BIOTERRORISM AND PROPOSALS TO COMBAT BIOTERRORISM
=======================================================================
HEARING
before the
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTH CONGRESS
FIRST SESSION
__________
NOVEMBER 15, 2001
__________
Serial No. 107-72
__________
Printed for the use of the Committee on Energy and Commerce
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COMMITTEE ON ENERGY AND COMMERCE
W.J. ``BILLY'' TAUZIN, Louisiana, Chairman
MICHAEL BILIRAKIS, Florida JOHN D. DINGELL, Michigan
JOE BARTON, Texas HENRY A. WAXMAN, California
FRED UPTON, Michigan EDWARD J. MARKEY, Massachusetts
CLIFF STEARNS, Florida RALPH M. HALL, Texas
PAUL E. GILLMOR, Ohio RICK BOUCHER, Virginia
JAMES C. GREENWOOD, Pennsylvania EDOLPHUS TOWNS, New York
CHRISTOPHER COX, California FRANK PALLONE, Jr., New Jersey
NATHAN DEAL, Georgia SHERROD BROWN, Ohio
STEVE LARGENT, Oklahoma BART GORDON, Tennessee
RICHARD BURR, North Carolina PETER DEUTSCH, Florida
ED WHITFIELD, Kentucky BOBBY L. RUSH, Illinois
GREG GANSKE, Iowa ANNA G. ESHOO, California
CHARLIE NORWOOD, Georgia BART STUPAK, Michigan
BARBARA CUBIN, Wyoming ELIOT L. ENGEL, New York
JOHN SHIMKUS, Illinois TOM SAWYER, Ohio
HEATHER WILSON, New Mexico ALBERT R. WYNN, Maryland
JOHN B. SHADEGG, Arizona GENE GREEN, Texas
CHARLES ``CHIP'' PICKERING, KAREN McCARTHY, Missouri
Mississippi TED STRICKLAND, Ohio
VITO FOSSELLA, New York DIANA DeGETTE, Colorado
ROY BLUNT, Missouri THOMAS M. BARRETT, Wisconsin
TOM DAVIS, Virginia BILL LUTHER, Minnesota
ED BRYANT, Tennessee LOIS CAPPS, California
ROBERT L. EHRLICH, Jr., Maryland MICHAEL F. DOYLE, Pennsylvania
STEVE BUYER, Indiana CHRISTOPHER JOHN, Louisiana
GEORGE RADANOVICH, California JANE HARMAN, California
CHARLES F. BASS, New Hampshire
JOSEPH R. PITTS, Pennsylvania
MARY BONO, California
GREG WALDEN, Oregon
LEE TERRY, Nebraska
David V. Marventano, Staff Director
James D. Barnette, General Counsel
Reid P.F. Stuntz, Minority Staff Director and Chief Counsel
(ii)
C O N T E N T S
__________
Page
Testimony of:
Thompson, Hon. Tommy, Secretary, Department of Health and
Human Services; accompanied by Jeffrey P. Koplan, Director,
Centers for Disease Control and Prevention................. 51
Material submitted for the record by:
American Bakers Association, et al, letter dated November 14,
2001, to Hon. W.J. Tauzin.................................. 101
Cady, John R., President and CEO, National Food Processors
Association, prepared statement of......................... 103
Heinrich, Janet, Director, Health Care--Public Health Issues,
United States General Accounting Office, prepared statement
of......................................................... 108
Nelson, Philip E., President, Institutte of Food
Technologists, letter dated November 15, 2001, to Hon.
Billy Tauzin............................................... 107
Thornberry, Hon. Mac, a Representative in Congress from the
State of Texas, prepared statement of...................... 102
(iii)
BIOTERRORISM AND PROPOSALS TO COMBAT BIOTERRORISM
----------
THURSDAY, NOVEMBER 15, 2001
House of Representatives,
Committee on Energy and Commerce,
Washington, DC.
The committee met, pursuant to notice, at 10 a.m., in room
2123, Rayburn House Office Building, Hon. W.J. ``Billy'' Tauzin
(chairman) presiding.
Members present: Representatives Tauzin, Bilirakis, Upton,
Stearns, Gillmor, Greenwood, Cox, Deal, Burr, Whitfield,
Ganske, Norwood, Shimkus, Wilson, Shadegg, Fossella, Davis,
Bryant, Bass, Pitts, Bono, Walden, Terry, Dingell, Waxman,
Markey, Towns, Pallone, Brown, Deutsch, Rush, Eshoo, Stupak,
Engel, Sawyer, Wynn, Green, McCarthy, Strickland, DeGette,
Barrett, Luther, Capps, Doyle, and Harman.
Staff present: Alan Slobodin, majority counsel; Joe
Greenman, majority professional staff; Amit Sachdev, majority
counsel; Anne Esposito, policy coordinator; Vikki Riley,
assistant press secretary; Will Carty, legislative clerk; Bruce
M. Gwinn, minority counsel; Edith Holleman, minority counsel;
and Courtney Johnson, minority professional staff.
Chairman Tauzin. The committee will please come to order.
Let me ask our guests to take seats and we particularly want to
welcome the Secretary of Health and Human Services to the
committee today. Mr. Secretary, our customary procedure is to
allow the chairman and the chairman of the subcommittee and
ranking members to make opening statements before such an
important hearing and our usual procedure is to allow all
members' opening statements. We would ask unanimous consent
that in doing so that the rest of the members of the committee
would agree to limit their opening statements to 1 minute. Will
that be acceptable to all members? Without objection--Mr.
Waxman?
Mr. Waxman. Mr. Chairman, many of us came here because we
had something to say in an opening statement. Are we going to
have the chairman and the ranking member take more than 1
minute?
Chairman Tauzin. My understanding is that the 3 minutes
would be allowed to the chairman, Mr. Dingell, Mr. Bilirakis,
Mr. Brown and I'm asking unanimous consent that other members
limit their opening statements to a minute.
Mr. Waxman. I'm going to object. I think members might want
to do that, but I don't think we ought to be restricted to 1
minute.
Chairman Tauzin. The objection has been heard. The Chair
recognizes himself for the appropriate time. Today, the full
committee examines the threat of bioterrorism and proposals to
combat bioterrorism. With the recent anthrax attacks, the
spectrum of bioterrorism becomes a troubling reality which we
need to address vigorously and obviously quickly.
Prevention, preparedness and response to bioterrorism is a
priority, I believe, that Congress must critically evaluate and
this committee will take this task on this morning. Much of our
attention will focus on the Centers for Disease Control and
Prevention and the preeminent agency in the Federal
Government's public health infrastructure which provides so
much of our national leadership and illness detection, response
and indeed prevention, including what occurs as a result of
deliberate release of biological agents. We recently witnessed
its capabilities at work in detecting and reacting to the
anthrax outbreaks and I believe I speak for the vast majority
of Americans when I say that I am proud and comforted that we
created the CDC. Lives have been saved in New York and Trenton
and Florida and here in our Nation's capital because we have
invested in its capabilities.
Now our ability to improve the response to present and
future health threats depends upon our ability to look at the
recent events and determine which parts of our public health
apparatus have worked and which parts need to be enforced. In
recent weeks, members of the committee led by Vice Chairman
Burr, the chairman of the Subcommittee on Oversight and
Investigations, Mr. Greenwood, and the gentlelady from
Colorado, Ms. DeGette, have visited the CDC. Some found its
facilities woefully inadequate to do its work. And over the
past 3 years, the committee has reviewed certain aspects of the
CDC and found serious gaps in the law, in the resources and the
programs and the strategy relating to the CDC. With this
background, we're working to upgrade and to equip the Agency
much more properly and to make sure that it can assist our
country in the time of need.
We're seeking to address critical aspects for our public
health infrastructure. In light of this, I'm pleased today to
welcome two witnesses who have spent countless hours in recent
months helping to safeguard the public from these acts of
bioterrorism. The Honorable Tommy Thompson, Secretary of the
Department of Health and Human Services will discuss the
coordinated response to acts of bioterrorism. His insights into
what is needed to ensure that our Nation has taken every
practical step to protect its citizens from bioterror will be
extraordinarily valuable today.
As an aside, Mr. Secretary, I want to salute you for your
foresight and leadership on these matters. You hired a
bioterrorism advisor early in your tenure. You created a
bioterrorism committee and a commission before the anthrax
attacks and you've been ramping up production of the smallpox
vaccine very rapidly and for all those things, our Nation is
grateful.
We're also honored to have before us Dr. Jeffrey Koplan,
the Director of CDC. Dr. Koplan participated in one of the
greatest achievements in public health history, the eradication
of smallpox. Now you're leading one of the largest public
health investigations of all time and I'm eager to hear your
thoughts on how the CDC should be strengthened to meet the 21st
century health threats.
At present, the committee is working on draft legislation
in close coordination with the administration and through a
bipartisan process to improve our Nation's preparedness for
bioterrorism and other public health emergencies which include
disease outbreaks and health problems stemming from chemical
and radiological emergencies.
The key to doing this effectively is to use existing
programs and increase their coordination and communication so
we can get more money out of the States, to those States and
local governments as quickly as possible. We want to build on
the President's leadership in the efforts we've already seen.
We'll continue to urge our Senate colleagues to pass a bill
that this committee and the House passed overwhelmingly several
weeks ago which would tighten safety and security controls on
those deadly potential biological agents and impose stiff
penalties to those who would break those rules. I'm confident
this committee will produce a smart, strong, comprehensive
package, one that increases security of deadly agents at its
research facilities, strengthens our surveillance of the
Nation's abundant food supply, enhances drug safety and
reinforces the protection of our drinking waters. These will be
sensible measures to address threats we simply cannot ignore.
I want to thank the witnesses for taking time out of the
busy schedule to be with us and I look forward hearing your
testimony and discussing these very vital issues.
[The prepared statement of Hon. W.J. ``Billy'' Tauzin
follows:]
Prepared Statement of Hon. W.J. ``Billy'' Tauzin, Chairman, Committee
on Energy and Commerce
Today, the Full Committee examines the threat of bioterrorism and
proposals to combat bioterrorism.
With the recent anthrax attacks, the specter of bioterrorism became
a troubling reality, which we need to address vigorously. Prevention,
preparedness, and response to bioterrorism is a priority, I believe,
that Congress must critically evaluate. This Committee will take on
this task this morning.
Much of our attention will focus on The Centers for Disease Control
and Prevention (CDC). This preeminent agency in the federal
government's public health infrastructure provides national leadership
in illness detection, response and prevention, including what occurs as
a result of a deliberate release of biological agents. We recently
witnessed its capabilities at work--detecting and reacting to the
anthrax outbreaks. And I believe I speak for the vast majority of
Americans when I say that I am proud and comforted that we created the
CDC. Lives have been saved in New York, Trenton, Florida, and here in
our nation's capital because we have invested in its capabilities.
Now, our ability to improve the response to present and future
health threats depends upon our ability to look at recent events and
determine which parts of our public health apparatus have worked and
which parts need to be reinforced.
In recent weeks, Members of this Committee--led by the Vice
Chairman, Mr. Burr, the Chairman of the Subcommittee on Oversight and
Investigations, Mr. Greenwood, and the gentlelady from Colorado, Mrs.
DeGette--have visited the CDC. Some found its facilities woefully
inadequate to do its work. Over the past three years, this Committee
has also reviewed certain aspects of CDC and found serious gaps in law,
resources, programs, and strategy relating to the CDC.
With this background, we are working to upgrade and to equip the
agency properly to make sure it can assist our country in this time of
need. We are also seeking to address other critical aspects of our
public health infrastructure.
In light of this, I am pleased today to welcome two witnesses who
have spent countless hours in recent months helping to safeguard the
public from acts of bioterrorism. The Honorable Tommy Thompson,
Secretary of Department of the Health and Human Services, will discuss
the coordinated response to acts of bioterrorism. His insights into
what is needed to ensure that our nation has taken every practical step
to protect its citizens from bioterror will be extraordinarily
valuable.
As an aside, Mr. Secretary, I must salute you for your foresight
and leadership on these matters: you hired a bioterrorism advisor early
in your tenure, you created a bioterrorism commission before the
anthrax attack, and you've been ramping up production of the smallpox
vaccine.
We are also honored to have before us Dr. Jeffrey Koplan, the
Director of the CDC. Dr. Koplan participated in one of the greatest
achievements in public health history--the eradication of smallpox. Now
you are leading one of the largest public health investigations of all
time. I am eager to hear your thoughts on how the CDC should be
strengthened to meet 21st century health threats.
At present, the Committee is working on draft legislation--in close
coordination with the Administration and through a bipartisan process--
to improve our nation's preparedness for bioterrorism and other public
health emergencies, which include disease outbreaks and health problems
stemming from chemical and radiologic emergencies. The key to doing
this effectively is to use existing programs and increase their
coordination and communication, so that we can get more money out to
the States and local governments as quickly as possible. We want to
build on the President's leadership and the efforts we have already
seen.
