CDC/ATSDR Tribal Advisory Committee Meeting and 

12th Biannual Tribal Consultation Session 

02/11/2015

CDC Headquarters 

Atlanta, Georgia 
2 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

February 11, 2015 

Opening Blessing

Councilman Chester Antone: Good morning everyone. This morning before we start, as is the 

custom of Native Americans, we do have an opening blessing, which will be provided by Mr. 

Flying Hawk this morning. 

(Prayer)

Councilman Chester Antone: I’m gonna turn it over to Joe; he’s got a few items that he needs to 

let us know.

CAPT Joe Maloney: Thank you, Mr. Chairman. Good morning everyone. Thanks for joining us. Just 

a few housekeeping items for folks that are new to the meeting today. The closest restrooms are 

out the door to the left; there’s others if you keep going right. In the event of an emergency, we 

do have a shelter-in-place in this room and in the event that we have to evacuate, we’ll go out 

the double doors and outside. Some quick reminders for the rest of the meeting today, the 

members of the public do need to sign in at the registration desk and wear your name badge at 

all times. Non-CDC/ATSDR attendees must be escorted by a CDC employee throughout the 

building. Just a very important reminder that today, during blessings and during Tribal Testimony, 

if people will not come in or leave the room during that time. And lastly, a reminder to please 

silence your electronic devices as we go through the meeting today. Think that will do it, 

Chairman.

CDC Office of the Director Update

Councilman Chester Antone: Ok, this morning we have the CDC Office of the Director Update and 

this will be done by Ileana Arias, Principle Deputy Director of CDC/ATSDR.

Dr. Ileana Arias: Thank you and good morning. Welcome to the Tribal Advisory Committee to 

Atlanta, and on behalf of Dr. Freidan, who unfortunately couldn’t be here, he wants to welcome 

you very warmly and glad that you’re here and looking forward to discussions that you’ll be 

having with the rest of the staff throughout- for the rest of the meeting that you have. 

Unfortunately, because of Ebola and Measles, which I’ll talk about in a little bit, he’s up in DC 

involved in hearings and briefings on the Hill and so was called away at the last minute and 

couldn’t join us but he sends his regards and warm welcome. I’d like to also welcome the new 

TAC member to this meeting and to this work and I also then would like to extend a very warm 

appreciation and thank you to our Chair and our Co-Chair for their great leadership in the work 

that has been done, that the TAC has done, and also in collaboration with us. I know that you 

have met with some folks yesterday, and you’re going to meet with a number of folks today to 
3 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

talk about some of the things that we can work on together. And Judy is going to also provide an 

update on some of the activities that I know you’re interested in and that influenced the work 

that you do and the ability to do your job. But what I’d like to do is just sort of give you sort of 

some updates on a lot of things that we have talked about previously and we had talked about 

sort of stepping up and following up on. And just to give you a little bit of an idea of how much 

progress we are making, and although we have significant progress to make I think, we are 

headed in the right direction. One of the things that, you know, yesterday from talking with Dr. 

Bauer, is that her Center has made a significant commitment to addressing health disparities and 

the health needs of American Indians and Alaska Natives. And one of the things that was done 

this year is put out an FOA that specifically was targeted at Native communities and entities in 

order to do that work. So that the amount of funding that is now being essentially used to address 

those issues has increased significantly. She personally is responsible for that; she personally is 

committed to continuing to do that, but the rest of us are as well and we’re very interested in 

sort of finding all opportunities that are available at our disposal that can be used in order to 

increase the funding and the resources that are available to you and your colleagues in order to 

address the health issues that are identified. 

In the spirit of that, one of the things that always has been pointed out to us is that in addition 

to funding, making the data available and improving the data that we have to address- #1 to 

identify what the health needs are for tribal communities is important and we have committed 

to doing that. One of the things that we did actually, this was in follow up to a discussion that I 

was involved in at the Secretary’s Tribal Advisory Committee meeting last...I lose track...I think it 

was in the Spring, was to make sure that we pulled our data and actually we did provide the data 

that are available that can be used although it may not be targeting that is monitoring specifically 

in Indian Country or specifically among American Indians and Alaska Natives. One of the things 

that has been done is call through all of the sources that we have available and identify when it 

is that those populations and subpopulations are identified and how it is that the data could be 

used. So we provided the link to those data so that they can be accessed directly and also put 

together a table that then sort of walk through what the data sources were, what the variables 

were, and what is it that could be done with that information. We are more than happy to 

continue to provide that information and any assistance in using those data sets that folks might 

need and be interested in. The best way of getting that assistance, of course, is to contact Judy’s 

Office, who then will find the appropriate people, whether it’s in the program office or in the 

specific CIOs, to help with that and provide that kind of assistance. Related to that, one of the 

things that I was very happy to see is, we also released in the MMWR in January, a supplement 

to the MMWR, an article specifically focusing on Native health disparities and addressing not only 

shining a light, but then also being a little bit more specific on what are the major problems that 

need to be addressed. I am committed to making sure that that continues, that we do put out 

that information on a regular basis; not only for us to be aware and then for the country to be 

aware at a national level what the problems are, but also so that information can be used in 

decision making, again, at the national-level and at the local-level in order to address those 

issues. 
4 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

One of the things that we had talked about, and Judy will talk more about this, is PHAP and how 

is it that we can increase accessibility to the Public Health Associate Program to Native 

populations and communities. I’m happy to say that we have six PHAPs, or associates, that are 

actually either assigned to a Native entity, or actually working on Native issues: three in the 2013 

class, three in the 2014 class, and we are very interested in continuing to increase that number. 

I’m happy to say that we’re in the process now of reviewing applications not only for the 

associates, but also for the entities that have applied to have associates, and we have eight 

applications from tribal entities and organizations in order to...applications for housing those 

associates. They are currently being reviewed and so we’re looking forward to what the outcome 

of that is. 

As you know, there are a number of sort of programmatic issues that have been very prominent 

in the media and so I just want to touch base where we are on those; just so that you know. And 

one of those we’ve already talked about before, unfortunately, because it’s been going on for a 

long time, and that’s the Ebola outbreak and the Ebola epidemic. As you know, and we’ve talked 

about it before, and as you know from yourself what’s being reported in the media, it is a 

significantly large and taxing issue that we have been working on for a significant period of time; 

and that we’re gonna continue working on for a long time. The epidemic, the outbreak is by no 

means over and so we have to continue to devote as much fervor and resourcing to the issue as 

we can, but there is some sort of early signs of success so that we are starting to see stabilization 

in some of those countries, no new cases. And in other countries, a significant change in how it 

is that public health entities, the country public health entities are approaching the issue. So there 

is significant success. We are hoping that it will continue. It has not spread; so Nigeria, Mali were 

able to now go to zero; and so we’re hoping that in the not too distant future, we’ll be able to 

say that about the other countries as well. We continue to deploy significant number of people 

to those countries in order to do the work that needs to be done to make sure that we get to 

zero, which is the goal that we have; the goal that we all have. As you know, there were back in 

November, some cases in the U.S. of Ebola as a result of travelers coming in and then healthcare 

workers who came in contact with that traveler. We do not- since then, we have not had any 

other cases, do not have any current symptomatic cases of Ebola in the U.S. and that’s good 

news. 

In the context of devoting as much- so much resourcing, including people, to Ebola as we can 

muster, we also are dealing with flu and within this Measles outbreak. Flu, not surprisingly, it’s 

seasonal flu; it’s what we go through every year. Unfortunately, this year we actually had 

evidence that there was some drifting and sort of some change in the viruses that were prevalent 

in cases and viruses that had not been included and had not been addressed by the vaccine that 

was developed to address flu in anticipation of what was going to be circulating. Some of the 

circulating strains are covered by that vaccine so we are still encouraging individuals to vaccinate 

against flu because there is some coverage, there will be some effect of the vaccine, but some 

people will not....essentially, for some people that will not be the case. Again, depending on what 

strain they actually come in contact with. For individuals who do get sick, we are trying to 

encourage physicians and other health care workers to use Tamiflu as a way of addressing the 
5 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

symptoms and sort of making sure that they control the disease and encourage some relief in 

those individuals. 

The other is then this outbreak of measles that started in Disneyland, and most of the cases, 

currently we have about 122 cases is the last count that we had. The majority of those, in excess 

of 90, are in California, and can be tied...and again, most of those can be tied to exposure in 

Disneyland. Most of the individuals who have developed the disease are individuals who either 

do not have a history of vaccination or of exposure, and so not surprisingly, they are the ones 

who are succumbing to those exposures. We are encouraging, even though as you know there 

are some holdouts, but we are encouraging people to be vaccinated against vaccines, both 

children and adults if they haven’t been just to make sure that they – if they come in contact with 

somebody that does have measles that they don’t contract it. Yesterday, we also contacted the 

WHO and provided sort of a what we called an emergency of international concern or potential 

concern in that since there is one case in Mexico now of measles and it can be traced to the 

Disneyland exposure. We are concerned that there may be some individuals who were in 

Disneyland at that time and traveled back to other countries and may be exposing other folks, 

and then vice versa; that people may be traveling here. So we want to make sure that people in 

other countries are aware, and when there are measles cases, that they actually do the right kind 

of questioning and investigation so that we can get a better idea of the complete spread and 

extent of the problem. There has been a lot of attention to the issue, and personally I think, not 

so much because of the numbers or the severity of the disease, but because of the reason we’ve 

had the outbreak and that is significant number of parents continuing to suspect that the vaccine 

is dangerous, that it’s not safe, which in fact the data have never supported that. However, they 

continue to be a significant number of holdouts that are concerned about exposing their children 

to the vaccine because of potential cognitive problems and other kind of problems that 

erroneously have been linked to those vaccines. We have, and others have, been very clear about 

the safety of those vaccines and that not being a reason for not vaccinating children. So we’re 

continuing to encourage that because of that controversy, it’s gotten a lot of attention in the 

media. One of the things that I’m happy to say is that coverage among tribal communities for 

measles vaccine is very high and so that’s very good. And so congratulations on that achievement 

and we thank you for partnership in making sure that that does happen. So, that’s just a snapshot 

of what we’re currently dealing with. It’s not necessarily what I think you are most interested in 

talking about, I think, but if there’s anything that you want to know about that I didn’t address or 

any questions about any of the things that I said, I’d be more than happy to answer those.

Councilman Chester Antone: I think, before you go, we have about 15 minutes of this time. Go 

ahead, Jefferson.

Lt. Governor Jefferson Keel: I have a question. In speaking about the measles outbreak and 

realizing that you know at one time we thought it was completely eradicated; and now it’s 

resurfaced, it’s reappeared; the international travel that you’re talking about, that you 

mentioned, is it not true that the visitors to the United States are supposed to be vaccinated or 

not?
6 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

Dr. Ileana Arias: I’m not sure about that. I don’t think that we require that; I can look into it and 

let you know. I know that as with TB and with measles a lot of the times the outbreaks can be 

traced to imported cases of measles where the vaccination rates in some countries are not as 

high as they are here in the United States, or even in other countries, for example, that have even 

higher rates than we do, like in Europe. So some of those cases, some of those outbreaks are the 

result of imported cases of measles; of individuals who have not been inoculated and then they 

actually do develop disease and bring it in. When then its people here who have not been 

vaccinated are exposed, then they’re gonna contract the disease and so that is a problem.

Lt. Governor Jefferson Keel: Well, take that one step further, is it not still required that all of our 

children be vaccinated?

Dr. Ileana Arias: It’s recommended, the requirements to...it’s recommended that they are after 

the age of one, or when they turn one. There is not a federal requirement for that to happen, 

and so a lot of it is done at the local level. Some states are more aggressive in requiring that, 

whether it’s for school entry than others and some are not. Then there’s also, even when it is 

required, there are waivers that are provided for a number of different reasons; mostly because 

of medical reasons. So high risk kids, for example, should not get vaccinated or have to be careful 

in how that’s done, But that has been used to then get waivers on other grounds and some states 

are more lax, or I should say, more flexible in how it is that they approve those waivers than 

others have been, which is why then that you get a difference in terms of inoculation rates across 

the country.

Councilman Chester Antone: Mr. Geisler.

Secretary Adam Geisler: Good morning. I want to thank you for your update that you provided 

to the TAC this morning. I had a couple of questions. You went through quite a bit of information. 

So the first question that I have is in relationship to access to data that you had discussed, and 

that we need to be working through, specifically Dr. Monroe, in order to access that data. Did I 

hear you correctly?

Dr. Ileana Arias: Not to access them necessarily, but for technical assistance in how to manage 

the data, if you will, that’s there and what’s there and that sort of thing. So we have data sets 

that are just public access, those are available so we can send, the- sort of links, to those data 

sets. You can go in yourself. Sometimes, depending on how the data sets are set up, you may 

need some kind of, you know, additional information in terms of how to identify, how to pull 

variables, how to sort through the data in order to get the numbers that you actually want. And 

so that’s the kind of technical assistance that I was referring to is if it’s needed that the best way 

to get to that is through Dr. Monroe’s Office.

Secretary Adam Geisler: My second question for you, I have three- the last one, I think, is 

probably low hanging fruit. The second question that I have for you is in regards to where the 
7 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

Director stands in relationship to specifically funding some of these activities. Yesterday we had 

a pretty significant discussion about surveillance, and I think the need to be able to properly 

implement those activities within our own centers. And so, I guess, you mentioned at the 

beginning that Dr. Bauer has kind of led the way, in the way that she’s approached this; does the 

Director support that activity with the other Centers? And I guess what I’m getting to is the dollar.

Dr. Ileana Arias: Yeah. No, for sure he does support it. And not only does he support it, a lot of 

our programs are interested in making sure that that happens. As you know, a lot of that, 

unfortunately comes from the top; so in terms of setting aside funds specifically for addressing 

these issues, a lot of times we don’t have the ability to do that, legally to do that, so it means 

getting Congress to essentially direct us to do that which is what happened in the case of Chronic, 

where there was specific mention in the Congressional record about using monies for tribal issue. 

So that makes it a lot easier for us to be able to then specifically and very directly set aside funds 

or direct funding specifically to that. In the absence of that, what we then try to do is, for 

whatever project is being done, is there a specific disparity that is relevant to tribal communities; 

and if so, then how is it that that can be addressed? It doesn’t necessarily mean that the funding 

would go to tribal entities for doing that work, but if it does go to a state, organization, or a 

community based organization, how is it that we can either set up the FOA, set up the funding, 

or work with them in order to make sure that those populations are well represented.

Secretary Adam Geisler: I appreciate the legal constraints that are associated with legislation that 

comes down and the way funds are appropriated, but at the same time, we also had a 

conversation yesterday regarding the development of the internal budget that’s recommended. 

And I guess, what I put forward, and I apologize I do not remember her name, who sat here and 

went through the budget process. Deb?

Dr. Ileana Arias: Deb Lubar. 

Secretary Adam Geisler: Yeah. One of the comments that I made to her yesterday, and I’ll make 

it directly to you, is that I think that in Indian Country, there’s – we’ve always- we’re always told, 

“You need to go to Congress. You need to go to Congress. You need to go to Congress.” But at 

the same time, I think if you’re seeing the need internally in the budget that you are creating and 

recommending, one of the things that can really help us out, so that we’re working together in 

partnership to solve the bigger issues that are out there, is the recommendation internally 

coming from the Director himself or from within the Centers.

Dr. Ileana Arias: I mean I think that, and we’ve gone through this with other issues and other 

communities as well. My, and I don’t know if this was discussed yesterday, but my sort of take 

away of what works is to focus it is as much as possible. You know, we do rely on Congress to sort 

of allocate resourcing generally and then specifically to us. If it’s very broad, it gets lost. And so 

one of the things that might be worth thinking about is whether in response to what was 

published in the MMWR about what those inequities are; or regardless of that, whatever issues 

it is that your organization, the tribal entities are interested in addressing and then being specific 
8 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

about that as opposed to funding tribal entities. That a lot of the times works a little bit better 

because then you are relying on two types of champions, if you will, on the Hill to get those folks 

who are interested in supporting tribal entities and folks who are specifically interested in that 

whether it is diabetes or cardiovascular disease; whatever the case may be. It also, you know, by 

starting and sort of focusing on a particular issue I think also is a foot in the door; and once you 

get a few of those, then you don’t have to fight the fight as much about the tribal entity issue. 

You can then branch out from that. So one of the things that might be good, whether it’s here 

during this meeting, or off, you know, in-between meetings to sort of start having that discussion 

about what are the issues that are relevant, that we know that something can be done, and that 

there would be champions for supporting and resourcing addressing that issue.

Secretary Adam Geisler: I think the challenge in that, and I apologize I don’t mean to take up too 

much time, but I think the challenge in what you just went through is that we have a hard time 

identifying those situations because we don’t have the funding to do the surveillance in order to 

reach those conclusions that this is what we need. So that’s the challenge that we’re always 

facing in Indian Country, and it’s not just here; we realize everything is data driven in order to 

make the ask right? In order to get there, a lot of times we don’t have the financial well-being in 

order to get to that place. And I’ll take it one step further in terms of tribal entities, you know, 

we’re tribal governments and the relationship that we have with the United States is unique in 

its political nature. We’re not just an ethnic group out there. You know, it is a political stature 

that we hold in the United States Government. So I just wanted to put that out there. I 

understand what you’re saying but I hope you understand where I’m coming from with it’s hard 

to get the data if we don’t have the money to do the analysis.

Dr. Ileana Arias: Right and I know that, you know, it makes sense to sort of focus on the immediate 

sort of community that you want to address, but we do have national data and that national data 

can be used. We’re trying to sort of make it more easily accessible, more easily digestible, if you 

will, so that it can be used to answer those questions. And so having the discussions about what 

is missing from the data that we are putting out to be able to make those kinds of decisions or to 

encourage others to have those kinds of decisions would be discussions that we should be having.

Secretary Adam Geisler: Ok. My last question was what is the PHAP? You said there was three2013 individuals, and three-2014.

Dr. Ileana Arias: So that’s the Public Health Associate Program and these are currently trainees 

that we have so the public, are you familiar with the program?

Secretary Adam Geisler: That’s why I am asking.

Dr. Ileana Arias: Ok. So Judy will talk more. It is the centerpiece of what we’ve been trying to do, 

which is essentially train a workforce that is going to be relevant and available, not for CDC, it’s 

not training people for us, but for public health. And the way that the program works is it’s a 

competitive program for bachelors-levels and masters-levels individuals who are interested in 
9 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

public health. They are in the program for two years. We’re changing it to maybe extending it, 

Judy might be talking about that a little bit more. The idea is that they get trained, they actually 

get placed in the State Health Department during those two years to basically do the public health 

work. We have been talking then about, not just in State health departments, but also putting 

them in Tribal health departments and so, how is it that we make that happen?

Councilman Chester Antone: We just have one more and I’ll defer to Mr. Keel and then we’ll end 

this part. Cathy?

Tribal Board Member Cathy Abramson: How can we seek the support of the Director to consider 

broadly assigning CDC field staff into Indian Country?

Dr. Ileana Arias: I don’t know, I mean he’s interested in just field staff generally. I think we have 

to have the discussions about, again, given the legal issues and sort of the other issues, how is it 

that we make that happen? We have been focusing on PHAP because that’s what we have the 

resources for, and that’s what we think actually adds the most value to whatever entity that we 

actually do place people in. But we can then also explore, and Dr. Monroe’s Office also does work 

on sort of field staff generally. So we do it from the OD; we also do it from the program-level.

CDC Office for State, Tribal, Local, and Territorial Support Update

Councilman Chester Antone: Well thank you, Dr. Arias. We’ll let you go for this time and we’ll 

switch over to Judith. Thank you.

Dr. Judith Monroe: Ok well thank you, Dr. Arias. Thank you Chairman Antone and Co-Chair Keel. 

Great to have all of you again with us so good morning. I don’t have any slides so I would like to 

make this as interactive as possible and so that we can have a discussion. I know we have new 

members on the TAC so I’m gonna go back, as I discuss the update for OSTLTS, I will give some 

background- broader background that some of you may already know about. So just for ground 

leveling, when Dr. Frieden became the director of CDC, he felt that the agency needed to better 

support our health departments, and so OSTLTS was created in that spirit, and this really goes 

back to the history of CDC, back in the 1940’s when CDC was first established. It was established 

because of malaria in the south and it was specifically established to help support health 

departments that were battling malaria. And so this really is at the root of, you know, CDC. And 

so OSTLTS was created; we’re right at our five-year mark. We’ve been part of the Agency 

structure now for a full five years and we’re unique in that we’re a cross-cutting Office so we’re 

very broad, we’re very cross-cutting unlike, you know, when you’ll hear from Dr. Bauer, as an 

example, they dive very deeply into chronic disease and then very specifically into the particular 

diseases so whether it’s diabetes or heart disease and so forth or whether like Hepatitis C you 

heard from yesterday; a very deep dive into those specific diseases. We’re very cross-cutting. I 

report to Dr. Frieden. I’m one of his direct reports, one of the Deputy Directors for the Agency. 

And so we, in many ways, have a bird’s eye view of the Agency because we were established with 
10 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

an eye towards supporting our state, tribal, local, and territorial health departments and 

communities; but to do that, we also are in a position to support our centers, institutes, and 

offices across CDC. 

So I’m happy to say that at a five-year mark, I think we’ve pretty much touched the entire agency 

one way or another. And much of that foundation of our office is communications. It’s something; 

I came in, having been a State Health Officer in Indiana, I really grew to appreciate the value of 

communications. And so we’ve built a pretty robust communications group within OSTLTS. I have 

a number of communication products, but we built those with an eye toward getting information 

out of CDC; and we really serve the CIOs. I mean we’re here to serve and to reach the health

departments; the STLT is what we call it. We also, in turn, have built communication products so 

that the field can communicate inside CDC. And so we really do serve as your, and I invite you to 

use us that way. I think there’s still a lot of room for advancement and growth as we continue to 

mature as an Office. One of the things, look to us as your touch point, and then we will reach 

across CDC or get messages out and then try to get messages out to you. So as an example, of 

just going with Ebola, we’re not Ebola experts within OSTLTS; we’re not infectious disease but we 

got called upon just like the entire Agency for the Ebola response. And so we did things like, you 

know, Joe yesterday talked about the reach to the Indian Health Service; and what we’ll do is find 

the experts at CDC and make sure we match up with where the need is. One of the things that 

came out of that, there was a Dear Tribal Leader letter about Ebola after Dr. Freiden visited Africa. 

That was something our Office helped facilitate because we saw the need. In fact, I talked to NIHB 

at a meeting and asked their advice whether that would be a good idea and they said, 

“Absolutely.” And so if you all just with the communication piece, if you see areas that you think 

we should be doing more Dear Tribal Leader letters from Dr. Freiden, please let us know. I would 

appreciate our TAC members giving us ideas for that because then we can then facilitate and 

make that happen; and so in many ways we are a facilitator. You know in my role for Ebola, as an 

example, I got called in to, I was actually full time on Ebola starting in October for several weeks 

just because there was so much demand and need once it became a domestic issue. You know, 

once we had the case in Dallas, the health departments, as you can imagine, in all the states in 

all the issues that would come up because we have existing and established relationships and 

ongoing communication channels with our partners out in the field. We’re a natural place then 

for the programs to come to so that we can help assist. One of the things we have said before is 

that we don’t make the ball, but we make the ball bounce higher. So we’re really here to try to 

facilitate. 

