidemiological surveillance.

CDPH and Emergency Medical Services Authority are co-leads for the California Emergency Support Function 8 – Public Health and Medical. CDPH also coordinates the state’s receipt, stage, and store warehouse; hosts the Medical Health Coordination Center; coordinates the department level continuity of operations plan; allocates PHEP, HPP, and state pandemic influenza funds; and monitors the grant subrecipients.

Reflecting on your career in public health emergency preparedness, what accomplishments are you most proud of?
I am most proud of the creation of the Public Health and Medical Emergency Operations Manual. It includes the development of regional assistance for public health and medical response mapping to the Emergency Management Mutual Aid Regions.

Representatives of state and local public health, emergency medical services, and other response groups developed this manual to cover the different types of emergencies and the role of public health. We think of it as the “3 a.m. emergency manual” to bring anyone up to speed on what needs to be done and how to coordinate response efforts.

Other than COVID-19, what public health emergency response experience stands out in your memory and why?

Two events stand out in my mind:

Camp Fire in Butte County in 2018

California is prone to an annual fire season. The response to the Butte County fire of 2018 affected this rural community tremendously. I was struck by the limited resources of the local health department, the shelters and pop-up shelters set up throughout the county, the number of deaths in this small community, and the ongoing impact on the health care delivery system. This event will forever impact my vision of what is needed during response to emergencies.

San Bernardino County Mass Shooting

This event in 2015 affected the local health department directly with many public health staff deaths. This event also showed that mass shootings could happen anywhere. Members of my team and several of our local partners were at a federal PHEP and HPP conference in San Diego that day when all of our phones and beepers went off at the same time. We set up a response center in the hotel pub. The event demonstrated the ability of the state and local jurisdictions to come together to not only address the immediate needs of the response but also the long-term impact on the San Bernardino Public Health Department. We shared local and state staff for many months to help the health department come back from this shock.

How do you maintain momentum and prevent personal burnout in the preparedness field? How do you do the same for your team?
This question is very timely as I think all of public health is exhausted with the ongoing COVID-19 response, infant formula shortages, monkeypox, fires, and public safety power shut offs. I am grateful for the amazing and committed staff in our department. They motivate and inspire me so that I do not get so burned out. I try support our team, break down barriers, and provide resources where we can to strengthen the response. This is often not soon enough or large enough.

I try to give them credit for the work they do and to take the heat when something goes wrong. A thank you and acknowledgement of the great work they are doing goes a long way. CDPH is trying to build more depth so that people can rotate out of response. I certainly encourage people to take time off when they can. We provide trauma responsive training. I think people appreciate taking time to learn and understand the impact of response on themselves and our staff.