Two very different challenges, and one shared public health reality: systems have to work when it matters most. In this episode, we speak with Dr. Erica Pan, director and state public health officer for the California Department of Public Health, and ASTHO member, about a rare and unprecedented infant botulism outbreak linked to contaminated infant formula. She explains how California’s unique Baby BIG® treatment program, home to the only infant botulism treatment in the world, helped detect a national pattern, how states coordinated with CDC and FDA, and the logistical strain of managing treatment supply, clinician hotlines, and public communication during a fast-moving emergency. Then, Alex Wheatley, senior director of island support at ASTHO, joins us to discuss a different kind of pressure point: helping U.S. Island jurisdictions navigate complex federal grant systems. She outlines a new resource designed to bridge gaps between federal funders and local health agencies, reduce misunderstandings, and build stronger, trust-based partnerships, especially when timelines, administrative processes, and time zones don’t align.
State Health Agencies’ Role in Implementing Pharmacist-Prescribed Contraception | ASTHO
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This is Public Health Review
MORNING Edition for Thursday,
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February 5th, 2026.
I'm John Sheehan with news from
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the Association of State and
Territorial Health Officials.
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Today we'll hear about a rare
and unprecedented infant
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Botulism outbreak linked to
contaminated infant formula from
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Doctor Eric Upon, director and
state Public health officer for
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the California Department of
Public Health and ASTO member.
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California is home to the only
infant Botulism treatment in the
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world.
Later, we'll change gears and
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hear how ASTO is helping US
island jurisdictions navigate
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complex federal grant systems.
Our guest, Alex Wheatley, Senior
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Director of Island Support at
ASTO, joins us to discuss a new
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resource designed to bridge gaps
between federal funders and
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local health agencies.
But let's start with Doctor Eric
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Upon.
I wanted to know how
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California's Infant Botulism
Treatment Prevention Program
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first detected the most recent
increase in cases and what
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sparked the investigation.
We have a really unique program
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here in the California
Department of Public Health,
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where we had developed this
product called Baby Big, which
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is the only treatment in the
world actually much less the
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country, for infant Botulism
specifically.
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It was developed in the 1990s.
We actually got FDA approval to
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produce this drug in 2003.
So it's the only source.
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And our clinicians who run this
program received calls from
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clinicians all over the country
with suspect cases.
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And then after they determine if
it's an actual case or or
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worrisome for a case, they
actually send the treatment out
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and also facilitate making sure
that the infant gets tested.
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So because they get that first
line call on these suspect
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cases, they started to notice
this pattern of, gosh, it seems
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like we've heard a few Times Now
that these cases have consumed
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this particular brand of infant
formula.
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So that's sort of the the
background of how it evolved and
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why a California specifically
started noting a national
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outbreak.
This is the only product we have
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like this.
It's definitely a unique role
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for a health department to have
and just due to some really
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amazing scientists and dedicated
people who who worked on this
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decades ago.
And Doctor Pan, was there
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anything unusual about this
outbreak?
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Yes, I think it's important for
people to kind of know and
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recognize that infant Botulism
in general is typically what we
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would call a sporadic disease.
And we often don't find out what
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the source is.
It's it's a common spore in the
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environment.
It can be in dust and soil.
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So most of the time we actually
don't know what an exposure is
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for infants.
It was really unusual and
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remarkable that this was the
first contamination of infant
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formula and the first outbreak
like this of a contaminated
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infant formula.
And what can other states do to
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coordinate?
With with.
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CDC with the FDA.
If.
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If they start seeing their own
rising cases.
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Yes, all of these cases are
reportable to the CDC and
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there's been a lot of great
coordination with our department
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and the CDC and the FDA that
does the investigation of the
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actual formula manufacturer and
producer.
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And this works like many other
reportable infectious diseases
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or outbreak investigations.
So frontline health departments
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end up hearing about, you know,
a rise in cases or see a pattern
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and then there can be a multi
state coordination and
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investigation.
So this happens with again, many
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other large infectious disease
outbreaks as well.
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And that coordination has gone
well between the CDCFDA, our
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department and then the other
states that have had cases.
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It strikes me as.
Kind of incredible that the
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California Department has such a
this robust program that it
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developed Baby big, the only
treatment for infant Botulism.
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How does that?
Distribution work.
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How are you able to distribute?
It nationally.
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Yeah.
We've spent a lot of time,
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especially recently with this
outing making sure we have a
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sufficient supply.
We do have a fee that gets sent
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for the treatment and then, you
know, that goes into a special
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fund to help do the production
and manufacturing.
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We've definitely been watching
very closely over time.
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There are lots that are created
and then, you know, projections
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that have happened historically
on how much do we think we, you
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know, need and use.
And we were concerned during the
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peak of this outbreak that we
might need to do some other
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things to make sure there was
enough.
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Thankfully, the outbreak does
seem to have subsided.
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We have once the recall happened
of the Bahart and the formula,
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we've not seen new cases since
December, I believe.
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So we seem to be on track to
have sufficient supply of this
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baby big product.
But it is something that we were
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working closely with the FDA and
others to make sure we would
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have enough.