There are kind of three areas that we focus on to categorize our work. One is with performance 

improvement and setting national standards. The second is with technical assistance as you 

heard Dr. Arias mention, and then the third area is workforce. So I’ll touch on each of those as I 

give the update on what OSTLTS has been doing. I do want to draw you all’s attention to the fact 

that we have- Dr. Freiden established an Advisory Committee to the Director and there are a 

number of members of that ACD, and they meet twice a year in the spring and in the fall, and 

they bring formal recommendations that are public records so you can go out and find these 

easily. They’re on our website, you can look at past minutes; everything- the meetings are all in 
11 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

the federal register and announcements and so forth so it’s all a matter of public record. And 

there are only a couple of subcommittees, and because Dr. Freiden feels so strongly about our 

support to the field, we have a STLT subcommittee. So I’m the designated Federal Official for 

that. We have a state, tribal, local, and territorial subcommittee to this ACD, the Advisory 

Committee to the Director. It’s been in existence about four and a half years now; we started it 

pretty soon after OSTLTS was established. Just to give you historically, that body, one of the things 

they made was a series of recommendations that went to the ACD that resulted in a standardized 

funding opportunity announcement here at CDC. And this is very important I think, especially for 

the new members to understand. It’s the first time CDC had ever had a standard format for 

funding opportunities and with it is a checklist; and that checklist gets updated every year. And 

so you heard yesterday, I think when Dr. Ward was speaking, Ursula Bauer and some of them, 

and even this morning with Dr. Arias, Congressional intent comes down and there’s particular 

language in our appropriations. And so if those appropriations specifically say American 

Indian/Alaska Native then you can be sure that that funding opportunity is going to have that 

opportunity in there. Other times, the language it may not specify, and then we have to work a 

little harder to find out whether it’s allowable. What we’ve done with our funding opportunity 

announcement, because of the standard checklist, no one across CDC can begin the process of 

writing an FOA without going through this standard checklist. And on that checklist, everybody 

has to stop and look at the language because the standard FOA requires the broadest, eligible 

grantees if you will. So everybody has to stop and think about it whether or not it’s allowable; 

and a lot of that was voices from our colleagues that are American Indian and Alaska Native 

colleagues that sat on the STLT subcommittee that raised that as an issue. So those are...that’s 

one thing that we’ve done historically and that’s been in placed now two or three years. 

Most recently, the STLT subcommittee raised recommendations that went to the ACD and were 

just approved by the Advisory Committee to the Director on three different categories. One were 

foundational capabilities of health departments. And there’s a big body of work that’s been done 

now looking at the foundational capabilities of what every health departments should be able to 

do. And that goes- it’s really complimentary to accreditation of health departments. That’s a 

whole talk in and of itself. A second set recommendations around social determinants of health, 

which certainly are very important to Indian Country. And then, some recommendations around 

the Block Grant. So you heard yesterday I think mentioned in the President’s budget that it’s been 

zeroed out. Every year, the Preventive Services Block Grant, which is the most flexible funding 

that goes to state health departments; every year it gets zeroed out of the President’s budget. It 

doesn’t matter, it’s always zeroed out. Congress tends to put it back in and this past year it was 

actually brought back up. It had been cut quite a bit but it was brought back up to a level that it 

had been having—so about 160 million dollars for the Block Grant. It’s flex money, Congressional 

language, the appropriations; that goes to state health departments. It’s very specific to that 

states but it’s flexible. So, to give you an example, and one of the things that we do in our – in 

OSTLTS, is we do try to be the voice when we’re working with our colleagues in states and locals 

and the longer we have matured, I think, as an Office I think we’ve gotten better at making sure 

that we’re bring up...at asking questions about tribes. So, as an example with the Block Grant, 

and I don’t know in how many states if any of the Block Grant funding gets to the tribes, but as 
12 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

one example the Kickapoo Boys and Girls Club had an after school activities program, so this will 

be in Kansas, and they had physical activity, they had sports and games and cultural activities; 

but their attendance was dropping off and they were – they needed some support. It was a very 

rural location and so the club partnered with two local school districts, got a loaned bus to 

increase attendance and to make sure the children were able to go into this program. But they 

were able to do that because they were given some of the Block Grant funds. So the state must 

have given Block Grant funds to the tribes to be able to do this and they were able to hire staff 

then to accommodate the increase in the children that were now getting the physical activity and 

the cultural activities; it sounds like a great program when you read about it. And so that’s just 

one example because it does- with funding it gets complicated because there are so many 

different streams of funding and where the opportunities might be. 

One of the things we’ve heard loud and clear is that it varies across the states how tribal 

governments work with state government. And that’s an area that we have actually worked with 

NIHB and with our Association of State and Territorial Health Officials to try to—actually both of 

them wrote primers on how to work with governments. So new state health officials today, and 

this is something that came out of OSTLTS and then our partnerships; today if a new state health 

official starts, the ASTHO sends them how to work with tribal governments. I will tell you, when 

it comes to state health officers, we have about half of them are brand new because of the 

election in the fall with new governors. We have about...yeah, so these are brand new people. 

They’ve maybe not ever been in government before or they’ve been in other walks of 

government so they will get that. And then the flip of that is folks coming in and leading tribal 

public health or getting, I believe NIHB then puts out... has a primer that ASTHO helped write, 

“How to work with your state government.” So trying to build that type of communication. So to 

just give you a flavor of some of the kind of work that we do. 

The other area I mentioned, standards and accreditation, we’re the Office here at CDC that 

supports the National Accreditation of health departments. We do that by supporting our Public 

Health Accreditation Board or PHAB, and funding- we have some funding that goes to PHAB then; 

but we also participate in a number of meetings. CDC plus PHAB established the Tribal Standards 

Work Group that has guided the standards, development, measures, and documentation 

guidance for tribal health departments. Joe, I believe you’ve been involved with PHAB? We have 

members actually around the table that have been involved in some of the...Ramona, I failed to 

mention, is a new member to our STLT subcommittee; and so we’ve got some cross-fertilization, 

if you will, between our TAC and some of these other opportunities. And so they’ve- the tribal 

representatives on PHAB’s Board of Directors have been very involved in numerous work groups 

and committees to support the continuous improvement in this accreditation. So since 2012, 

when accreditation launched, there have been two tribal health departments that have applied 

for accreditation. But the new and exciting thing that we did, and actually through conversations 

with National Indian Health Board, we realized that we should seize an opportunity to better fund 

tribes to help directly to help them prepare for accreditation. So in 2015, and it was just 

announced, NIHB just announced this, we were able to fund NIHB and they’ve been able to have 

the Tribal Accreditation Support Initiative, where there have been a number of tribes. Let’s see I 
13 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

think there were five tribes that received some direct funding to be able to help them achieve 

accreditation. And they’re varying sizes, they’re from Wisconsin to Washington State, Michigan, 

North Carolina, they’re across the country. The funding was $10,500.00 per tribe so it’s not a lot 

of money in the scheme of things; huge, but it does go a long ways for this type of work and to 

be able to do this. So each of the tribes is constructing an individual work plan to accomplish 

specific, concrete steps toward achieving at least one or more of the PHAB standards. So we’ve 

been very excited about that; and that targeted funding is something that we’ve got an eye on, 

you know; how do we do that to achieve the goals. One of the things, because our office has –

because we’re crosscutting and because we’ve done a lot around performance improvement, 

just to let you know, Craig Thomas, our Division Director for our Division of Public Heath 

Performance Improvement, actually is on international travel. Global Health, invited him to give 

a presentation. I just got a note from him yesterday. He gave a presentation in Paris to a European 

Delegation around performance improvement, standards, and accreditation; and then he is 

leaving there going to India for a big meeting in India. And so Global, from an international 

perspective, folks are very interested in the system’s approach and setting standards and how do 

you build relationships so that you can get things done. So we’re very proud of Craig and that 

request that came from Global. So that’s our accreditation work. The other thing with 

Performance Improvement, this program now has ended; the funding- we only had the funding 

for four years but we had funding through the Prevention and Public Health Fund that we were 

able, out of our Office put over nine and a half million dollars went into tribal governments that 

actually reached about 250 of our federally recognized tribes. It was the National Public Health 

Improvement Initiative, NPHII is what we called it. It really was to help advance standards and 

performance. So to give you an example of some of the things that it helped advance, the Alaska 

Native Tribal Health Consortium more than doubled, they looked specifically at tobacco 

cessation; and they more than doubled the percent of their patients in pulmonary and cardiac 

clinics that were smokers, those that were being referred for smoking cessation. So it was a very 

nice increase in that and that was a process improvement and we look at things through our 

Office as, what are the systems and how do you do something...tweak something in the system 

to improve and move everything forward. Cherokee Nation used NPHII fundings and they were 

able to write their first Tribal Public Health code. In Arizona, Gila River, is it Gee-ia? Gila River 

Indian community—okay, Gila with an “H”. Sorry about that. They worked on Medical Electronic 

Disease Surveillance and built an integrated system that better protects patient information. So 

it’s really wide ranging the types of projects that people use, you know, the tribes use the funding 

for. Other examples were improvement in tribal emergency planning for heat emergencies. Some 

of the tribes looked at that. We had the Montana-Wyoming Tribal Leaders Council supported 

efforts to identify public health gaps among member tribes and gave out mini grants; so they 

received funding and then from there, they gave out the mini grants to the tribes to be able to 

conduct health assessment using the National Public Health Performance standards and the 

Mobilizing for Action through Planning and Partnerships, or the MAPP process that has been 

around. So we have a number of examples that we’ve been very happy about in OSTLTS, and 

would love to- of course we would love to have more funding to be able to put out for those 

types of activities. 
14 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

In terms of- the other thing that is within OSTLTS is Public Health Law, and I invite all of you to- if 

you have questions or need technical assistance, our Public Health Law Program stands ready to 

help. They’ve already done a number of different projects and provided technical assistance to 

tribes on Public Health Law issues, and they do a number- they have a Public Health Law Tribal 

Public Health page on their website so we’ll make sure we get that out to all of you because that 

would be a page you could go to that’s specific to those laws that would impact the tribes. A new 

body of work that we’re really excited about that they’re doing is the Tribal Epidemiology Centers 

as designated public health authorities and we think there is great opportunity with the Tribal 

Epi Centers being public health authorities. There was some technical assistance, questions that 

came to our Public Health Law Program so in response to that, they’ve created an issue brief to 

really walk folks through, and they’ve done this with a cooperative agreement with the 

Association of American Indian Physicians, AAIP, to summarize the Affordable Care Act’s Tribal 

Epidemiology Center provisions. And you heard from Ursula Bauer that, you know, she has 

funded all of the Tribal Epi Centers through some of the funds she was able to mobilize; so we’re 

very excited about that. This publication, this memo will be coming out at the end of the month 

or early next month, in just the next few weeks. 

Workforce, I said was one of the three areas. We have the Accreditation and Performance 

Improvement, technical assistance that we offer, and then workforce. So to talk a little bit more 

about the Public Health Associate Program; Dr. Arias did a nice job of describing that program. 

For the new members, this is a program that had started but it was just a very pilot program prior 

to 2010. And then OSTLTS was established, and Dr. Freiden said, “I think this is a program you 

guys need to really build.” And so we have every year increased the number. Our ultimate goal 

is to have 200 per class and the classes, they’re in training for two years. So when we reach our 

stretch goal, hopefully that will be the – hopefully Dr. Freiden will be happy when we reach that 

number because he keeps increasing the number for us, but that would be a total of 400 folks 

that have bachelors or masters degrees; and about a third come in with master-level degrees 

that are CDC employees. We’ve hired them, they have training here, so we offer classes, we have 

ongoing – you know, we have a whole curriculum that has been established, continues to be 

improved upon, but they are placed in health departments. But we’ve gone beyond that. We now 

are allowing applications from other organizations like 501C3s and so forth; so we’ve broadened 

that because we’ve increased the number. Now, I know from our Summer TAC, we talked about 

this, and we’ve talked about trying to place more associates in either tribal serving organizations 

or tribes. We’re committed to doing that and I’ve talked with our staff about it because I do 

understand that there have been applications, some very good applications applying and then 

they didn’t-from tribal organizations- that did not receive a PHAP, weren’t actually placed. There 

was a matching, we obviously have to match, because we don’t want to send you someone that 

doesn’t want to be there or wouldn’t be a good match so that it gets, there’s some complexity 

behind the scenes here. But I’ve talked to staff about making sure that we’re pulling out those 

applications that come from our tribes and we’re gonna work harder at trying to increase the 

number; especially with the increasing number in PHAP. At this point, we have...Ileana was giving 

you the numbers in terms of how many are actually there now. We have six associates currently 

with tribal-related assignments but I would love to see more of those. And then the flip of that is 
15 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

that we would like to have more applications from individuals that are from tribes that would like 

to come into the program; so there’s two opportunities here both to have trainees and then also 

to have placements. It’s been high growth; it’s the type of program we’ve had to continue to do 

a lot of improvement on and we welcome your input on maybe how to go about doing this even 

better; but we are committed to having more placements. I will tell you, the public health 

associates, it’s just amazing the capacity that they’ve helped us increase. I don’t know if 

mentioned this, with Ebola, we’ve had over 50 of the associates I believe that have stepped up, 

went to quarantine stations, and went into health departments. So we have a workforce that’s 

in training, but then something like Ebola hits that’s a threat to the whole world and we can 

mobilized quickly and it gives them great training experience, if you will. So we’ve been very 

pleased with that. 

Sam Taveras, I see Sam sitting here, Sam oversees our national partners. And we have- OSTLTS 

has, how many now, 24, 25? Twenty-five national partners that we manage the cooperative 

agreement. Two of those, we have the National Indian Health Board and the Association of 

American Indian Physicians, are two grantees right now that are focused obviously on tribes. And 

Sam and his shop, my hats off to the hard work there that’s been done because he’s built an 

opportunity for CDC where we manage the cooperative agreement; but then the CIOs, it’s a 

mechanism for them when they have funding or special projects, they can come through that 

mechanism to get the money out to the partners very efficiently to get the work done. And so 

it’s, I don’t know, hundreds of projects that are happening because of this mechanism. And it 

continues to be again, it’s another opportunity for tribes that we probably should continue to 

explore more opportunities. I don’t know if Ursula mentioned this yesterday, but sometimes 

there is year-end funding; on the front-end we’re trying to establish budgets and put money 

forward. On the back-end, there’s year end funding sometimes and this mechanism. I know Sam 

works very hard at the end of the year because folks want to put year-end funding in through the 

partners. But another opportunity, especially I think going back to what Dr. Arias said, if the TAC 

comes to us with specific areas that you’d want us to focus on, then we make sure that’s 

communicated throughout CDC and then sometimes opportunities come up that are short time 

lines; we can move quicker perhaps to make things happen, we would welcome that 

conversation. 

And then we’re certainly changing, no I won’t end here because I’ve got a few more things. I 

didn’t think I’d take up all my time but I may. There’s a lot to report out. But as OSTLTS has 

continued to grow and develop, now we have Annabelle Allison, as you heard yesterday, and so 

that’s, I think, a big change because when we had really the visibility now of environmental health 

and associated tribal work can be even broader because with Annabelle in OSTLTS, I mean, this 

really was the National Center for Environmental Health, in the Agency for Toxic Substances and 

Disease Registry’s tribal affairs activities coming over to OSTLTS. And it gives Annabelle the 

opportunity then to have broader audiences and to do broader public health but with her 

expertise in environmental health so we’re excited about that. A few other things with- just a few 

last comments and then we’ll open up for questions and whatever y’all would like to advise me 

on as the Director of OSTLTS. 
16 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

With our partnerships, I wanted to mention through AAIP and work with Professor June 

Strickland at the University of Washington, one of the activities they do is they conduct Tribal 

Grant Writing Trainings; and so if folks want to know more about that, Delight Satter can give 

you more information or AAIP for the details on that. So that’s another way that we’re 

approaching this work. I was asked last night what I do, what’s my portfolio? And one of the areas 

that has become a really big part of our portfolio is the fact that the Centers for Medicare and 

Medicaid Services, CMS, established The Innovation Center, CMMI. And CMMI got 10 billion 

dollars to innovate across the country, and about two years ago; yeah it was actually two years 

ago this month that they awarded the first State Innovation Model Initiative awards and they just 

did their second round of funding; and so we now have 38 entities. It’s states, D.C., territory; 

there’s a territory or two in there that have been funded. There are 38 grantees now receiving 

funding from The Innovation Center. For the states, this funding goes through the Governor’s 

office. What we’ve learned, is Oklahoma, I believe, really stands out as a state, that as they are 

doing their SIM work, my understanding from Terry Cline, the Health Officer there, is that tribal 

leaders are at the table in a very meaningful way. With OSTLTS, when we hear those types of 

things, that’s the type of message that we will try to carry to other states as well; that look to the 

example of Oklahoma, because when you’re doing your SIM work, where are your tribes. Because 

this impacts Medicaid, it’s gonna impact all funders. At the end of the day, we’re really at a point 

in our country where they are trying to move to value based purchasing, and away from paying 

to do things to people to try to keep them healthy. And every state, anyone receiving this funding 

has to have a State Population Health Improvement Plan and that requires everyone at the table; 

and so we want to make sure the tribes are at the table for that because this is an opportunity 

that’s come along. With that, the work that we are doing with the states, and I’m getting a lot of 

calls now from states to give technical assistance as they now are developing these plans. We 

work very closely with Chronic, Ursula Bauer’s shop is really big in this. The plans have to address 

at a minimum diabetes, obesity, and smoking tobacco. So those three things are kind of a floor, 

and then the states can have other population health approaches that they would want to have. 

Just to give you an example, the state of New York had the largest award and that was 100 million 

dollars to do this work over the next three to four years. So there’s some substantial funding 

that’s gone in to help the system change so pay attention to what’s happening in your state and 

whether your state receives some funding. And then John Auerbach is working with Medicaid 

programs. He is reaching out to the Medicaid programs; he’s our Associate Director for Policy 

here at CDC and we’re working very closely with his Office. But really, we’re trying to reach across 

all the programs with this transformative work. And then lastly, some of the new work that we’ve 

been asked to do in OSTLTS is to take on rural health. So we’re now the point of contact for the 

Agency for Rural Health and the White House has some initiatives around rural health. And if you 

look at the President’s budget, he actually has in there 20 million dollars to support 

demonstration projects aimed at really combatting- having strategies to combat rural child 

poverty and that includes American Indian Alaska Native; so they’ve included that. I’m on a call, 

I think, tomorrow to learn more about this; but OSTLTS, again, is the Office that will help on behalf 

of CDC to understand what this work is about. We’ve been the Office to help with something 

called “Strong City, Strong Communities.” So anyway, the rural focus is somewhat new but I think, 
17 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

especially with this White House initiative, that’s something new and evolving and we’ll see 

where that goes. So let me end there and certainly open to feedback, comments, and questions.

Joe Finkbonner: Dr. Monroe. No questions, just want to tip my hat and thank you for all the work 

that you’re doing in trying to engage tribes more interactively with CDC. It’s been apparent at 

least through yesterday and today that you and Dr. Bauer have really stepped up in trying to 

include tribes and getting additional resources and I applaud you for that. And I hope that as your 

colleagues show up around the table that we have a chance to have some discussions about how 

they can become more engaged with tribes. And my thought and concern, when there’s always 

an Office that deals specifically with tribes or Indians, is that they become the go to place to deal 

with all problems that are tribes or Indian, and instead there’s supposed to be that Office that 

then is the conduit to help them understand how to work with tribes and Indians and I hope that 

by the end of today, get that message across to them that you are that conduit that helps them 

to more effectively work with tribes so thank you.

Dr. Judith Monroe: Thank you. I can’t say enough about Ursula Bauer. She’s been a great 

colleague and it’s really been a big help absolutely. But Ileana Arias has really stepped up as well 

in the OD; she’s a real champion as well. And so we begin to see this, you know, you get the 

leadership that begins to filter out. And I was happy yesterday with the Hepatitis C discussion. 

When they asked for more funding, they called out the disparity. So if all the programs would 

begin to do that that takes us a long ways.

Lt. Governor Jefferson Keel: Go ahead Cathy.

Tribal Board Member Cathy Abramson: I too just want to thank you for all the work in bringing 

us all together. I’ve just seen great improvements each time that we meet and I’m really 

impressed with that and let everybody know that. I like what you were just letting us know. And 

is there a way that you could, for each state, let us know what funding that they do get that we 

can talk to our state reps about and let them know that we know?

Dr. Judith Monroe: Yeah, actually I think Georgia Moore-, Georgia is still here. We have a funding 

tool; we do track that and so that would be, what we can do is package that probably, 

communicate that probably a little differently and package that in a way that you all have that; 

because we have the information.

Tribal Board Member Cathy Abramson: Ok, because I’m from Michigan and there is no really 

consultation in the, I don’t know. Right now I’m missing a meeting with some of the state liaisons, 

but it’s probably best that I’m not there because, an example is when some of the people that 

work for the state of Michigan say, “Well, we have to deal with you.” And, you know, these are 

attorneys and so I have a problem with that. But there are new people, as you said, and I just 

want to be able to know what’s available, the tribes...you know, funding sources that the tribes 

can be included in and applied for and we’ll go after those as we go and improve our 

communications and relationships with the state.
18 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

Dr. Judith Monroe: One of the things, Cathy, that’s happened is that as we’ve continued to 

mature in our work here. ASTHO, I think, they’re communicating differently to the new State 

Health Officers as well around tribal health and the fact that they should have consultation and 

so forth. So it’s- the work gets complicated but there are multiple avenues to carry the message 

and so through our other partners, no, I think we’ve seen a big change. 

Secretary Adam Geisler: Just one. It is just one. As everybody said, it’s impressive to see what 

your Office is doing; it’s been evident over the last day, two days to see the progress. And I do 

want to commend you because in working with other Agencies, you are a lot further along than 

a number of them that are out there in terms of the way you’re engaging tribes. Even the way 

that this session has been organized the last two days so I do want to commend you on that. With 

regards to the workforce component that you had discussed; tribes are spending a lot of time 

focusing on the employment future for our tribal members or citizens of our Nations; and I guess 

I’d really like to find out more about the program and it sounds like it’s been discussed in the past 

probably quite a bit. The new guy doesn’t know it yet. But, I would love to get the information if 

that could be disseminated out because there’s a big push I know in our area especially with the 

Medical and Research Centers that are in San Diego, such as Scripps, UCSD, etc., that we’ve been 

pushing for that. And with the PHAP, the Public Health Associate Program, so now I understand 

what the three- 2013 and three- 2014; so are those specific to Indian Country that are out there 

being deployed in Indian Country currently? 

Dr. Judith Monroe: So, yeah. She was talking about the year that the classes came in, the 

2013/2014. And so there’s six right now that are specific to tribes but what I’d like to do is carve 

out...—well 200 would be the total class, so there would be 400 total. But yeah, I mean feel free 

to advise us how many of those 400 should be in Indian Country. We’ll take a number.

Ramona Antone-Nez: Good morning members of the TAC and thank you to CDC. Thank you TAC 

members and CDC representatives. I’d like to also say thank you to Dr. Monroe for your 

leadership and to your support staff. Support staff always helps the leadership look really good 

so thank you. There’s three things that I’d like to just acknowledge. Number one is that the Tribal 

Epi Centers are Public Health Authorities. We’d like to thank you for that recognition because it 

is very important that we continue to have access to data and quality data. We’ll work on that 

and classifications, race classifications, etc. But to have access to that is very important. In that, 

I’d like to make a recommendation that we continue to have access to and make 

recommendations for assignments of Career Epidemiology Field Officers to Indian Country. 

We’ve made that request and I’d like to make that recommendation to your Office. If you could 

start helping us to make that a reality because that would really help in the link of data, to 

monitoring our health status, as well as, I will lead to the next is budgeting and health priorities 

for the Field Officers. The second is about funding. I would like to see that the TAC start to move 

towards generating a budget priority in terms of what our health is here in Indian Country. We’ve 

had some discussion on that yesterday, and I hear the report....I heard the report that these are 

CDC priorities. My question to that is what did the TAC, CDC TAC, contribute and how did we 
19 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

contribute to those priorities? I’d like to see that we become more involved in recommendations. 

So that would move to act, the CDC TAC to identify what that looks like here in Indian Country. 

So in the line of budget, I will continue to advocate and request for direct funding to tribes. 