And we will continue to urge our Senate colleagues to pass a bill
that this Committee and the House passed overwhelmingly several weeks
ago, which would tighten safety and security controls on the most
deadly potential biological agents and impose stiff criminal penalties
for those who break these new rules.
I'm confident this Committee will produce a smart, strong, and
comprehensive legislative package--one that increases the security of
deadly agents at our research facilities, strengthens our surveillance
of the nation's abundant food supply, enhances drug safety, and
reinforces protection of our drinking water. These will be sensible
measures to address threats we simply cannot ignore.
I thank our witnesses for taking time out of their very busy
schedules to be here, and I look forward to hearing your testimony and
discussing these vital issues.
Chairman Tauzin. Mr. Dingell is not here. The Chair will
recognize Mr. Brown for an opening statement.
Mr. Brown. I thank the chairman for scheduling this hearing
and especially thank my friends, Dr. Koplan and Secretary
Thompson for joining us.
I want to raise, briefly raise in the 3 minutes, a handful
of issues. First of all, I appreciate the efforts on the CDC on
antibiotic resistance, the links between antibiotic resistance
and bioterrorism are clear. We must isolate emerging antibiotic
resistance pathogens, track antibiotic overuse and misuse and
monitor the effectiveness of existing treatments over time. I
hope that the Secretary and that the CDC will work with us to
address the critical issue of antibiotic resistance before our
antibiotic stockpile is irreversibly compromised partly because
of the events of September 11 and the aftermath, partly because
of other problems we were obviously facing on that.
Second, I'm pleased the administration has requested
additional authority to safeguard our food supply as
conversations we've had in the past, Secretary Thompson. To
address the safety of food crossing our border, Congressman
Dingell and I introduced the Imported Foods Safety Act last
month to provide the FDA with a host of new authorities and
resources to inspect and detail food entering the United
States. As you know, budget constraints have reduced the
inspection--reduced ourselves to the level of inspecting only 1
percent of food crossing the border and because FDA lacks the
ability to conduct real time tests for microbial pathogens and
pesticides, very few shipments are actually tested.
Enactment of the Dingell-Brown bill would increase overall
resources, provide more inspectors and bring forward adoption
of technology to conduct ultra-rapid tests for contamination
unseen by the human eye.
Moving to the issue of public health preparedness, I have
serious concerns about the administration's funding proposal. I
have enormous respect for the CDC and the work they do for our
State and our local health departments. We're fortunate that
Dr. Koplan is at the helm. CDC was strained before September 11
and as a result since then they've had to shift personnel,
personnel they really are not able to shift in many ways in
terms of the work they need to do, key functions to respond to
anthrax. Before September 11, the administration proposed
decreasing CDC's funding from the previous year. Having
personally seen, as the chairman mentioned, and I know Mr.
Bilirakis has seen also the crumbling CDC facilities, knowing
the critical responsibility that that very, very important
agency fulfills, several of us on this committee have expressed
serious concerns about the administration's commitment to this
agency. I hope the events of September 11 have taught us how
important that agency is.
The most important step we can take in bioterrorism
preparedness is to stop neglecting CDC as our Government has
done too often, and stop neglecting State and local public
health departments that are the agency's partners in protecting
the Nation's health.
The last issue, Mr. Chairman, I'd like to raise is the
Cipro patent. You acknowledged that you had the right to
temporarily break Bayer's patent under imminent domain
authority, but argued the Government would face hefty costs if,
in fact, required to pay whatever price the patent holder
wanted to charge for a drug. I wanted to bring to your
attention legislation I've introduced that would address the
compensation issue and most importantly would preclude endless
court battles and not necessarily Government spending. My bill
would give you as the Secretary, compulsory licensing authority
in the event of a public health emergency which means you could
issue compulsory licenses to secure generic versions of a brand
name drug, as long as you followed the regulatory and the
statutory procedures established to ensure fair compensation
for the brand name drug company. There are already compulsory
licensing laws in place for the cable industry, for the air
pollution industry, for atomic energy and other products and
services. Unencumbered access to drugs is an essential element
in our response to bioterrorism. Establishing the statutory and
regulatory framework now to secure generic drugs on an
expedited and affordable basis, simply makes sense.
I'd like to work with you, Mr. Secretary, to ensure that
the tool of compulsory licensing is available to you which will
keep us away from the difficulties of another Cipro kind of
situation.
Mr. Chairman, I appreciate your holding this hearing. I
particularly appreciate Secretary Thompson and Dr. Koplan for
joining us. Thank you.
[The prepared statement of Hon. Sherrod Brown follows:]
Prepared Statement of Hon. Sherrod Brown, a Representative in Congress
from the State of Ohio
Mr. Chairman, Thank you for scheduling this hearing on bioterrorism
preparedness. Secretary Thompson, Dr. Koplan, welcome. It is always a
pleasure to have each of you here to testify before the Committee.
Mr. Secretary, in response to the emergent threat of bioterrorism,
your Department needs greater resources and authority to adequately
protect the public health.
During your prior visits here, we have agreed on the need for
improvements in several areas within your jurisdiction. I look forward
to continuing discussions with you and the Majority on this committee
to achieve consensus on these issues.
To fully prepare for potential bioterrorist attacks, we will have
to deal with a wide variety of public health issues, including
vaccinations, food safety, and government stockpiling of vaccines and
antibiotics.
In doing so--we must not forget the issue of antibiotic resistance.
The links between antibiotic resistance and bioterrorism are clear.
According to the Journal of the American Medical Association
(JAMA)--during the Cold War--Russian scientists engineered an anthrax
strain that was resistant to the tetracycline and penicillin.
We can only assume that anthrax, and other bacterial agents, could
also be engineered to resist antibiotics--including drugs like Cipro.
During the last couple of months, thousands of Americans have been
prescribed the antibiotic Cipro because of a legitimate risk of
exposure to Anthrax. Physicians tell us this use of antibiotics is
appropriate.
But thousands of other Americans have sought prescriptions for
Cipro without any indication of need or even a risk of infection.
If the U.S. and the rest of the world begins using drugs like Cipro
haphazardly, these drugs will eventually lose their effectiveness.
And when facing lethal diseases like Anthrax, it is important to
find an effective therapy quickly. Any delay can result in the death of
a patient--or in the case of a larger exposure--in the deaths of
thousands of individuals.
To adequately prepare for a bioterrorist attack, state and local
health departments must be equipped to rapidly identify and respond to
antibiotic-resistant strains of anthrax and other lethal agents.
We must isolate emerging antibiotic resistance pathogens, track
antibiotic overuse and misuse, and monitor the effectiveness of
existing treatments over time.
I hope you will work with me to address the critical issue of
antibiotic resistance before our antibiotic stockpile is irreversibly
compromised.
I'm pleased the Administration has requested additional authority
to safeguard our food supply.
The recent attacks on the United States have aroused concern that
food could be used as a weapon of bioterrorism.
Yet, the authorities and tools used to prevent, identify, and
intercept tainted shipments at our borders are not up to the job.
To address the safety of the food crossing our border, Congressman
Dingell and I introduced the ``Imported Food Safety Act'' last month to
provide the Food and Drug Administration with a host of new authorities
and resources to inspect and detain food entering the United States.
Budget constraints allow FDA to inspect less than 1% of all
imported food shipments.
And because FDA lacks the ability to conduct real time tests for
microbial pathogens and pesticides--very few shipments are tested for
these adulterants.
Enactment of the Dingell/Brown bill would increase overall
resources, provide more inspectors, and require adoption of technology
to conduct ultra rapid tests for contamination unseen by the human eye.
Moving to the issue of public health preparedness, I have serious
concerns about the Administration's funding proposal.
I have enormous respect for CDC and the work they do for our state
and local public health departments.
We are fortunate to have Dr. Koplan at the helm of CDC as we face
this unprecedented situation. CDC was strained before Sept. 11--the
agency doesn't have surplus staff waiting in the wings in the event of
a bioterrorist attack--and as a result they've had to shift personnel
from other key functions to respond to the anthrax attacks.
If I have any concerns, it is that CDC has not had more say in the
nation's response to this and future bioterrorist threats. I've had
credible sources tell me that CDC was not the first, or even the second
agency called in when anthrax was first detected. That worries me.
Before September 11, the Administration proposed decreasing CDC's
funding from the previous year. Having seen the crumbling CDC
facilities and knowing the critical responsibilities CDC fulfills,
several of us on this committee expressed serious concerns about the
Administration's commitment to this agency and its public health
mission.
Now, when the demands on CDC and its partners, the state and local
public health departments, have never been greater, the Administration
is not willing to provide enough resources to respond to a public
health crisis in even one state, much less 50.
Frankly, I don't understand it.
People and infrastructure are paramount to bioterrorism
preparedness. You can stockpile antibiotics and vaccines, but without
people on the ground to quickly identify and respond to threats, you
aren't prepared. That's what CDC, in conjunction with state and local
health departments, does.
CDC is the only agency that has infrastructure in all 50 states.
They have a relationship with state health departments and they train
these public health workers so they are prepared to respond at a
moments notice.
The most important step we can take in bioterrorism preparedness is
to stop neglecting CDC and the state and local public health
departments that are the agencies partners in protecting the nation's
health.
Mr. Secretary, In the dispute over the Cipro patent, you
acknowledged that you had the right to temporarily break Bayer's patent
under ``eminent domain'' authority, but argued that the government
could face hefty costs if required to pay whatever price the patent
owner wanted to charge for a drug. I wanted to bring to your attention
legislation I have since introduced that would address the compensation
issue, precluding endless court battles and unnecessary government
spending.
My bill would give you compulsory licensing authority in the event
of a public health emergency, which means you could issue compulsory
licenses to secure generic versions of a brand-name drug, as long as
you follow statutory and regulatory procedures established to ensure
fair compensation for the brand-name drug company.
There are already compulsory licensing laws in place for the cable
industry, air pollution prevention devices, atomic energy, and other
products and services.
The spread of anthrax has already taken a significant toll on the
nation's sense of security. Unencumbered access to drugs is an
essential element in our response to bioterrorism. Establishing the
statutory and regulatory framework now to secure generic drugs on an
expedited and affordable basis simply makes sense.
Taking that step now will help ensure that the priority of doing
what's best for the public is not subsumed by cost concerns, red tape,
or legal haggling.
I'd like to work with you to ensure you have this tool compulsory
licensing tool available to you before another ``Cipro situation''
arises.
Again, I appreciate your willingness to join us this morning, and
look forward to your testimony.
Chairman Tauzin. I thank the gentleman and I thank the
gentleman for his, and Mr. Dingell's, and the rest of the
members' extraordinary work with us as we attempt to fashion a
bipartisan package. The Chair is pleased to now welcome and
recognize for an opening statement, the chairman of the
committee's Health Subcommittee, the gentleman from Florida,
Mr. Bilirakis.
Mr. Bilirakis. Thank you, Mr. Chairman. I have a more
lengthy statement that I would submit for the record and in the
interest of time----
Chairman Tauzin. Let me make the unanimous consent that all
members have the ability to introduce their written statements
as part of the official record and without objection, it is so
ordered.
Mr. Bilirakis. I would also like to thank you, Mr.
Chairman, for holding this very important hearing. Bioterrorism
is an issue that our subcommittee has been examining for
several years now, but never as know, has the issue been as
timely as it is now. The world has changed dramatically and
it's imperative that we respond and prepare appropriately and
that's why we're all pleased that the Secretary and the
Director are here, along with Dr. Henderson. Mr. Chairman, you
said it, this has been a bipartisan effort from the beginning.
The staffs have been working in a bipartisan manner and I'm not
really sure how we're going to come out in the final analysis,
but the fact of the matter is we have not tried to steamroll a
piece of legislation through this committee. Thank you very
much, Mr. Chairman.
[The prepared statement of Hon. Michael Bilirakis follows:]
Prepared Statement of Hon. Michael Bilirakis, a Representative in
Congress from the State of California
Mr. Chairman, thank you, for holding this important hearing today
on the threat of bioterrorism. Bioterrorism is an issue the Health
Subcommittee has been examining for several years now, but never has
the issue been as timely as it is now. The world has changed
dramatically since September 11th and it is imperative that we respond
and prepare appropriately. That is why I am so pleased that Secretary
Thompson and CDC Director Koplan have taken the time to testify before
the Committee on these important issues.
On September 11th, America was brought into a war against
terrorism. I share the concerns of many Americans who are worried about
bioterrorism, including anthrax exposure and outbreaks of smallpox.
Bioterrorist threats have become real, and we must ensure that this
nation is ready to respond quickly and successfully in the event of
future bioterrorist attacks.