That would that should have been
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one of my earlier questions is
what is the status of the
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outbreak.
So cases are are are going down.
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The worst seems to be behind us.
Yes, that's right.
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There was a total of 51 cases
nationally especially they
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looked back at before this year
and there were a few additional
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infants that had consumed the
same by heart formula, but 51
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cases as of mid-december and no
new cases that we've identified
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since then.
And another aspect of of the
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response has been a a hotline
set up to specifically address
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infant Botulism.
Can you tell us about it?
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Sure.
And I would just say that this
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is definitely an area that I
have encountered both in my work
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at the local level and at the
state level.
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Occasionally when there is a big
public health emergency, there
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are a lot of important questions
from the public and ideally you
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set up a way to triage those so
that the public can get some of
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their questions answered.
But people who are doing the
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investigations of highly
suspicious cases or in this
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case, clinicians are able to get
through as well to get the
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information and the potential
treatment and testing needed.
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So this evolved because we have
a hotline in general for
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clinicians across the country to
call when they have a suspect
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case.
But as the news got out about
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this outbreak, there were more
and more calls.
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So we tried to offload that
first with some of our own
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staff.
And so we actually cross trained
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some of our staff within the
state health department to help
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answer some of the calls from
the public or families or
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concerned families related to
the outbreak.
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We were also at the same time
thinking about trying to
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reactivate a contract that we
used during the COVID pandemic
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when we stood up a public
hotline as well.
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But I will say this is a real
challenge in public health in
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general where we are often
trying to have things on the
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ready or standby for surges or
emergencies and often have
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challenges in the administrative
processes or the resources to do
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that.
In the end, thankfully, again,
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because the outbreak subsided
and the calls subsided, we were
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able to redirect to our our sort
of normal processes and we've
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been able to allow the staff
that had been redirected to
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answer calls go back to their
normal work.
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And we didn't activate this
other contract.
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But I do think it's, it's an
ongoing challenge that I would
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actually love to learn from
other health departments as
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well, if they've been able to
figure this out on how to have
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some sort of standby call Center
for these kinds of situations.
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Because it very quickly becomes
an important issue.
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And you can get your sort of
usual investigators or
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responders can get flooded when
you want to be able to offload
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that so that you don't delay the
investigation or or in this case
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treatment of cases.
And something that goes sort of
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hand in hand with the hotline is
making sure that people know
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that a hotline exists or just
that there are rising cases and
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and for the public to be aware
of it.
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Can you talk about sort of the
challenges?
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Of just getting.
That word out?
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Sure.
I think it's another important
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role of health departments.
When you have these outbreaks
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and you're looking to increase
awareness and also increase
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detection, sometimes many of
these diseases might start very
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non specifically this particular
disease of infant Botulism can
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be quite distinctive once it
progresses.
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So babies are very weak and
floppy.
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They don't have head control,
but really making sure people
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are alerted quickly to get seen
by their health care provider
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and doing health alerts and or
public information is the other
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thing that we encourage health
departments across the country
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to do.
When we were all learning about
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this multi state outbreak
because this product was
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distributed to many states.
So that's just another role I
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think we're always working on
together as a public health
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community to get information out
to help providers and also
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families and the public's that
they know to look for certain
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signs or symptoms and report
them so they can get the help
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they need.
Doctor Eric Upon is director and
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state public health officer for
the California Department of
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Public Health and an ASTO
member.
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Now let's hear from Alex
Wheatley, senior director of
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Island Support at ASTO, who will
explain a new resource designed
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to help island and territorial
public health systems navigate
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federal grant requirements.
So we have a lot of wisdom in
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our island areas workgroup,
health financing subgroup.
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These are the folks that get
asked difficult questions around
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grants management all the time.
And they said, you know, it'd be
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great if there was a centralized
resource that had all of this.
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It felt particularly important
with all the federal
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uncertainty.
Right now, as funding shifts or
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is a little bit unclear, it's
more important than ever to have
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strong relationships between
grand tours and grantees.
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So what kind of information were
they?
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Were they being asked to share?
A wide variety.
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So some of the common paying
points are around federal grant
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platforms and processes, who
needs access to what and when.
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They also got sort of the
inverse of that question.
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Grant grantor is not
understanding what the local
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processes were.
So they said, well, why can't
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you fix this?
And the health agency would say,
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because that's the Department of
Finance's job.
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So just clarifying some
expectations there.
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And this sort of gets to this
sense of foundational knowledge
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that gets mentioned a lot.
And in the report, what are some
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other sort of common
misconceptions that that both
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sides were not seeing?
Yeah, I think it's really
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important for project officers
and technical monitors to
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understand what's happening on
the ground.
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Just as important as grantees
understanding the current
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federal guidance, I think those
sorts of details are what prompt
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effective spend down and
actually prompts the impacts
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that federal grantors and
grantees want to see.
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But those conversations don't
always come up at the start of
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the grant period, and that's
what this resource is really
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trying to prompt.
Yeah.
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Can you give us some examples of
the kinds of things that that
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are in the resource?
Sure.