Although we are working towards improving our relationship with the state health departments 

who do receive funding, that’s always gonna be there and some tribes have better relationship 

than others. It’s also a step towards recognition of that government-to-government relationship 

that the federal CDC agent has to our sovereign nations. So I’ll continue to advocate for direct 

funding. The third is I’d like to thank you. With how it all happened I don’t know, behind the 

scenes, perhaps it was support staff; don’t know and then of course leadership, that ATSDR is 

now recognized at this table in terms of the work that has been done and to have that be here 

and having Ms. Allison here to really start working towards what environmental health and 

impact in public health as it relates to health status; and all the possible environmental injustices 

that do exist and the need for the responsibility of both federal and tribal, local, state to address 

these environmental issues that are ailing our, or lifting our health. So those are the items that 

I’d like to bring forward and also call to action the CDC TAC. I address that to the Co-Chairs, and 

I just want to say thank you to that.

Lt. Governor Jefferson Keel: Could I say something? She covered one of the recommendations 

that I had and one of them was going to be that in the TAC, when we talk about the Advisory 

Committee, and she touched on it; actually covered it very well that the TAC currently has no real 

role in the budget development process here other than looking and reviewing what’s already 

been developed by the CDC staff. My recommendation would be that the TAC be involved, and 

through your leadership somehow, we get to the point where we can have a session where we 

look at the budget, particularly for FY16, we look at what the recommendations have been or are 

already on the table; because I know it’s already been in discussions. We’re gonna talk about that 

at HHS in a couple of weeks. And then particularly, moving forward, looking at FY17, looking at 

how we develop the recommendations for Indian Country. If, in fact, the TAC is chartered as an 

Advisory Committee to the Director then we ought to have at least a role in developing 

recommendations for the Director on how they look at priorities for Indian Country in terms of 

overall wellness. We heard yesterday about everything from safety to environmental health. We 

talk about mental health, suicide prevention, and all those things we need to develop some 

priorities for Indian Country on how CDC can address those needs. And I would recommend that 

we get together and determine how we can best resolve that. We’ve got technical experts 

throughout Indian Country that understand budget development. They get all the way down in 

the weeds with you on, you know, indirect cost, and all of those things. So our capacity has 

increased and it’s at a level where we feel like we have some technical expertise to assist in that 

process. So it’s time that we assume that responsibility also. And with that, we’re almost at break 

time so we’re gonna take—does anyone else have anything they want to add or did you want to 

respond? Did you want to respond before we go to break or... I see some anxiety here you know? 

I sense some strong feelings here. 

CAPT Joe Maloney: So, hi this is Joe. So part of the discussion was what do we do with this photo 

opportunity for Dr. Arias? So Dr. Arias, we traditionally have a group photo with the TAC 
20 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

members, and she’s in the Ready Room so for the TAC members around the table we can just 

kind of regroup maybe by the door over there. 

Lt. Governor Jefferson Keel: Ok, then let’s come back in at 10:00 o’clock as best we can. Thank 

you.

Roundtable Discussion with CDC Senior Leadership

Councilman Chester Antone: Good morning again. We’re about ready to begin our roundtable 

discussion with CDC senior leadership, and I would like to have the CDC senior leadership come 

up to the table. And I would also like to pass on this information to you for the CDC leadership to 

briefly introduce yourself and briefly mention your duties here at CDC because we’re gonna try 

to direct most of the time to discussion; and so I’m gonna start off to the right side.

CAPT William R. Mac Kenzie: Good morning, my name’s Bill Mac Kenzie. I’m the Deputy Director 

for Science for CSELS, which is the Center for Surveillance, Epidemiology and Laboratory Services. 

CSELS provides a broad array of cross-cutting services to support CDC partners. These services 

include the building and maintenance of information systems and platforms such as the 

Nationally Notifiable Disease Surveillance System that receives data from state and local partners 

and provides it to CDC programs. It is also engaged in Workforce and Career Development and 

administers training programs such as the EIS, the Epidemic Intelligence Service, the Public Health 

Informatics Fellowship, and the Prevention Effectiveness Fellowship. CSELS also provides 

laboratory standards and guidelines for the Nation and research and training in collaboration 

with FDA and CMS. Finally, CSELS is the home of dissemination of public health information for 

action through its publication of the MMWR, Vital Signs, and its work with the Community Guide 

Taskforce. Thank you.

Dr. Hazel Dean: Good morning. I’m Hazel Dean. I’m Deputy Director of the National Center for 

HIV/AIDS, Viral Hepatitis, STD and TB Prevention. Within our National Center there are five 

divisions. We have the Division of HIV/AIDS Prevention, the Division of Viral Hepatitis, the Division 

of STD Prevention, the Division of Tuberculosis Elimination, and the Division of Adolescence and 

School Health. Our mission is to save lives, protect people, and reduce health disparities 

associated with the diseases of our Center. We achieve this by the three goals of decreasing 

incidents of infection of these diseases, decreasing morbidity and mortality, and decreasing 

health disparities. We do this through what we call high impact prevention, which is maximizing 

impact through efficient implementation of cost effective and feasible interventions through our 

research and through our policies. Good morning to everyone.

CAPT Thomas Hennessy: Good morning. My name is Tom Hennessy and I’m here representing 

the National Center for Emerging and Zoonotic Infectious Diseases. We have seven divisions in 

our Center and are involved in a wide array of infectious disease threats, some of which include 

water-borne and food-borne infectious diseases, conditions related and that are controlled 
21 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

through quarantine activities. Also, we have the Division of Healthcare Quality Promotion, which 

is involved in hospital or healthcare-associated infections. Three of our divisions are very actively 

engaged in Indian Country. The Division of Vector-Borne Diseases has the activities related to 

Rocky Mountain Spotted Fever that have been carried on for many years now with the Tohono 

O’odham Nation, St. Carlos Apache, and White Mountain Apache. Also, the Division of High 

Consequence Pathogens and Pathology is involved in a collaboration for many years with Indian 

Health Service to use the National Indian Health Service data warehouse to evaluate rates of 

infectious diseases among American Indians and Alaska Natives and that activity has produced 

over 45 reports that chronicle the improvements and challenges related to infectious diseases. 

I’m also the Program Director for the Arctic Investigations Program, which is CDC’s field station 

for infectious diseases in Anchorage, Alaska, and we’re located on the Alaska Native Medical 

Center campus and work very closely with tribal health organizations throughout the state of 

Alaska to augment their activities related to infectious disease prevention and control. We also 

operate and co-manage the Alaska Area Specimen Bank and I know there’s gonna be a discussion 

later this afternoon on specimen banking. Some of you have visited that facility in the past, but 

basically, it’s a collection of public health specimens and research specimens that are comanaged with tribal health authorities in Alaska. So thank you.

Dr. Corinne Graffunder: Good morning everyone. I’m Corinne Graffunder. I’m the Deputy 

Associate Director for Policy here at CDC so we’re one of the OD offices that is a cross-cutting 

office. The mission of our Office is to identify in advance opportunities to use policy and leverage 

the health system transformation and other sectors to improve the public’s health, and to do 

that we really have three priority areas that we focus on. The first is the identification of high 

value prevention in public health policies and interventions. So some of the kinds of work that 

we’re doing there are work related to policy analysis, tools and resources to support policy 

analysis both within our Agency and to be shared with our constituents, economic analysis really 

looking at budgetary impact of some of the public health interventions and how you think about 

those impacts within a budgetary environment whether that’s a health system or whether that’s 

Medicaid, Medicare, etc. I should have started—I apologize—by saying our Director, John 

Auerbach, regrets not being able to be here with you all today. He actually is up in Maryland 

meeting with CMS colleagues today. So he sends his regrets and you got me instead. The second 

priority is to increase the understanding and use of credible evidence of preventions’ impact by 

policymakers, healthcare and other sectors, and some of the ways again that we’re doing this is 

we’re working directly with CMS, we’re working with the hospital systems, we’re working with 

payers, providers, etc. to really try to work on that issue of how do you integrate population 

health and what we know from the evidence into this transforming health system. The last 

priority for us is really catalyzing collaboration within multiple sectors, multiple systems. So 

clearly a lot of our work is in the public health, healthcare system transformation space but we 

also have responsibility for the National Prevention Strategy and work with the National 

Prevention Council and through the health-in-all-policies kind of lens—we really are working to 

advance population health through housing, transportation, economic development, etc. So it’s 

a pleasure to be here, thank you.
22 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

Dr. Katherine Lyon Daniel: Hi, I’m Katherine Lyon Daniel. I’m the Associate Director for 

Communication here at CDC. It’s great to be back here and see some familiar faces again. Our 

Office serves the communication function in the Office of the Director. So each of the programs 

have their own very great communication offices and we work overall across CDC with the goals 

of helping our programs to communicate in such a way that is strategic, understandable, and 

actionable. And each of those three things take a lot of work, especially when you’re trying to get 

scientists to communicate in a way that people can actually understand what they say. So we 

have in my Office the Division of Public Affairs, so all the media work comes through us and then 

to the programs. We work very closely with them and try to shine a light on the issues that are 

most affecting public health and communities. Then we also do communication services, so we’re 

proud to work on videos and graphics and translations and all those kinds of things. Thank you 

again for coming. Pleasure to be here. 

Dr. Harold Jaffe. Good morning. I’m Harold Jaffe. I’m the Associate Director for Science at CDC. 

Our Office is responsible for three basic functions that sound simple but aren’t: science quality, 

science integrity, and technology transfer. And I think I’ll leave it at that.

Sandra Bonzo: Good morning. My name is Sandy Bonzo and I’m the Deputy in the Office for NonCommunicable Diseases, Injury and Environmental Health, and our Office works with the four 

non-communicable disease centers, which include Dr. Bauer’s center, Dr. Breysse’s center, Ms. 

Dulin’s center, and Ms. Patterson’s center and they each will describe more in detail what they 

work on. Our Office is to promote, and to facilitate, and to coordinate the non-communicable 

disease work at the CDC. Thank you.

Dr. Ursula Bauer: Good morning. My name is Ursula Bauer and I’m the Director of the National 

Center for Chronic Disease Prevention and Health Promotion. Pleasure to be here again today. 

Our Center addresses the major chronic diseases, so heart disease, cancer, stroke, diabetes, 

arthritis, and so on. And the major risk factors, so commercial tobacco use, poor nutrition, 

physical inactivity and alcohol; although alcohol is disseminated across the agency in a number 

of centers that work together on that. We also have a strong Community Health program and we 

have in our Center an Oral Health portfolio and Reproductive Health as well. We work in four 

broad areas; epidemiology and surveillance, collecting data, using data, turning data into action, 

communicating data, getting data to decision makers for use; an area that we call policy and 

environmental approaches that’s creating the communities that are going to support and 

reinforce healthful behaviors. The third area is working with healthcare systems to more effective 

deliver quality clinical and other preventive services, so all of your cancer screenings, screening 

for tobacco use, management of hypertension and diabetes, and so on within the healthcare 

system. And then the last area we call community clinical links. That’s helping people with or at 

high-risk for chronic conditions to better manage those conditions themselves; that’s community 

delivery of self-management programs and supports and knowledge, that’s connected to the 

clinic and that hopefully we’re building a third party reimbursement for. Thank you.
23 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

Dr. Patrick Breysse:- Good morning, I’m happy to be here. My name is Pat Breysse and I’m the 

Director of the—recently hired director- of the National Center for Environmental Health and the 

Agency for Toxic Substances and Disease Registry, ATSDR. So I’ve been on the job for I think 

someone told me yesterday was my 7-week anniversary, so I’m really pretty new but I’m excited 

to be here, I’m excited about the work that we’re doing and every day I learn more about what 

NCEH/ATSDR does and I just get more excited every night. So it’s kind of a great job. We have 

within the two groups that I head, and they’re separate but they’re similar because they have 

similar missions and so I do wear two hats and I want to keep that clear. But we look to implement 

across these two Agencies and Centers the implement environment health programs and 

interventions that are evidence-based. So we’re looking at things that we can do to improve 

health based on modifications we can make to the environment because the environment is our 

focus. We look to prepare and respond to public health emergencies, whether those emergencies 

are primarily environmental health related or whether environmental health is a component of 

that emergency response. So that’s a big part of what we do, and then finally, our third major 

goal is to identify, characterize, and monitor health outcomes and environmental exposures. So 

there’s a monitoring surveillance tracking component to what we do. And within that we’ve 

established four research topical area priorities and I think you’ll see all these will resonate with 

what you’re interested in. So the first one is asthma. There’s an asthma epidemic today and we’re 

really struggling with how to combat the asthma epidemic. There’s a huge component of 

disparities associated with that. There’s genetic component and it cuts across all aspects of

society from the well-to-do, to the poor, and understanding those risk factors and what we can 

do is an important part of what we do. We have a focus on children’s environmental health. It’s 

a topical area that spans a number of Agencies across the federal government, and we have an 

important interest in children’s environmental health, so asthma is a children’s component but 

there’s also an adult component to asthma, but we’re very much interested in children’s 

environmental health. We’re interested in safe water and have a water program, and our niche 

there is we’re looking at water systems that the EPA does not currently regulate so there’s a large 

fraction of the U.S. population that uses well water, for example. And I guess that also applies to 

a number of your communities as well. And then finally we have I think the world’s best 

laboratory for analyzing toxins and agents and chemicals in people’s biological systems as well as 

developing new medical tests for looking at aspects of physiology that might be impacted by the 

environment. So we’ve been involved, as many of you know, with the tribal activities through a 

number of technical assists when those questions come in. We run the Navajo Birth Cohort Study 

through the ATSDR side of the equation. And I’m excited to learn more about what your needs 

are and I’m excited to help you understand what we’re doing so we can be of better service to 

you. Thank you.

Stephanie Dulin: Good morning. I’m Stephanie Dulin. I’m the Deputy Director of the National 

Center on Birth Defects and Developmental Disabilities, and it’s a pleasure to be with you here 

this morning. We have the honor of being the smallest but the mightiest Center here at CDC. We 

have a very diverse portfolio that we save babies, we help children, we protect people, and we 

help those vulnerable populations live with their disabilities to their fullest potential. And we do 

that through a variety of programs and categorical funding which you’ve heard about as we’ve 
24 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

discussed over the last two days. But specifically what we do to help in saving babies is we do 

research to look at what are known risk factors that we can help mothers be aware of so that 

they can avoid those during their pregnancy; one of those being alcohol and alcohol-exposed 

pregnancies. And so we do a lot of work with our tribal partners in Fetal Alcohol Syndrome 

Disorders. Currently, we fund two resource centers, the University of Wisconsin and Denver 

Public Health and Hospital Authority to provide technical assistance on two interventions that 

we help to promote and that is the CHOICES- which is a behavioral intervention program- as well 

as Screening and Brief Intervention, which is a program or an intervention that is clinically set 

and done with both male and females to assess their alcohol exposure and to refer those folks to 

interventions throughout the pregnancies. So we’re very pleased to be here. I have two of our 

SME’s in the back that have been here for the last two days so if I can’t answer any questions for 

you, I have my resources that will be here and will assist me. But we’re very pleased to be here 

today with you. Thank you.

RADM Stephen Redd: My name is Steve Redd and I think I am the most junior person in my job 

on the panel. I have five weeks and two days in this particular job although I’ve worked at CDC 

for almost 30 years, so I have a little bit on the other side there as well. I’m Director of the Office 

of Public Health Preparedness and Response, and we have two primary missions. The first is to 

prepare the country for the next public health emergency and the second is to support the 

Agency’s response in ongoing emergencies as we’re doing with Ebola right now. We have four 

divisions. The Division of State and Local Readiness supports state and local and tribal entities to 

respond to public health emergencies. So there’s a preparedness grant award that goes to the 

62 identified grantees. The second program is the Strategic National Stockpile that purchases and 

stores material that might be needed for a public health emergency and also works to make sure 

that there are systems in place so that if those products are needed to be used that there’s a 

system that can use them and dispense them. We also have two smaller programs, the Division 

of State...sorry... of Select Agents and Toxins that’s a regulatory program that regulates and 

inspects facilities and laboratories that work on those pathogens or toxins. And we also have the 

Division of Emergency Operations, which is the home for CDC’s emergency responses. It’s a 

pleasure to be here and I look forward to the discussion.

Sara Patterson: Good morning. My name is Sara Patterson. I’m the Associate Director for Policy 

at the National Center for Injury Prevention and Control, and at the Injury Center, we work on 

two primary broad areas: unintentional injuries, which include things like prescription drug 

overdose, motor vehicle related injuries which I know you’ve talked about some and we’ll 

probably talk about more today, older adult falls, child injury and many other topics. And the

other main topic that we work on is violence prevention and that includes topics such as suicide 

prevention, child abuse and neglect, rape prevention or sexual violence prevention, domestic 

violence prevention, so the gamut of all of those areas fall within our purview and we do most of 

our work—we’re a pretty small Center also. We’re about 2 and a half percent of CDC’s budget so 

a lot of our work is done by collecting data to understand what the problem is, trying to identify 

what works and really get that disseminated and we do that mostly through partnerships. We do 

provide some funding to states and localities and we have provided funding to tribes but a lot of 
25 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

our work is done through partnerships and trying to work with organizations like the Indian 

Health Service, the Bureau of Indian Affairs, NHTSA, and many other organizations to get our 

mission done. So happy to discuss any of these topics with you and looking forward to it.

Elizabeth Dalsey: Good morning. My name is Elizabeth Dalsey. I’m here representing NIOSH. Our 

Director, Dr. John Howard, was not able to be here today but he says “Hello” and he looks forward 

to hearing our discussions today. NIOSH is the federal agency that is responsible for conducting 

research on worker safety and health. We want to ensure that workers come home as safe as 

when they left to go to work. We are...NIOSH is geographically disbursed throughout the U.S., 

and we have about 1200 employees. We do work in all different industries and our mission is to 

generate new knowledge in the field of Occupational Safety and Health and to transfer that 

knowledge into workplace practices to prevent worker injury, illnesses, and disease. And I look 

forward to the discussion. Thank you.

Councilman Chester Antone: For the TAC members, we’ll now open it up for the discussion phase 

of this presentation. So if anybody has any questions they want to ask of any one of these 

representatives, I’ll recognize you as you raise your hand. Geisler.

Secretary Adam Geisler: Good morning everybody. Again, I want to thank the CDC for organizing 

the TAC and the compliment that was given earlier was that this is an Agency that I think in 

relationship to other Agencies that I’ve come across that we work with on a government-togovernment basis, you guys are off to a great start and I want to commend the leadership for the 

efforts that have been made thus far. But with that being said, there’s obviously always gonna 

be room for growth and speed bumps along the way as we develop our relationship that we want 

to try to smooth out. Over the last couple of days we’ve had some pretty good discussion, I think, 

about varying issues as we’ve had different presentations from some of the directors that have 

come in to speak to us. With respect to the policy component, and I was writing down very quickly 

what each of the Centers do so I apologize if I can’t read my chicken scratch. I really want to try 

to understand the policy integration with tribal components as you make your... as you review 

current policy. I think we discussed looking at, you know, we’d really like to understand because 

we realize there’s limitations in terms of access to funds based upon legislation. There was a 

request this morning to try to get our hands on some kind of a list of funding opportunities that 

we are eligible for, and since you’re going through and analyzing each piece of policy or 

legislation, I think that would be helpful. Another thing that we were looking at, and I apologize 

that this is probably gonna be very policy centric, but I’ve also found that that is the starting point 

for access and partnership. So the other aspect that I think I would like to understand more is 

how the CDC wants to or is looking to continue to include tribal specific language in its 

recommendations in policy development as it’s coming down both from a budgetary standpoint 

but then also internally within each of the departments. And I apologize if it’s agency department. 

Because we’re seeing—and this is something I’ve learned over the last day, day and a half that I 

think that the will to work with tribes is here. It sounds like there are some aspects legally and 

policy-wise that we need to work through in order to achieve the outcome. Obviously, I don’t 

think there’s a tribe around this table that wouldn’t like to see direct funding for different areas, 
26 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

especially in terms of being able to collect the data ourselves, directly give you the data. I think 

in terms of the way that the structure is coming down from a policy standpoint everything comes 

from the feds to the state to the tribe and we’re just kind of, if we’re lucky, able to compete or 

go after or share information in that process, and I think that as much as that makes sense from 

a certain planning standpoint tribes don’t always have the best relationships with their states 

because of other political issues above and beyond health components that aren’t a priority to 

them. So I just wanted to put that out there for food for thought. The other comment that I had 

was regard to the public health and preparedness and response. I’m really curious how you’re 

working with the Department of Homeland Security and FEMA specifically and their tribal liaison 

because we do have one tribal liaison for the Department of Homeland Security and one within 

FEMA. I do a lot of emergency management work as well and this has been a discussion locally 

within San Diego. Obviously, we’re a large military town. There’s concerns about we have a 

nuclear power plant down the road so there’s all kinds of environmental components that are 

associated with this as well as the stockpiling components. So I’m just curious how you’re working 

with Homeland Security and FEMA. Those are I guess two questions that I put out there to both 

of you.

RADM Stephen Redd: Actually, as you were talking, I didn’t think I would get the first question, 

so I’m also going to give you a not-very-specific answer and I’ll plead five weeks on the job. We 

recognize the importance of the collaboration with FEMA and DHS and we have actually had a 

liaison from CDC to DHS in Washington. That actually was a temporary position but I’m gonna 

have to look into a better answer to your question than I’m gonna be able to give right now. I 

think that the relationship between our office and FEMA and DHS is something that’s really 

important because we do need a unified federal approach to emergency preparedness and really 

to bring in the public health part of that. So let me get back to you with a more specific answer.

Dr. Corinne Graffunder: You’re looking at me because I’m from the Policy Office. Unfortunately, 

I think it’s a broader discussion because the way our policy activity is structured at the Agency. 

We have policy activity in the Financial Management Office, we have policy activity in Judy’s shop, 

there’s policy activity across all the different Centers so they all have policy offices, so some of 

our responsibility is to work with and help support each of those Offices and to help strengthen 

the policy activities. So some of the kinds of policy I thought I heard you talking about in terms of 

some of the grant making and some of those things are probably better addressed either by some 

of the other folks around the room, because we don’t have any programmatic activities in our 

Office. We don’t do any programmatic grant making. So we could either see if others have some 

thoughts about that, or again, we’d have to follow up with you all. Is there somebody here from 

Sherri’s office?

Dr. Ileana Arias: No but I’ll have some of the policy folks who are here from the Centers can also 

speak to how it is that they approach it. One of the things that I heard you that we can easily do 

is be able to identify, for example, although we can’t do it prior to actually publishing the FOA for 

the obvious reasons, what we can is be poised to once the FOA hits the ground to be able to then 

communicate with the TAC and then on further what the status of tribal entities is in terms of 
27 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

responding for whatever is in that FOA. Is it possible, is it not possible. Sometimes it is, sometimes 

it isn’t and there are all sorts of reasons why the difference may exist but at least we can convey 

that so that when the FOA is out, either I’m not even gonna fuss around with that one, or this is 

one that we actually can get funded by and so let’s focus on this and tap into whatever technical 

assistance then there is back at CDC for addressing and being responsive to that FOA. So that I 

think we should definitely look into and find a mechanism for, number one, identifying the 

eligibility and then communicating that as early as possible.

Councilman Chester Antone: Thank you. I’ll turn it over to Cathy Abramson.

Tribal Board Member Cathy Abramson: Thank you, Mr. Chair. I’ll put this really close to me so I 

can save you a trip over here. I would just like to say, again, I appreciate all of you being here. I 

don’t know if there’s some of you that I know you have to be here because your boss said you 

have to be, but I appreciate it and I appreciate that you’re listening to us. Again, I see better 

communications and that going on. I’m not going to leave anybody out in this question. I would 

like to- the question that I’d ask is, and go around the room, what is the one main priority 

identified in your Center addressing needs in Indian Country? And we can start over there.

Elizabeth Dalsey: We talked about this yesterday during our presentation but with our new 

American Indian/Alaska Native Initiative and our workshop is really trying to do an environmental 

scan, is trying to address and understand what are the priorities in Indian Country regarding 

worker safety and health and how we can address the needs and try to better understand how 

NIOSH can provide support.

Sara Patterson: For the Injury Center, I think our number one priority would be motor vehicle 

related injury prevention and we really have been very strongly committed to working with tribes 

directly and now through the TTAP program to try to provide technical assistance and resources 

to help with enforcement of existing laws and improving laws to make motor vehicle related 

injuries far lower in tribes because it’s just such a huge burden. So that would be our number one 

priority.