The Department of Health and Human Services, under Secretary
Thompson, is our national coordinator of public health surveillance and
protection while the Centers for Disease Control and Prevention (CDC)
are directly responsible for the nation's public health. Fortunately,
the CDC has been researching and planning responses to bioterrorism.
The CDC has established a Bioterrorism Program to ensure the rapid
development of federal, state and local capacity to address potential
bioterrorism threats. Security, communication, and infrastructure are
all important components of the CDC that need to be evaluated. I
believe it is important to ensure that the CDC is prepared for all
possible future public health emergencies.
Response to a bioterrorist attack will require rapid deployment of
public health resources. Public health threats come in many forms. We
can not know when or how a public health threat could occur and we must
be prepared to combat biological agents in every form. A vital part of
protecting the American population is guaranteeing a safe food and
water supply and water supply.
Today we will hear from the Secretary Thompson and Dr. Koplan
regarding the roles of CDC and other government agencies in combating
bioterrorism. These agencies, working closely with Congress, must make
certain that our public health infrastructure can detect disease
outbreaks and other possible threats. We must realize that this is a
long-term investment in our nation's public health that will require a
long term commitment by Congress and the federal government. The Health
Subcommittee will continue to look into bioterrorism and our national
response in the next year and the coming sessions as we make this firm
commitment to our public's health.
This is a time for the nation to unite. I personally thank and
honor those who are on the front lines fighting this war, domestic and
abroad. Again, thank you Mr. Chairman for holding this important
hearing and thanks again to Secretary Thompson and Director Koplan for
sharing their insights with us today.
Chairman Tauzin. I thank the gentleman. Further requests
for opening statements? When Mr. Dingell arrives, he's
entitled, obviously, to preference. The Chair will recognize
the gentleman, Mr. Waxman. Under our rules, members may give a
3-minute opening statement at this point.
Mr. Waxman.
Mr. Waxman. Thank you very much, Mr. Chairman. While we're
all very concerned of bioterrorism, this is not the first time
that our public health has seen a crisis. We saw the
Legionnaire's Disease, Toxic Shock Syndrome and most obviously,
we face the AIDS epidemic. It is not the first time as well
that experts have come to us and said that our public health
system is in disrepair. We've had warnings and reports from the
National Academy of Sciences, the Institute of Medicine for a
decade now. We should have been able to learn the lesson from
the previous disasters that we cannot short change our health
care system. The most obvious lesson was in the 1980's, we were
suddenly faced with the AIDS epidemic, so we require the
Centers for Disease Control to take people away from the work
they were doing to work on AIDS and now that we have to respond
to an anthrax threat, we're taking people away from working on
AIDS and other public health measures, to work on anthrax.
Now when we look at energy issues in this committee, we
plan for surge capacity so that power systems can deal with
unexpectedly high demands. We should learn some lessons to
apply for the CDC and the public health. We can't budget for
some sort of theoretical normalcy, that's not how the public
health works. It's not a predictable assembly line. We should
build in surge capacity for bioterrorism, epidemics and new
problems.
I would emphasize that we need to focus our spending on
systems and people, not just things. It's important to
stockpile vaccines and drugs, but that's not enough. We need
on-going epidemiology and disease surveillance. We need
communication systems that work. We need better labs and more
lab workers. We need people who can train and work with health
professionals during a crisis.
I'm concerned that the budget that we got from this
administration is insufficient to meet these needs. It relies
on moving CDC and public health professionals from job to job,
the same musical chairs that we saw with CDC when they had to
cope with AIDS 20 years ago. It also provides a drop in the
bucket for spending on public health systems and people and
spends largely on things. It is as if the administration were
building lots of fire stations and buying some fire trucks, but
not hiring fire fighters or installing alarm systems.
Now let me add, this is not an issue of being unable to
afford all the things we need to do to protect the public
health. What we have is a conscious decision that we ought to
use our money for tax cuts, especially for the wealthy,
especially for corporations, rather than have money available
to do the kinds of things that will protect all of the American
people when we have a public health emergency. It's the
clearest example of penny wise and pound foolish that I can
imagine. We can do better. We should learn from our previous
health problems and we shouldn't short change these efforts.
[The prepared statement of Hon. Henry A. Waxman follows:]
Prepared Statement of Hon. Henry A. Waxman, a Representative in
Congress from the State of California
While the threat of bioterrorism cannot be overstated, this is not
our first public health crisis. We have had Legionnaire's Disease and
Toxic Shock Syndrome and earthquakes and hurricanes. Most obviously, we
have had--and still have--the AIDS epidemic.
It is also not the first time that experts have told us that our
public health system is in disrepair. We have had warnings and reports
from the National Academy of Sciences and the Institute of Medicine for
a decade now.
We should be able to learn lessons from these disasters to help us
respond now.
The most obvious lesson is that we cannot shortchange the Centers
for Disease Control and public health agencies. During the Eighties,
CDC was so short of staff that it had to pull its professionals off of
their ongoing work to devote themselves to the emerging AIDS epidemic.
Just last month, CDC again had to pull its staff off of their other
work (this time including AIDS) so that they could respond to anthrax
and other threats.
When it works on energy issues, this Committee has learned that we
have to plan for ``surge capacity'' so that power systems can deal with
unexpectedly high demands. We should learn the same lesson for CDC and
public health. We cannot budget these programs for some sort of
theoretical ``normalcy.'' That's not how public health works; it's not
a predictable assembly line. We should build in ``surge capacity'' for
bioterrorism, epidemics, and new problems. Only with new FTE's and
contingency funds can we be prepared.
I would emphasize that we need to focus our spending on systems and
people, not just things. It's important to stockpile vaccines and
drugs, but it's not enough. We need ongoing epidemiology and disease
surveillance. We need communications systems that work. We need better
labs and more lab workers. We need people who can train and work with
health professionals during a crisis.
I'm concerned that the budget from the Administration is
insufficient to meet these needs. It relies on moving CDC and public
health professionals from job to job--the same musical chairs that CDC
had to cope with twenty years ago. It provides a drop in the bucket for
spending on public health systems and people and spends largely on
things. It is as if the Administration were building lots of fire
stations and buying some fire trucks, but not hiring fire fighters or
installing alarm systems.
And it is not a question of what we can afford to do for public
health. The Administration has consciously decided to spend its money
on tax cuts--tax cuts that benefit the wealthiest and corporations--and
not to spend the funding on public health preparedness.
This is the clearest example of penny-wise and pound-foolish that I
can imagine. We can do better. We should learn from our previous public
health problems. Now we know what to do, and we should not shortchange
the efforts.
Chairman Tauzin. The gentleman's time has expired. The
Chair asks are there requests for additional opening
statements? The gentleman from Michigan, Mr. Upton, is
recognized for an opening statement.
Mr. Upton. Thank you Mr. Chairman. The anthrax attacks have
brought home to each of us how important it is that we do all
that we can to be prepared to respond quickly and effectively
to bioterrorism. What was perhaps an abstract concern has now
become very, very real. I wanted to share some good news from
Michigan that I received this morning. We were granted a
weapons of mass destruction civil support team by the
Department of Defense. We're battling two fronts as we all
know, one a world away in Afghanistan and the other one at
home. It's a huge task to adequately protect our people,
infrastructure, and we're grateful for that help.
The anthrax attacks have thrown the spotlight not only upon
the vital role of the CDC, but also on the enormous challenges
that the FDA must take on and meet in combatting bioterrorism.
It has to be prepared to expedite the development, approval and
production of bioterrorism vaccines, drug therapies and
diagnostic tests to give us the weapons that we need to fight
new strains of anthrax, smallpox, ebola and anything else.
We must also step up to the plate with regard to
inspections of imports, whether of drugs and devices or
imported foods. By rights, the Commissioner of the FDA ought to
be at that table as well, but sadly, the FDA has gone into
battle without a general at its head and I'm deeply concerned
and I would urge the administration to quickly make that a top
priority to help us.
I yield back.
[The prepared statement of Hon. Fred Upton follows:]
Prepared Statement of Hon. Fred Upton, a Representative in Congress
from the State of Michigan
Mr. Chairman, thank you for convening today's hearing to continue
our committee's examination of bioterrorism and proposals to combat it.
I am pleased that Secretary Thompson and Dr. Koplan, the Director of
the CDC are here to give us an overview of their activities. The
anthrax attacks have brought home to each of us how important it is
that we do all that we can to be prepared to respond quickly and
effectively to bioterrorism. What was perhaps an abstract concern has
become very, very real.
First, I just want to share some very good news for Michigan that I
received this morning. We are being granted a Weapons of Mass
Destruction Civil Support Team by the U.S. Department of Defense. We're
battling on two fronts right now--one a world away in Afghanistan, the
other right here at home. It's a huge task to adequately protect our
people and infrastructure, and we are grateful for this help.
The anthrax attacks have thrown the spotlight not only upon the
vital role of the CDC, but also on the enormous challenges that the FDA
must take on and meet in combating bioterrorism. It must be prepared to
expedite the development, approval and production of bioterrorism
vaccines, drug therapies, and diagnostic tests to give us the weapons
we may need to fight new strains of anthrax, smallpox, Ebola, and other
agents of infection. The FDA must review and give approval to every
drug, therapeutic, vaccine and anti-toxin that is to be administered to
our population. It must work proactively with the NIH, the CDC, and the
pharmaceutical and medical device community from the outset. It must
significantly step up its inspections of imports, whether of drugs and
devices or of imported foods, plugging the gaps and holes in our
dangerously porous borders that could so easily be exploited by
terrorists.
By rights, the Commissioner of the FDA should be flanking Secretary
Thompson today, too. But we don't have a Commissioner. The FDA is going
into battle without a general at its head, and I am deeply concerned
about that. I want to stress in the strongest possible terms to
Secretary Thompson and the Administration the need to act swiftly to
nominate a new Commissioner who is well-prepared to lead the FDA into
battle.
In the short time I have this morning, I would also like to
highlight the vital role that telehealth networks can play. As chairman
of the Telecommunications and the Internet, I have seen firsthand the
potential of telehealth systems. We need to coordinate existing
networks and link them with the CDC, the NIH, the FDA and other
agencies joined in our war against bioterrorism. Such coordinated
networks could be used for timely disease surveillance and reporting,
for the rapid diagnosis of symptoms that could signal a bioterrorist
attack, for training health care professionals and first responders
even in the very rural areas of our country in the diagnosis and
treatment of anthrax, smallpox, and other deadly diseases, and for
linking the victims of attacks and those caring for them with the
sophisticated information and treatment available at major medical
centers.
That is why I was very disturbed to learn, Secretary Thompson, that
the Department of Health and Human Services has plans to eliminate the
Office for the Advancement of Telehealth and transfer its functions to
the HIV/AIDS Bureau. The Office is currently the focal point for
telehealth activities across federal agencies. It was instrumental in
the formation of the Joint Working Group on Telemedicine, for which it
provides both leadership and staffing. Rather than eliminating the
Office, which should consider charging it with taking the lead in
coordinating the telehealth networks currently in place and helping
them become effective partners on the frontlines across America in our
war on bioterrorism. Secretary Thompson, I hope you will give me a
commitment today to strengthen the role of this Office and deep six the
proposal to eliminate it.
Secretary Thompson, I look forward today to exploring these issues
further with you.
Chairman Tauzin. I thank the gentleman. Are there further
requests for opening statements? The gentleman from
Massachusetts, Mr. Markey, is recognized.
Mr. Markey. Thank you, Mr. Chairman, very much and we thank
our guests for coming here today. My concern in my very brief
opening statement is on the question of what happens if the
terrorists make a successful attack at a nuclear power facility
in the United States. Obviously, there would be a very large
release of radioactive iodine into the atmosphere. There would
be a population which would be at greatest risk that live
within the first 5 to 10 miles, but of course, it could go out
further, but especially within those near in closer areas. And
depending upon which way the wind was blowing, the radioactive
plume would carry that radioactivity toward tens of thousands
of Americans.
Now thus far the Nuclear Regulatory Commission has refused
to order the stockpiling of potassium iodide within the
communities that would be most likely affected across the
United States. It seems to me that this is a decision that
should not be made by Nuclear Regulatory Commission. It should
be made instead by the health officials which are going to have
responsibility for dealing with the consequences of a potential
health disaster. And it seems to me that since it only costs
between 3 to 5 cents to have a potassium iodide pill available,
at least in the schools that are within the vicinity of a
nuclear power plant, which is how they do it in other
countries, that it's a relatively inexpensive way of
stockpiling the needed antidote to the very great danger that
would be created and thus far the Nuclear Regulatory Commission
has refused to do it.