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So the resources really built
around conversation prompts.
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It's broken into five different
sections of sorts of pain points
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that we know come up frequently.
And then within those, it
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provides a little bit of
background about what grantors
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need to know and what grantees
need to know, and then questions
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to help a productive
conversation at the start of the
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grant period to identify some of
those pain points and then avoid
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them.
The Federated States of
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Micronesia is 1 of Asto's
members.
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Their National Health agency.
I'm going to refer to them as
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FSM National.
Before FSM National can spend
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down funds that CDC has awarded
to them, the FSM Congress has to
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approve those funds and
establish an account.
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Congress meets once 1/4.
In addition, where the funds
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actually get spent is at the
local level.
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For FSM National to pass the
funds to local, local
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legislature also has to meet and
set up an account.
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That whole process can mean 6 to
8 months before any dollars can
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be spent, and it's important
that federal funders understand
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that.
Gotcha.
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And because it's relying on 2
systems that don't necessarily
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talk to each other or wouldn't
have been consulted ahead of
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this grant, it's important to
have some kind of link to
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explain those differences.
Exactly.
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Federal funders say, well, we
haven't seen the request come
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through to draw down the funds.
And FSM says of course you
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haven't, it's only in stage 2 of
17, but that's not always clear.
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And so to to that point there
are there are suggested changes
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within the report.
What kinds?
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What kinds of changes do you
suggest, and is it for the
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grantees?
Or the grantors.
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It's for both.
I think we really leaned on the
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wisdom of the health financing
subgroup.
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It is the grants management
staff from islands, from federal
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agencies, from nonprofits
suggesting just some best
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practices that they've seen work
in terms of how do you monitor
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your spend down?
How do you keep up to date on
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the most recent federal
guidance?
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How do you troubleshoot when
things come up?
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There are best practices, but
they're not easy to find.
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So this resource, we hope, makes
them easy to find.
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Yeah.
And are there other steps for
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just improving the?
Overall relationship.
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I think it's it's all about.
Trust.
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It's all about communication and
it's about setting feasible
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expectations.
And I think those things are
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hard.
There isn't an easy answer, but
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prompting some conversations to
get at some of these issues
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early and then sort of making it
clear that you're on the same
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team and you want these funds to
be used for these purposes with
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00:13:24,360 --> 00:13:26,360
these impacts, that can go a
long way.
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00:13:27,400 --> 00:13:29,520
You touched on this a little,
but could you explain a little
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00:13:29,520 --> 00:13:33,320
bit more how how these questions
can lead to?
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00:13:33,320 --> 00:13:35,800
To better understanding.
Absolutely.
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00:13:36,360 --> 00:13:39,720
I think meaningful dialogue
early on is what strengthens
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00:13:39,720 --> 00:13:43,680
working relationships.
And by fostering mutual
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00:13:43,680 --> 00:13:46,480
understanding, having some of
the same vocabulary and the same
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00:13:46,480 --> 00:13:50,000
understanding of some of the
basics, I think that strengthens
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00:13:50,000 --> 00:13:51,960
engagement.
It sets the ground for more
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00:13:51,960 --> 00:13:56,200
collaboration and it just opens
lines of communications so that
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00:13:56,760 --> 00:14:00,280
both grant tours and grantees
set themselves up for successful
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00:14:00,280 --> 00:14:03,200
grant implementation and the
positive impacts that everybody
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wants.
Yeah.
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00:14:04,880 --> 00:14:09,000
And and also to your point, we
could be talking about
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conversations between
communities half a globe away.
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I feel like there's a lot of,
there's a lot of room from his
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communication.
Absolutely.
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If you send, if you have office
hours from 1:00 to 2:00 PM
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00:14:23,200 --> 00:14:25,600
Eastern, that's the middle of
the night in the Pacific.
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00:14:25,600 --> 00:14:29,080
So how do you work around it?
Alex Wheatley is senior director
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00:14:29,080 --> 00:14:32,160
of Island support at ASTO.
Earlier we heard from.
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00:14:32,160 --> 00:14:35,200
Doctor Eric Upon, Who's director
and state public health officer
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00:14:35,200 --> 00:14:38,360
for the California Department of
Public Health and an ASTO
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00:14:38,360 --> 00:14:42,000
member.
State health agencies lay the
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00:14:42,000 --> 00:14:45,360
groundwork for sustainable and
equitable contraceptive access.
279
00:14:45,920 --> 00:14:48,320
They play a pivotal role in
expanding access to
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00:14:48,320 --> 00:14:51,240
contraception by supporting the
implementation of Pharmacist
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00:14:51,240 --> 00:14:55,920
Prescribed contraception PPC.
The new ASTO report, State
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00:14:55,920 --> 00:14:58,200
Health Agency's Role in
Implementing Pharmacist
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00:14:58,200 --> 00:15:02,000
Prescribed Contraception, walks
readers through three major
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00:15:02,000 --> 00:15:05,800
areas for doing so, mechanisms
that expand pharmacist roles and
285
00:15:05,800 --> 00:15:09,520
contraceptive access, payment
for services, and workforce
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00:15:09,520 --> 00:15:11,440
education and consumer
awareness.