RADM Stephen Redd: For the Office of Public Health Preparedness and Response, the highest 

priority would be that when a public health emergency occurs in a tribal area that the response 

is as effective as it could be and that the work has been done to be prepared to respond to that 

emergency.

Stephanie Dulin: For the National Center on Birth Defects and Developmental Disabilities, it’s 

Fetal Alcohol Syndrome Disorders, and again, the work that we’re doing is through the two 

technical assistance centers to help bring the two intervention strategies to Indian Country to 

help best intervene and reduce alcohol-exposed pregnancies.

Dr. Patrick Breysse: Do I have to give one? 
28 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

Tribal Board Member Cathy Abramson: You can give two.

(Laughter)

Dr. Patrick Breysse: So, obviously, we’re committed to the Navajo Birth Cohort Study but that’s a 

very specific project so I’m not gonna mention that but I think a couple of things I would mention. 

One is clean water, access to clean water, and water distribution from droughts to excess to 

agriculture versus drinking. So there’s huge issues around water. And then the other one I think 

is climate change and it’s kind of related, so climate change and resilience in preparing for climate 

change I think are two areas that are important to us that would, I think, also resonate with you.

Dr. Ursula Bauer: Our priority, which we’re in the process of implementing, is developing and 

delivering a more coordinated approach to chronic disease prevention and health promotion that 

brings together the resources and knowhow from across the Center and puts that out in a way 

that the tribes can own and make their own. If we have a chance to go around again, I’d like to 

come back to Adam’s question because there’s another issue we’d like to elevate to a priority 

around policy.

Sandra Bonzo: The Office of Non-Communicable Diseases does not have programs so we don’t 

have one specific programs but we can work with the four non-communicable disease centers to 

determine how we can maximize our work across the four centers as it relates to tribal work.

Dr. Harold Jaffe: Our office also has no programmatic responsibility so I think we’ll pass on that 

one.

Dr. Ileana Arias: My priorities are their priorities. 

Dr. Katherine Lyon Daniel: From the aspect of Communication, I think my priorities are your 

priorities. So finding out what kind of information you and the people that you serve need so that 

we can meet those needs is paramount, and part of the difficulty there is that because we work 

on a federal level, often when we’re getting audience research and information about what 

people want and need, it’s such a small sliver of the data it’s hard to get breakdowns underneath 

that. So I would love to have an increased way to get information from you about what you think 

we should be doing more of in Communication.

Dr. Corinne Graffunder: For our Office, we have had a priority through the work of the National 

Prevention Council that includes the Bureau of Indian Affairs of working with each of those 

colleagues around high priority prevention and health promoting policy systems in 

environmental change efforts. We’re really focused right now on tobacco and on food working 

with colleagues in the Chronic Disease Center. I think the opportunity that I want to just mention 

is also with the work that we’re doing in trying to really understand the health reform aspects 

including delivery reform and payment reform, figuring out who we could be collaborating with 

more closely to understand what that looks like in Indian Country would be an opportunity.
29 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

CAPT Thomas Hennessey: With regard to Emerging and Zoonotic Infectious Disease Centers, our 

approach has been to identify and characterize health disparities in Indian Country as a way of 

ordering priorities for applying subject matter expertise and consultation with tribal groups. Two 

of the examples that I mentioned earlier were with regard to Rocky Mountain Spotted Fever and 

then my own program, which addresses health disparities among Alaska Native persons.

Dr. Hazel Dean: In my Center, a priority is reducing health disparities across all of our Divisions. 

You heard from Dr. John Ward yesterday with the Division of Viral Hepatitis and their view on 

programs and processes that are in place for hepatitis. We have similar processes for HIV, STD, 

TB, our School Health program, as well. And for us we’ve already characterized the disparities 

and you’ve seen it in our publications. So now it’s moving forward with programs and working 

together with you to make sure that we’re actually reducing disparities.

CAPT William Mac Kenzie: Thank you for the question. For our Center we would focus on what 

the Community Guide Taskforce would put out, which works with all the other centers to provide 

interventions, information about interventions that would work within the Indian community.

Tribal Board Member Cathy Abramson: Thank you all. I just wondered with the HIV and AIDS. No 

tribes got any funding at all. So how are you going to address that so we could get some help that 

way because that’s desperately needed?

Dr. Hazel Dean: So we’re part of the policy dilemma of the first question, where our funding 

opportunity announcements are primarily the state and local health departments and we 

encourage state and local health departments to work with tribal communities. I see you shaking 

your head. So we’re part of this policy dilemma that you’re talking about where some of our 

programs are challenged in offering direct funding to tribes versus going through the state and 

local health departments.

Tribal Board Member Cathy Abramson: Thank you.

Dr. Ileana Arias: Just as a follow up, the Center has done an incredibly wonderful job at sort of 

tying the effort to data, and not only that, really monitoring closely just implementation but then 

outcome of that. And so one of the things as a follow up maybe that they can do is for those 

states that do have reach and should have reach to those tribal populations, maybe what is ithow is it that we’re sort of doing it to make sure that that is happening both in terms of 

monitoring and then looking at the outcome and so we can follow up with that description.

Tribal Board Member Cathy Abramson: Thank you. That would be great.

Councilmember Chester Antone: Mr. Keel.
30 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

Lt. Governor Jefferson Keel: Thank you. Good morning. Thank all of you for being here and sharing 

with us. As a member of the advisory committee, and I’ve been a member since it was chartered, 

I’ve seen a lot of growth and a lot of progress in terms of how we’re approaching the different 

subjects and different areas of need within Indian Country, but we still have a long way to go 

when we talk about the relationship you just mentioned between the states and the tribes. For 

some tribes in many states they have a good relationship. Most do not. Most of the states across 

the Country, for whatever reason, do not have a good, firm, smooth working relationship with 

the tribes. Tribes are not included in the discussions in terms of budget development and 

priorities, the surveillance activities are lacking and part of that is because of historic 

misunderstandings or problems within the different states. And there are a number of reasons 

for that. The fact is, tribes have been historically left out of the process of developing the 

priorities of need for their citizens across the Country. Again, some tribes have good relationships 

and we’ve been able to sit down with the state health departments and develop some of those 

protocols and communication and address many of the communication needs. But the fact is that 

Indian Country is severely lacking in terms of funding to address most of those needs. You 

mentioned Fetal Alcohol Syndrome, injury prevention, all of those things that affect Native 

Americans. Those are not just Native Americans, though, and we recognize that those problems 

exist across the community. But if we can improve the lives and the quality of life of our citizens 

within our communities, it raises the level and quality of life of all the people. So we’re simply 

asking for—and we’ve made mention of this earlier, the TAC is going to be recommending to the 

director of CDC that the TAC be involved in the budget development process in the future. We 

want to sit down with the experts and we have technical experts at our level who are able to sit 

down and make reasonable recommendations on how these things can be improved, and we 

believe that going forward that will be an improvement in all of this. Not to say that we’re 

satisfied with where it is right now because we’re not. Indian Country cannot be satisfied until 

the needs of all of our citizens are met, and if you look at proportionately the number of Native 

Americans that exist within different states, there are some states in the Country that have no 

Native Americans to speak of. And so when we go to Congress to—we go to lobby Congress and 

I realize that your relationship with Congress can’t do that but we can and we do. But the 

problems that we run into is that most of the states, 430 people in the House of Representatives, 

only about 350 have—or 350 don’t have any Native Americans. Only about 75 of those 

congressmen have Native Americans within their districts. So it’s an education process for us 

continually. It doesn’t mean that we don’t reach out to all of those others because we do, but it’s 

very difficult for us to go when we don’t have the right materials or information, and when we 

talk about surveillance, the data collection, it would be beneficial to us to have those highly 

trained and highly skilled CDC folks in each region of our areas, particularly those that have high 

concentration of Native Americans so that we can, as Dr. Giroux yesterday pointed out to us that 

we need someone who speaks the CDC language. Realizing that we all speak English but there’s 

a lot of lingo that’s spread around that we sometimes don’t understand. You know, acronyms 

and those kinds of things. So if we can have those folks in the regions in our areas who understand 

and who can help us to get there, I think it will be beneficial for all. So that’s gonna be one of the 

recommendations that I make is that going forward the TAC be involved in the budget 

development process, and I’m saying that to all of you so that you know that, yeah, it came from 
31 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

that guy; you know, he’s the guy that started this. And I think it will be helpful not only to Native 

Americans, I think it will be helpful to you in your position to understand why we’re asking for

these things and develop this positive relationship. Historically, the federal government and the 

tribal governments have had this adversarial relationship for a number of reasons. Well, we’re at 

a point in our history now where we can move forward. We don’t have to agree on everything 

but can we live—we can get to a point where we can continue to move forward. So thank you.

Councilman Chester Antone: Joe.

Joe Finkbonner: Thank you, Chester. I want to thank you all for being here. I know that it may 

seem like we don’t have a whole lot of questions but it’s actually the opposite way around. We 

could probably spend an afternoon with each one of you individually and occupy the whole time. 

If you just take a look at the disparities in Indian Country and the portfolio that you work with, 

you’ll know that we have a lot in common to talk about and I appreciate that you’re all here and 

are making the efforts to reach out. And I want to have...I like the format that Cathy brought up 

of asking you each individually to respond to a question, and I want to exclude OSTLTS from the 

answer of this question for my own edification here and that is, if you had a specific effort within 

your program or your division that you wanted to work with Indian Country, who would you call

first? That just helps me with some insight of who we need to work with in order to be able to—

public health is about personal relationships and I guess I just want to know where you are getting 

your advice from, who you go to to get advice on how to work with Indian Country. 

CAPT William Mac Kenzie: So as I stated before, I would probably go to the Community Guide 

Taskforce to discuss potential options for getting more information directly with regard to Indian 

Country and interventions that would work effectively; therefore, motor vehicle injuries, alcohol, 

etc.

Dr. Hazel Dean: So my response is two-prong. First, I would go to Judy’s office, OSTLTS, and talk 

with her tribal liaison to get permission to talk to Chester. I’ve known Chester for a long time.

CAPT Thomas Hennessy: Well, wearing the hat from the Arctic Investigations Program, I would 

probably reach out to Roald Helgesen at the Alaska Native Tribal Health Consortium who we work 

closely with. The other person I would speak with is—within the State of Alaska Section of 

Epidemiology there’s a designated tribal liaison, her name is Louisa Castrodale, and that’s been 

part of an effort from the Consulate of State and Territorial Epidemiologists to identify within 

each state a person who can be a designated person to work on American Indian Alaska Native 

issues. So those are the two people I work most closely with.

Dr. Corinne Graffunder: We would also go to OSTLTS just because depending on the nature of 

the question that we had. We would look to them for advice about who to talk to as a starting 

point.
32 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

Dr. Katherine Lyon Daniel: I think it’s difficult for those of us on the OD because we are trained 

and directed to go through the proper channels. But I think if you were asking me from a 

communication perspective where would I get the information, we would probably go to some 

of the smaller surveyors or audience analysis groups that do research and try to get some 

information from them that are databased as opposed to going to an individual. 

Dr. Ileana Arias: The only entity is STLTS. Other than that, it would depend on the issue and really 

it’s sort of depending on what program who have they worked with, what has been profitable 

and what hasn’t, and then moving forward on the profitable side and if we need to use the ones 

that haven’t worked as well, why didn’t that work and what can we do. So a lot depends on what 

relationships have already been created.

Dr. Harold Jaffe: Again, we don’t have any specific programs, but if a question arose, I think we’d 

start with Judy.

Sandra Bonzo: Again, for us it would be OSTLTS but if it involved one of our centers, we would go 

directly to our centers and make contact with the subject matter expert in that area.

Dr. Ursula Bauer: I take a three-pronged approach. I begin with the TAC when I have questions. I 

bring those questions to the TAC and we’ve had a lot of good discussions here over the last four 

years. The second thing I do is I visit. I can’t visit everywhere but I visit a number of places each 

year and I learn what’s going on on the ground and I talk to people who are Native Americans, 

Alaska Natives working in Indian Country. I talk to tribal health leaders. And then my third 

approach is more informal. I identify people that have brought problems to me or brought 

solutions to me, even better, and ask them to convene a group. And, again, I’ve gone out – I did 

this in Northwest Portland area, go out and visit and tribal leaders will come in and meet and 

we’ll have a discussion. So those are my three strategies.

Dr. Patrick Breysse: So the Pat answer is probably not what you’re looking for but I’ll tell you first 

I’d start with calling Annabelle because she used to work in our group and she’s still an important 

part of our group. We include her in a lot of our leadership meetings and stuff, so I want to make 

sure I keep that bridge open. And I also talk to Annabelle when I—similar to what Ursula just saidI’m about to go visit regional offices so we have regional staff across the country and as each of 

those regional office visits if there’s a tribal entity close by or that’s appropriate, I’m gonna try 

and meet with them to develop those personal relationships because I agree it’s also personal. 

I’ve done work in my previous life with tribal populations in New Mexico and the State of 

Washington and other research settings. We did some indoor air quality studies in Navajo. So I’ve 

worked with tribal entities before and I look forward to developing the personal relationships 

that you talked about so I can hear the kind of things that were mentioned in terms of what are 

the needs of the tribal entities, how we can better fill those needs and how do we make sure 

people are aware of the funding opportunities that are coming through our center and how do 

we make sure you’re well situated to take advantage of those funding opportunities as well.
33 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

Stephanie Dulin: For us, we would go through OSTLTS. We currently have quite a few projects 

that we’re working on with OSTLTS to reach tribal communities; one being spoke earlier about 

methamphetamine use. So our go-to is OSTLTS.

RADM Stephen Redd: I would also begin with OSTLTS but I would actually ask for advice. That 

would only be kind of a pass-thru of who is it that I need to talk to, and use that as a way to find 

the right person to talk with.

Sara Patterson: We would probably use our informal channels in thinking about the different 

topics. So kind of like Ileana was talking about. There are so many topics that we’ve already been 

working on that are a priority for us, so I’d go to the people that we’ve been working with and 

try to figure out if that’s the right group or if we need to expand our network more. But if it’s a 

topic that we haven’t worked on and we need to explore more, we’d go through OSTLTS and 

engage this group.

Elizabeth Dalsey: As mentioned by this group, we also would start with OSTLTS. This is still a new 

initiative for us and they’ve been very helpful as we’ve started. We have some informal contacts, 

Navajo OSHA has been extremely helpful and so has Ramona. So we would start with those 

relationships and hope to build more.

Councilman Chester Antone: Thank you for your responses. I kind of want to save mine for the 

end but I could do it now. Mr. Flying Hawk.

Chairman Robert Flying Hawk: Good morning leadership. I’m the representative from the Great 

Plains Area and as you’re probably aware of, we have a question with a pipeline, and I did hear a 

response earlier about some water, and we are looking for the well-being and the overall health 

of our area. So I just wanted to throw out a question regarding that if there was any kind of a 

response in the ideal world, it would all be good but if something did happen, what kind of a 

response would we be available to or would we have?

Dr. Patrick Breysse: I’m not quite sure what you mean by response. If you can elaborate for me a 

little bit, then I’ll tell you what I think.

Chairman Robert Flying Hawk: I guess I’m saying in the ideal world everything would work, the 

pipeline would be intact and there would be no spills, no breaks. If a break did happen, the water 

table, and the effects on that water and anything else, our crops, the land itself.

Dr. Patrick Breysse: So that’s a fantastic question and it’s a very difficult question to answer. 

Obviously, there’s a lot of political aspects to the pipeline you’re talking about but we did, for 

example, respond to a broken pipeline a couple of weeks ago carrying Bakken crude into the 

Yellowstone River and we respond to events like that way too frequently in my opinion. But I 

think we’re learning from our experiences about the pipeline breaks. We know a lot about how 

to respond to them. Obviously, the solution is to make them so they don’t happen, but it was 
34 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

impressive to me that in this case when the leak occurred, it was detected by a fail-safe system 

in the pipeline. The pressure dropped right away so we knew about it. It didn’t occur for long 

periods of time until they were able to address the problem. There was a water system that was 

affected. We worked with the local groups to minimize the effect to that water system and so 

we’re postured, we’re ready to respond to those things when they occur. And I think we’d also 

like to participate in a bigger discussion about how do you make sure that they don’t occur rather 

than making sure we’re ready to respond to them after they occur. And I think that’s a different 

question and that’s probably a bigger discussion that what occur in a Center such as mine. 

Lt. Governor Jefferson Keel: I have a follow up to that, and you mentioned about, and I agree, 

that the best solution is to make sure it doesn’t happen. But across this Country, we’ve got 

pipelines all over the country, you know. We’ve got this tremendous—if you want to talk about 

structure and infrastructure, we’ve got pipelines all over the Country in every state going towards 

the South and I’m not sure how often those leaks or breaks occur but I know that they do, and I 

know that the response is often delayed for whatever reason, maybe political, maybe financial, 

whatever. But disregarding all the political aspects of this, forget that whether we like it or don’t 

like it or agree or disagree. If it happens, when we talk about the aquifers and the damage that’s 

going to occur or may occur to the water supply but it’s not just the water supply water that’s 

damaged. It’s all the other things that depend on water. So I guess my question would be are 

tribes being consulted in any of these types of discussions surrounding the prevention activities 

and solutions or whatever?

Dr. Patrick Breysse: Just to be clear, so we get involved when there’s a spill and we get invited to 

be involved. So we know about ones that happen and we get invited to assist. So you’re right, 

there’s probably others that occur that are not on our radar and I don’t think there’s a—I’m not 

aware of a national database that tracks these things in terms of how frequently they occur. Of 

course, the environmental health problem is much bigger if it’s a ground water problem in 

addition to or instead of a surface water problem. I’m not sure...It would be a much bigger 

response if that were the case. But the national-level discussion you’re talking about I think goes 

beyond certainly what my Center might participate in and I think maybe a broader CDC focus 

could participate in that. But I think it needs to occur and I’m not sure how you get to where you 

want to be but if we have any advice to offer, I’d be happy to kind of participate in that.

Dr. Ileana Arias: I can’t offer you any specifics, but I know that there are inter-agency sort of 

meetings where we attend but we have a very small piece of that, as you can imagine, since a lot 

of what we’re talking about, especially in the prevention side, is a regulatory issue. Department 

of Defense...I’m sorry Department of Interior usually is the one who is the primary one for—they 

will reach out to us sometimes to sort of address health issues that they may feel they need to 

address as they do their work, but both in terms of the inspection and then how is it that new

construction efforts get approved and what are the requirements for them in order to prevent 

those health issues, a lot of times it’s an Interior issue.
35 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

Lt. Governor Jefferson Keel: Thank you. It occurred to me probably EPA and Interior and all of 

those would be—okay, thank you.

Secretary Adam Geisler: Dr. Bauer made a comment about circling back so I don’t know if this 

would be an appropriate time to circle back but there was something you wanted to reflect on?

Dr. Ursula Bauer: I wanted to respond to your policy question and tie it in to the priorities 

question. So thinking about policy with a capital “P”. I was thinking back to the American Indian 

Healthcare Improvement Act of 2010 and the public health authorities that were given to the 

Tribal Epidemiology Centers and I would like to see as a priority for the Agency and certainly my 

Center as well how we work with the Tribal Epidemiology Centers to develop the capacity to take 

on and wield that authority.

Councilman Chester Antone: Ramona.

Ramona Antone-Nez: Good morning. I’m Ramona Antone-Nez and I represent the Navajo 

Area...Navajo Nation. I’d like to say thank you for inviting us to your facility here at CDC. It’s 

wonderful to be here and get to meet you. What I’d like to tag on to what Dr. Bauer had talked 

about in terms of the Tribal Epidemiology Centers as public health authorities. I’ve stated this 

earlier just shortly after Dr. Monroe had provided an update, and many of you were here or 

weren’t here; I didn’t recognize whether you were or not, but I just want to emphasize that there 

is a request that Career Epidemiology Field Officers are identified and deployed and assigned to 

the various Indian communities and to help us with this part about the public health authority 

and the need to identify and establish surveillance systems in Indian Country. I also want to go 

back to the priorities based upon the CDC FY 2016 congressional justification proposed budget. 

Identified in there is the HIV and AIDS, that there is a budget increase of approximately $12 

million. There is a need specifically for Navajo area for increased prevention and in the linkage 

from secondary to tertiary care when we get to treatment. So I’d like to just put that there for 

CDC in terms of these proposed budgets that were identified, I see that there’s an increase overall 

that you keep Indian Country in mind. I know there’s increased dollars proposed but to be more 

resourceful about how you allocate those dollars and identify where—each of you have identified 

the priority areas about where you can improve services to Indian Country; I just would like you 

to keep that in your forefront although we are part of a population that is a smaller percentage 

nationwide; however, I want to emphasize that government-to-government relationship that we 

have and to be identified as such. I also want to bring in one more part about those states that 

are being direct funded are funded through any one of your grants. My question is how 

accountable are they to the tribes when they identify many of the health disparities that arethey use to get an FOA. And then once they are awarded, who goes back and says how have you 

actually met these justifications or these objectives when you identified perhaps tribes as where 

you would provide your scope of work? Because we have experienced such practices from the 

states now; I want to also state that there are different states who work very well with the tribes 

and then there are others that that relationship can certainly be strengthened. So I’m just asking 

that when they report back to you via their annual reports, semiannual reports, to keep in mind 
36 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

how well are they implementing their scope of work in what they said they would do in servicing 

the special population areas and specifically to tribes. So I just want to put that....Mr. Chair.

Councilman Chester Antone: Thank you. Are there any responses to Ramona’s questions?

Dr. Ursula Bauer: So Ramona, based on guidance that we receive from the TAC, we do not fund 

tribes through state health departments. We fund tribes directly or we fund tribal organizations. 

We certainly allow state health departments to work with tribes if they’re going to do that, they 

state that in their application and they have a letter from the tribe describing the partnership.

Sara Patterson: I can just add from the Injury Center, one thing we really try to do when we do 

support states or localities that are engaging with tribes and their work, we really try to highlight 

that so when we’re writing our CJ, when we’re talking about the work that’s being done at the 

state or local level, we really try to highlight those partnerships and where that work is being 

done well. I think that helps us to kind of make the case for the need to link that state and tribal 

relationship more and try to identify interventions or tools or resources that can be really part of 

a collaboration between the tribes and the states. So that’s one thing, although we don’t fund a 

lot of tribal work directly, we really try to augment the stories that we tell about that, and this 

gets back to the comment earlier about talking about the budget. We really think it’s important 

when we’re talking about the way our resources are used to explain how they get used in a way 

that’s really impactful and that’s something we can work on is messaging together about how 

the resources that do get used at the state or local level are effecting your population and that 

really can support your constituency.

Councilman Chester Antone: Oops....Delia.

Tribal Council Member Delia Carlyle: My name is Delia Carlyle. I’m from the Ak-Chin Indian 

Community and a Phoenix Area delegate. I really appreciate all that you’ve said today. I was 

telling others earlier I’m like a big sponge. I’m soaking up so much information and my tribe 

actually has received some small grants for emergency preparedness and all, water issues with 

that. My question...not my question...I guess basically my comment, I hear a lot of talk about 

obtaining data and I hope that all the data relating to Native Americans is collected and not lost 

somewhere. My daughter had...was diagnosed with triple negative breast cancer. We were like, 

what the heck is that? It turns out it’s a rare, it’s probably it’s one of the more aggressive, can 

only be treated by chemo and radiation. You know, typical medicines won’t work for her. And 

what I’m saying is that she was diagnosed through the IHS system but then she was sent out to 

you know Chester will understand when I say “milgan”- the non-Native world- to be taken care 

of. And so I would like to think that any kind of data you receive—and I know that’s just a personal 

story—but we had so much—we met hurdles in trying to get not necessarily services but 

information on what this all entails. But we were able to do that, and when you talk about data, 

I’m just hoping that those that hit those minute smaller percentages, they still count, and they 

still mean something that could help someone. Even like with epileptics. That is another area that 

we see is happening, and unfortunately I lost my granddaughter to epilepsy. She had an epileptic 
37 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

seizure. She was seen, but for whatever reason it just never—she was through so many doctors 

that we just don’t know what really happened but it was a seizure that took her life. But again, 

any number, no matter how small, should not be forgotten. So I keep hearing about the data 

collection so that’s just what—I’m just putting that out not just for what’s happened to my family 

but others that we know that it’s happening to out there because I hear all – you know, what 

we’re talking about and it’s good but let’s not also forget those that may not be in that high 

priority but they are...they have experienced something that hopefully the information can be 

used to help others, or even prevent, if that’s possible. That’s just my comment. Thank you, 

Chairman.