Now I believe that the Nuclear Regulatory Commission has
been negligent in refusing to mandate that precaution. It can
be stockpiled again, in schools. Children are the most
vulnerable population. Adults are not as much and in the course
of my questioning, Mr. Chairman, I am going to ask that our
experts, our health care experts here enlist in the effort to
put that kind of precaution in place. I thank you for holding
the hearing.
[The prepared statement of Hon. Edward J. Markey follows:]
Prepared Statement of Hon. Edward J. Markey, a Representative in
Congress from the State of Massachusetts
Mr. Chairman, good morning and thank you for holding this important
and timely hearing on bioterrorism. I join you and my colleagues in
welcoming Secretary Thompson and Director Koplan and I thank them for
being here today.
In 1998 Ashton Carter, John Deutch and Philip Zelikow spoke of the
impending threat of terrorists using weapons of mass destruction in a
Foreign Affairs magazine article called ``Catastrophic Terrorism''. The
article opens with the following prescient and chilling description:
``If the device that exploded in 1993 under the World Trade
Center had been nuclear, or had effectively dispersed a deadly
pathogen, the resulting horror and chaos would have exceeded
our ability to describe it. Such an act of catastrophic
terrorism would be a watershed event in American history. It
could involve loss of life and property unprecedented in
peacetime and undermine America's fundamental sense of
security, as did the Soviet atomic bomb test in 1949. Like
Pearl Harbor, this event would divide our past and future into
a before and after. The United States might respond with
draconian measures, scaling back civil liberties, allowing
wider surveillance of citizens, detention of suspects, and use
of deadly force. More violence could follow, either further
terrorist attacks or U.S. counterattacks. Belatedly, Americans
would judge their leaders negligent for not addressing
terrorism more urgently.''
September 11th and the subsequent Anthrax crisis have served as the
sonic boom of wake up calls that no one can ignore. Much as our nation
is using its military superiority to wage a war against Osama Bin Laden
in Afghanistan, we must rely upon our healthcare superiority to wage a
public health war against bioterrorism.
This war must include protecting dangerous bioagents from falling
into enemy hands. In 1996 I introduced the ``Biological Weapons Control
Act of 1996'' with former Representative John Kasich, and Senator
Hatch. The bill imposed requirements for the transfer of select agents
and was later signed into law as part of the Anti-terrorism and
Effective Death Penalty Act of 1996. If we had not passed this law, we
would be largely in the dark with respect to who possesses which
bioagents in this country. Last month the House took one more step in
the battle against bioterrorism by voting to expand the 1996 law to
require that all select agents be registered.
While there is no doubt that the United States has the resources
and capability to wage this war, in its current form, the public health
system is ill-prepared.
It is my hope that the Administration will agree to significantly
increase emergency funding to the CDC so that a strong force can be
deployed to combat bioterrorism . We will need the well prepared health
care ground troops pre-positioned by improving hospital ``surge''
capacity in the event of a bioterrorist attack or epidemic. We must
create the best command control center. This means providing the
resources necessary to upgrade States' preparedness, improve public
health laboratories and heighten disease surveillance and response and
communication between state, local and federal officials. And finally,
we need to provide the most sophisticated defensive weapons by
expanding our current stockpiles and encouraging the development of new
treatments.
And while the focus on stockpiling lately has been largely on
Cipro, and smallpox vaccines we cannot be negligent in addressing other
obvious and necessary protective measures.
For example, we are guilty of gross negligence for failure to
stockpile potassium iodide--the Cipro of Nuclear Exposure in localities
surrounding nuclear power plants. Potassium iodide is a cheap and
effective protection against the cancer-causing effects of radioactive
iodine on the thyroid gland. In the event of a terrorist attack on a
nuclear power plant, cancer-causing radioactive iodine could be
released into the surrounding area. In an urban setting it may take
hours to escape the area. During Hurricane Floyd, it took some drivers
8 hours to go 35 miles. Yet the radioactive plume can travel much
faster if the weather conditions permit.
In light of over 20 years of government inaction, I have introduced
a bill to require the stockpiling of Potassium Iodide within the
vicinity of all nuclear plants, HR 3279. Additionally, I thank you, Mr.
Chairman for agreeing to work with me to address my concerns in the
Commerce Bioterrorism Bill.
In closing, we've heard the clarion call to arms--we can't waste
time we must address our ailing public health system. We must act
responsibly lest we be judged negligent.
Chairman Tauzin. I thank my friend. The Chair again reminds
all members that their written statements are part of the
record and would now ask if there are further requests for
time. The gentleman from Florida, Mr. Stearns, is recognized
for 3 minutes.
Mr. Stearns. Mr. Chairman, thank you again for holding this
hearing. I thank as a member on the Oversight Subcommittee,
Chairman Greenwood, who ably conducted hearings on October 10
and November 1, in this area and I'm pleased we'll hear from
one of the architects, chief architect of the Federal effort of
striking back at bioterrorism, of course, which is Honorable
Secretary Thompson.
One of the questions I think all of us are concerned about
is should the public health system and the public safety and
intelligence community share a uniform approach to planning
against bioterrorism? Is that being done? If not, why? As we
know, all us Members of Congress, how bureaucracies work.
Sometimes there's no communication between them. I think that's
perhaps a key that Honorable Thompson will address, and should
CDC place greater emphasis on developing the front end of the
public health system to ensure the creation of a robust ability
to both detect and assess suspected bioterrorism incidents. And
last, how can the CDC best coordinate with State and local
health departments in an effort to assure that they have
completed adequate bioterrorism preparedness plants.
So Mr. Chairman, I commend you for opening these hearings.
This is a sobering high alert time and I think it's very
important to get the Secretary's insights and the witnesses',
and I yield back the balance of my time.
Chairman Tauzin. I thank my friend. I would like to
announce also for the benefit of our audience that Chairman
Greenwood had scheduled a bioterrorism hearing on September 11,
ironically, and we had to postpone it and held that hearing
just last week instead, but again, I do commend the chairman
for his comments and his good work.
Are there further requests for opening statements? The
gentleman from New York, Mr. Towns, is recognized for 3
minutes.
Mr. Towns. Thank you very much, Mr. Chairman. The events of
September 11 and the recent anthrax attacks have brought home
just how real the threat of bioterrorism can be. While we all
feel the need to take action, I would caution my colleagues to
remember that old adage, act in haste, repeat at your leisure.
For example, we're all concerned about the availability of
vaccines for smallpox, but should we risk the public health by
taking shortcuts in vaccine production which could create
serious side effects for hundreds of thousands of Americans and
ultimately not protect against the disease?
We have a public health system in this country which varies
greatly in terms of its sophistication and its ability to
access the most up to date information about bioterrorist
threat. Currently, only 13 States are connected to all of their
local health jurisdictions. How do we ensure that the other 37
States have the same communication links? How do we ensure that
our rural communities are as prepared as our urban areas to
deal with the bioterrorism threat? On that note, Mr. Chairman,
I yield back.
[The prepared statement of Hon. Edolphus Towns follows:]
Prepared Statement of Hon. Ed Towns, a Representative in Congress from
the State of New York
Mr. Chairman, I am pleased that this committee will indeed have an
opportunity to review the important issue of bioterrorism before we
adjourn this session.
The events of September 11th and the recent anthrax attacks against
the media and members of this body have brought home just how real the
threat of bioterrorism can be. While we all feel the need to take
action, Mr. Chairman, I would caution my colleagues to remember that
old adage: ``Act in haste repent at your leisure''.
For example, we are all concerned about the availability of
vaccines for smallpox. But should we risk the public health by taking
shortcuts in vaccine production which could create serious side effects
for hundreds of thousands for Americans and ultimately not protect
against the disease?
Within the approaching holiday season, we have concerns about the
security of our food supply. But are country-of-origin labeling
requirements practical and, more importantly, will they make our food
any safer?
And finally, Mr. Chairman, we have a public health system in this
country which varies greatly in terms of its sophistication and its
ability to access the most up-to-date information about a bioterrorist
threat. Currently, only 13 states are connected to all of their local
health jurisdictions. How do we ensure that the other 37 have the same
communication links? How do we ensure that our rural communities are as
prepared as our urban areas to deal with a bioterrorism threat?
These are concerns which must be addressed responsibly and not in a
hasty fashion just so that we can claim ``we did something'' before
Congress adjourns. This is one area, Mr. Chairman, where we may not
have the ability to leisurely repent our earlier decisions. I look
forward to hearing the testimony from our witnesses.
Chairman Tauzin. I thank my friend for his statement. Are
there further requests for opening statements on this side? The
vice chairman of the committee, Mr. Burr.
Mr. Burr. Thank you, Mr. Chairman.
Chairman Tauzin. I'm sorry, the gentleman from California,
Mr. Cox, is signalling and is recognized for 3 minutes for an
opening statement.
Mr. Cox. I thank you. In fact, I thought Mr. Greenwood was
going to ask for time which is the only reason I yielded. I
want to thank you, Mr. Chairman for----
Chairman Tauzin. Would the gentleman yield a second--Mr.
Greenwood is here. I think the committee ought to take great
pride in the subcommittee's work, Mr. Greenwood performed this
week, this last week, on the issue of charitable aid to the
victims of the catastrophe in New York and Washington and
Pennsylvania. As you know, the Red Cross just yesterday
announced it was reversing its course and directing the money.
Mr. Greenwood, a great job, sir.
There are lots of folks who will claim some credit for
that, including Mr. Bill O'Reilly on his show who did a great
deal to expose the problem early, but Mr. Greenwood and his
subcommittee did a great job, I think, in helping to educate
the Red Cross on the voices that we were hearing from America.
And I think the Red Cross is to be commended for correcting
that course and for dedicating itself to putting that money now
to the victims of the families of New York and Washington and
Pennsylvania.
Again, thank you, Mr. Greenwood. Mr. Cox is recognized for
3 minutes.
Mr. Cox. Thank you, Mr. Chairman, again, thank you for
holding this hearing on bioterrorism and I want to welcome
Secretary Thompson, add my welcome to those of my colleagues. I
know all of us on the committee appreciate the time that you're
taking away from your other responsibilities to testify before
us this morning. I would personally like to thank you as well
as Deputy Assistant Secretary Claude Allan and Dr. Donald
Henderson for meeting with the House Policy Committee to
discuss this exact topic over the last month.
This committee has dedicated itself for several years to
improving the resources and programs of the National Institutes
of Health, the Centers for Disease Control and the Food and
Drug Administration. Now we are taking additional steps to
improve the Nation's ability to respond and more importantly
prevent public health emergencies instigated by terrorists'
attacks. In the process of drafting the legislation that this
committee is currently considering, it's become clear that our
Nation's biomedical researchers and scientists are being
hindered by laws already on the books that constrain them from
developing products that could treat, detect and prevent
bioterrorist attacks. Some of these impediments are as simple
as our failure to make the R&D tax credit permanent, as a
result of which America's biomedical research has been
conducted in an atmosphere of uncertainty, financial
uncertainty.
The Food and Drug Administration still takes too long to
approve lifesaving products, although efforts have been and are
being made to improve and streamline the approval process and
our increasingly dysfunctional lawsuit system which imposes
exorbitant and easily avoidable costs on our health care
consumers and providers alike, has particularly deleterious
effects on the development and marketing of vaccines.
I know, Mr. Secretary, that you have been a leading
advocate of reform in all of these areas and I would
particularly like to commend you, the President and the rest of
the Bush Administration for your leadership at this time. Mr.
Chairman, I yield back.
Chairman Tauzin. I thank the gentleman for his statement.
Are there further requests on this side? Mr. Pallone from New
Jersey is recognized.
Mr. Pallone. Thank you, Mr. Chairman. On September 28, the
General Accounting Office published a report requested by
Senators Kennedy and Frist which stated that, in fact, our
health departments are ill-equipped, we are vulnerable to
bioterrorism and that our response to bioterrorism is poorly
coordinated and under funded on the Federal, State and local
level.
Mr. Chairman, I have to say I was disappointed in the
Federal Government's response to the chain of anthrax events.
The information that was presented about medications and doses
were inconsistent and in general, fear and confusion about the
power and limitations of anthrax were instilled in an already
panicked nation. For the future, our efforts need to focus on
preparing for similar threats, as well as more severe threats
of diseases that are highly contagious and deadly such as
smallpox.
Mr. Chairman, bioterrorism is not a partisan issue, but I
did want to mention that our Democratic caucus has spent a lot
of time since September 11 focusing on this issue. Last week,
the Democratic Health Care Task Force invited Janet Heinrich
and her team from the GAO, the comment on their report which,
as I said, cited bioterrorism and vulnerability. And this
presentation was very helpful in understanding the current gaps
in our public health infrastructure. Several proposals were
brought up during this meeting, namely H.R. 3255,
Representative Bob Menendez' bioterrorism bill which has been
introduced on behalf of the House Democratic Caucus and H.R.