287
00:15:11,880 --> 00:15:13,800
Find a link to the report in the
show notes.
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00:15:15,000 --> 00:15:17,960
Join Manisha Juthani, MD,
commissioner at the Connecticut
289
00:15:17,960 --> 00:15:21,320
Department of Public Health and
ASTO President, and John
290
00:15:21,320 --> 00:15:24,320
Auerbach, MBA, senior vice
president for Public Health at
291
00:15:24,320 --> 00:15:27,240
ICF, for an insight and
inspiration webinar that
292
00:15:27,240 --> 00:15:30,320
examines how clear, purposeful
leadership strengthens both
293
00:15:30,320 --> 00:15:33,680
internal and external trust.
Through discussion and
294
00:15:33,680 --> 00:15:37,040
reflection, we will examine how
leaders embodies steadiness amid
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00:15:37,040 --> 00:15:40,920
uncertainty, set a sustainable
pace, and provide calm direction
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00:15:40,920 --> 00:15:43,160
that builds trust and drives
performance.
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00:15:43,840 --> 00:15:46,200
This conversation aims to
inspire participants to
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00:15:46,200 --> 00:15:49,480
recognize their composure and
capacity not as a personal
299
00:15:49,480 --> 00:15:52,760
indulgence, but as a fundamental
leadership function that shapes
300
00:15:52,760 --> 00:15:55,720
the overall tone, focus, and
confidence of their
301
00:15:55,720 --> 00:15:58,960
organizations.
Join us for this Steady Hands,
302
00:15:58,960 --> 00:16:02,400
steady teams leading with
Confidence and composure session
303
00:16:02,640 --> 00:16:05,520
happening February 11th at 4:00
PM Eastern.
304
00:16:06,000 --> 00:16:08,080
The link to register is in the
show notes.
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00:16:09,400 --> 00:16:11,360
This has been Public Health
Review MORNING Edition.
306
00:16:11,480 --> 00:16:14,040
I'm John Sheehan for the
Association of State and
307
00:16:14,040 --> 00:16:15,360
Territorial Health Officials.
00:00:01,320 --> 00:00:03,840
This is Public Health Review
MORNING Edition for Thursday,
2
00:00:03,840 --> 00:00:07,480
February 5th, 2026.
I'm John Sheehan with news from
3
00:00:07,480 --> 00:00:10,280
the Association of State and
Territorial Health Officials.
4
00:00:10,800 --> 00:00:13,760
Today we'll hear about a rare
and unprecedented infant
5
00:00:13,760 --> 00:00:17,440
Botulism outbreak linked to
contaminated infant formula from
6
00:00:17,440 --> 00:00:20,520
Doctor Eric Upon, director and
state Public health officer for
7
00:00:20,520 --> 00:00:23,680
the California Department of
Public Health and ASTO member.
8
00:00:24,400 --> 00:00:27,440
California is home to the only
infant Botulism treatment in the
9
00:00:27,440 --> 00:00:30,440
world.
Later, we'll change gears and
10
00:00:30,440 --> 00:00:33,680
hear how ASTO is helping US
island jurisdictions navigate
11
00:00:33,680 --> 00:00:37,960
complex federal grant systems.
Our guest, Alex Wheatley, Senior
12
00:00:37,960 --> 00:00:41,560
Director of Island Support at
ASTO, joins us to discuss a new
13
00:00:41,560 --> 00:00:44,760
resource designed to bridge gaps
between federal funders and
14
00:00:44,760 --> 00:00:48,120
local health agencies.
But let's start with Doctor Eric
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00:00:48,120 --> 00:00:49,880
Upon.
I wanted to know how
16
00:00:49,880 --> 00:00:52,880
California's Infant Botulism
Treatment Prevention Program
17
00:00:52,880 --> 00:00:56,240
first detected the most recent
increase in cases and what
18
00:00:56,240 --> 00:01:00,040
sparked the investigation.
We have a really unique program
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00:01:00,040 --> 00:01:02,200
here in the California
Department of Public Health,
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00:01:02,200 --> 00:01:06,280
where we had developed this
product called Baby Big, which
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00:01:06,280 --> 00:01:09,960
is the only treatment in the
world actually much less the
22
00:01:09,960 --> 00:01:12,560
country, for infant Botulism
specifically.
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00:01:12,880 --> 00:01:16,920
It was developed in the 1990s.
We actually got FDA approval to
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00:01:16,920 --> 00:01:20,480
produce this drug in 2003.
So it's the only source.
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00:01:20,720 --> 00:01:24,680
And our clinicians who run this
program received calls from
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00:01:24,680 --> 00:01:28,240
clinicians all over the country
with suspect cases.
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00:01:28,240 --> 00:01:31,720
And then after they determine if
it's an actual case or or
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00:01:31,720 --> 00:01:34,920
worrisome for a case, they
actually send the treatment out
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00:01:34,920 --> 00:01:38,400
and also facilitate making sure
that the infant gets tested.