Councilman Chester Antone: Thank you, Delia. 

Dr. Katherine Lyon Daniel: If I could just respond. First of all, please accept my condolences on 

the loss of your granddaughter and I hope your daughter does well. I think that you all know very 

well the power of the story, so when it comes to communication, yes, we want to make sure we 

give everyone information that’s based on that data, but the personal narrative and how people 

are affected by health issues is often what drives either the funding or the listening or the focus 

on an issue. So I encourage you to not only keep telling your stories and not think of them as just 

an anecdote but also to share those stories with us. We have a story bank of how we work and if 

there is a way in which you or any of the people that you know have worked with CDC and you 

can tell a story about how it affected someone’s lives or how it could have but didn’t, those are 

very powerful and we would love to have those shared through Judy’s office or any other way 

that you like.

Lt. Governor Jefferson Keel: Your turn.

Councilman Chester Antone: Okay, my turn. I’ll just throw out some questions in between this 

discussion that I’m gonna have with you and if you can pick it up, you can respond. If you can’t 

respond, just take it for what it’s worth and give some thought to it. Last month, at the STAC 

meeting I had a discussion with one of the federal folks there and I told her, I said, you know, this 

access to care, this whole Affordable Care Act thing speaks to a change in the history of Native 

Americans as far as policy...health policy, government-to-government policy. And I told her it is 

one of inclusion if we choose to look at it that way. But along with that we need to discuss and 

maintain the trust responsibility. And I was telling her, I said, maybe in about 30 years you’ll 

probably be the one to write about that. That shift that has been occurring over the last 3 years, 

4 years, more so the last 3 years and if we’re included and we have access to care under the 

Affordable Care Act, then we ought to have access to the budget, too. Because the best example 

that I have, and I don’t know if there was any support given for the Arizona’s Uncompensated 

Care from here which I had requested the previous year that we needed support to pass that, or 

to renew that uncompensated care cost. And the reason why we did that was because the state 

legislature of Arizona took out a lot of those optional benefits that were beneficial to us and we 

worked out a scheme to where the CMS through the State of Arizona would reimburse Indian 

Health Services to provide certain services that the state did not have in their optional benefits 
38 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

package and would not allow it. This past year it was renewed again because the state does not 

have that option for American Indians. Some of the options including emergency, dental, 

podiatry. I think the only thing they had in there was insulin pumps. So it is possible to direct fund 

tribes but I think we need to think outside the box in one way, because if that can happen directly 

from CMS to the State of Arizona to the Indian Health Service reimbursement, which in turn 

provides more services from the IHS, then it’s possible here at CDC. And Mr. Keel was talking 

about that. If we have some access to putting our items on the table, overall Indian Health Care 

and perhaps specific to some areas that have very high rates of x-number of things, then it is 

possible because it can use that example. Going around certain things. That’s why I said yesterday 

I know we can do it some other way. So I wanted to give you that much as far as an example. The 

other thing is CMS, we are going to approach CMS further on down the road to talk about 

reimbursements for traditional healing practices because I know that that’s a major collision 

there when it comes to federal regulations versus what the Natives know helps them out, that’s 

beneficial to them. So I wanted to give you that scenario and I also in this writing thirty years 

from now when people write about the inclusion of Native Americans into healthcare and really 

at different levels of the government more so than ever before in this Administration, people 

look at it as assimilation of the Native American into the overall Western philosophy. But the 

difference between there is it’s not so much assimilation as it is acculturation that we have come 

to certain points in our tribal lives that there are some things that we want to do. So it’s not 

coming down at us, we’re going up towards it because we realize the benefits of it. So that 

concludes that part. There’s more to come. 

I want to thank those folks that brought to us—or to my question a few years ago regarding the 

Fetal Alcohol Spectrum Disorder. That web page was provided but I think we need to focus a little 

bit more on that particularly when it comes to Natives because I don’t think even though it was 

provided through my legislative consult in my report, that I don’t know if anybody really 

understood how to approach that. So maybe a little primer on how to do that. And this is the 

team diagnosis of FASD. We realize that many physicians are reluctant to diagnose that on their 

own but this is really a team effort that I think is really gonna be helpful.

I want to thank the CDC for their response to the Rocky Mountain Spotted Fever, particularly in 

Arizona. We have had people from here detailed out there and we really appreciate that. It’s still 

there. It’s one of those diseases that when there is no additional incidences, or so we think it’s 

still there, it’s an invisible kind of thing. It’s very visible at first and then it kind of dies down. We 

always have to be vigilant on that and we still have to get on top of IHS to keep maintaining that 

protocol that they have because they have a tendency to slip sometimes. So we have to do that 

every so often. We also made a recommendation for the Strategic National Stockpile that when 

you dole out the medication should it become necessary that the IHS will be the best place to do 

that. Otherwise in our Nation we have three counties which is Maricopa, Pinal and Pima and so 

if we go to the counties—we will do like the last time...which was really good last time because 

we got additional vaccinations. The IHS provided this and then some of the counties also provided 

that because we didn’t have that straight line of distribution, so we got additional which is good. 

But I think if we didn’t make that recommendation at one time, somebody asked by email or was 
39 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

it discussed here or on the phone but we did recommend that since IHS is in each area where we 

have tribes, that probably would be the best way to funnel it because they know their area. On 

the foodborne, I don’t know the infections. Currently, we are developing a food code over at 

Tohono O’odham Nation. We have a food policy that’s gonna back it up, so one of the things 

there is that we... one of the problems that we run into is we have feasts and food is cooked so 

the thing is, when you regulate it from the tribe, it’s not too popular. So one of the things that 

we’re looking at is how to be able to achieve that. We know Gila River has – they have a really 

good program. We’ve visited them and so that’s just to throw it out that they might be coming 

from Indian Country somewhere down the road. And I just want to reiterate what Mr. Keel said 

regarding the budget and the inclusion of us because we’re included at other places. But I think 

the system here or the process here is so rigid that people won’t go beyond that. I took that 

seating arrangement and showed it and I said this is an example of the rigidity that exists here 

because it kind of shows us that this is the place where this exists. And I can understand why but 

we can address that again later. My last comment is a long time ago, I met Hazel and we were 

discussing the social determinants of health. I still maintain that if the tribe knows and is able to 

measure their progress with regards to the social determinants of health, I think we can better 

plan the next steps. But we need to know how we’re fairing with regard to other Nations. It’s 

very important and it kind of goes everywhere and I’ll leave this discussion with this example. I 

was living in Tucson and my sister kind of has like a disability. She has a low white blood count, 

or so they say she’s very susceptible to infections. Actually I used to call the ambulance quite 

often to the apartment because not realizing that the carpet, you can see it when the sun comes 

in, you can see those little things flying around. That was doing most of that. I’ve had to call I 

don’t know how many times and the fire truck will come over, the ambulances will come pick her 

up and take her to the hospital and she developed an infection. Then the home health nurse has 

to come by, so she’s okay for a while and then it happens again. But my district, the Pisinemo 

district, saw the need that she had and were able to come up with some funds and they built her 

a house; it’s tile 

This is in March will be the second year that we’ve been there. Not once have I had to call the 

ambulance. Now, to me it has something to do with the social determinants of health where our 

standards have risen to a point where there is not—if you’ll take out the possibility of infections 

whether it be to a structure, whether it be through intervention or whatever policy we have, then 

you can see the difference. I’ve seen it. But to me, it comes in the form of housing, good housing, 

because our old house had all kinds of holes in there so every time we went to visit the Res she’d 

come up with an infection. Now she hasn’t and I really don’t know how to frame that as far as 

the social determinants of health but it gives me an idea of some of the things that Indian Country 

needs to keep their workforce healthy to be able to provide for the Nation. So I wanted to just 

say that much as far as having you all here to share that with you, all of the things that I did 

because I’ve been here for quite a while with Jefferson and I’ve heard many of these things that 

have never been addressed. But I think we’re in a new direction now because we’re starting that 

conversation again. Testament to that is Ms. Bauer’s Center over there. Now if we can get other 

Centers to look at that that way, we would really be off to a good start. Is there anybody else 

want to make some comments? Actually, we’re at 11:30, a minute over. Quisno?
40 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

Council Member Patricia Quisno: Yes, I’m Patricia Quisno from Montana, the Billings Area, and 

specifically from Ft. Belknap. Ft. Belknap is located approximately two miles from the Burlington 

Northern or Santa Fe Railroad on which runs 100 count at least oil carriers which because this 

pipeline...I was reminded of this by Mr. Flying Hawk. These 100 mile oil carriers go through I’m 

not sure how often but I see them very much of the time and I’m wondering if CDC has had any 

heads up or any contact with what might happen if these went off the track, especially going 

through the states of Idaho and Washington where they would contaminate rivers and I don’t 

know what. To me it just seems like an accident waiting to happen and I’m just wondering if CDC 

has any plan or if you’ve thought of anything in case something like this did happen.

Dr. Patrick Breysse: So we have thought of that and we are planning for how that response might 

be. You’re absolutely right, there’s a lot of oil product now being shipped on rail; more and more 

every day and it’s tied to the pipeline issue. The argument is we can’t put it in the pipeline, we’ve 

got to put it on railcars. And they’re going through the same sensitive areas that the pipelines 

are, so it’s one of those things you hope to God never happens but we’re thinking about what 

that would look like if it did. And hopefully we’ll be ready to do the best we can at that point.

Lt. Governor Jefferson Keel: I would also say that it’s not just oil that’s being transported. A lot of 

other hazardous waste type things. So it’s an EPA problem also.

Council Member Patricia Quisno: It’s just so much oil. It’s just so obvious, you know.

Councilman Chester Antone: At this time we’ll go ahead and end this discussion. I want to thank 

all the federal partners and everyone for their questions and their responses. It’s really helpful 

to be with the leadership here just as we do at STAC, we do the same thing. And so right now I’m 

gonna ask Ms. Fetherolf, Romana to give us a little update from this morning’s session and then 

we’ll go to lunch.

(Inaudible.)

Romanadvoratrelunder Fetherolf: Good morning. My name is Romana Fetherolf and I will be 

providing the morning session summaries. Dr. Arias gave an update from the Office of the 

Director. Dr. Monroe gave an update from the Office for State, Tribal, Local and Territorial 

Support. As follow up, we will send TAC members the link to the Public Health Law’s, Tribal Law 

web page. Dr. Monroe discussed the Public Health Associate Program and mentioned that we 

are dedicated to increasing placement within tribal entities and organizations. As follow up, we 

will send TAC members information on PHAP, the Public Health Associate Program. Ramona 

Antone-Nez made a recommendation that Tribal Epi Centers be able to make recommendations 

on placement of field epidemiologists. TAC members also made the recommendation that the 

TAC become more involved in budget and funding for tribal entities. During the roundtable 

session, CDC senior leadership gave descriptions of their Centers and Offices. And TAC members 
41 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

and senior leadership engaged in discussion on topics including but not limited to priorities, 

policy, and budget. Have I missed anything?

Councilman Chester Antone: Before I excuse us all to go to lunch, I was telling Dr. Monroe 

regarding the PHAP, Dr. Freiden sent out an email to all tribes regarding the PHAP and I wanted 

to be sure to mention that because I know I got one.

Dr. Judith Monroe: And one last thing. There’s a request for a photo op with all the senior leaders. 

Adam is our new member of TAC and has a camera...got a phone... so where did you want to do 

that?

Secretary Adam Geisler: I thought maybe the staircase or in here? This is...the reason I’m asking 

for this is, again, because this is unique in the way that senior leadership is sitting at the table 

and having this dialog today, and so it’s twofold. Obviously, I’d like the opportunity—what I’m 

gonna be proposing this afternoon is actually that in order for us to effectively have conversation 

with Congress, it would be great to walk in with facts. You collect all the facts. So it would be 

great to get a report from you, from each of you, compiled into something that shows the status 

of CDC issues in Indian Country. So you might not be able to say it but we can. What I’m hoping 

is that this picture would go on the cover of that report. (Laughter) The other reason is that I 

want to be able to show other federal agencies how well you are working with Indian Country 

and the efforts that you’re making because I’m not joking when I say it’s unique. It’s very unique 

to see this level of engagement and I’m happy to see it.

Native Specimens

Councilman Chester Antone: (Inaudible.) Presentation...If I could have everyone return to their 

seats. And for this presentation, we have Michael Shaw, Office of Infectious Diseases, CDC and 

Chair of the CDC Specimen Policy Board. We have Stacy Howard, Associate Director for Policy, 

Division of Laboratory Programs; and Delight Satter, Senior Advisor for Tribal Research and 

Program Integration. And we’re ready to go.

Dr. Michael Shaw: Thank you Mr. Chairman and other council members. We really appreciate 

this opportunity to present some of the issues we are all dealing with, and what we would like to 

do is give you an idea of the policies we have in place, how human specimens are handled, how 

they are used, and also the path forward for establishing a new policy should that be decided to 

be needed. First, I want to go into the policies and practices because it’s important for you to 

understand what’s in place now. The policy we have is one that is actually fairly new, which I’ll 

go into some details but it has evolved over the years into its present form and it’s a fairly 

comprehensive policy. It’s not specific to American Indian/Alaska Native specimens. It covers all 

collections that are in CDC possession. To give you some background, CDC Laboratories are 

spread all over the Country. There are at least 1,000 rooms of laboratory space, probably 150 

different laboratory units. Each of them maintain their own collections of different sorts of 
42 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

specimens, and they collect a wide variety of types of specimens. This makes it especially 

challenging to get a policy in place that can adequately tell people how they’re supposed to 

handle the specimens that they do have. We estimate right now that we have inventory and 

documentation for over eight million samples. That includes clinical isolates, serum, urine, other 

patient samples, also the bacteria, viruses, and other pathogens that have been grown from 

these samples. This eight million includes everything that we’ve got. It’s domestic, it’s 

international and it represents probably the Nation’s preeminent reference collection for 

pathogens. A governing policy had to be established to try to harmonize all of these different 

specimen management practices because obviously a laboratory dealing with viruses would 

handle specimens differently from a laboratory handling environmental specimens. So we tried 

to establish a standardized approach so that everyone was using the same basic criteria for 

managing their specimens. What arose from that is the CDC Specimen and Sample Management 

Policy. This is an official CDC policy that came into effect in December of 2013. It’s MASOapproved and all of CDC agencies are working under this policy. The purpose was to have, as I 

said, some sort of uniform requirement for managing, tracking, and safeguarding the specimens 

that we receive in addition to the specimens that are generated internally. As I mentioned, we 

often grow pathogens from the specimens that we get in. We often make derivatives, which I’ll 

get into a little later. All of these have to be accounted for. The Policy Board was set up under 

this policy as the senior leadership body to advise the CDC Director. It has representatives from 

all of the major activities at CDC. It meets regularly to discuss specimen management issues and 

to delineate the responsibilities of the different groups throughout the Agency. It’s applicable to 

all domestic CDC laboratories and all of the staff working there who either receive, store, or 

manage specimens, or are involved with maintaining the specimen inventory and any staff who 

oversee or participate in any of these activities. So it’s all encompassing. The Policy Board itself, 

as I mentioned, is specifically set up to advice the CDC Director on specimen policy issues. The 

duties include that we monitor progress of the different groups with implementing the policy. As 

you might expect, some groups are farther along than others. The duty of the Policy Board is to 

make sure that no one falls behind, that everyone is aware of the policies and is implementing 

them. They advise the programs on particular policy issues they may have because of their 

particular circumstances, and also responsible for communicating any revisions to that policy that 

arise from special circumstances such as outbreak investigations, emergency situations where 

things may have to be changed depending on a very fluid situation on the ground. They also 

recommend appropriate actions when a group is not adhering to the policy. Noncompliance is 

taken very seriously. Everyone is expected to treat these specimens with the proper respect and 

also to maintain scientific integrity. To be quite frank, specimens are not going to be of great deal 

of use unless you have the data to back them up; where they came from, what sort of situation 

warranted their collection, as much information as possible. So if that isn’t included in the 

inventory, then it becomes less useful. As I’ll describe a little later, in different situations, different 

degrees of information are available. But one of the things we’re trying to standardize is the type 

of information that is going to be held at a minimum for every specimen coming in to the CDC or 

created at CDC. The final responsibility of the Policy Board is to create an annual report for the 

senior leadership which gives basically an update on CDC specimen holdings and any issues that 

have come up within the past year regarding those holdings. 
43 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

Specimen identification is obviously something that’s of great deal of concern to this group in 

particular. I think you’re all aware of the issues that happened over the summer with laboratory 

safety in general, but one particular issue that affected all Agencies in the U.S. government was 

the discovery of smallpox in a place where it wasn’t expected. That led to the secretary 

requesting that all Agencies in HHS, and later this was expanded to all U.S. government Agencies, 

do essentially what they were calling a clean sweep; go into all of your facilities, look to see if 

there was anything out of place. What we did at CDC was we decided to take advantage of this 

process and implement a full inventory of what we have. That vial-by-vial inventory is underway 

as we speak. Some groups have already completed it, others have asked for delays because of 

outbreak response. Obviously, the Ebola group doesn’t have a lot of time to go through their 

freezers and look at every vial. The measles group similarly is very busy right now. So we make 

special allowances for situations but everyone is expected to complete this inventory. In the 

process of doing this inventory they’re asked to pay special attention to any collections that may 

contain American Indian or Alaska Native specimens and they’re to let us know about those. If 

they’re uncertain about them, then the groups are being asked to trace all the documentation 

that they have available for these to see if it’s possible to identify the origin. Now, in some cases, 

CDC has legacy collections that go back decades and decades, some of which have been inherited 

from retiring academicians. We have no control over the metadata associated with those 

specimens but whenever possible we’re trying to figure out the origin of them because as I said, 

the more data we have about them, the more useful they are scientifically. We’re also asking the 

groups to identify derivatives of any American Indian/Alaska Native specimens, and by 

derivatives, I mean anything that was created from the specimen after it got here. For example, 

we might get a stool specimen as part of a surveillance project from which we were trying to get 

an idea of the prevalence of polio in the population from some very old study. Derivatives would 

be any viruses that had been grown out of those specimens, any DNA or other nucleic acid that 

had been isolated from them. If they’re histology specimens, say a biopsy or an autopsy 

specimen, there might be slides with the fixed cells on them that are also being kept. In some 

cases for tumors there might be cell lines that are derived, but the majority of what we have in 

our collection that are derivatives are the isolates, the bacteria, the viruses that have been grown 

from these specimens. And in those cases, we would also like to be able to trace them back to 

the human specimen from which they were originally isolated to be able to close that loop and 

know where everything came from. How these specimens are used, I think some of the 

presentations you’ve heard over the last day and a half of showing you that there are two basic 

approaches. The so-called research versus non-research use. The purpose of research is, to put 

it as simply as possible, is to create generalizable information. For example, information that 

could be applied to create a vaccine policy to say which age groups need to be targeted. As 

opposed to non-research use which is often for treatment of a specific patient or to identify an 

outbreak in a particular community. It’s more tightly focused. But obviously there is going to be 

some overlap between those two situations. A non-research specimen could eventually find its 

way...could eventually be useful in a research project that looks for a prevalence of that same 

disease nationwide, for example, or to pull it into some sort of international database. But 

generally those are the two ways we try to differentiate them because the two types of research 
44 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

are handled differently. Non-research dealing with a public health emergency often has to be—

the decisions have to be made quickly. People have to be gotten to the site of the outbreak to be 

able to act quickly to try to determine what it is and how to stop it. But all CDC activities have to 

be reviewed whether they are research, and if they are research involving human participants, 

they go through an additional level of scrutiny. I think a lot of you are probably familiar with the 

concept of institutional review board. The purpose of an IRB is to have a formal review 

mechanism to look at not just the way the human subjects are treated but the ethics of the overall 

research itself. All CDC-conducted activities that are covered by the human research regulations 

have to be reviewed. They have to be reviewed before the project is begun if it’s a research 

project and they have to be continually reviewed at least annually as the project is ongoing. One 

of the reasons of this is to ensure that the research involving human participants protects all the 

rights and welfare of the study participants and conforms to all U.S. regulations. Now, the 

members we try to pull into these IRB’s are obviously subject matter experts but they’re also 

people who are conversant with issues that might arise that don’t fall within the usual scientific 

disciplines of CDC such as ethics, cultural diversity, and CDC makes it a point to have at least one 

non-CDC member on every board. The board cannot convene unless it has a non-CDC member 

on it so it’s not us approving our own stuff and saying that we’re doing it right. 

To give you an example of some of the uses that these specimens can be put to; I chose two 

particular examples. One was an investigation that was done during the 2009 influenza 

pandemic. A study was done in the Southwest, primarily in the Four Corners area, looking at the 

effect of the pandemic on especially the more rural populations among the American Indians 

there. It looked at both clinical and demographic information including the medical records of 

people hospitalized for basically a three-month period right at the beginning of the pandemic 

when the first wave was hitting the country. Infection had to be confirmed which means the 

specimens had to be obtained from the patients. These were usually nasopharyngeal swabs. They 

would also take convalescent serum to look for antibody. This was used to confirm whether they 

actually had influenza virus or not because obviously there are a lot of things that can cause 

similar symptoms. In the case of children, adults gave verbal consent for any child under 18, but 

informed consent was asked for every participant in the study. Some of the results that came 

from this were very useful for our future planning. It was discovered, for example, that the 

hospitalization rate among this particular isolated community was higher than what we’d been 

seeing in the rest of the U.S. population and that almost all of those hospitalized cases had other 

high-risk health conditions. One thing that particularly stood out was that children less than fiveyears of age hospitalization rates were especially high, much higher than the national data. What 

we took from this was that in planning for future pandemic responses, we have to pay special 

attention to these types of populations that are in isolated rural areas that are especially 

vulnerable, so they’re going to have to get special attention when making decisions about 

deployment of drugs from the Strategic National Stockpile or from decisions about how to initiate 

vaccination campaigns when those are begun. 

Another example is the Alaska Area Specimen Bank. Dr. Hennessy talked about that some this 

morning but that’s one of the major success stories being run by the Arctic Investigations 
45 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

Program, National Center for Emerging Zoonotic Infectious Diseases. This one is actually a 

partnership with the Alaska Native people and the intention is to specifically benefit the health 

and well-being of the native people. These are specimens that can be used for research purposes 

or they can also be used for non-research purposes. It’s a very valuable collection that offers a 

cross-section of the populations in Alaska. It’s quality controlled, secure storage, and it’s available 

for approved research purposes that have gone through the IRB reviews like I mentioned. The 

reason it was set up was to make sure that there was proper management, especially in regard 

to human subjects review and making sure that informed consent had been gotten from all of 

the participants. The types of specimens collected were chosen on the basis of the concerns of 

the communities affected and it was maintained in accordance with the missions of the Alaska 

Native tribal health entities that are participating in this activity. And needless to say, as other 

CDC activities, it meets all federal, tribal standards regarding privacy, research ethics and the 

protection of the human subjects. Some of the things that have come out of this, you heard the 

presentation about hepatitis yesterday. That was mainly about hepatitis C but he also mentioned 

that hepatitis B is one of the major success stories. That’s particularly true of the Alaska Native 

population. These specimens in the Alaska Native Specimen Bank were used to show the 

prevalence of hepatitis B to show that it was a real problem and was used to justify a concerted 

effort to get as many people vaccinated as possible. And as a result, it virtually eliminated 

hepatitis B in the Alaska Native population. Currently, it’s being used to determine the prevalence 

of Helicobacter Pylori. The reason this is of concern is I think a lot of people have read the 

literature of it being associated with gastric ulcers. It’s also been associated with...long term with 

gastric cancer and iron deficiency anemia. These are particular problems in the native 

populations, and using these specimens that have been collected, were able to get some idea of 

prevalence, whether particular age groups need to be targeted, particular areas need to be 

targeted. That’s the sort of information that can come out of these large scale collections like 

this. As I mentioned, we have a separate policy for human research protections. This was set up, 

it actually predated the specimen policy. It confirms the CDC commitment to protect the rights 

and welfare of all the participants. It also specifies specific roles and responsibilities for all CDC 

staff and tells them what procedures they have to go through to get approval for use of any 

human specimens. And I should also note that CDC reserves the option to impose stricter 

standards than the minimum that are legally applied, and that happens fairly often at CDC 

because we are aware of cultural sensitivities and we know that the same standards won’t apply 

to all groups. So that is specifically stated in the policy that CDC may have additional restrictions 

beyond what’s legally required. We’re going to go into the policy development. I don’t know if 

you wanted to stop for questions there before I turn it over to the next speaker or wait until the 

end?