3219, Representative Jane Harman's bill to fund the CDC
renovations. And the team from the GAO agreed that these
proposals would certainly be a good starting point for
improving our bioterrorism response and Mr. Secretary, I'm not
trying to be partisan in saying this, but I really believe that
and I know that you have looked at these proposals and I really
would commend them to you because I think that having taken
them out on the road and talked at Town Forums about them, they
really seem to be a good basis for dealing with the issue.
The first bill, the Menendez bill, H.R. 3255, proposes a
$3.5 billion package for public health preparedness, the
majority of which would be directed toward State and local
governments. Ms. Harman's bill, H.R. 3219, would provide $1.5
billion over the next 5 years for CDC renovation and this would
help speed up completion of the CDC's master building plan.
With regard to the CDC, I just wanted to mention, of the
$3.8 billion, fiscal year 2001 CDC budget, only $181 million
was devoted to bioterrorism, of which only $67 million went to
State and local governments. This year, $1.6 billion has been
proposed in the emergency supplemental. However, only a small
portion of that amount, $175 million would go to State and
local governments and we all know the importance of public
health on the State and local level and much more needs to be
done in terms of funding.
I'm just asking you, Mr. Secretary, if you would take these
two bills that I've just mentioned into serious consideration.
I'm getting a lot of feedback back from locals about what needs
to be done and I think the House Democrats, without being
partisan, really spent a lot of time getting feedback from
State and local governments and that these are the types of
things that are trying to be addressed in these two bills and I
hope that we can work together on a bipartisan basis to improve
our public health system as timely as possible, because this
is--the issue we're discussing today is the key issue that I
hear about in the District and at home. This is the thing that
most people care about as their priority right now.
Thank you, Mr. Chairman.
[The prepared statement of Hon. Frank Pallone, Jr.
follows:]
Prepared Statement of Hon. Frank Pallone, Jr., a Representative in
Congress from the State of New Jersey
Chairman Tauzin, Chairman Bilirakis, thank you for holding this
important hearing on proposals to combat bioterrorism.
As we saw just a month ago from the unfortunate anthrax incidents
on Capitol Hill and throughout the nation, the need for better
communication in response to bioterrorism threats is extremely
compelling. Immediate collaboration among federal, state and local
government and their medical communities; public health officials;
emergency management; and law enforcement is crucial.
When the terrorist attacks against the World Trade Center and
Pentagon took place on September 11th, shortly thereafter concerns
about biological or chemical warfare were voiced. The nation was given
the impression by Secretary Thompson that the United States was fully
prepared to combat terrorism and that there was no need for panic. On
September 28th, the General Accounting Office (GAO) published a report
requested by Senators Kennedy and Frist, which stated that in fact, our
health departments are ill-equipped, we are vulnerable to bioterrorism
and that our response to bioterrorism is poorly coordinated and under-
funded on the federal, state and local level.
As a result of this ill-preparedness, the response to anthrax found
in Senator Daschles office, and the chain of anthrax events that
followed, was decentralized, uncoordinated, and quite frankly,
confusing. The CDC unfortunately lacked leadership in presenting
information to the public and to key health departments. The
information that was presented about medications and doses were
inconsistent, and in general, fear and confusion about both the power
and limitations of anthrax were instilled in an already panicked
nation. It is unfortunate that 4 deaths were the result, but it is
important to keep in mind that this was anthrax, a substance that is
not contagious. Obviously our efforts need to focus on preparing for
future similar threats, as well as more severe threats of diseases that
are highly contagious and deadly, such as small pox.
We as a Committee and we as a Congress, want to help to improve
this current situation of bioterrorism unpreparedness. Far greater
challenges are headed our way, and it is our responsibility and
aspiration to provide what you need to ensure the publics safety.
Last week, the Health Care Task Force invited Janet Heinrich and
her team from the GAO to present to us on the report, which cited
bioterrorism vulnerability. This presentation was very helpful in
understanding the current gaps in our public health infrastructure.
Several proposals were brought up during this meeting, namely HR 3255:
Rep. Bob Menendezs bioterrorism bill introduced on behalf of the House
Homeland Security Task Force, and HR 3219: Rep. Jane Harmans bill to
fund CDC renovation. Our team from the GAO agreed that these proposals
would certainly be good starting points for improving our bioterrorism
response.
HR 3255, the Bioterrorism Preparedness Act of 2001, proposes a $3.5
billion package for public health preparedness, the majority of which
will be directed toward state and local governments. The main
highlights of the bill that address public health infrastructure and
response to bioterrorism are: 1) improving community emergency response
capacity and preparedness, 2) ensuring an adequate supply of vaccines
and treatments for all Americans, 3) enhancing community planning and
intergovernmental coordination and 4) enhancing surveillance, improving
communications and strengthening technology infrastructure. I feel that
this bill provides an excellent starting point for ensuring a strong
and organized response to bioterrorism.
In addition, several of my colleagues recently visited the CDC
campus and came back to report to Members that a substantial investment
in our public health system and CDC bioterrorism-related programs is
badly needed. The CDC is responsible for our national pharmaceutical
stockpile, our health alert network, our public health training
network, and many infectious disease labs. Of the $3.8 billion FY 2001
CDC budget, only $181 million was devoted to bioterrorism, of which,
only $67 million went to state and local governments. This year, $1.6
billion has been proposed in the Emergency Supplemental, however, only
a small portion of that amount, $175 million would go to state and
local governments. We all know the importance of public health on the
state and local level and much more needs to be done in terms of
funding.
One of the most striking comments made by my colleagues regarding
their visit to the CDC, was that the buildings and facilities were
badly in need of renovation. My colleague, Rep. Jane Harman, has
introduced a bill, HR 3219, that would provide $1.5 billion over the
next five years for CDC renovation. This will help speed up completion
of the CDCs master building plan, which is crucial at this time when
the CDC must have the ability to carry out vast communications and
maintain a high level of security.
Thank you, Secretary Thompson and Director Koplan, for coming
before our Committee to address this important issue of response to
bioterrorism. I hope that you will take these two bills that I have
just mentioned into consideration and I hope that we can work together
to improve our public health system as timely a fashion as possible.
Thank you.
Chairman Tauzin. I thank the gentleman. Further requests
for opening statements? The gentleman from North Carolina, the
vice chairman of the committee, Mr. Burr.
Mr. Burr. Thank you, Mr. Chairman. Let me take this
opportunity to welcome Secretary Thompson and Dr. Koplan. We've
tried to put this slate together several times and if it hadn't
been us that's messed it up, it's been the President, but we
excuse him for last week.
Mr. Chairman, let me reiterate something that you said and
that's that, in a bipartisan way, the committee staff has
worked aggressively for the last week or longer to address the
bioterrorism bill that I think members on both sides of the
aisle agree that we need to do. It will focus on two specific
areas, but not limited to those two, a rebuilding of our public
health infrastructure in America that I think all of us agree
needs to be done to respond successfully to any threat that we
might see in any community. And second, to accelerate the
facility upgrade of our CDC facilities which will be really the
nucleus of our ability to understand what's happening and what
we should do. Mr. Linder from Georgia, has worked aggressively
with the CDC. He, along with Ms. Harman, has introduced that
bill and it is the plans of this committee to incorporate that
acceleration in our bioterrorism bill where we would accelerate
a 10 year plan, Jeff, to a 5 year plan, and hopefully find
appropriators to go along with us. It is my hope that it won't
be too long before we have an opportunity to produce out of
this committee a bipartisan piece of legislation on
bioterrorism and I look forward to that.
Mr. Chairman, I yield back.
Chairman Tauzin. I thank the gentleman. Further requests
for time? The gentleman from Michigan, Mr. Dingell, is
recognized for 5 minutes.
Mr. Dingell. Mr. Chairman, I thank you. Mr. Secretary
Thompson and Director Koplan, thank you, for being here and
welcome. I particularly want to discuss proposals to address
possible acts of bioterrorism directed against our citizens. I
believe there are serious deficiencies in our public health
systems, inadequacy of budget and equipment at CDC, major
shortfalls in the capability of Food and Drug to address its
problems, antiquated facilities at CDC, and indeed, an overall
shortage in the ability of our hospitals and local units of
Government to respond to the serious challenges that can come
from these kinds of events.
We know how to fix our public health system. We know
increased funding is required, as well as improved Federal
direction and coordination. I believe it is now a simple and
direct question of political will, given greater urgency
because of recent and unfortunate terrorist events. We need
money for training, more nurses, more laboratory staff, for
developing new vaccines and antibiotics, for developing
stockpiles of pharmaceuticals and other medical supplies. We
need more money for public hospitals and community health
centers and we do need leadership from the Federal Government.
Second, the administration should be able to address and
fix the problems in the initial response to anthrax attacks. I
have attached to my statements for inclusion in the record, a
copy of the November 10 National Journal article entitled
``Contagious Confusion'' which discusses many of the lessons
learned. Legislation can help in some respects, but ultimately
the Secretary and the administration will have to be the ones
who ensure that Federal response improves and that State and
local authorities have the tools and the support that they
desperately need to do better; and I would note that in
discussions with my local officials, they find a massive
problem in term of inadequate Federal support for local
undertakings which are, after all, the front line of defense in
matters of this sort.
Third, there is a greater recognition that our general
level of preparedness is not adequate. For example, our food
safety system is not prepared to prevent international and
intentional adulteration from occurring, particularly with
imported food. We have neither the manpower at the borders, nor
the technology, to detect adulteration, intentional and
otherwise, or to direct it to proper hands so that it may be
scrutinized and the dangers detected.
When food arrives at U.S. ports of entry, there are an
inadequate number of people and inadequate inspection awaiting
it. It can come wherever the sender wishes it to go and there's
no way of channelling it into proper and necessary inquiries
into the safety of foods and other imported commodities of that
character. Even when imported food is sampled and tests are
conducted, it takes overlong. It takes days or weeks for labs
to process the tests. By that time, the food is long gone and
people have been significantly at risk for significant period
of time.
We in Congress must give Secretary Thompson the tools and
resources he needs to properly address the threat and he must
face up to the fact that he has great needs and speak honestly
of those needs to this Congress. And the administration must
not shy away from seeking what is needed to take the necessary
steps.
Mr. Secretary and Director Koplan, thank you for being here
and I look forward to your testimony and I thank you, Mr.
Chairman.
I yield back the balance of my time.
[The prepared statement of Hon. John D. Dingell follows:]
Prepared Statement of Hon. John D. Dingell, a Representative in
Congress from the State of Michigan
I welcome Secretary Thompson and CDC Director Koplan to this
Committee, particularly to discuss proposals to address possible acts
of bioterrorism directed against our citizens. We all know there are
serious deficiencies--in our public health system, in our initial
responses to the anthrax mail attacks, and in our general level of
preparedness. Our task now is to discuss them objectively and
constructively, and to craft solutions. This Committee has been engaged
in such an effort over the last two weeks, and although no agreement
has been reached, I commend the Chairman for undertaking this task.
Many other efforts in the Congress and the Administration are underway,
and the collective efforts should ultimately bear fruit.
First, we know how to fix our public health system. We know that
increased funding is required, as well as improved federal direction
and coordination. Now it is a simple and direct question of political
will, given greater urgency because of recent terrorist events. We need
money for training, for more nurses and laboratory staff, for
developing new vaccines and antibiotics, and for developing stockpiles
of pharmaceu-ticals and other medical supplies. We need money for
public hospitals and community health centers. And we need leadership
from the Federal Government.
Second, the Administration should be able to address and fix the
problems in the initial response to the anthrax attacks. I have
attached to my statement, for inclusion into the record, a November 10
National Journal article ``Contagious Confusion,'' which discusses many
of the lessons learned. Legislation can help in some respects, but
ultimately the Secretary and the Administration must work to ensure
that the Federal response improves, and that the state and local
authorities have the tools and support they need to do better. We must
have a clear, timely, and medically credible response at the Federal
level.
Third, there is greater recognition that our general level of
preparedness is not adequate. For example, our food safety system is
not prepared to prevent intentional adulteration from occurring,
particularly with imported food. We have neither the manpower at the
borders nor the technology to detect adulteration, intentional or
otherwise, of food when it arrives at U.S. ports of entry. Even when
imported food is sampled and tests are conducted, it takes days or
weeks for labs to process the tests--and the food is long gone. We in
Congress must give Secretary Thompson the tools and resources he needs
to properly address this threat, and the Administration must not shy
away from seeking what is needed.
I thank Secretary Thompson and Director Koplan for being here, and
I look forward to their testimony.