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00:01:38,880 --> 00:01:42,320
So because they get that first
line call on these suspect
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00:01:42,320 --> 00:01:46,520
cases, they started to notice
this pattern of, gosh, it seems
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00:01:46,520 --> 00:01:50,400
like we've heard a few Times Now
that these cases have consumed
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00:01:50,400 --> 00:01:52,760
this particular brand of infant
formula.
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00:01:52,760 --> 00:01:55,360
So that's sort of the the
background of how it evolved and
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00:01:55,360 --> 00:01:58,640
why a California specifically
started noting a national
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00:01:58,640 --> 00:02:00,400
outbreak.
This is the only product we have
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00:02:00,400 --> 00:02:02,240
like this.
It's definitely a unique role
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00:02:02,240 --> 00:02:04,760
for a health department to have
and just due to some really
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00:02:04,760 --> 00:02:08,039
amazing scientists and dedicated
people who who worked on this
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00:02:08,039 --> 00:02:10,479
decades ago.
And Doctor Pan, was there
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00:02:10,479 --> 00:02:13,720
anything unusual about this
outbreak?
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00:02:14,920 --> 00:02:18,080
Yes, I think it's important for
people to kind of know and
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00:02:18,080 --> 00:02:21,080
recognize that infant Botulism
in general is typically what we
44
00:02:21,080 --> 00:02:24,960
would call a sporadic disease.
And we often don't find out what
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00:02:24,960 --> 00:02:28,040
the source is.
It's it's a common spore in the
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00:02:28,040 --> 00:02:30,080
environment.
It can be in dust and soil.
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00:02:30,080 --> 00:02:33,480
So most of the time we actually
don't know what an exposure is
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00:02:33,480 --> 00:02:35,760
for infants.
It was really unusual and
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00:02:36,000 --> 00:02:39,720
remarkable that this was the
first contamination of infant
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00:02:39,720 --> 00:02:42,640
formula and the first outbreak
like this of a contaminated
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00:02:42,640 --> 00:02:48,280
infant formula.
And what can other states do to
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00:02:48,280 --> 00:02:50,200
coordinate?
With with.
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00:02:50,200 --> 00:02:52,600
CDC with the FDA.
If.
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00:02:52,680 --> 00:02:55,480
If they start seeing their own
rising cases.
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00:02:56,960 --> 00:03:00,280
Yes, all of these cases are
reportable to the CDC and
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00:03:00,280 --> 00:03:03,880
there's been a lot of great
coordination with our department
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00:03:03,880 --> 00:03:07,280
and the CDC and the FDA that
does the investigation of the
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00:03:07,280 --> 00:03:10,240
actual formula manufacturer and
producer.
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00:03:10,520 --> 00:03:13,840
And this works like many other
reportable infectious diseases
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00:03:13,840 --> 00:03:17,760
or outbreak investigations.
So frontline health departments
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00:03:18,240 --> 00:03:22,280
end up hearing about, you know,
a rise in cases or see a pattern
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00:03:22,560 --> 00:03:25,040
and then there can be a multi
state coordination and
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00:03:25,040 --> 00:03:28,400
investigation.
So this happens with again, many
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00:03:28,400 --> 00:03:31,080
other large infectious disease
outbreaks as well.
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00:03:31,640 --> 00:03:35,160
And that coordination has gone
well between the CDCFDA, our
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00:03:35,160 --> 00:03:37,360
department and then the other
states that have had cases.
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00:03:38,640 --> 00:03:42,080
It strikes me as.
Kind of incredible that the
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00:03:42,080 --> 00:03:45,760
California Department has such a
this robust program that it
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00:03:45,760 --> 00:03:49,640
developed Baby big, the only
treatment for infant Botulism.
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00:03:50,360 --> 00:03:52,080
How does that?
Distribution work.
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00:03:52,080 --> 00:03:54,800
How are you able to distribute?
It nationally.
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00:03:56,000 --> 00:03:57,600
Yeah.
We've spent a lot of time,
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00:03:57,600 --> 00:04:00,280
especially recently with this
outing making sure we have a
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00:04:00,280 --> 00:04:05,680
sufficient supply.
We do have a fee that gets sent
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00:04:05,680 --> 00:04:08,960
for the treatment and then, you
know, that goes into a special
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00:04:08,960 --> 00:04:11,800
fund to help do the production
and manufacturing.
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00:04:12,240 --> 00:04:15,960
We've definitely been watching
very closely over time.
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00:04:15,960 --> 00:04:20,360
There are lots that are created
and then, you know, projections
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00:04:20,360 --> 00:04:23,160
that have happened historically
on how much do we think we, you
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00:04:23,160 --> 00:04:26,040
know, need and use.
And we were concerned during the
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00:04:26,040 --> 00:04:29,520
peak of this outbreak that we
might need to do some other
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00:04:29,520 --> 00:04:30,960
things to make sure there was
enough.
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00:04:30,960 --> 00:04:33,720
Thankfully, the outbreak does
seem to have subsided.
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00:04:33,720 --> 00:04:36,560
We have once the recall happened
of the Bahart and the formula,
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00:04:36,560 --> 00:04:40,600
we've not seen new cases since
December, I believe.