Councilman Chester Antone: Let’s go to the presentation and then we’ll open it up for questions.

Stacy Howard: Thank you. Good afternoon. Lieutenant Governor Keel and Councilman Antone, 

it’s a pleasure to be back before you again this afternoon to discuss native specimens. I know 

we’ve been before the members through several meetings and wanted to provide an opportunity 

this time to really outline to you what our process is, what our current thinking is of the process 
46 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

for addressing policy requirements specific to managing specimens taken from the native 

specimens. The CDC policy process was really outlined—I share with you a process that was 

outlined by CDC’s Office of Associate Director for Policy and you’ve heard from us in prior TAC 

meetings that the process is pretty generic across any policy development process, but just to 

kind of put it in perspective in terms of a process that CDC has developed that aligns with what 

you may likely already be familiar with, it’s a phased approach. And with the first part of the 

process it’s identifying what the problem is, and the problem—and I use that word very loosely—

is really reiterating what you’ve already heard before. CDC has a number of different operational 

policies including the Specimen Management Policy that was most recently approved and 

adopted last year, the end of 2013. But that policy is not specific to specimens from native 

communities. So what we’re trying to do and what our aim is, is to really fill that gap. What are 

the needs and how can we best address it. The next part of the policy process is analysis of the 

issues, and during this part of the process we are looking at existing policies, the ones you’ve 

heard from already. We’re looking at existing laws and regulations to see where there may be 

areas in which CDC may need to address and move forward in addressing and determining how 

to best address that. We’re also looking at background papers on the issues relevant to this topic, 

and you’ll hear a little bit more about that during Delight Satter’s part of the presentation. The 

next phase of the policy process is the strategy and policy development. And by that I mean that 

we’re actually writing the policy, what are the policy requirements. We’re also looking at what 

would be our approach to determining which policy or policies would such policy requirements 

apply to; is it just one policy, is it a new policy or does this imply based on what the newly defined 

policy requirements are that it may impact several policies. We’re also looking at during this part 

of the policy process looking ahead at implementation; what needs to be in place to implement 

a policy. It’s one thing to have a policy drafted, written, approved, but it’s really another thing to 

actually put it in practice and we’re looking at how it can be appropriately implemented. Perhaps 

it may require developing some implementing procedures and we’ll be looking at that during that 

phase of the policy process. Policy enactment simply means the approval process and CDC’s 

process is a process in itself. Dr. Shaw mentioned MASO. MASO is the area within CDC, 

Management, Analysis, and Services Office...Support Office. It’s another acronym. I’m sure you’re 

on acronym overload but it’s the area of the CDC that is responsible for formal vetting and 

approval of all agency policies. I know you’re quite interested in the timeline for which such policy 

will be in place and I’ll speak to that at the end of the presentation in terms of typically how long 

just that section is in itself. And then also policy implementation. Dr. Shaw previously mentioned 

the CDC Specimen Policy Board and its responsibilities, and it is the responsibility of that board, 

just to reiterate, just to ensure that all policies are implemented as they are intended. It’s also 

looking at monitoring implementation. It’s also looking at conveying back to you how we’re doing 

in that process. One area that I want to also highlight those crosscutting areas, stakeholder 

engagement evaluation. You know, policy development process is not really linear. There are 

several different aspects of policy development that are undergoing concurrently with 

stakeholder engagement being critical to the success of this policy development process. We’ve 

been engaging you, we plan to continue to engage you, and we really look forward to continue 

to hear from you in terms of how we can best proceed with your assistance in navigating through 

this process. The purpose of this slide is just to highlight to you where we are in the process now. 
47 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

We’ve already identified what the issue is that we’re actively working on addressing. We are 

actively in the process now of analyzing background papers, we’re analyzing input from 

stakeholder engagement, we’re analyzing current policies that are in place that Dr. Shaw 

previously mentioned. We’re really looking at what are the sources of information through 

literature review, through stakeholder input that would inform policy development, where are 

the gaps that need to be addressed, and we’re also actively engaged in stakeholder engagement. 

We’re here today to hear, again, from you and that’s very important to this part of the process. 

As I mentioned before, we will continue to communicate with you as often as you desire as we 

need to as progress is made as we navigate along this process. So with that said, I’ll turn it over 

to Delight.

Delight Satter: Alright let me know Joe, if you can hear me over there. Thank you for providing us 

the opportunity to present to you and let you know where we’re at in the project, what we’ve 

learned so far and where we’re headed in the future in partnership with you. I want to put this 

blanket statement out for this project as well as all things at CDC that the CDC does recognize its 

trust responsibility and government-to-government relationship with federally-recognized 

tribes, and we are trying to approach this project in a good way under that overarching 

statement. So, let’s see if she can drive. Ok, I first wanted to present to you some of the places 

that we’ve been. These are our listening sessions which we’ve mentioned to you before and our 

community dialogs. Listening sessions are open at venues like conferences or larger events and 

a community dialog might be a smaller event where we’re just meeting with some elders in one 

of the communities we happen to be at at that time. These are facilitated by our partners, the 

Association of American Indian Physicians and Delores Welch and her consultant, Dr. Doris Cook, 

partner with us on those and help us find communities to partner with. Last summer, we had our 

first the kick-off was at the Native Research Network Conference. Where were we? Denver. And 

what was fabulous was that the NRN board not only agreed to provide us time and space for a 

listening session but agreed to partner with us ongoing into the future on this project and 

thanked us for coming to them. That’s what they’ve been asking for as a board to help engage 

federal agencies, academics, and communities. They also gave us an entire day to focus on 

bioethics and so several of our external experts who help us on this project who are keynote 

speakers, Bill Freeman, who you may remember from Indian Health Service, Rebecca Tsosie, a 

lawyer from Sandra Day O’Connor School of Law, for example, Patricia Cochran from Alaska was 

the facilitator for the entire day, and we had a great learning experience and exchange. Another 

one was the Association of American Indian Physicians annual conference, and we had great 

information received from—it was so amazing because we had different generations of doctors 

and researchers and clinicians and people who had worked on a variety of projects throughout 

their lives. Judith Cowart-Hollow, Gerald Hill, for example. It was just very diverse. And then all 

of these new physicians, native physicians, coming in to the scene. And because as you all know 

I’m extremely cheap, we also do side visits wherever we are so the Denver Indian Center agreed 

to have a meeting with us and an elders women’s group met with us and gave us information 

and thanked us for reaching out to them while we were there. I say this because it’s a warning. 

Wherever we happen to be going, we will be setting up side trips and we hope that you help 

facilitate those for us. We work the rolodex wherever we are going. The University of Arizona 
48 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

held meetings with us and I’m so sorry, I don’t know why this isn’t on here but the National 

Congress of American Indians also partnered with us in the fall. You look at these slides 500 times 

and you still forget an entire meeting. They helped us and will continue to partner with us in the 

future with listening dialogs at their conferences and they gave us quite a bit of other help in 

learning about the process of engagement, so that was really nice as well. And, of course, most 

recently Dr. Cook and I were invited by the Tohono O’odham Nation to participate in their annual

reburial, I have another slide about that in a few secs. We also had the chance at the NCAI 

meeting, which just happened to be here in Atlanta. We encourage Atlanta meetings because 

then we can see all of you more regularly. We had a meeting with the Councilmen Chester Antone 

and Jefferson Keel just to have that chance to keep updated in between on the project, and 

there’s proof of that meeting because we took them to dinner at the Mary Mac Tea Room and 

they took our photo and it’s up on the wall. So we’ll go to the next one. You’ve seen this slide 

before. This is about stakeholder engagement, what we’ve heard. We have two different columns 

here. First one on the left, is what we have heard from you over time over several meetings. That 

slide is sort of what we’ve heard from our engagements, from academics, other stakeholders, 

youth, elders, you name it we’re listening. And we’ve pointed out before that these two columns, 

they go together. They’re related. But different stakeholders have different advice for us. All of 

this is very helpful and it takes time to be able to gather that information and to get ourselves 

around the Country listening. Accountability you all have talked about with us. Consent at the 

individual and the community level. Integrity, honesty, and in listening sessions we hear a little 

bit different information, tribal oversight and disposal of specimens, the need for more 

opportunities for education. So different stakeholders have different interests, and of course CDC 

laboratorians and scientists are stakeholders, too, and they have different viewpoints and we’ll 

figure out how to put all these together. It was our honor to attend the annual reburial at the 

Tohono O’odham Nation and we thank Mr. Antone for allowing us that opportunity and working 

with the Cultural Appropriations committee there. For obvious reasons to the TAC members 

there’s not much detail on this slide but we did learn quite a bit. I didn’t think that would happen 

but I looked at Cathy. So TON has years of experience receiving specimens and remains. We kept 

hearing one story after the other from the Cultural Appropriates Committee; it was wonderful. 

They told us their experience. They gave us information on timing. They talked about what they 

thought would make it successful for us and they offered to share over time more information 

with us to teach us. The community elders shared perspectives on recovering those remains, you 

know, where they come from, how they are there. We participated in the ceremony and they all 

welcomed us and they all acknowledged and appreciated that we were engaging them in the 

early phase of policy development rather than we created a policy and here it is. Then, we heard 

two other great things. The community elders, at one of those, you know, non-approved 

luncheons that Chester was talking about, in the beautiful desert they had their whole...these 

women came and cooked for us all night long so that we could eat the next day. A whole family, 

children too, they tented in the freezing cold just to be sure we could eat the next day. But the 

elders asked us to also create training opportunities, student opportunities for learning from us 

about policy development and the use of specimens in public health. So that was very helpful to 

us and I have something up my sleeve on that now with the Ferguson Fellowship here at CDC. 

Alright, where are we going? The list could be forever. These are just some examples of where 
49 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

we might go, and as you know, where we travel is always directly related to our travel budgets, 

but we hope to stretch as far as we can. We’re definitely going to the 7th Annual Tribal Epicenter 

Public Health conference in Oklahoma. Tom Anderson was in town and let us know that we could 

feel welcome to participate at that conference not only on native specimens but in our Data-intoAction training and some of our other activities that you’ve heard about before, the success 

stories from Indian Country. And we have begun discussions with Cherokee. Actually, Cherokee 

was the first tribe to invite us to just come and join them after that NRN conference in Choctaw. 

And, again, I don’t know why Chickasaw is not there because I know he’s looking at me right now. 

But it’s meant to be there. And there’s a few others. Please do send to Delores Welch or myself

upcoming events and conferences as you know about them in your region so that we can be sure 

to try to get those on the long schedule. Our dear friend, Rex Lee Jim, invited us to come visit 

with the Navajo Medicine Men and we look forward to that. Now Ramona is helping us 

coordinate that. So that will be happening in the near future as well. Okay, so that was our 

visiting. 

Now, we’re going to talk about our background papers. Through our contract with AAIP, we 

commissioned four papers in core areas that we needed further information. So these academics 

did literature reviews for us and write-ups. In your packets under one of the tabs is the executive 

summary to the four papers. We do have the four papers. They’re almost ready and we would 

be happy to share those with you at that time. But that executive summary gives a nice overview. 

Professor Teshia Solomon, who many of you know as the former Tribal Epi Center director for 

Oklahoma, and her colleague, Yamila El-Khayat, did a literature review on Socio-Cultural, we have 

a typo in here sorry, literature review on Socio-Cultural Factors and American Indian Values of 

Bio Specimen Management and Policy. That’s sort of the cultural paper. The next one by Rebecca 

Tsosie, who I mentioned earlier, Indian law professor, is on the Collection, Storage and Use of 

Native American Biologic Specimens, a Summary of Relevant Legal and Ethical Issues to inform 

policy development. Jessica Bardill, who has worked for NCAI in the past on multiple policy 

analyses, provided for us Comparing Tribal Research and Specimen Policies: Models and 

Practices, literally going into tribal policies and review. And last and certainly not least is my dear 

fellow, Ibrahim Garba. He is not just my dear fellow, he literally is my fellow. He conducted A 

Survey of International Policy Guidance on Indigenous Specimen Research and Management. 

Ibrahim was introduced to me originally by Dr. David Satcher, who you probably both worked 

with early on in the Tribal Advisory Committee, the former director of CDC who is at Morehouse, 

a college here in town, and I received Ibrahim as a fellow and then we’ve hired him in OSTLTS to 

continue the work with us on native specimens. And I’ll turn it back over Stacy. She’s going to 

review the timeline with you all.

Stacy Howard: Thank you, Delight. So we included our current thinking on the timeline for 

developing policy. I know this is a question that has come up from time to time from one TAC 

meeting to the next, do we have a policy yet. So in explaining to you and highlighting to you what 

the overall process is, I wanted to put it within context of within each phase typically how long 

we anticipate that it would take. So problem identification, we’ve had a number of different 

sessions with you during the TAC meetings. We know what the issue is, so we can say that we 
50 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

have- that issue has been appropriately identified and that was last year. We’re currently in the 

policy analysis phase. We’ll be looking critically at the background papers. We’ll be participating, 

as Delight has mentioned, through a number of additional stakeholder engagement through the 

future opportunities as budget permits for us to engage with hearing from you at different 

venues. We anticipate us...that activity going through mid of next year and I give that amount of 

time; we have the Specimen Policy Board meetings already on a standing calendar so it’s not by 

chance will this group come together. We have a schedule of meetings. This topic is on the 

agenda for each of the meetings, different aspects of this topic on each of the agenda for the 

scheduled meetings, and we anticipate through mid of next year we would actually have finished 

analyzing the issues and papers that have been put before us hopefully sooner, and if that 

changes we’ll make sure we communicate and convey that to you. Strategy and policy 

development, as I mentioned before, we’re looking at not just the writing of the policy but what 

approach will we be taking to address those policy requirements through existing policies or 

potentially new policy, and we’ll start that process this year. We’ve already started taking a look 

at it but more formally once we have identified those policy requirements and we anticipate 

having that completed by the end of next year. Policy enactment as I mentioned before is the 

actual CDC approval process and that process internally takes anywhere from 4-5 months. It is 

an iterative process so it has to go through all of the Centers and Offices, particularly those 

laboratories that may be affected by such policy and that process in itself we anticipate that we’ll 

have policy requirements, depending on how the other phases go, completed mid next year and 

early ‘17 and it’s a guesstimate just based on where we are today. Policy implementation will, of 

course, follow after the approval of the policy and that’s highlighted for mid next year 2016, 2017 

depending on where we are in the process. Stakeholder engagement and education is 

continuous. It started at our very first meeting, Tribal Advisory Committee meeting, and it’s 

ongoing now and it will continue throughout the process as we move forward in addressing 

specific policy requirements. So I’ll stop there and I will turn it back over to the Chairs for 

questions, discussion.

Councilman Chester Antone: Are there any questions anyone wants to ask? Comment? Mr. 

Geisler.

Secretary Adam Geisler: Thank you, Mr. Chairman. This is something that I haven’t even thought 

about so it’s interesting to see the issues that other tribes, it sounds like, have brought forward 

on a national scale and I can understand the sensitivity behind this topic. With regards to the 

policy that you’re creating, in the timeline one of the things that I noticed on your list was 

meaningful consultation on the development, and this will probably be a point of discussion for 

later on today as well but understanding how that’s rolled out on a nation-to-nation basis, and I 

realize the challenge of that with over 500 tribes in the United States, it’s not an easy thing to 

accomplish which is why number one, I appreciate the time that you’re taking in putting this 

together because my initial thought was four years is a long time to put this together but I want 

to put forward that I really appreciate the effort that you’re putting forward in making sure that 

this is something that has really been thought through and respecting the importance of it. But I 

guess what I’m kind of wondering is once this policy is completed, will there then be consultation 
51 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

on a tribe-to-tribe basis as opposed to just bringing it to the TAC because oftentimes I think that’s 

the confusion. There’s advisory committees that are out there all over with federal agencies and 

they think that because they brought it to an advisory group such as this, that that is consultation 

and that, in my opinion, is not in the way that I know a number of tribes in California, they really 

want to have that government-to-government engagement. And it looks like there’s opportunity 

to have that and you’ve really thought through the national conferences that are going on with 

NCAI. You set some of the others that are out there as a forum because it is very hard to go to 

each nation to have that conversation. I guess I’m just kind of wondering how you’re going to roll 

the policy out to complete the consultation on it because you’re gonna take this time, put it out 

there, it’s well thought out, you’re gonna put it out and then I guarantee you there’s gonna be 

comments that are gonna come back that might have you reflect on that. So I’m just curious 

about the roll out part of the process.

Delight Satter: Thank you. First and foremost, we hope to...we do go out to La Jolla. There are 

plans to go to the NIHB spring conference in Palm Springs, Aguascalientes, and then I’ve told 

them how to drive from there to La Jolla and to visit with IHB, Geneva Fitzsimmons. But as far as 

consultation, it’s true that we understand that a Tribal Advisory Committee does not replace 

tribal consultation, so that’s not in the plan to avoid an opportunity for consultation by meeting 

with you all. You all are here to provide us advice in the development of programs and activities. 

That said, a CDC operational policy normally wouldn’t be vetted on the outside with the public. 

However, Dr. Monroe has had experience with creating opportunities following the Indian Health 

Service model for engagement and an opportunity for viewpoints, opinion, and consultation 

through sharing internal policies. It’s complex because some matters within CDC don’t rise to the 

level of requiring consultation but that doesn’t mean there aren’t other avenues to ensure that 

each tribe had a chance to review it or provide comment. So I guess I would spin that over to Dr. 

Monroe.

Dr. Judith Monroe: Sure. Thanks, Delight. Yeah, so I think you’re absolutely right and we have 

taken that under consideration. So when the time is right with all the papers being done and all 

the work that’s being done that’s taking time, we would- I would envision that we would send 

out to all the tribes, and we do “Dear Tribal Leader” letters and so forth we send to all the tribes 

information on this, as well as, the background and then perhaps—and I don’t know at this point 

whether it would be a draft policy for input exactly what we’d be sending but we would send that 

out long before it has been finalized for input from all of the tribes and we’d give them ample 

time to be able to respond. And we’ve done that with some other things here at CDC that worked 

well when we approached it that way. Does that make sense, because—and just to add to that, 

recognizing we can’t do that just through electronic communication, either. We have to do it 

through regular standard mail because we recognize that many of the tribes do not have the 

electronic means to communicate, as well.

Secretary Adam Geisler: Yeah, I appreciate you saying that because my community in particular, 

our internet comes and goes depending on whether or not it’s cloudy outside, and I’m not joking. 

I guess just to kind of piggyback on what you shared, I think that it’s the face-to-face dialog that 
52 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

is also helpful. Sometimes tribes aren’t always in the best position to sit down and write a written 

response to the information just because that’s not how they convey communication amongst 

themselves from a cultural standpoint and so I guess what I’m getting at is the face-to-face 

regional meetings where this draft is being reviewed and discussed is really something—it’s the 

way that other policies are being rolled out at least in California and in the way that we work with 

federal agencies in our region. And then the other piece on top of that is I think and 

understanding that this is a living breathing policy so that it’s not a one-time slam the door, okay 

we spent four years and we’re done with it now. You know, I’m really hoping that there’s a next 

step on that timeline that says, okay, we’ve tried this for a few years, can we now- let’s take 

another look at it.

Stacy Howard: Right. Thank you. And just to add to that, if you recall one of the slide that has the 

circle and there was an evaluation component. After the policy has been implemented, let’s look 

at where we are. Is it working, let’s evaluate how well it’s been implemented. 

Delight Satter: There could be some opportunities as well to participate in the HHS regional 

consultation sessions, and the way that functions is the OpDiv’s, the Operating Divisions like CDC, 

we don’t propose topics to those regional meetings. The items for consideration on the agenda 

are brought forward from tribal leadership. 

Councilman Chester Antone: Any other comments? If not, I just want to say a few things regarding 

the Tohono O’odham Nation’s reburial. That’s what they call it, but over the years we’ve had a 

lot of interactions with the State of Arizona, the museums of the places where the human 

remains and artifacts are kept and we’ve had agreements going in and reclaiming under the 

Native American Graves and Protection and Repatriation Act, and they accumulate. So we store 

them at our culture center and then every year we rebury them because what people say out 

there is it kind of affects the balance of life when people aren’t made whole and so that is why 

we do that. We’ve gone so far as Mexico City to retrieve remains. The Jewish community helped 

us out there to get into the museums to reclaim remains. So we’ve kind of had a lot of experience 

doing that, and I appreciate that the slide only shows where they went, some of the ideas that 

came from there, but it doesn’t show detail for reasons that trust has been built and trust can 

come down quickly. And so I asked Delight and Doris that we not share the details, but that’s fine 

that we do that because that shows that this process is building from the tribe up rather than 

what Delight eluded to earlier as we make a policy, we dish it out to the tribes and say what do 

you think? This way it’s the other way but it does take time. It does take time just like the National 

Institute of Health’s guidance document did. It took maybe 2-3 years. At that time, the leadership 

at the NIH were people that were tasked with that were kind of fearful that they were trying to 

do something quickly because of the tribes lobbying for that, but at the same time, we’re kind 

of- what if we do something too quickly and we don’t have everything in there. So I told them, I 

said well, when it comes down to it and if there’s something that comes up, I made them an offer. 

I said, I will defend you to take that time to get tribal input because that’s what you need and if 

there’s anything that happens, I will stand up and say that we need the time. So it went on but 

now it’s done so now they’re going to move forward on that committee. And I think the same 
53 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

kind of applies here because we really do need that time, particularly with this topic. I don’t know 

about other tribes how they choose to handle the specimens. Some may probably not want them 

back, would probably just as well have them disposed, but for us, it’s a different thing. That’s why 

I ask these guys, why I invited them, too, and I asked the Cultural Preservation Committee of the 

Tohono O’odham legislative council would that be okay, and the medicine lady was there and I 

told her about the reasons why I want them to know the way we see things here because when 

they start writing, I want that to guide them in part. That’s why it’s like a personal thing and so 

they said that it would be alright. That’s what we need. We need people to come here and see 

us, and we want that to happen because we want part of that protocol to be – to recognize how 

we feel, the respect we feel to our human remains. So that was the reason why, to help guide 

the writing of that protocol to show some respect to the deceased. So there’s a lot of things we 

still need to answer over there. It’s not done, it’s not a done deal because we really do need to 

take that into consideration. But the overall thing is making the person whole again otherwise 

they’re missing something from their previous life. We like to make them whole. So anyway, that 

was the whole idea behind there and I’m glad that these folks that are doing the policy are taking 

this into consideration and not doing the detail, but I will tell you that they did help...they did 

help rebury some of those remains with us, both Doris and Delight, and it was really something. 