______
[Friday, Nov. 9, 2001--National Journal]
Contagious Confusion
By Sydney J. Freedberg Jr. and Marilyn Werber Serafini
In a way that the far bloodier September 11 attacks did not, the
anthrax assault has required unprecedented collaboration: among law
enforcement, emergency management, and public health officials; among
federal, state, and local government; and between government at all
levels and the medical community. If the attacks-by-mail did America
any kind of favor, it was to highlight how many weak links there are in
the chains that bind these agencies to each other in a crisis--links
that must be strengthened before a far heavier blow breaks them apart
completely.
Consider Clifford Ong, Indiana's new statewide counter-terrorism
coordinator, appointed two weeks into the crisis as the Hoosier version
of national Homeland Security chief Tom Ridge. Ong's office, intended
to be the state's central clearinghouse for anthrax information, first
learned about Indiana's most serious anthrax scare, not through
official channels, but from the media. Although about 600 miles from
any confirmed case of anthrax, Indianapolis happens to have one of the
only two facilities nationwide that repair and recycle post office
sorting machines--including a tainted printer from Trenton, N.J. State
authorities did not even know the repair plant was there until a
subcontractor called asking for advice about how to handle machinery
possibly exposed to anthrax. The state then tested for anthrax at the
repair plant, and the report came back negative. Ong relaxed. But he
didn't know that the main contractor at the plant had asked the U.S.
Postal Service to come and do its own test. This second test, performed
by an out-of-state lab, came back positive. Suddenly, there was anthrax
in Indiana, and yet state authorities weren't told. Reporters in
Washington were. Ong had to field the frantic calls.
``Our problem isn't locally,'' said Ong, who has long worked with
the local U.S. district attorney and the FBI field office. ``Washington
seems to respond within the Beltway to national media without any
concern that we have local media . . . It puts us in somewhat of a
defensive position.''
This snafu--just one of many--shows how vital information can fall
into the cracks between organizations, into blind spots where fear can
flourish like mold inside a wall. Considering that just four people
died of anthrax in one month, the average American was far more likely
to be struck by lightning, which kills 80 to 100 people every year,
than to contract the disease. The point is that anthrax is not
contagious--but fear is. ``The medical problem was actually pretty
small,'' said Jack Harrald, the director of the Institute for Crisis,
Disaster, and Risk Management at George Washington University in
Washington. ``The terror problem, in terms of managing people's fear,
was pretty huge--and not very well managed.''
The failure of government, medicine, and media to respond to fears
and ignorance about anthrax with real understanding led to millions of
dollars in losses--to businesses that had to find substitute mail
carriers or evacuate their workplaces for testing, as well as to local
governments that had to respond to every emergency anthrax scare. In
Los Angeles, where hazardous-materials responses increased 300 percent
in mid-October, ``we received a call from an employee at a doughnut
shop that there's a white, powdery substance on the floor,'' said
Deputy Chief Darrell Higuchi, of the Los Angeles County Fire
Department. The shop, of course, sold doughnuts with powdered sugar.
``Yet,'' said Higuchi, ``you feel for the callers, because they are
scared.''
Fear thrives on ignorance. But there is no effective,
authoritative, nationwide system to communicate information about
bioterror. Nor is there a single national spokesperson for the public's
health. Indeed, some have criticized the Bush Administration for
failing to designate someone as the voice of the anthrax crisis, even
acknowledging White House reluctance to call on Surgeon General David
Satcher, a leftover Clinton Administration appointee. Instead,
information has moved through dozens of parallel and poorly coordinated
channels of communication: The Centers for Disease Control and
Prevention talks to state health officers, the FBI to local sheriffs,
the Federal Emergency Management Agency to disaster officials, medical
associations to their members. But when people in different fields,
such as police and physicians, must work together, or when there simply
is no state or local counterpart to a federal agency, the channels are
less clear--as Ong found out in dealing with the Postal Service. The
system simply isn't set up to share information.
In fact, civil liberties laws often forbid necessary communication.
Said Lawrence Gostin, the director of the Center for Law and the
Public's Health, a joint project of Georgetown University and Johns
Hopkins University: ``The law thwarts vital information-sharing
vertically from federal to state, and horizontally between law
enforcement, emergency management, and public health.''
The biggest gap is between government and the medical community. A
CDC alert on bioterrorism, sent to state health officials just after
September 11, had still not reached many local emergency rooms a week
later. And the crucial linchpins between doctors and officials--local
public health offices--are notoriously overworked and short of funds.
As many as one in five public health offices do not even have e-mail,
said Sen. Bill Frist, R-Tenn., a physician. Many localities still
collect epidemiological data on disease outbreaks only by asking
doctors to send postcards through the mail--hardly an ideal approach in
any fast-moving outbreak, let alone one that strikes at the postal
system.
Anthrax has finally kick-started efforts to revive public health
systems, after decades of neglect. In North Carolina, for example, the
Legislature is about to allocate millions of dollars to replace
reporting by postcard with high-speed, highly secure electronic links.
Ultimately, the network will connect not only local officials, but also
every hospital, pharmacy, and doctor's office in the state.
New funding and new networks are essential first steps. But in a
country where almost all health care is provided by the private
sector--indeed, where most critical terrorist targets, from Internet
servers to nuclear plants to sports arenas, are privately owned--
defense against terrorism probably cannot be achieved by a new agency,
a new program, or a new technology. True ``homeland security,'' most
experts say, will require an overarching system that links not just
every level and agency of government, but also the private sector,
nonprofit groups, and the general public. Computers and the Internet
will be vital in helping to set up this new national network, but it
will be the intangible connections between people working together in a
common cause that will really make the new system work.
The Broken Linchpin
If it sometimes seems as if the world has turned upside down since
September 11, that's because it has. Terrorism has upset the
traditional pyramid of who protects Whom. No longer do the Pentagon's
armed troops bear the brunt of foreign blows. Whether the danger comes
from airliners-as-bombs or from anthrax envelopes, local firefighters,
medics, and police respond long before Washington can act. But even the
local emergency teams come second to the scene. In a terrorist attack,
the first responder is the ordinary citizen--the airline passenger who
decides to rush the hijackers, the mailroom clerk who notices a
suspicious package, or anyone who wonders whether these flu-like
symptoms they're feeling might be anthrax. It is their decisions,
prudent or paranoid, that trigger the government response. Said Peter
Probst, a former Pentagon and CIA official, ``The first line of defense
is an educated, engaged public.''
That word, ``educated,'' signals where things start breaking down.
Even those officials who should be best equipped to inform have
stumbled over their own statements, and each other's--and that includes
Surgeon General Satcher and Health and Human Services Secretary Tommy
G. Thompson.
``You've got Satcher saying one thing, Tommy Thompson saying
another, and the CDC saying a third,'' fumed one local official who
spoke with National Journal. One day the word is to put everyone on
Cipro, the next day not, the third day it's another antibiotic
altogether. ``There isn't a consistent message.''
With that confusion at the top, many officials, never mind ordinary
citizens, admit turning to the news media as their first source of
knowledge. But as reporters themselves grope in the dark for
information, and constantly face the pressure for round-the-clock, up-
to-the-minute coverage, they may magnify inconclusive clues, or even
outright rumors, into major scare stories. There was so much
misinformation about anthrax early on, said one congressional staffer
well versed in bioterror, ``the first few days, I was kicking the
television a lot.''
Many confused citizens dialed 911, just to be sure. Far more fell
back on the second line of defense: their doctors. Physicians are still
trusted more than most other professionals. And even though only a
handful of American doctors have ever seen a case of inhalation anthrax
(the last U.S. case was in 1978), most rushed to learn what they could.
Until recently, medical education on bioweapons has been minimal. But
after September 11, well before the first anthrax case in Florida,
sensitivity to terror of all kinds was so high that the major medical
associations quickly rallied to upload data to their Web sites and
downlink teleconferences to their members.
That information probably saved lives. Had Florida photo editor Bob
Stevens died in August, said Randall Larsen, director of the Anser
Institute for Homeland Security, a consulting group in Northern
Virginia, ``it's highly unlikely he would have been diagnosed as dying
with anthrax, because they weren't looking for it.'' Before September
11, when authorities sent anthrax samples to four medical laboratories
as a test of their bioterrorism alertness, three of the labs just threw
the samples out, mistaking the anthrax bacteria for contamination on
the slides.
In another test, out of a roomful of doctors at Johns Hopkins
medical center, just one recognized an X-ray of a strange chest
inflammation as characteristic of anthrax. Even after the September 11
attacks, HHS Secretary Thompson initially suggested that Stevens's
death was due to a freak natural cause. But doctors were on high enough
alert by then to spot the symptoms.
Although the professional medical associations could deluge their
members with basic references on anthrax, they lacked the quick
communications systems to collect and broadcast up-to-date data on the
ever-changing outbreak. In fact, since most associations serve only a
single medical specialty--and even the mighty American Medical
Association serves fewer than half of all doctors--they could not even
help share information among different types of doctors in a given
community.
The painstaking, county-by-county collation of data gathered from
individual physicians has always fallen to local public health
offices--the traditional American defensive line against disease. But
emergency officials, medical associations, and independent experts
alike all agree that the public health infrastructure has long been, to
quote one congressional staffer, ``the forgotten stepchild.'' These
local offices are perpetually short on funds, technology, and--above
all--personnel. They are burdened with laws written to guard against
19th-century scourges such as syphilis and tuberculosis, and few of
these laws even require doctors to report outbreaks of likely
bioweapons such as anthrax, much less the subtler indications of
spreading disease.
``Suppose there's a run on anti-diarrhea medication. How would we
know that? If there are a lot of absences from school or work, how
would we know that?'' said Georgetown University's Gostin. ``We need a
public health agency to be able to get information from the private
sector.''
New York City, considered a national model, does keep hourly tabs
on such things as sales of the anti-diarrheal Kaopectate. Los Angeles
hospitals are linked by computer to share diagnosis data. But most
areas lack such sophisticated ``disease surveillance'' systems, even in
states that have really tried. Virginia, for example, connects its
local health offices across the state by computer, said George
Foresman, a Virginia emergency management official, but the state's
effort to bring private practices into the network stalled because ``we
just had not been able to secure the funding.''
The problems are not only fiscal. Even with a $1.4 million federal
grant, Michigan found the private sector deeply reluctant to share
information. ``We've asked pharmacies if we could monitor what
antibiotics are going out,'' said Dr. Sandro Cinti, of the University
of Michigan medical center, ``but they didn't want to give away that
information.''
In the absence of even such imperfect electronic systems, most
public health officials collect data the old-fashioned way: slowly. In
some places, doctors' offices fill out and mail in forms to health
agencies; in other places, they call in, and local officials must
laboriously enter the information by hand, and then in turn mail
another piece of paper to the state health office. Conversely, when
Illinois authorities, who have invested heavily in linking public
health offices to local hospitals, wanted to send every physician in
the state advice on anthrax, they had to take the licensing board's
master list of addresses and mail every one of them a letter. There was
no comprehensive e-mail or electronic system.
``The information-gathering and decision-making loop isn't fast
enough,'' said Clark Staten, the executive director of the Emergency
Response & Research Institute in Chicago. ``The bad guys can move
faster than the good guys--at the present time.'' And during that lag,
fear can spread, and people can die.
More Than Medical
Even in a better-than-average flu season, doctors may run out of
vaccine and hospitals out of beds. In some cities last year, said Sen.
Edward Kennedy, D-Mass., ``they had sick patients that couldn't even be
treated in the emergency rooms--they were out in cars.''
Any major natural disease outbreak overtaxes American medicine. But
biological terrorism takes the complexity an octave higher. Each
scattering of spores is obviously a public health problem. But it is
also evidence of a crime--and of a hazardous material in the
environment. Anthrax not only requires close ``vertical'' cooperation
among federal, state, local, and private medical organizations, it also
cuts horizontally across functional lines. Ordinary disease can be
dropped neatly into an organizational box marked ``medical.''
Bioterrorism requires out-of-the-box cooperation among public health
professionals, private doctors, law enforcement agencies, firefighters,
emergency management systems, and even foreign intelligence agencies.
This kind of jurisdiction-crossing is so alien to American
government that it is often outright illegal. If the Central
Intelligence Agency had somehow found out beforehand about the anthrax-
laced letter addressed to Senate Majority Leader Thomas A. Daschle, for
example, it may not have been allowed to warn health officials until
after it was sent, according to James Hodge, the project director of
the Center for Law and Public's Health. To protect civil liberties,
said Hodge, ``there's a firewall between intelligence agencies and
public health.''
Even when there's no legal obstacle to collaboration, many of the
various agencies lack the experience, the contacts, or the procedures
to work together. Both the U.S. Postal Inspection Service and the
Centers for Disease Control are trying to track the anthrax letters to
their source. The two agencies share information, but they don't share
people: Instead of combining forces, detectives and doctors are on two
separate teams following different methods to reach the same goal.