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00:04:40,600 --> 00:04:44,640
So we seem to be on track to
have sufficient supply of this
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00:04:44,640 --> 00:04:47,520
baby big product.
But it is something that we were
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00:04:48,000 --> 00:04:50,760
working closely with the FDA and
others to make sure we would
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00:04:50,760 --> 00:04:53,120
have enough.
That would that should have been
90
00:04:53,120 --> 00:04:56,160
one of my earlier questions is
what is the status of the
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00:04:56,160 --> 00:04:59,080
outbreak.
So cases are are are going down.
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00:04:59,760 --> 00:05:02,560
The worst seems to be behind us.
Yes, that's right.
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00:05:02,600 --> 00:05:06,480
There was a total of 51 cases
nationally especially they
94
00:05:06,480 --> 00:05:09,840
looked back at before this year
and there were a few additional
95
00:05:10,200 --> 00:05:13,760
infants that had consumed the
same by heart formula, but 51
96
00:05:13,760 --> 00:05:17,200
cases as of mid-december and no
new cases that we've identified
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00:05:17,240 --> 00:05:21,400
since then.
And another aspect of of the
98
00:05:21,400 --> 00:05:27,840
response has been a a hotline
set up to specifically address
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00:05:27,840 --> 00:05:29,520
infant Botulism.
Can you tell us about it?
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00:05:30,600 --> 00:05:32,840
Sure.
And I would just say that this
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00:05:32,840 --> 00:05:36,480
is definitely an area that I
have encountered both in my work
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00:05:36,480 --> 00:05:38,400
at the local level and at the
state level.
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00:05:38,400 --> 00:05:41,240
Occasionally when there is a big
public health emergency, there
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00:05:41,240 --> 00:05:44,240
are a lot of important questions
from the public and ideally you
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00:05:44,240 --> 00:05:48,600
set up a way to triage those so
that the public can get some of
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00:05:48,600 --> 00:05:51,240
their questions answered.
But people who are doing the
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00:05:51,240 --> 00:05:53,960
investigations of highly
suspicious cases or in this
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00:05:53,960 --> 00:05:58,360
case, clinicians are able to get
through as well to get the
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00:05:58,360 --> 00:06:01,120
information and the potential
treatment and testing needed.
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00:06:01,520 --> 00:06:04,120
So this evolved because we have
a hotline in general for
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00:06:04,120 --> 00:06:06,560
clinicians across the country to
call when they have a suspect
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00:06:06,560 --> 00:06:08,920
case.
But as the news got out about
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00:06:08,920 --> 00:06:11,400
this outbreak, there were more
and more calls.
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00:06:11,400 --> 00:06:14,640
So we tried to offload that
first with some of our own
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00:06:14,640 --> 00:06:17,000
staff.
And so we actually cross trained
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00:06:17,000 --> 00:06:19,360
some of our staff within the
state health department to help
117
00:06:19,360 --> 00:06:22,040
answer some of the calls from
the public or families or
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00:06:22,040 --> 00:06:24,080
concerned families related to
the outbreak.
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00:06:24,360 --> 00:06:27,040
We were also at the same time
thinking about trying to
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00:06:27,040 --> 00:06:30,560
reactivate a contract that we
used during the COVID pandemic
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00:06:30,560 --> 00:06:32,920
when we stood up a public
hotline as well.
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00:06:32,920 --> 00:06:35,560
But I will say this is a real
challenge in public health in
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00:06:35,560 --> 00:06:38,720
general where we are often
trying to have things on the
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00:06:38,720 --> 00:06:43,040
ready or standby for surges or
emergencies and often have
125
00:06:43,040 --> 00:06:46,120
challenges in the administrative
processes or the resources to do
126
00:06:46,120 --> 00:06:48,080
that.
In the end, thankfully, again,
127
00:06:48,080 --> 00:06:51,320
because the outbreak subsided
and the calls subsided, we were
128
00:06:52,080 --> 00:06:56,560
able to redirect to our our sort
of normal processes and we've
129
00:06:56,560 --> 00:06:59,800
been able to allow the staff
that had been redirected to
130
00:07:00,040 --> 00:07:02,000
answer calls go back to their
normal work.
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00:07:02,840 --> 00:07:04,800
And we didn't activate this
other contract.
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00:07:04,800 --> 00:07:07,040
But I do think it's, it's an
ongoing challenge that I would
133
00:07:07,040 --> 00:07:09,240
actually love to learn from
other health departments as
134
00:07:09,240 --> 00:07:12,520
well, if they've been able to
figure this out on how to have
135
00:07:12,520 --> 00:07:16,560
some sort of standby call Center
for these kinds of situations.
136
00:07:16,560 --> 00:07:19,120
Because it very quickly becomes
an important issue.
137
00:07:19,840 --> 00:07:23,320
And you can get your sort of
usual investigators or
138
00:07:23,320 --> 00:07:26,240
responders can get flooded when
you want to be able to offload
139
00:07:26,240 --> 00:07:29,840
that so that you don't delay the
investigation or or in this case
140
00:07:29,840 --> 00:07:33,080
treatment of cases.