The only thing was that some of the elders were saying, are we now allowing white people to 

come into the—I said, no, they’re tribal members. And I explained to them they’re here because 

I want them to know what we do here because these guys are charged with writing a protocol 

from a federal agency and we never really ever get the opportunity to inform that policy but now 

we are, so it’s important. And so I just wanted to, you know, share that much with you, and I 

appreciate the work that’s going on. But the only thing is I know all this stuff that you’ve got to 

jump through CDC processes and I have in my testimony that there seems to be a lot more 

emphasis on the process and policy here at CDC than it is with the native specimens protocol. I 

don’t know if you know what I mean but it exists and you have to accept it, I guess. But it kind of 

takes priority over what we need to do. But if we look at that process as time consuming, it’s the 

same thing as giving time for input. So I guess either way it just depends on how you want to look 

at it. So we are two minutes over this time. And I don’t know if anyone has any last comments 

but if not, we’ll go ahead and excuse the presenters and I thank you very much. Ramona?

Ramona Antone-Nez: Thank you Mr. Chair and members of the CDC TAC and federal—thank you.

I just want to say that this dialog has been taking place for over a year now, perhaps a year and 

a half and what I’d like to do is go back to my community and just really just develop a... propose 

to my tribal leadership to develop a position paper on behalf of the Navajo Nation. Part of what 

you have in your slide to come and visit the Navajo Nation Medicine Men, I would also like to 

touch base back with Vice President Rex Lee Jim about that. The concern that I have is that even 

among the Navajo, there are different practices of how we take care of specimens and how we 

take care of this very sensitive topic, and my concern is that when you...if CDC were to come and 

be invited and actually be in and amongst our medicine people that you might have only one 

perspective of that diversity within our community from our communities, and even then, it may 

or may not have that representation throughout what this policy is about. The policy that I 

thought we were looking forward to or working to build is what is in the current CDC bank right 
54 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

now as it relates to specifically the American Indian/Alaska Natives that are there historically. 

And I thought that was the initial questions about what is CDC gonna do about those specimens. 

And then that is historical collections. Now the question is about what is the current, the most 

recent, and then now current specimens that might be collected. I don’t really, I don’t know about 

all that part there but I would like to take that opportunity to address this within our Nation and 

get back to CDC. I would like to have that as a self-call to action that this be done at Navajo 

Nation. At this time, that’s what I’d like to remark in terms of just stressing that there is great 

diversity within our own community and to be—I respect that the Tohono O’odham had invited 

the CDC to come in and observe and be part of a ceremony, and that’s where I would like to 

protect the Navajo Nation. I don’t think it’s necessary that CDC start coming in and be part of 

those ceremonies or these rituals that we have. But of course, as I stated earlier, that would be 

where I would want to involve our tribal leaders on that as well as our medicine people (speaks 

in Navajo).

Councilman Chester Antone: Thank you, Ramona, for that comment. Are there any other 

comments? 

Secretary Adam Geisler: I probably sounded really outrageous when I said I’d never thought 

about this before. The repatriation components—we have the same thing between the Luiseño

people. Some believe in repatriation and some believe that you leave it where it is; you leave it, 

you don’t touch it, you shouldn’t build over it, you shouldn’t move it, it needs to be there, it was 

placed there for a reason and that needs to be respected. But I think oftentimes when you have 

this dialog, there’s a big difference amongst Indian people, I think, in what we view as significant 

and I think its terminology so the collection—a policy that you’re developing in terms of a 

collection of a stool sample as opposed to the collection of remains is two completely different 

things to me in the way that that’s being viewed and so I just wanted to clarify my previous 

statement that repatriation is a huge issue. UCSD is holding several bodies that should be 

returned to the Kumeyaay (Kamia) people in San Diego County and it’s outrageous that they 

haven’t released those and we’ve been fighting that fight for years and I’m sure you’re well aware 

of in your relationship with Ms. Fitzsimmons. So I guess as this rolls out, I would really like to 

understand the differentiation between those things. 

Dr. Michael Shaw: If I could say something, one of the things that would help us tremendously is 

to know what sort of specimens you want to know about. I mean, I can understand you wouldn’t 

want to know every urine specimen we have, every bacterium that was grown. It would be very 

helpful to us if we knew what we’re looking for.

Secretary Adam Geisler: So I guess I’ll speak specifically for my Tribe. When we come across—the 

things that are most important to us are the specific remains of bodies, so whether it’s areas of 

cremation because that was a large...that was one of the main ways that we would do our doings 

when people passed, and when you come across hearts and other things where those are the 

items of importance, whereas I think sometimes... and tribes are going to be very different, every 

response here is going to be very different. You know, you come across other aspects such as, 
55 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

like, a bowl. For us, that was simply a tool. For others, you’re gonna find that there’s more 

significance to that, and I realize you’re talking about specifically human specimens, but I guess 

for us, that’s where I would be coming from. Anything related to the being themselves that made 

that person needs to be left alone or not touched. So if you have... I think that’s kind of the 

question that I’m hearing and I don’t know the background because I haven’t been here, but I 

think the question that was being posed was what do you have here at the CDC in terms of what’s 

being termed as specimens in terms of people. You know, it’s one thing if you’re growing a cancer 

cell or something that you’ve compiled through sampling or swabbing people’s noses or 

whatever. It’s another thing if you’re actually holding on to the remains of people as opposed to 

things that are just daily functions that come out of people.

Dr. Michael Shaw: Well, I can assure you we have no human remains. We may have tissue 

specimens like from a biopsy or an autopsy. We’d have blood and serum. That’s where we need 

the guidance. 

Councilman Chester Antone: (Inaudible.) Ramona.

Ramona Antone-Nez: Thank you. I also would like to add that when we talked about—going back 

to the listening sessions and community dialogs, future opportunities. I’m just gonna put as a 

reactive concern that if there were a meeting arranged with Navajo Medicine Men, if that could 

be a fine line of information gathering/research. You mentioned the IRB. Navajo Nation does 

have a human research review board. The kinds of questions that would be asked in a—I’m just 

gonna put quote-unquote—“focus group” and the subject are medicine people or medicine men. 

Then that information that you’re gathering and come back to how you’re gonna write it up and 

tell other people about that specific topic is where I would just be very careful about that type of 

information gathering. And I bring this because there are a number of researchers that come to 

Navajo seeking information, and there is a process there that needs to be followed. So I just want 

to put that on the record and have CDC leadership be informed or just aware that, at least 

specifically for Navajo, those are points of concern and future discussion. (Speaks in Navajo.)

Delight Satter: Thank you, Ramona. It was the Vice President, Rex Lee Jim, who did invite us to 

come. He specifically asked us about a year ago to consider a trip out there. So our protocol would 

be to contact him to help us set that up and this isn’t a research project. It’s information sharing 

so that we can do a better job at understanding what the cultural and ethical concerns are from 

different people, whether they’re within an tribe or different generations, so that we can do the 

best job we can do for a universal policy within the Agency. But let me give you kind of a concrete 

example of how we go about looking for opportunities. After he did invite us, I happened to meet 

up with Beverly Pigman who is the—what’s her title- The chair of the Navajo Nation IRB. Beverly 

and I have known each other for years since I’ve had former students who did work at Navajo 

and just because we ran in the same circles in my old life. And I just let her know about the project 

and she said she’d be happy to welcome us when we came to the Nation just to talk to their IRB 

about what their concerns are, what their advice would be to us. Same thing. We plan on...we’ve 

already met with Joe Finkbonner to help introduce us to communities that might want to have a 
56 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

community dialog when we go up to the Tulalip Tribe in Washington State. So we don’t... we’re 

hoping that we don’t ever break some cultural taboo or information taboo and we’re setting up 

approaches to help us ensure that we don’t do that. We don’t plan on writing up research articles. 

We do have a dream one day of writing up the process- that policy process and how our Agency 

did partner with communities and do the bottom-up strategy, and we think that that may be 

helpful to other Agencies or other people in developing policies with communities, not just Native 

communities but community engagement for policy making. But no particular and specific 

cultural or sacred information would ever be shared by myself or Dr. Cook; and Chester—I guess 

he’s, you know, given us that vote of confidence. But on the other side, we’re not pushing either. 

If people don’t feel welcome or don’t want to take that risk, that’s fine, too. I love the idea of a 

position paper or perhaps the reports that you all give could have a special section on native 

specimens and the community’s views. That would be fabulous. However, it’s appropriate for us 

to learn about these things we’re willing. And then, of course, we’ll always hear feedback in the 

end with the consultation loop as well.

Councilman Chester Antone: So we’re a little bit over, 1:46, and we start Tribal Testimony at 1:30 

but what I would suggest would be just a little break, maybe of ten minutes because we have the 

Tribal Testimony the rest of the afternoon. And so I would like to thank the presenters for that 

very sensitive topic, and we hope we’ll see some good results from there. So we’ll have a break 

for about ten minutes and then we’ll start with the tribal consultation because that’s the only 

thing left on the agenda.

Tribal Testimony

Councilman Chester Antone: ...feel free to do so. The other announcement I want to make, I know 

that earlier Mr. Maloney had asked that everyone remain in here when testimony or people are 

presenting but we’re gonna change that directly from Mr. Maloney. We understand that some 

of you may be catching flights this afternoon and might want to leave, so I would just say to go 

ahead and do that if you have to and don’t worry about being disruptive, we have microphones. 

If we talk real close to the microphone I’m sure we’ll be able to hear each other and won’t hear 

you leave. So thank you. And the way it has been my experience throughout the years here, that 

when we come to Tribal Testimony, we leave it up to the Tribal Advisory Committee members, 

the tribal leadership, to bring forth their testimony to CDC as represented by Dr. Judith Monroe; 

and there are also people here who are authorized representatives of their elective leadership 

and they will also have the opportunity to address and testify here and everything is being 

recorded so we can look back on it and be able to call through it and see where things are of 

major importance and how we need to address them. So at this point, I’m going to go ahead and 

ask if anyone wants to do their testimony at this time. If you have it, but you can also do it on the 

fly as we usually do. Cathy?

Tribal Board Member Cathy Abramson: I’ll go. I’m going to read my testimony for the Bemidji 

area. Of course, we say greetings to everyone. Cathy Abramson from the Sault St. Marie Tribe of 
57 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

Chippewa Indians. And here come... (Laughter.) ...I know what she is doing; she’s trying to get in 

her steps...I figured it out. So I represent 34 tribes in the Bemidji area and four urban Indian health 

programs residing in Michigan, Minnesota and Wisconsin. I wish to provide the following 

comments on these key issues, on three of them. Health and wellness in Indian Country. CDC has 

gathered funding and other resources from across relevant organizational divisions to invest 

specifically in tribal communities’ efforts to address the persistent chronic disease burden. I’d 

like to acknowledge and express our appreciation for CDC’s efforts to reach American 

Indian/Alaska Native communities through establishing a funding mechanism directly to tribes 

and tribal organizations known as Comprehensive Approaches to Health and Wellness in Indian 

Country. Tribes, tribal organizations in the Urban Indian Health Institute are kicking off local and 

regional activities proposed in their applications while working with CDC resources to design 

effective evaluation methodology in order to fully communicate program impact to Congress. In 

the spirit of government-to-government relationships, tribal leaders must also be fully engaged 

and informed of the progress and impact made through this investment. We are proposing that 

a standing agenda item be designated for a Comprehensive Approaches update and progress 

report at each CDC TAC meeting going forward. OSTLTS communication. First and foremost, the 

first step in understanding how to best communicate with tribes is to hire viable, committed, 

long-term and inclusive thinking Director of the OSTLTS’ Office of Tribal Engagement. Valuable 

time has elapsed while temporary assignments have filled the position risking the inability to 

respond to opportunities requiring a foundation of continuity, established relations and issue 

consensus. Please seek a permanent assignee, hire as soon as possible. 

Hepatitis C and TB elimination: Several tribal communities in the Bemidji area have raised 

concerns about a perceived increase in hepatitis C. While anecdotal reports are valuable in raising 

red flags, actual data to confirm observations are not clear nor in the absence of data explained. 

For example, are hepatitis C diagnosis data underreported in general? Are data reported from 

different providers or laboratories serving the same tribal population not combined to reflect a 

community rate of disease? Do local healthcare providers in tribal communities receive data 

reports from public health communicable disease authorities such as states and CDC? In order to 

address the perceived hepatitis C outbreaks in tribal communities, we are proposing that upon 

request a CDC EIS officer or other comparable practitioner be dispatched to the tribal area to 

support the work of the respective Tribal Epidemiology Center to establish a hepatitis C registry 

and conduct an investigation using disease outbreak methodology as needed. From there, work 

with the community can commence to develop appropriate disease reporting and control 

measures to identify, treat, and ultimately prevent hepatitis C. And in conclusion, I would just like 

to thank you for your time. Thanks for listening, and I really thank you for the improved 

communication and input that we’ve all worked hard to develop. Thank you.

Councilman Chester Antone: Thank you, Cathy. Is there anyone else that would like to provide 

testimony? Joe?

Joe Finkbonner: Thank you, members of the TAC and distinguished representatives from CDC. 

Throughout the day and a half that we’ve been talking, I think there have been some clear 
58 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

messages that have surfaced about tribal and CDC relationship and one of those is that tribes 

desire to have direct relationship with CDC rather than through the trickle down through the 

states and then the locals. So every opportunity that you have to make that relationship direct I 

would encourage you to do that. In the past we have tried to make efforts for direct allocation of 

vaccines and antivirals to the tribes in the case like H1N1 when that was our disease of the day 

and now we’re talking about Ebola and how we deal with that, and while I know that it maybe is 

less likely that we have to deal with Ebola, knocking on wood, in tribal communities I still think 

that those are models that we should seek to duplicate for other types of communicable disease 

emergencies or public health emergencies. And we certainly can’t count on states to have that 

positive relationship with tribes and tribal government; however, I would also urge CDC that 

every opportunity they have where they’re not given the authorization to work directly with 

tribes to make it known that you’re at least keeping an eye on the states that they do include 

tribes in the resources that they get for the populations that’s within their borders. I think those 

are easy fixes that we can at least deal with in the immediate, whether that be an email or some 

letters requiring that they’re working with all of the communities or other partnerships that they 

have. I think those are valid ways of at least holding them accountable for working with tribal 

populations. Second, I would like to also encourage you to nudge those other Agencies, like IHS, 

to make Tribal Epi Centers permanent. It is currently very well received and very well respected 

in terms of what Tribal Epi Centers can do for the areas; however, there’s always that fragile 

relationship that when it comes to cutting within the Agency of IHS that everything is on the 

table. But if we can make Tribal Epi Centers something that sticks around, that gives us all in 

public health a conduit to work with tribal communities specifically on an area-by-area basis. 

Second is that I’m disappointed that the Injury Prevention Program is going away. I think that in 

one of the most disparate areas are motor vehicle accidents and to have a program like Injury 

Prevention that specifically addressed that in Indian Country I think was valuable, and as we saw 

from the numbers it was making a difference and we just need to constantly look for ways that 

we can address those “winnable battles”, to use Dr. Freiden’s quotes, and I think injury 

prevention through seatbelt utilization or other things are those winnable battles that we can all 

package up and implement in all of our communities. Oh, I know there was one other thing. Public 

Health Infrastructure and the NPHII Grant disappearing. I was disappointed to hear that 

disappear as well. I think that in the future with the—and I’m saying this from my experience 

with public health accreditation, I think that is becoming more mainstream and that it is going to 

be more everyday language for folks is that public health, whether what jurisdiction it is, is going 

to be either seeking accreditation or has been accredited, and whether tribes choose to 

voluntarily enter that process or not, I think the three prerequisites of a community health 

assessment, a health improvement plan, and a strategic plan are valuable to any health 

jurisdiction and certainly would benefit tribes in terms of the developing intervention strategies 

to address their own health status. And the other aspect of public health accreditation that’s 

vitally important I think with any system is the performance improvement aspect that’s stressed 

in accreditation. I think that where CDC has opportunities to develop programs working with 

tribes on that system improvement, whether that be QI or any other type of science that would 
59 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

help with performance improvement, I would welcome that and I certainly would seek to make 

sure that was successful in Indian Country. So thanks for listening.

Councilman Chester Antone: Thank you, Joe. Is there anybody else that wants to present their

testimony? I’ll go ahead and present mine. It is my written testimony but I’ll go ahead and go into 

the other stuff that I’ve been jotting down as my memory was being jogged. I have Centers for 

Disease Control and Prevention, February 11, 2015, Tribal Consultation Testimony, Chester 

Antone, Councilman, Tohono O’odham Nation. Good afternoon honored tribal leaders and 

honored guests and Director Freiden and Director Judith Monroe. Today, I am here to put forth 

a request concerning the development of the Native Specimens Protocol. It would seem that such 

a task would take some time for tribal input to be accomplished; however, it seems as though 

the process within CDC is of much more value for CDC. It is understandable, but we are relegated 

to being a lower priority, and so it is right to form a subcommittee of the Tribal Advisory 

Committee to help with this task. I would ask that the subcommittee be fully briefed on exactly 

what those that are working on this inside the CDC are doing and what these processes are. In 

this way we can be able to create this Native Specimens Protocol. 

ATSDR should have our native presence there. Lately there have been concerns coming from 

Indian Country regarding mine operations on tribal lands. Concerns for safe drinking water and 

for contaminated water and soil has been brought up before in previous consultations. I believe 

that these concerns should be addressed as best as CDC can and the Tribal Advisory Committee 

as well. Request for health studies with regard to mine operations are probably coming in to 

ATSDR although I am not privy to this information. Throughout the years, there has been 

increasing concern in Indian Country with regard to this. And this was before I knew Annabelle 

had transferred to TSU, the whole Tribe Affairs Office. Behavioral health agenda for American 

Indian/Alaska Natives is an idea that we discussed at the Secretary’s Tribal Advisory Committee 

in December of last year. This discussion came about when the then Chairman of the Kickapoo 

Nation, Steve Cadue wrote an email to Dr. Freiden. This was concerning the most recent acts of 

violence in Indian Country, especially the incident in Washington State and California. This 

coupled with the President’s instructions to his staff that they visit Indian Country to familiarize 

themselves with the problems that exist there also provided sustenance to this idea. Many of us 

Indian tribes talk about and do things tribal with the grants we receive, but we oftentimes have 

to work with strings attached to these grants. In fact, we have to formulate our proposals 

according to the letter, that of the regulations that are attached to those grants. There does not 

seem to be any recognition of tribal ways that could benefit tribes and the Agencies. As I indicated 

at the STAC meeting, there should be a Tribal Behavioral Health agenda developed and adopted 

by the current Administration that would provide a roadmap for the future of American Indians 

and Alaska Natives. This agenda should be based on the tenets or commonalities that exist with 

all tribes; things such as creation stories that teach morality and values, traditional and cultural 

aspects that exist in Indian Country such as the coming of age, how special it is, rites of passage, 

defining Native ways of worship to the creator. Commonalities exist here. The role of the male 

and the role of the female, the celebration of life, etc. These would define the commonalities 

that are in each tribe but that are addressed in different ways by each tribe. These are 
60 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

overarching tenets that would be the roadmap for us. In this way, we define who we are and 

define our state of well-being in our way. Does CDC have any funds to direct toward this effort 

such as helping pay for some conferences that would help us define this concept? 

CDC’s budget has long been a major part of the Tribal Advisory Committee agenda item. This 

should continue to be a part of it. Where do the funds go? Tribes have always requested direct 

funding; however, most funds are funneled through the states. CDC’s grant management office 

and the TAC had at one time made a change and required states to provide information to CDC 

about how those flow through funds benefited Indians as a prerequisite or condition before any 

funds were released or applied for. I feel that this should be reviewed again. 

Fetal Alcohol Spectrum Disorder is another concern to have brought forth. I am glad of the effort 

that CDC has made as far as information provided, specifically the web page that takes clients 

into a team setting approach to diagnosing FASD. I feel that CDC should create a more focused 

approach to the FASD and get TAC input on it. I am also requesting a copy of the cooperative 

agreement between CDC OSTLTS and the National Indian Health Board, specifically or as well as 

the CDC cooperative agreement and/or work plan with the Association of American Indian 

Physicians. Finally, the engagement plan should be more than a plan. It should be actively 

engaging with tribes and resolve some consultation items. And I thank you and I conclude my 

testimony for the moment. 

Now, I’ll just reiterate what I had discussed earlier with the leadership that was here and that is 

that you heard me speak of the inclusion part of tribes into the overall health system of the 

United States, and because I see that as access to care for all. That access to care also comes with 

the other side that is the positive side, but there are other sides that the tribes should really 

assess themselves on and be aware that there are going to be some changes within your tribal 

infrastructure. One of them being health transportation services, which we do. We get 

reimbursement from AHCCCS, which is Medicaid in the State of Arizona. But the access to care 

also provides transportation services through the form of independent providers, and we have a 

number of those on the reservation which pull reimbursements outside of the HTS system that 

we have which was self-sustaining. Now we’re in a different situation. So the question becomes 

access to care, employment, and access to care. So how do we do that because we really need 

to reassign our drivers if we can or we might be forced to thin out our workforce? So those are 

the things I just wanted to make sure that we’re aware of because those situations will come up, 

particularly for tribes that have addressed health in many ways and have built up infrastructures 

but the access to care may change some of those. The direct funding that I had mentioned earlier 

between the Centers for Medicare and Medicaid Services and Arizona have created this 

mechanism whereby what the state doesn’t fund, the tribes can be reimbursed for in providing 

certain of those services that aren’t available under the state legislation. That was approved, 

again, December 15, 2014 and I believe they’re for three-year periods. So there are ways to do 

things going around certain things. 
61 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

One of the key things that’s gonna help us here is knowing how far the CDC Director’s authority 

goes as when it comes to budget. What decisions can he make as it concerns the budget with 

regard to the Indian population? Does he have waiver authority over certain regulations; that is 

the other part? So we really need to research that so we know how far we can go. The Fetal 

Alcohol Spectrum Disorder, I had brought that quite a few years ago. Prevention is the key was 

the outcome of that presentation. So for tribes, exactly how is this awareness service being done 

at the present time? I made a suggestion earlier that I’m thankful for that CDC had provided us 

that web page, but when I report back to my council and it goes through all the 12 districts that 

we have through the legislative representatives, I didn’t see the people wanting to get involved 

in that, and I’m kind of wondering is it our approach...is it our approach about making this 

information available or do we need more... something more that will generate that interest? 

And that’s just something that we can think about because I believe years ago, I had brought this 

story to CDC about my niece. She was born with FAS. She was a ranger working for the police 

department. Now she is a detention officer that tells me that people with FAS can contribute to 

themselves and to the Nations. It is possible. We just need to figure out a way to get these folks 

to that point. That was a priority under IHS at one time, the Fetal Alcohol Syndrome as it was 

called. Now it’s Fetal Alcohol Spectrum Disorder and there’s only two tribes as far as I know, 

which is Navajo and Tohono O’odham, who employ people who deal with FASD. So that’s 

prevention certainly, yes, that should be the top priority but we also have to handle those that 

currently exist. It was a priority back then when it was not a priority anymore. It did not stop the 

incidents. We just kind of forgot about them, I think, on the national scale for a while. That 

doesn’t mean that there aren’t incidents piling up, but somehow I do believe that it has kind of 

come down. We can see that at different times. 

Certainly the Rocky Mountain Spotted Fever in Arizona as I indicated earlier, very difficult to keep 

making it a priority because of the way it is. You know, you get retested two weeks later, you’re 

positive then. But you’ve already been given doxycycline that got rid of it but you’re diagnosed 

with—your lab results come in 2, 3 weeks later and you’re positive. So it’s kind of something that 

we’re kind of having some—we’re still fighting it, but it’s really hard to go to the communities 

and say this is where it is. The thing that’s really helpful there is thank God we haven’t had anyone 

die from it yet. How far does the authority of the Director extend over the budget and regulations 

which I discussed earlier? 

On our reservation, we’re currently developing a food code, and we also have a food policy that 

has to be backed by that code. So one of the questions that we see coming forward is the feast, 

as I indicated, where we cook and we feed, but then you bring in our regulatory scheme over 

that. How is that gonna fly? But that is our problem but sometimes we might reach out to CDC 

or FDA to see what they’re doing on that. Lastly, that I would reiterate is the social determinants 

of health and you know the story I told earlier that that is really telling when you haven’t called 

the ambulance in almost two years versus quarterly. It really shows that when our... the tribal 

living conditions are raised to a certain part that it really affects health. It really affects health 

because I’ve seen it in my own experience. The chronic illnesses such as respiratory diseases. We 

told the Department of Homeland Security about four years ago you need to stop patrolling, 
62 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

making roads on our reservation when you’re looking out for the border because when the wind 

blows, that dust picks up. They’ve since kind of stopped a little but not a whole lot. But what 

happened after that is we’ve seen less dust, so there are interventions to prevent certain things. 