Sometimes, the lack of coordination could have even worse
consequences. ``When I was the health commissioner of New York, I had
no clue who was the head of the FBI office, and he had no clue who I
was,'' said Margaret Hamburg, who went on to become HHS's top bioterror
official under President Clinton. ``The last thing they want to be
doing is exchanging business cards in the middle of a crisis.'' Yet,
that is just what often happened with the anthrax scare.
In the District of Columbia, for instance, where traditional
federal-local complications compounded all the other problems, the
initial confusion and inconsistencies in testing and treatment for
Capitol Hill staff versus postal workers boiled over into racially
tinged fury. One community forum turned, unfairly, into a pillorying of
D.C. public health chief Ivan Walks. Soon Dr. Walks and Mayor Anthony
Williams were holding joint press conferences with Postal Service
officials and the CDC. But those relationships had to be set up on the
spot--and the public health office still does not have a full-time
representative in the District's interagency Emergency Operations
Center.
D.C.'s problem is not uncommon. ``We somehow managed to leave the
public health system . . . outside the emergency system,'' said
Harrald, at D.C.'s George Washington University. Emergency managers,
firefighters, and police have largely overcome past problems of
coordination by planning and training together before disasters, and by
jointly staffing command posts during times of crisis. Such a combined
system cranked into action in New York City on September 11. ``The
federal government had thousands of people moving in the right
direction 20 minutes after the second tower was hit,'' Harrald said.
``We know how to do this. That's the good news.''
The bad news is that, in most places, no one told public health
officials the good news. In D.C., ``it took a long time before the
emergency room at [George Washington University] hospital and the
emergency room at Children's Hospital and the attending physician of
the Capitol and the CDC had the same picture of what they were dealing
with,'' Harrald said. ``I'm not throwing stones at individuals. The
problem is that we didn't set the systems up before the event.''
The American Answer
In the first month of anthrax attacks, the country's system of
defenses against bioterror often seemed to be no system at all, only
chaos. Fortunately, reality is more nuanced, and more heartening, than
that. True, there is no one coherent national system. But there are
systems--all partial, all imperfect, but needing mainly to be
strengthened and brought into an overarching structure. Senate Health,
Education, Labor, and Pensions Committee Chairman Kennedy and panel
member Frist last year co-sponsored the Public Health Threats and
Emergencies Act of 2000, which authorized $540 million a year to
strengthen the public health infrastructure and to better recognize and
respond to bioterrorism attacks. Congress has not yet funded the new
law, but already the two Senators have upped their request to $1.4
billion a year.
The final sum needed for homeland security will surely be much
higher. But ``we're not going to create a whole new Department of
Defense,'' with a $350 billion budget and staff of 3 million, said
David McIntyre of the Anser Institute. ``We're going to play with the
chips that are on the table.''
``The pieces are there,'' said Frist. The task is taking the pieces
that exist--federal, state, local, and private--``and coordinating them
in a seamless way. It can be done.'' In Frist's own field, transplant
surgery, moving precious organs quickly across the country and then
ensuring that patients' bodies do not reject the new tissue require
far-flung hospitals and diverse disciplines to work closely together--
and they do it, every day.
High on Capitol Hill's agenda is a massive reinvestment in the
nation's long-neglected public health system. Top priority is a secure,
high-speed electronic data-link for doctors and public health officials
who are now scrawling disease reports on postcards. The CDC already has
an electronic Epidemic Information Exchange system to share outbreak
alerts among federal, state, and local public health officials, as well
as the military. And long before September 11, the CDC had given all 50
states seed money to start work on a National Electronic Disease
Surveillance System to link all 2,000-plus local health offices around
the country. This network could automatically and swiftly share, for
example, the results of a crucial diagnostic test. Ultimately, it could
also tap into hospitals and even private practices. But for now, the
surveillance network does not actually exist. A bare-bones ``base
system'' is scheduled to begin in 20 states in 2002. That seemed plenty
fast--before September 11. Now, lawmakers are likely to hit the gas.
But strengthening public health is only half the battle, because
public health officials will still get their information from the
private sector. The real challenge is to track--from every hospital,
every doctor's office, and every pharmacy around the country--the
telltale upticks in certain symptoms, or prescriptions, that although
seemingly innocuous in isolation, could signal an impending crisis. It
is a daunting task.
Yet it is also mostly done already. Insurance companies routinely
require doctors to code each diagnosis and report it electronically for
reimbursement, keeping electronic tabs on everything from
pharmaceutical sales to major surgeries. The Health Insurance
Portability and Accountability Act of 1996 (HIPAA) made such reporting
systems mandatory nationwide, though a significant 43 percent of
doctors are not yet hooked up. In its patient-privacy rules, the act
also has a little-known exception that requires doctors to share data
on threats to public health.
Medical information companies are already on the Hill touting
software solutions. A properly designed system could tap into the
existing streams of data, strip off names and other individual
identifiers, and crunch the numbers into trends. To be sure, such an
early-warning system might well find false patterns. An upsurge in
sales of certain drugs might indicate an outbreak of disease, or it
could simply reflect effective advertising. Conversely, the system
might miss a real outbreak if doctors consistently misdiagnosed as flu
the ambiguous early symptoms of, say, anthrax--the reason why D.C.'s
Walks is currently working on a system that codes not just final
diagnoses but actual symptoms as well.
Still, the most sophisticated computer is only a tool. The most
important linkages are among people. And in small ways, that linking
process has already begun, too. Tom Ridge has held teleconferences with
all 50 state governors. Local officials and medical associations are
reaching out to one another, often through e-mail. And a FEMA program
called ``Project Impact'' gives local governments grants and training
to bring together different agencies, businesses, and community groups
for disaster planning. Mayor Susan Savage of tornado-prone Tulsa,
Okla., says that Project Impact simply but systematically asks, ``What
does the private sector bring to the table that can complement public
resources?'' On September 11, for example, when 800 airline passengers
were stranded at the Tulsa airport, the city mobilized everything from
public buses for transportation to local preachers for counseling,
pulling resources freely from the public, private, and nonprofit
sectors.
Officials, legislators, and experts increasingly agree that such
bottom-up approaches are the model for homeland security. Imposing a
single national system from the top down is not only impractical, it is
probably unwise. What makes more sense is a ``network of networks,'' an
overarching system that lets each local government or private group
tailor its approach to its own unique needs--within the overall
framework.
A prototype nationwide network of networks has actually already
been built. Unfortunately, it was promptly taken apart soon after. Late
in 1999, when the public and private sectors alike were fretting that
their computers might crash once the year hit ``00,'' then-Secretary of
State Madeleine K. Albright visited the national Y2K crisis center and
exclaimed, ``You could really run the world from here.''
Like a terrorist, the Y2K bug threatened to strike unpredictably at
any target: federal, state, local, or, in the vast majority of cases,
private. Imposing a topdown structure to address the potential threat
was impossible, recalled John Koskinen, Clinton's Y2K coordinator:
``You need to build off existing structures, and not create new ones.''
So Koskinen pulled together existing networks--government agencies,
corporations, trade associations, and industry groups--in a loose but
comprehensive confederation that reached into every threatened sector,
with himself as the lead spokesman.
``The year-2000 preparations were a pretty good dress rehearsal''
for the kind of coordination required since September 11, said David
Vaughan, a Texas public health official. JoAnne Moreau, the emergency
preparedness director of Baton Rouge, La., agreed: ``We developed
relationships with agencies and companies and factions that we never
knew would have some kind of role.''
The lesson that Y2K holds for homeland defense is that the federal
government cannot, need not, and probably should not, do everything. Of
course, without strong guidance from Washington, the thousands of
private and local government responses could create an irrational
tangle, like an ill-tended garden. The federal role is to fertilize the
growth and, when necessary, prune it back. ``There are 1,800 separate
legal jurisdictions in the United States, and the American people and
the Constitution like it that way,'' said David Siegrist of the Potomac
Institute for Policy Studies think tank. ``The federal government needs
to offer incentives . . . and set standards.''
In a shadow war with an amorphous foe, America can prevail only by
empowering individuals and small groups to innovate--because it is
they, and not any federal official, who will be on the front lines.
Thirty years ago, noted McIntyre, if a child showed up at school beaten
black and blue, teachers might think, ``Tough parents,'' and move on.
Today, they would report the possible abuse--and thereby set various
responses in motion. A public similarly well-educated to watch for
something genuinely wrong in their world would go a long way, not just
toward calming panic, but toward stopping terrorists before they
strike.
``We don't want to be people who watch each other. We want to be
people who watch out for each other,'' said McIntyre. ``It's the
distinction between a controlled society and a civil society. A civil
society requires citizens. And in good times, maybe we forgot that.''
We have certainly been reminded now.
Chairman Tauzin. The gentleman yields back the balance of
his time. Mr. Whitfield? Dr. Ganske, 5 minutes for an opening
statement.
Mr. Ganske. I thank you. I thank the chairman for calling
this hearing and I thank the Secretary for coming. I'm sure
that the Secretary, after all the additional study he's done on
microbiology should probably be awarded a master's or a Ph.D.
at the end of his tenure as Secretary.
I hope that this committee is able to come together on a
bipartisan agreement on a bioterrorism bill, Mr. Tauzin and Mr.
Dingell. I hope they're able to do that. To date, we haven't
seen an agreement. For the past month, I have been, you might
say in consultation with Senator Bill Frist, a physician in the
Senate, on the bill that he and Senator Kennedy have been
working on and have come to an agreement on in a bipartisan
way. In fact, I talked to Senator Grassley just a day or so ago
and he informed me that he thought that would be
noncontroversial and most likely we will see a nearly unanimous
vote in the Senate on that bill.
I've also had extensive discussions with Senator Chuck
Hagel on the food provisions in that bill which I think are
excellent. It is my intent to introduce that bill in a
bipartisan manner, either today or tomorrow. I do not feel that
the level of funding in the Senate bill is excessive,
considering the things that we need to do for the CDC, for
animal disease labs, for vaccines, and for supplies of drugs.
As a physician, I've been interested in this issue for a
long time. I'm happy to have worked with Congressman Brown on
issues related to antibiotic resistance. I've had some personal
experience with some serious infectious diseases, such as the
so-called flesh-eating infection, necrotizing faceitis. I've
also had personal experience with a very serious food infection
that became a case of encephalitis a few years ago when I was
on a surgical mission.
We recently got a phone call from a constituent because we
had sent her a letter in response to an inquiry. She phoned
back irate that we were potentially contaminating her household
with anthrax in sending her a letter from Washington. This is
really on a lot of people's minds. The bill that I will
introduce deals with a lot of things, but one of the things
that I think is a good item in the Frist-Kennedy bill is the
issue of block grants to States because it is clear that
whereas we need to do many things on the Federal level, the
States are in a lot of trouble financially. Secretary Thompson
knows that and they are frequently bound by balancing budget
amendments to their State constitutions. They need some
additional financial help to deal with the public health
aspects of this bioterrorist threat. I think that is one of the
advantages of the Kennedy-Frist, Frist-Kennedy bill which I
will be introducing. There are other aspects of that bill
particularly on food safety, and the threat to agriculture that
we need to address further than what we have done in Congress.
The economical blow to our agricultural sector from the
introduction of bioterrorist agent such as hoof and mouth
disease would be absolutely devastating.
So I am hopeful that this committee can come to a
bipartisan agreement, but if not, we will have an alternative
in the form of a companion bill to the Senate bill and I yield
back.
Chairman Tauzin. The gentleman's time has expired. Mr.
Deutsch.
Mr. Deutsch. Thank you, Mr. Chairman, and thank you, Mr.
Secretary for being here this morning.
Mr. Secretary, I know you have spent a great deal of time
and effort in terms of trying to have the smallpox vaccine
available in our stockpile in a number sufficient for all
Americans, and I'm very pleased that Mr. Henderson is here
today and actually, obviously, very pleased that you brought
him on board as part of your team.
This is really the first opportunity since September 11
that I have and this committee, even though we have
jurisdiction over CDC, to really talk to you specifically about
smallpox. And I would tell you that from my own perspective,
there is no more important issue that you can do as Secretary
than to get the vaccines available for Americans on the shelf.
And the reason why I'm taking the time in terms of the opening
statement is in this setting, which I have mentioned, is the
first hearing that we have had in over 2 months, specifically
on--or the opportunity to ask questions on smallpox. I only
have 5 minutes in that setting and hopefully, either in your
statement or in dialog we've had in other settings, to talk
about it, but i guess, I know that you're absolutely doing the
most you can possibly do. You're working the hardest. Your
intentions are the same intentions, but still we're more than 2
months down the road and we don't have a contract. We don't
have a specific plan to put smallpox vaccines on the shelf, in
our stockpile and I think Mr. Henderson, probably as much as
anyone in the world can talk about the disaster that would
occur if there was literally one case of smallpox that was
found int he United States of America. And unfortunately, it's
sort of the more you know, the more you don't want to know
situation and I think by this point you know far more than you
want to know, but what we all are aware is how even though
there are only two official stockpiles of smallpox in the
world, it is very clear that there is probably much more
smallpox that had been developed and was available for
terrorists in the world.