And something that goes sort of
141
00:07:33,080 --> 00:07:36,520
hand in hand with the hotline is
making sure that people know
142
00:07:36,520 --> 00:07:40,960
that a hotline exists or just
that there are rising cases and
143
00:07:40,960 --> 00:07:42,640
and for the public to be aware
of it.
144
00:07:42,840 --> 00:07:44,400
Can you talk about sort of the
challenges?
145
00:07:44,400 --> 00:07:46,360
Of just getting.
That word out?
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00:07:47,480 --> 00:07:49,360
Sure.
I think it's another important
147
00:07:49,360 --> 00:07:51,880
role of health departments.
When you have these outbreaks
148
00:07:51,880 --> 00:07:54,920
and you're looking to increase
awareness and also increase
149
00:07:54,920 --> 00:07:58,160
detection, sometimes many of
these diseases might start very
150
00:07:58,160 --> 00:08:03,200
non specifically this particular
disease of infant Botulism can
151
00:08:03,200 --> 00:08:04,760
be quite distinctive once it
progresses.
152
00:08:04,760 --> 00:08:07,480
So babies are very weak and
floppy.
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They don't have head control,
but really making sure people
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are alerted quickly to get seen
by their health care provider
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and doing health alerts and or
public information is the other
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thing that we encourage health
departments across the country
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to do.
When we were all learning about
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this multi state outbreak
because this product was
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distributed to many states.
So that's just another role I
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think we're always working on
together as a public health
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community to get information out
to help providers and also
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families and the public's that
they know to look for certain
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signs or symptoms and report
them so they can get the help
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they need.
Doctor Eric Upon is director and
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state public health officer for
the California Department of
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Public Health and an ASTO
member.
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Now let's hear from Alex
Wheatley, senior director of
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Island Support at ASTO, who will
explain a new resource designed
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to help island and territorial
public health systems navigate
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federal grant requirements.
So we have a lot of wisdom in
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our island areas workgroup,
health financing subgroup.
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These are the folks that get
asked difficult questions around
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grants management all the time.
And they said, you know, it'd be
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great if there was a centralized
resource that had all of this.
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It felt particularly important
with all the federal
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uncertainty.
Right now, as funding shifts or
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is a little bit unclear, it's
more important than ever to have
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strong relationships between
grand tours and grantees.
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So what kind of information were
they?
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Were they being asked to share?
A wide variety.
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So some of the common paying
points are around federal grant
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platforms and processes, who
needs access to what and when.
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They also got sort of the
inverse of that question.
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Grant grantor is not
understanding what the local
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processes were.
So they said, well, why can't
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you fix this?
And the health agency would say,
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because that's the Department of
Finance's job.
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So just clarifying some
expectations there.
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And this sort of gets to this
sense of foundational knowledge
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that gets mentioned a lot.
And in the report, what are some
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other sort of common
misconceptions that that both
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sides were not seeing?
Yeah, I think it's really
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important for project officers
and technical monitors to
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understand what's happening on
the ground.
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Just as important as grantees
understanding the current
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federal guidance, I think those
sorts of details are what prompt
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effective spend down and
actually prompts the impacts
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that federal grantors and
grantees want to see.
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But those conversations don't
always come up at the start of
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the grant period, and that's
what this resource is really
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trying to prompt.
Yeah.
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Can you give us some examples of
the kinds of things that that
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are in the resource?
Sure.
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So the resources really built
around conversation prompts.
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It's broken into five different
sections of sorts of pain points
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that we know come up frequently.
And then within those, it
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provides a little bit of
background about what grantors
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need to know and what grantees
need to know, and then questions
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to help a productive
conversation at the start of the
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grant period to identify some of
those pain points and then avoid
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them.
The Federated States of
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Micronesia is 1 of Asto's
members.
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Their National Health agency.
I'm going to refer to them as
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FSM National.
Before FSM National can spend
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down funds that CDC has awarded
to them, the FSM Congress has to
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approve those funds and
establish an account.
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Congress meets once 1/4.
In addition, where the funds
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actually get spent is at the
local level.
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For FSM National to pass the
funds to local, local
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legislature also has to meet and
set up an account.
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That whole process can mean 6 to
8 months before any dollars can
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be spent, and it's important
that federal funders understand
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that.
Gotcha.
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And because it's relying on 2
systems that don't necessarily
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talk to each other or wouldn't
have been consulted ahead of
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this grant, it's important to
have some kind of link to
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explain those differences.
Exactly.
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Federal funders say, well, we
haven't seen the request come
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through to draw down the funds.
And FSM says of course you
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haven't, it's only in stage 2 of
17, but that's not always clear.
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And so to to that point there
are there are suggested changes
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within the report.
What kinds?
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What kinds of changes do you
suggest, and is it for the
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grantees?
Or the grantors.
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It's for both.
I think we really leaned on the
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wisdom of the health financing
subgroup.
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It is the grants management
staff from islands, from federal
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agencies, from nonprofits
suggesting just some best
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practices that they've seen work
in terms of how do you monitor
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your spend down?
