Evaluating the Effectiveness of a Full-Scale Exercise of Epidemiologic Capacity for Bioterrorism Response

Introduction: In May 2016, the Texas Department of State Health Services Public Health Region 7, in partnership with the local health departments in their region, designed and conducted a full-scale exercise (FSE) with a real-time epidemiologic phase leading to full-scale medical countermeasures distribution. Methods: The exercise was designed to be a plausible scenario with a biologic agent that occurs naturally in Texas, Bacillus anthracis, and align with the Homeland Security Exercise and Evaluation Program (HSEEP) recommendations. After Action Reports (AAR) were reviewed and key informant interviews were conducted and content analyzed for themes through inductive coding. Results: Themes identified include: benefits to exercising epidemiology's role in public health preparedness; identification of gaps in real-time communication between public health and epidemiology; need to incorporate epidemiology into future exercises; importance of exercising realistic epidemiology scenarios in real-time; and identification of strengths and weakness in exercise coordination and logistics. Conclusion: There is value in exercising epidemiology capabilities in real-time and in an operational full-scale context. Fully incorporating epidemiology into public health emergency preparedness exercises is one way to strengthen the relationship between these two disciplines and ensure well-coordinated rapid responses to public health threats.