Three years ago, as you are well aware, less than 3 years
ago, was the last time we had inspectors in Iraq and by the
public domain information it appears very convincing that Iraq
had smallpox at that time. The same thing which we are well
aware that in the 1990's when the Soviet Union basically
disintegrated, it was not just one location where they were
developing smallpox, they were developing it in many locations
and just so that people are aware, to take smallpox and I'm not
an expert and Mr. Henderson really is the--Dr. Henderson is
really the world expert on this, but we're really talking about
a vial which could have kept a smallpox in a freeze-dried
state, could have been sent, just one vial. We're not talking
about a nuclear power plant. We're not talking about a reactor.
We're not talking about a plutonium facility. We're talking
about a vial and a vial potentially with one person could have
the destructive capability of ten hydrogen bombs. And I guess I
have a concern that as significant as all of our acknowledge
that that is the potential. The intensity and I know you're
doing as much as you possibly can do, but what I really have
had sought and asked for and really in the setting today is
really what more can we do, because the downside exposure of
smallpox is so severe that it's almost as if anything we can do
to get vaccine on the shelf is critical and I--at the opening
in terms of questions, I look forward to that and again I
appreciate your being here.
Chairman Tauzin. I thank the gentleman for his statement.
Further requests for opening statements? The gentleman from
Georgia, Mr. Norwood is recognized.
Mr. Norwood. Thank you, Mr. Chairman, I'll accept your
unanimous consent request for 1 minute out of respect for the
Secretary's time. Welcome, Mr. Secretary, we're glad you're
here.
Last week, I had the privilege of joining the President and
Secretary Thompson on the trip down to CDC. You don't have to
spend time there to realize the importance of their work to
national security. My Georgia colleagues, John Lender and Saxby
Chambliss recognize, as well. I'm happily a co-sponsor of their
bill, as is Ms. Harman and I sincerely hope this committee
accepts their work to make certain CDC has the appropriate
authorizations to accomplish their very important mission and I
hope we will work that into this committee's bioterrorism bill.
I also briefly want to commend your attention to Mr.
Thornberry's bill. It's very simple. In an emergency, frankly,
the difference between a for profit and a nonprofit hospital is
basically irrelevant and access to Federal funds in an
emergency should not be limited in my view, just to nonprofit
hospitals. I hope the committee will accept that simple fix as
well.
I appreciate you being here today, Mr. Secretary and Dr.
Koplan and we all look forward to your testimony.
I yield back, Mr. Chairman.
[The prepared statement of Hon. Charlie Norwood follows:]
Prepared Statement of Hon. Charlie Norwood, a Representative in
Congress from the State of Georgia
Thank you Mr. Chairman for holding this hearing this morning. Last
week I had the privilege of joining the President on his trip to the
CDC. You don't have to spend too much time there to realize the
importance of their work to our nation's security.
My Georgia colleagues, John Linder and Saxby Chambliss, recognize
this as well. I sincerely hope the Committee accepts their work to make
certain CDC has the appropriate authorizations to accomplish their very
important mission into the Committee bioterrorism bill.
I would also like to bring attention to Mr. Thornberry's bill as
well. In an emergency, the difference between a for-profit and a non-
profit hospital is irrelevant. Access to federal funds in an emergency
should not be limited to non-profit hospitals. I hope the Committee
accepts this very simple fix.
I appreciate your attendance today Secretary Thompson, Dr. Koplan
and look forward to your testimony. I yield back the balance of my
time.
Chairman Tauzin. I thank my friend. Further requests for
time on this side? The gentlelady from California, Ms. Eshoo,
is recognized.
Ms. Eshoo. Thank you, Mr. Chairman, for holding this all-
important hearing, and Secretary Thompson, it's wonderful to
see you again. Drs. Koplan and Henderson, welcome.
I have questions, obviously, that I would ask this morning,
but I want to welcome you, No. 1, and I can't help but think of
the time, the years in growing up and what my father would tell
me about World War II. He talked about the attack and then he
said our country went into high gear. And so I think as we're
shifting into high gear, we have to be mindful of what we can
do in our time, in our day.
We know that our public health service across the country
is absolutely key and central in this. We have outstanding
professionals in all of our communities, but we know that they
need more. We know that the CDC is superb, but we have a ways
to go in terms of upgrading that place being Ground Zero in
this preparation for us to respond, God forbid, to what we need
to respond to.
What are the medications that we need to have on the shelf?
These are all the thing that we need to be prepared for. That's
what this hearing is about. I don't think this is a Democrat
and Republican--this is not a partisan issue. This is where we
have to join ranks and not debate about the sums, but the
substance. The sums should be attached to the substance of what
we come up with and I also am very, very mindful that out of
this effort, out of this bioterrorism discussion that new
discoveries are going to come in terms of the drugs and the
research and the development of that research and that will
hold our Nation in good stead for years to come. So I look
forward, very sincerely, Mr. Secretary, with the chairman, with
all of my colleagues on this committee that is front and
central in this issue to coming up with those things that
generations to come, they will look over their shoulders and
say we did something noble and good in our time and in our day.
Thank you.
Chairman Tauzin. I thank the gentlelady. Further requests
for time? The gentleman from Illinois, Mr. Shimkus, is
recognized for 3 minutes.
Mr. Shimkus. Thank you, Mr. Chairman and thank you, Mr.
Secretary, for coming and I would just want to say this is a
national security issue. I think we all agree. We did have a
historical aspect of the influenza outbreak in 1918. It shows
us the risk we have. Had we had 5,000 casualties--had we had
5,000 injured people instead of approximately 5,000 dead, we
would have found out that we wouldn't have been able to contain
and treat those folks in New York City.
World War II and the cold war really had a good model. Our
civil defense plan was a pretty good model to nationalize civil
defense issues and I think it's time we kind of turned that
back, especially as we address bioterrorism and my big concern
is our front line responders, the fire departments, the police
officers. No matter what we do at the Federal level, they're
going to be the first ones there and we have to help them
prepare and then follow up with the surge capacity needed to
meet the needs early. We know that early intervention will be
the key and somehow we've got to find that great balance to
bring in our locals and prepare them to respond and they can do
the job if we're there to assist them and that will be my focus
and Mr. Chairman, thank you. I yield back.
[The prepared statement of Hon. John Shimkus follows:]
Prepared Statement of Hon. John Shimkus, a Representative in Congress
from the State of Illinois
Thank you Mr. Chairman for holding this hearing on the important
issue of bioterrorism. Now, more than ever, our country needs to be
prepared to deal with terrorist attacks of all kinds, including
bioterrorism.
I am especially concerned over the growing shortage of medical
laboratory personnel. These professionals are needed for the immediate
response to a bioterrorist situation.
Laboratory professionals must provide prompt and accurate
laboratory results so that a potential biological threat can be
detected. Considering the times, it is difficult to imagine how our
health delivery system would function without this needed laboratory
workforce. I am hopeful that any bioterrorism package that moves
forward would recognize this need.
In addition, I would like to mention the importance of community
health centers as a first line of detection for a bioterrorism attack.
Health centers are often located in isolated rural areas where they
are the only health care provider for miles. They are also often
expected to fulfill vital local public health functions because there
is no local health department or its resources are limited. I urge the
members of this committee and HHS to remember this important part of
our nation's health care delivery system as we craft this proposal.
Again, I would like to thank you Mr. Chairman, for holding this
important hearing today.
Chairman Tauzin. The Chair thanks the gentleman. Further
requests for time on this side? The gentleman from Ohio is
recognized. Mr. Rush, do you seek recognition? The gentleman
from Ohio is recognized.
Mr. Sawyer. Thank you, Mr. Chairman, for holding this
hearing and I thank our witnesses for your participation today.
I'd just like to make a couple of brief observations. First
of all, the CDC has made a good beginning. The strategic plan
is a good start and during the anthrax episode, health
officials in my District tell me that health alert network
functioned well in sharing timely information. That's
important.
The work entered into cooperative agreements with State and
major local health departments I think is an important element
in preparedness, because clearly and I think we would all agree
that in a crisis, all responses is local. It falls to our
cities and our counties first to be able to react and we've got
to make sure that they have the tools they need to react
appropriately.
That leads me to my second observation and that is that
that does not seem to be the case yet, that of the $8.7 billion
that OMB suggests we're spending in fighting terrorism, only
about 3.5 percent of that is reaching the local level in the
form of training, planning and equipment grants. I believe we
need to do better than that. I think we can do better than that
in the kind of environment that we've heard talked about by the
chairman and others. I'm confident that we will do that.
I yield back the balance of my time, Mr. Chairman.
[The prepared statement of Hon. Tom Sawyer follows:]
Prepared Statement of Hon. Tom Sawyer, a Representative in Congress
from the State of Ohio
Thank you Mr. Chairman and thank you for holding this hearing. I
would also like to thank the Secretary for testifying in front of the
committee today about ways the government can better protect the public
from bioterrorism.
In early October, when the first anthrax case was confirmed, the
threat of bioterrorism ceased being theoretical or distant. It became
real and immediate, regardless of its ultimate source. Subsequently, 22
cases have been confirmed by CDC and tragically, four people have died
as a result of anthrax inhalation. Clearly, the treatment of postal
workers who were exposed to anthrax was a disaster. The federal and
local governments must do a better job in responding because in the
future, the biological agents that terrorist use may be more contagious
and more deadly.
The CDC has made a good beginning in leading the nation's efforts
to prepare for a bioterrorism attack. As part of HHS's 1999
Bioterrorism initiative, the CDC took on this burden and has performed
admirably working with limited resources. Over a year ago, CDC issued a
well thought-out strategic plan to deal with bioterrorism and has
worked with State public health departments to strengthen planning, lab
capacity and communication. In conversations with heath officials in my
district, they have all told me that during the current anthrax
episode, the Health Alert Network has performed exceptionally well in
informing them about the latest developments and medical information.
In response to the bioterrorism initiative, CDC also began entering
into cooperative agreements with State and major local public health
departments to help them upgrade their preparedness and response
capabilities. These agreements focus on five areas: Preparedness
Planning and Readiness Assessment, Surveillance and Epidemiology, the
Health Alert Network, and Biologic and Chemical Agents Laboratory
Capacity. However, last year, the CDC was able to award only slightly
more than $50 million to all public health departments across all five
of these areas. Due to a lack of funding, all state public health
departments could not even access money in each of the grant
categories. In light of September 11 and the anthrax mailings, we need
to increase the funding substantially for these vitally important
programs.
During a crisis, all response is local. Police, firefighters,
health workers, EMTS and mayors are immediately responsible to react.
The federal government cannot meet these events as they occur.
Consequently, we must make sure that our local health care and safety
forces are prepared, and that bioterrorism funding is targeted
appropriately.
Unfortunately, this does not seem to be the case yet. An analysis
of OMB's figures shows that the federal government is spending about
$8.7 Billion to fight terrorism but only 3.5% of that is making it to
the local level in the form of training, planning and equipment grants.
We need to do better. We must ensure that bioterrorism proposals direct
resources to those who will be responding. I look forward to hearing
from the witnesses on how they believe that this can best be
accomplished.
Chairman Tauzin. Thank you, my friend. Further requests for
time on this side? The gentlelady from New Mexico, Ms. Wilson.
Ms. Wilson. Thank you, Mr. Chairman, Mr. Secretary, I
appreciate your being here today. All of us know that we have
to strengthen our capacity to respond to and detect biological
threats, but I think we also have to recognize that what we're
talking about here is only one part of a renewed focus on
health security. Many of the threats that we know we're going
to have to face include nuclear and chemical contaminants and
those are largely unaddressed thus far in the legislation
that's emerging certainly from the Senate and possibly also
here in the House.
We do know with respect to biological agents that there are
some things we have to do. We have to expand our laboratory
capacity which was overwhelmed by a relatively small incident
involving anthrax in three different communities. That regard
last year, the Congress established a national center for
infectious disease which a year ago the CDC did not recommend
for continuance and I hope that that's been reconsidered.
We need to research, develop and deploy low cost
technologies for real time detection of contaminants, whether
they are biological, nuclear or chemical. The idea that--the
visions that we've seen on our televisions of q-tips and petri
dishes and men in bunny suits are not where we should be. We
are within 3 to 5 years of the deployment of real time
detection of chemical and biological and nuclear contaminants
in water systems across the country and we should accelerate
that deployment and develop those technologies for the air, the
water and the food that we eat. We need to strengthen our
controls on hazardous biological agents and this committee has
al