How do you keep up to date on
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the most recent federal
guidance?
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How do you troubleshoot when
things come up?
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There are best practices, but
they're not easy to find.
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So this resource, we hope, makes
them easy to find.
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Yeah.
And are there other steps for
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just improving the?
Overall relationship.
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I think it's it's all about.
Trust.
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It's all about communication and
it's about setting feasible
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expectations.
And I think those things are
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hard.
There isn't an easy answer, but
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prompting some conversations to
get at some of these issues
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early and then sort of making it
clear that you're on the same
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team and you want these funds to
be used for these purposes with
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these impacts, that can go a
long way.
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00:13:27,400 --> 00:13:29,520
You touched on this a little,
but could you explain a little
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00:13:29,520 --> 00:13:33,320
bit more how how these questions
can lead to?
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00:13:33,320 --> 00:13:35,800
To better understanding.
Absolutely.
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I think meaningful dialogue
early on is what strengthens
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working relationships.
And by fostering mutual
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understanding, having some of
the same vocabulary and the same
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understanding of some of the
basics, I think that strengthens
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engagement.
It sets the ground for more
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00:13:51,960 --> 00:13:56,200
collaboration and it just opens
lines of communications so that
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both grant tours and grantees
set themselves up for successful
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grant implementation and the
positive impacts that everybody
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wants.
Yeah.
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And and also to your point, we
could be talking about
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conversations between
communities half a globe away.
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I feel like there's a lot of,
there's a lot of room from his
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00:14:18,200 --> 00:14:19,600
communication.
Absolutely.
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If you send, if you have office
hours from 1:00 to 2:00 PM
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Eastern, that's the middle of
the night in the Pacific.
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So how do you work around it?
Alex Wheatley is senior director
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00:14:29,080 --> 00:14:32,160
of Island support at ASTO.
Earlier we heard from.
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00:14:32,160 --> 00:14:35,200
Doctor Eric Upon, Who's director
and state public health officer
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00:14:35,200 --> 00:14:38,360
for the California Department of
Public Health and an ASTO
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00:14:38,360 --> 00:14:42,000
member.
State health agencies lay the
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00:14:42,000 --> 00:14:45,360
groundwork for sustainable and
equitable contraceptive access.
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00:14:45,920 --> 00:14:48,320
They play a pivotal role in
expanding access to
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00:14:48,320 --> 00:14:51,240
contraception by supporting the
implementation of Pharmacist
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00:14:51,240 --> 00:14:55,920
Prescribed contraception PPC.
The new ASTO report, State
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00:14:55,920 --> 00:14:58,200
Health Agency's Role in
Implementing Pharmacist
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00:14:58,200 --> 00:15:02,000
Prescribed Contraception, walks
readers through three major
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00:15:02,000 --> 00:15:05,800
areas for doing so, mechanisms
that expand pharmacist roles and
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00:15:05,800 --> 00:15:09,520
contraceptive access, payment
for services, and workforce
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00:15:09,520 --> 00:15:11,440
education and consumer
awareness.
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00:15:11,880 --> 00:15:13,800
Find a link to the report in the
show notes.
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00:15:15,000 --> 00:15:17,960
Join Manisha Juthani, MD,
commissioner at the Connecticut
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00:15:17,960 --> 00:15:21,320
Department of Public Health and
ASTO President, and John
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00:15:21,320 --> 00:15:24,320
Auerbach, MBA, senior vice
president for Public Health at
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00:15:24,320 --> 00:15:27,240
ICF, for an insight and
inspiration webinar that
292
00:15:27,240 --> 00:15:30,320
examines how clear, purposeful
leadership strengthens both
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00:15:30,320 --> 00:15:33,680
internal and external trust.
Through discussion and
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00:15:33,680 --> 00:15:37,040
reflection, we will examine how
leaders embodies steadiness amid
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00:15:37,040 --> 00:15:40,920
uncertainty, set a sustainable
pace, and provide calm direction
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00:15:40,920 --> 00:15:43,160
that builds trust and drives
performance.
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00:15:43,840 --> 00:15:46,200
This conversation aims to
inspire participants to
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00:15:46,200 --> 00:15:49,480
recognize their composure and
capacity not as a personal
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00:15:49,480 --> 00:15:52,760
indulgence, but as a fundamental
leadership function that shapes
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00:15:52,760 --> 00:15:55,720
the overall tone, focus, and
confidence of their
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00:15:55,720 --> 00:15:58,960
organizations.
Join us for this Steady Hands,
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00:15:58,960 --> 00:16:02,400
steady teams leading with
Confidence and composure session
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00:16:02,640 --> 00:16:05,520
happening February 11th at 4:00
PM Eastern.
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00:16:06,000 --> 00:16:08,080
The link to register is in the
show notes.
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00:16:09,400 --> 00:16:11,360
This has been Public Health
Review MORNING Edition.
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00:16:11,480 --> 00:16:14,040
I'm John Sheehan for the
Association of State and
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00:16:14,040 --> 00:16:15,360
Territorial Health Officials.