Sometimes it requires having to go to where the problem comes from. Oftentimes not in our 

tribal communities but from another source. So sometimes we need to do that. And I will just 

reiterate the budget process that we feel that we should be a part of and the key there is figuring 

out what we can do presently without no new money, and there will be a policy change such as 

Cathy Abramson mentioned, field officers in the area that requires no new money. It just requires 

it to be done which will be a policy change, right Judith? And those little ways we can move within 

CDC, we need to explore that, and for that we need help from the OSTLTS for anybody that has 

any ideas, and Ursula Bauer, you probably have additional ideas, and I want to thank both of you 

for being here and the TAC membership and everyone else that is here for listening to what I 

have to say. And I really think that these items that I brought forth, if we really concentrate to do 

that, we will certainly be a major step ahead of where we are now. Thank you, and I’m gonna call 

on Ramona Antone-Nez.

Ramona Antone-Nez: Honorable tribal leaders, distinguished federal officials and guests, it is an 

honor and responsibility to represent the Navajo Nation at this official tribal consultation session 

to share testimony and several accomplishments that we have, critical concerns and also provide 

some recommendations, which pertains to the CDC and ATSDR. The Navajo area delegated 

representative, Mr. Rex Lee Jim, Vice President of the Navajo Nation, sends his warm regards and 

regrets that he is not able to attend today’s important session. I am Ramona Antone-Nez, 

(speaking Navajo). I am Navajo and Iroquois Oneida. I’m originally from eastern Navajo. I direct 

the Navajo epidemiology center and currently acting Executive Director for the Navajo 

Department of Health, and it is my privilege to be here as a Navajo Nation authorized 

representative. I want to build upon testimonies that we have provided in years past. One is the 

Navajo Nation is building our public health infrastructure system to become a state-like health 

department, as well as, a Medicaid system. I am pleased to report that after years, possibly 

decades, we have now passed legislation with our 22nd Navajo Nation Council to become a Navajo 

Department of Health. This legislation is CO-50-14, and it was signed by the Navajo Nation 

President on November 6, 2014. The significance of that is that it establishes the Navajo 

Department of Health as the lead Agency delegated to ensure that quality, comprehensive and 

culturally-relevant healthcare and public health services are provided on the Navajo Nation. It 

specifically not only changes the name from the Navajo Division of Health to the Department of 

Health, but also it has such powers and authorities to the Navajo Department of Health. To name 

a few, is to monitor, evaluate, regulate, enforce and coordinate health codes, regulations, policies 

and standards that provide public health services in order to protect the health and safety of the 

Navajo people and communities. There are certainly additional powers and authorities; I will not 

go through them each; however, what I want to stress there is that the Navajo Department of 

Health certainly has our work cut out for us. It’s something that we have spoken of now and we 

have wished to become, we are so now. Therefore, we have our work and we look forward to 

the collaboration with CDC to assist us in this transformation. 
63 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

I also want to reiterate additional items that we had talked about earlier today, and one of them 

is the ATSDR. It has been mentioned the Navajo Birth Cohort Study, we are at the latter part of 

the study; however, there is a need to continue this. Now there is tribal testimony that is available 

for a long-term study and my understanding is that the funding has been reduced, and we’d like 

to ask that if there are- there’s any ways that we can continue to study and increase funding 

which has been cut to another level, that would be a request. The other is the National 

Environmental Think Tank. I’d like to thank the ATSDR for allowing that to happen and I’d like to 

see activities continue because as mentioned earlier, there’s a great need and a great correlation 

and inter-wovenness between American Indian/Alaska Native health status is as it relates to our 

environment in which we live and operate. I also want to bring up public health emergency 

preparedness. I want to thank the CDC that there is a protocol that is in place for Ebola, for 

providers that are returning and also travelers that return to the United States after travel. We 

are using that as a guide because, as you know, we have health providers that are on Navajo that 

have also gone to serve with the Ebola crisis and outbreak that’s taken place. Some of the 

concerns that we have is possibly the misconception or the communication and education about 

when they return and the possible exposure and risk factors that come, and that is something 

that we’re dealing with in terms of health education and preparedness. 

I always will continue to advocate for direct funding. The reason for the direct funding, and I 

know we’ve been told that it has to do with better coordination, coordinate with the people that 

are around in the states of Arizona, New Mexico and Utah. The issue that we have is jurisdiction. 

This is the reason the Navajo Nation continues to advocate for direct funding. We have a line that 

separates us and yet we don’t see those boundaries within our communities. The boundaries of 

the Navajo Nation is such that it becomes a jurisdiction issue and we just ask that that would be 

part of what we continue to work towards. Because we have different funding sources on one 

item, in this case public health emergency preparedness, the State of Arizona Department of 

Health has agreed to become the sole grantor, or receive the grant, and then they will send it to 

the Navajo Nation. There you go. Another example of how the monies are split along the way, 

and of course as it’s being distributed along the way till it finally reaches Navajo Nation, then 

people have taken their IDC cuts along the way, administrative costs along the way, and so the 

question is are we using our money effectively?

The other issue that I want to bring forward is Navajo Nation had requested for results for the 

veterinarian and livestock program. We had sent reports of sera samples, and I just want to close 

that item right there because we have received the results. Thank you. That makes me a believer 

that tribal consultation and testimony is effective and it can work. So just a really great thank you 

for that because we are very curious about the results of those sample, and we’ve received the 

results. 

About Tribal Epidemiology Centers. I will continue to advocate that they are recognized as public 

health authorities and also need access to data not only from the CDC but all data that’s under 

the Secretary of Health. As we continue to work for relationships and building those relationships 

that is a need where that path needs to be developed. I also want to reiterate the request of 
64 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

Career Epidemiology Field Officers. From my view, I think it’s very possible, how can that 

mechanism be put into place, and it would really support the infrastructure and capabilities of 

the Tribal Epidemiology Centers to allow for improved health surveillance and monitoring. 

I just want to also iterate the importance of partnerships with NIH and also SAMHSA for various 

reasons. I’m not going to go into whole details but to say that mental health is a huge issue that 

we face on the Navajo Nation, and as related to alcohol. Chairman... Councilman Antone talked 

about social determinants and that’s part of the root cause that we have is alcohol and how do 

we address that. It just has many contributing factors to many of the other health conditions that 

we face on Navajo. I want to iterate the importance of injury prevention. When we talked about 

mortality rates, the number one mortality on Navajo is unintentional injuries as it relates to 

motor vehicle and also pedestrians. So it’s important that we have that and I just want to thank 

Ms. Billie about her presentation and just remind that we’d like access to how other tribes and 

nations are using their activities and scope of works to address alcohol prevention. 

I would also like to reiterate about the budget. It has come to my attention that the budget 

priorities that are identified through CDC is very important; the budget proposals. I’d like to see 

that we, the CDC TAC, become more involved in that process, and we could build a mechanism 

of perhaps that would be somewhere we start to put into the charter perhaps, but I would just 

like to see that we become more involved in that and make recommendations to how the 

different Centers can use their discretionary dollars. And I’d like to say thank you very much to 

Dr. Bauer for how you have taken the leadership to use discretionary dollars to disburse dollars 

and make available to Indian Country, specifically through the Tribal Epidemiology Centers. I have 

full confidence that when this process evaluation continues to take place 2, 3, 4, 5 years down 

the road that this is gonna be a really effective model of how we build these types of relationships 

you have for that. Lastly, the NPHII grant. We were one of the recipients. The value of that is 

although the grant has ended, the cycle has ended, and we have learned the importance of public 

health domain and the standards. As it relates to the law that I had talked about earlier that now 

we’re a department of health, we’re using that as part of our function and how to operate and 

manage and build the Navajo Department of Health, as well as we will continue to work towards 

accreditation readiness. That’s a huge process that we have been undertaking and I just want to 

make testimony that we are working towards that. The Comprehensive Health and Wellness 

grant, we thank you for the opportunity to join this particular grant and look forward to building 

that partnership. At this time I just want to say my closing remarks are that under the leadership 

of Dr. Monroe, I just want to say thank you and I will provide our written testimony, and just want 

to thank you for your commitment to consult with tribes on our programs, policies and related 

matters that affect the tribes like you have. 

Councilman Chester Antone: Mr. Flying Hawk?

Chairman Robert Flying Hawk: (Speaks Native language.) Thank you, friend. I just wanted to say 

that I come from the Great Plains Area and my last name is Flying Hawk. And I greet each and 

every one of you with a heartfelt and happy handshake. And I’m talking about our children. We 
65 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

do have something written that addresses our children who are our tomorrow and the children’s 

mothers. We consider them the rock of our communities, of our life, and that is what we’re 

talking about here. So I’m going to invite Ms. Giroux up to read what we have addressing this at 

this time. Jennifer?

Dr. Jennifer Giroux: This is the Great Plains testimony for the CDC Tribal Consultation, Robert 

Flying Hawk, Chairman, Yankton Sioux Tribe, February 11, 2015. Thank you, Dr. Bauer, for your 

commitment to integrating tribes into the work of the National Center for Chronic Disease 

Prevention and Health Promotion, and providing models to other Centers. Excuse me, I’m not 

used to doing this. Please continue to fund Good Health and Wellness in Indian Country, Partners 

In Community Health, and Racial and Ethnic Approaches to Community Health. Public health 

research has led to the understanding of toxic stress and adverse childhood experiences on 

lifespan, morbidity, and mortality. Northern Plains’ tribes experienced the highest chronic 

disease mortality rates of any racial group in the United States. In order to turn the tide of this 

generational experience, we need to focus on prevention. We need to go upstream and address 

preconception health in pregnancy. We need to know and understand what’s happening during 

these most important times. We commend the work of the Reproductive Health in conducting 

the Pregnancy Risk Assessment Monitoring System in tribal communities, PRAMS. We appreciate 

the findings of the CDC’s Adverse Childhood Experiences, ACEs, study and see the strong 

correlation with historical trauma, as defined by Maria Yellow Horse Brave Heart. CDC funded 

the Yankton Sioux Tribe and the Northern Plains Tribal Epidemiology Center to conduct the first 

tribal PRAMS. We need ongoing funding for subsequent tribal PRAMS. We need assistance with 

translation and facilitation of community responses to that data. We would like to conduct an 

American Indian ACE study. Few CDC education prevention dollars distributed through 

cooperative agreements and grants to state health departments make it to tribal communities in 

North Dakota, South Dakota, Nebraska or Iowa. We need direct funding for education and 

prevention dollars that are associated with the results of the data. We need education and 

funding to inform and re-educate tribal communities on how historical trauma, toxic stress, ACEs 

inter-relate and we need evidenced-based practices to offer women and babies healthier 

environments. Thank you.

Councilman Chester Antone: Thank you. Is there anyone else? Delia?

Tribal Council Member Delia Carlyle: First of all, thank you again. Delia Carlyle from the Phoenix 

Area. This will be my first time providing testimony, so I’m hoping that you all report back to the 

Phoenix Area tribes that I did okay. If not, they’ll probably let me know. I won’t go into a lot of 

repetition because I think a lot has been said prior, whether it’s with funding, epidemiology 

centers, Intertribal Council was one of the first that was funded, one of the first four. They’re 

doing great work and it’s still sad knowing that funding—I’m sure all the Centers have provided 

great information on the works that they’re doing out there, but it still doesn’t seem to be enough 

when it comes to funding. So I’m hoping that it will be really looked at. Chester, Chairman Antone, 

mentioned the Rocky Mountain Spotted disease and we have that. But I’d like to speak on 

something specifically that they had asked...I was asked to mention. For 32 years, the Inter Tribal 
66 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

Council of Arizona, Tribal Water and Waste Water Operation Certification program has been 

continuously supported by a multi-year block grant program from the Department of Health and 

Human Services, Administration for Children and Families, Office of Community Service, Rural 

Community Facilities grant program. The ITCA Tribal Op-Cert program averages an annual budget 

of $800,000. However, over the last four years, the funding has been continuously reduced. The 

ITCA Tribal Cert program has been supplementing its program budget shortfalls with small shortterm grants, competitive grants from the U.S. Department of Agriculture. The ITCA Tribal Op-Cert 

program currently is in its 5th and final year of the DHHS block grant. There are indications that 

the DHHS RCF funding program may have FY 15 appropriations to open another grant at least for 

one year. However, President Obama’s FY 16 budget has the DHHS RCF funding program listed 

with zero funding. State Operator Certification programs are supported in part by an annual setaside that is part of the state revolving fund under the Safe Drinking Water Act. The Safe Drinking 

Water Act has a tribal set-aside but it does not include a set-aside for Tribal Operator Certification 

program. ITCA continues to engage the U.S. Environment Protection Agency, both headquarters 

and regional offices, in discussions regarding the funding disparity. In November of 2014, ITCA 

presented this issue of funding disparity at a meeting of the National Drinking Water Advisory 

Council in Washington, D.C. The council was unaware of the funding disparity and expressed 

concern and desire to further investigate the matter. ITCA is attempting to schedule follow-up 

meetings with EPA headquarters for the months... this February and April of 2015, and since its 

inception, the ITCA Tribal Operator Certification program empowered more than 600 tribal 

personnel nationwide ensuring that they have the knowledge, skills, and abilities that are 

necessary to operate and safely maintain the drinking water and sanitation infrastructure of their 

respective communities. My tribe opened up a new multi-million dollar waste water facility and 

has been visited by many tribes to see its operations, and we could not have had that done 

without the support of ITCA’s Water Certification program. So, again, good drinking water for our 

communities is vital but yet, again, it somehow seems like it’s not vital enough to keep funding 

going. And also in part of the area report, and I was asked to reiterate the same thing about 

budgeting, to please include tribes whether at the TAC level, CDC TAC level. I think someone had 

mentioned before, because we don’t want to receive a budget that says here it is and we had no 

input in there. Just the same with the policies. Again, don’t want to get a policy that says here it 

is, and we were never involved. So, again, I only reiterate what was eloquently spoken by the 

ones previously before me as we continue to work together. Just in the short time I have seen or 

heard of the changes that have been made and I think we can just make them even better by 

that commitment of true collaboration, cooperation and coordination. Thank you.

Councilman Chester Antone: Thank you, Delia. Is there anybody? Mr. Geisler?

Secretary Adam Geisler: (Speaks in Native language.)My name is Adam Geisler. I am from the La 

Jolla Band of Luiseño Indians. I serve as the Secretary for my tribe. I’ve been asked to represent 

my tribe on behalf of—in addition to the Southern California Tribal Chairmen’s Association, which 

is a consortium of tribal leaders in Southern California totaling 18 tribes. California holds the 

largest amount of both reservation and urban Indians in the entire country. My reservation in 

particular resides in the county that has the most reservations than any other county in the 
67 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

United States. I want to thank Dr. Freiden, Director Freiden for the foresight and understanding 

to create a body such as this, such as the TAC. I want to thank Dr. Monroe for the time put forth 

in coordinating the efforts that have gone on over the last two days. And obviously, I want to 

thank all of the deputy directors that have spent the time to discuss various topics previously to 

this consultation session that is being documented. 

Through the discussions that have taken place, I find it somewhat ironic that the history of an 

organization such as the CDC comes from the result of pandemic outbreaks that occurred 

affecting large amounts of people, and I think when you look at the history of Indian Country and 

the United States, the need for direct services dating far back to colonization is something that 

the assistance of the CDC really would’ve been great at those times as smallpox and other things 

were presented into our communities. And I think that it is even more interesting that as time 

has evolved, we are in a situation where we were left out from the beginning, exterminated as a 

result, and now we are at a point in our history where we are seeing a need for collaboration and 

coordination to protect the health and safety of our families and of the children of our 

communities. With that being said, I think that it is not unreasonable for tribes to expect to have 

a seat at the table in a budgeting process when they should’ve had a seat at the table for many, 

many years since the inception of this organization. The fiduciary trust responsibility of the 

United States government is something that many tribal leaders will speak about but the reason 

why that is always brought up is because the situation in which many tribes are in is not 

something that we chose, and the political nature is the result of treaties and executive orders 

that have come out of the creation of reservations, Rancherias and other forms of trust holdings, 

are something that we have had to live with, with an understanding that there would be support 

from the federal government and the agencies underneath. The inclusion in the budgeting 

process is something that tribes may ask but I’m going to make a formal demand that we be 

included both in the general budgeting process but more importantly as it comes down from the 

deputy director engagement. I find that the challenge in being able to compete for sources of 

funds when they’re coming through state agencies is challenging as most tribes have never been 

in a financial position to be able to have the resources to collect the information, and oftentimes 

that information is not making it into state agencies so the CDC is able to make a fair assessment 

of the data that they’re trying to review. I also feel that the need for an annual report coming 

from the CDC regarding issues related specifically to Indian Country on an annual basis is a tool 

that tribes need in this Nation in order to better understand where the CDC is coming from and 

what you’re seeing so we can have a more informative dialog in the development of solutions 

and mitigation to address the issues that are out there. I will take it one step further in looking at 

the most recent allocation of funds for the Ebola outbreak. The irony that exists in a $1.8 billion 

allocation of funds to—and I do not mean to take away from the importance of the matter or 

take away from the severity of the fact that people are dying in other places around the world 

and the potential impact that goes on around the world as a result of such a disease, but I would 

also like to point out that we have seen documentation in the last two days that shows evidence 

of very similar things happening here in Indian Country with relationship to Hepatitis C. And when 

I look at the correlation between the two statistically, I think that the impacts, if you looked at 

the data, would show that the number of people affected might have some parallels, and as such, 
68 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

I realize that there have been policy discussions or legislative reasoning behind the justification 

as to why additional services can’t be coming to Indian Country, yet I find that there is allowances 

under other circumstances that permit such actions to be occurring. Obviously, in speaking 

generally, because I want to be clear that I’m speaking on behalf of my tribe, that this is being 

considered as formal consultation, I want the CDC to understand that the diversity in Indian 

Country is great and that when you try to have a conversation with a large land-based tribe, there 

is a large difference between the capabilities between the Nations. Ideally, the idea of tribal 

sovereignty is to reach a point where we don’t need the help of anybody else, and that is what I 

think Indian tribes are striving towards. I know that that is what my community is striving towards 

because that’s the ultimate of exercising your sovereignty as a nation. But with that being said, 

tribes in California tend to be smaller land bases making it more challenging for us to have the 

types of facilities that you might see with other tribes throughout the United States. And with 

that being said, that impacts the number of programs and resources available to community 

members within our communities which is why, again, I will advocate for increased funding and 

looking at tribal-specific programs because it’s hard to hold our own in a state like California being 

the size that we are in terms of the competitive nature of funding mechanisms that are coming 

down. Obviously, a large portion of this statement is coming from a financial perspective, and 

with that, I want to add two more recommendations to the CDC. One is a request that the CDC 

use a portion of the 37 million increase in the surveillance epidemiology and public health 

informatics line item to support the creation of data collection and storage systems within the 

existing Tribal Epidemiology Centers. I realize, and I would like to state for the record, that this 

has been stated multiple times, but I also feel that the more we say it, hopefully the larger the 

impact will be, as I realize we are trying to represent ideas from different regions. The second is 

that we would request that a portion of the $15 million increase for public health workforce 

capacity support efforts to bolster the tribal public health workforce through innovative training 

at tribal colleges and universities as well as dedicating specific CDC fellows to serve in Indian 

Country. The preparation of our youth to take on the challenges as we grow our Nation’s 

capabilities in this area of study regarding health is a priority. Representing the people of La Jolla, 

I know that we are always looking for opportunities to grow and educate our youth, and the more 

that CDC can offer the programs, and I want to acknowledge the different programs that have 

been discussed over the last week and I think it’s a great starting point, but the more that we can 

encourage opportunity for our youth to come out and understand how this impacts their 

communities, I think the better we’ll be prepared to address the various challenges including the 

mental health components and suicide prevention issues that a number of our communities are 

continually facing. In closing, I again want to thank the TAC and the leadership that has been 

brought forth on the tribal side from Tohono O’odham. I also again want to thank Dr. Freiden and 

Dr. Monroe for understanding the complexities of Indian Country and being willing to work 

through the issues. I specifically want to thank Dr. Bauer for the time and effort that she has put 

forward in understanding the needs of Indian Country and trying to address those. And lastly, I 

want to thank the TAC membership that is here. It is an honor to be sitting here with you, and I 

thank you for sharing your time and your leadership with myself and my tribe. (Speaks in Native 

language.)
69 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

Councilman Chester Antone: Thank you, Mr. Geisler. Anyone else want to provide some 

testimony, comments? Are we all out of things to say? If we don’t have anything else, I think this 

is our last item on our agenda, and I really want to thank everyone in the audience on both sides. 

I want to thank the leadership that stayed for this afternoon to listen and I appreciate your 

presence here. And I would ask Judith to convey that to the directors and the deputy directors 

that were presenting this morning. I know they all have things to do, but we appreciate their 

presence for the time that they were here to listen to us and to respond to certain questions that 

were asked of them, and especially to Ileana Arias, I would like to have you convey that to her 

also for having her directors here and herself, and to give the message to Dr. Freiden that we 

want to be included in the budget process, and we want to know what his authorities are as far 

as regulations and line items that could be done. So with that, I would ask Mr. Flying Hawk if he 

could give us a closing blessing.

Meeting Closing 

Chairman Robert Flying Hawk: Again, I’d like to ask all of us again to call on our Creator as we 

understand him in our own way.

(Blessing.)

Councilman Chester Antone: Amen. Well thank you everyone. I believe for those going on the 

visit to the Civil Rights Museum, the shuttle will be in the lobby...we will wait for the shuttle in 

the lobby. It should be coming by 8:30 and then we will go over to the Civil Rights Museum. This 

is exactly what we are talking about....so 8:30 and we conclude this consultation. It was a lively 

debate, lively testimony, but for us it’s real and hopefully for y’all to consider. Thank you. Would 

you have any closing remarks anyone? Judith?

Dr. Judith Monroe: Well thank you. Let me extend thanks to you, Chairman Antone, and to our 

Co-Chairman Keel, for your leadership. I just want to say to all of the TAC members it’s been an 

honor to meet with you over the last two days, and really appreciate your really meaningful and 

well thought out testimony. So we will take forward all that we’ve heard to senior leadership. So 

thank you all very much. And let me...and also a big thanks to Joe and to all the CDC colleagues 

and staff that made this happen.

(Applause)

Councilman Chester Antone: Joe, do you got anything?

CAPT Joe Maloney: I won’t hold anybody up. I’ll let Dr. Monroe have the last word. But just the 

thanks again to the TAC members. You’ve all come a very long way. You’ve been away from your 

tribe and your families and we really appreciate your investment in all this. So thanks again.
70 This transcription represents the meeting minutes/discussion, etc. of the February 2015 

Tribal Advisory Committee Meeting and 12th Biannual Tribal Consultation Session and does 

not necessarily represent the Centers for Disease Control and Prevention’s views or policy.”

Councilman Chester Antone: Annabelle, I’m gonna call on you. I know you have a little something 

to say. 

Annabelle Allison: Thank you, Chairman. I just want to also extend my thanks and gratitude to 

everyone for being able to come here today. The past two days have been really insightful. We’ve 

taken a lot of information; we’ve had numerous discussions just between us and between the 

TAC members and my colleagues, and we’re really excited about moving forward. I also just want 

to say thank you for all of your support as I move into this new role. I’m really excited about it 

and I really hope that we can continue to work together. Thank you. (Speaks Navajo.) 

Councilman Chester Antone: Thank you to everyone here, the support staff at the TSU. You guys 

make this possible from....how do you say that...taking us down to the lunch room....cafeteria. 

Being all worried for us and what’s missing, and what’s there? Thank you all. So that’ll be it. 

END.