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April 15, 2014
When leaders at the Centers for Disease Control and Prevention (CDC) identified the threat of disease outbreak, they turned to Booz Allen Hamilton for strategic direction and support to respond to those threats and protect global health. That partnership continues today.
In 2006, after poring over historical data, CDC experts had anticipated the potential for an influenza outbreak. At the time, the highly pathogenic H5N1 avian influenza epizootic was endemic in parts of Asia, Europe, and Africa. Although transmission of H5N1 to and between humans was rare, the CDC was on alert about potential spread to the Americas. Statistically speaking, we were overdue -- the last influenza pandemic was in 1968.
The CDC was concerned about the ability of the nation’s public health laboratories to handle the volume of biospecimen testing that would be needed leading up to, and during, a pandemic. To begin with, testing capacity across CDC and state-level public health laboratories was unknown. Could an undefined capacity match this hard-to-predict demand? Second, nationwide coordination and collaboration between CDC and state laboratories in an outbreak environment has been limited. Finally, workload capacity of the labs would likely be reduced during a pandemic by staff illness and potentially even death.
The CDC needed to coordinate, and assess the capabilities of, a national influenza response – without the expense of conducting a full-blown, all-hands pandemic exercise. How to do something of this magnitude in an age of limited resources? That’s when the CDC turned to us.
Booz Allen knew planning exercises like this had been done before. Success of prior studies, however, had been limited by over-reliance on approaches that were agnostic to scientific realities and laboratory processes. A more informed methodology was called for.
Booz Allen formed a cross-disciplinary stakeholder team of programmers and statisticians and also included infectious disease scientists and laboratory technicians with expertise performing influenza testing assays. This team worked with the CDC to transform their existing commercial process improvement modeling software.
Booz Allen designed custom software components so analysis could be tailored to reflect the nuances of individual laboratories. Our approach enabled all modeling data to be easily exported into Excel, providing an unprecedented level of transparency. This data was used by stakeholders to review the modeling as it unfolded, ensuring that day-to-day laboratory operations were accurately reflected and that improvements suggested by the simulation were feasible.
Booz Allen worked with the CDC and the Association of Public Health Laboratories (APHL) to conduct simulations at numerous laboratories and identify recommendations. For example, the modeling “put under the microscope” the common perception that simply adding additional high-throughput equipment (e.g., automated DNA extraction platforms) would help meet the testing demand. Recommendations instead pointed toward process modifications like assigning individuals a single step in the testing algorithm. This structure would allow the individual to become the “resident expert” in that particular step during surge periods, enabling greater efficiency and reducing bottlenecks.
The success of these recommendations developed in partnership with the CDC was not fully recognized until the H1N1 pandemic hit in 2009. By then, twenty different CDC and state-level laboratories had implemented the recommendations and had raised influenza testing capacity by an average of 82 to 195 specimens per day – an improvement of 138 percent.
Since this time, Booz Allen has applied our simulation capabilities to assess and improve capacity in other US and international laboratories. These models are regularly providing useful for surge event planning (e.g., pandemic, natural disaster, bio-terrorism) as well as return on investment testing and process streaming in more everyday environments. There is perhaps no better demonstration of how our work is improving public health safety in real-time than our “Protecting Public Health” video.
Years of successful work with the CDC has fueled our growth in the laboratory sciences. Who knows where the coming years will take us? Let’s find out.