<DOC>
[107 Senate Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:77048.wais]


                                                        S. Hrg. 107-452
 
                           BIOTERRORISM, 2001
=======================================================================



                                HEARINGS

                                before a

                          SUBCOMMITTEE OF THE

            COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE

                      ONE HUNDRED SEVENTH CONGRESS

                             FIRST SESSION
                               __________

                            SPECIAL HEARINGS

                    OCTOBER 3, 2001--WASHINGTON, DC
                    OCTOBER 28, 2001--WASHINGTON, DC
                    NOVEMBER 2, 2001--WASHINGTON, DC
                   NOVEMBER 29, 2001--WASHINGTON, DC

                               __________

         Printed for the use of the Committee on Appropriations








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                      COMMITTEE ON APPROPRIATIONS

                ROBERT C. BYRD, West Virginia, Chairman
DANIEL K. INOUYE, Hawaii             TED STEVENS, Alaska
ERNEST F. HOLLINGS, South Carolina   THAD COCHRAN, Mississippi
PATRICK J. LEAHY, Vermont            ARLEN SPECTER, Pennsylvania
TOM HARKIN, Iowa                     PETE V. DOMENICI, New Mexico
BARBARA A. MIKULSKI, Maryland        CHRISTOPHER S. BOND, Missouri
HARRY REID, Nevada                   MITCH McCONNELL, Kentucky
HERB KOHL, Wisconsin                 CONRAD BURNS, Montana
PATTY MURRAY, Washington             RICHARD C. SHELBY, Alabama
BYRON L. DORGAN, North Dakota        JUDD GREGG, New Hampshire
DIANNE FEINSTEIN, California         ROBERT F. BENNETT, Utah
RICHARD J. DURBIN, Illinois          BEN NIGHTHORSE CAMPBELL, Colorado
TIM JOHNSON, South Dakota            LARRY CRAIG, Idaho
MARY L. LANDRIEU, Louisiana          KAY BAILEY HUTCHISON, Texas
JACK REED, Rhode Island              MIKE DeWINE, Ohio
                  Terrence E. Sauvain, Staff Director
                 Charles Kieffer, Deputy Staff Director
               Steven J. Cortese, Minority Staff Director
            Lisa Sutherland, Deputy Minority Staff Director
                                 ------                                

 Subcommittee on Departments of Labor, Health and Human Services, and 
                    Education, and Related Agencies

                       TOM HARKIN, Iowa, Chairman
ERNEST F. HOLLINGS, South Carolina   ARLEN SPECTER, Pennsylvania
DANIEL K. INOUYE, Hawaii             THAD COCHRAN, Mississippi
HARRY REID, Nevada                   JUDD GREGG, New Hampshire
HERB KOHL, Wisconsin                 LARRY CRAIG, Idaho
PATTY MURRAY, Washington             KAY BAILEY HUTCHISON, Texas
MARY L. LANDRIEU, Louisiana          TED STEVENS, Alaska
ROBERT C. BYRD, West Virginia        MIKE DeWINE, Ohio
                           Professional Staff
                              Ellen Murray
                              Jim Sourwine
                              Mark Laisch
                            Adrienne Hallett
                              Erik Fatemi
                               Adam Gluck
                       Bettilou Taylor (Minority)
                        Mary Dietrich (Minority)
                    Sudip Shrikant Parikh (Minority)

                         Administrative Support
                             Carole Geagley
                        Emma Ashburn (Minority)










                            C O N T E N T S

                              ----------                              

                       Wednesday, October 3, 2001

                                                                   Page

Opening statement of Senator Tom Harkin..........................     1
Prepared statement of the American Pharmaceutical Association....     3
Prepared statement of the American Society of Clinical 
  Pathologists...................................................     5
Prepared statement of the Commissioned Officers Association of 
  the U.S. Public Health Service.................................     6
Prepared statement of the Association of State and Territorial 
  Health Officials...............................................
Opening statement of Senator Arlen Specter.......................    13
Opening statement of Senator Robert C. Byrd......................    14
Statement of Hon. Edward M. Kennedy, U.S. Senator from 
  Massachusetts..................................................    16
    Prepared statement...........................................    19
Statement of Hon. Bill Frist, U.S. Senator from Tennessee........    20
    Prepared statement...........................................    23
Statement of Hon. Chuck Hagel, U.S. Senator from Nebraska........    28
Statement of Hon. John R. Edwards, U.S. Senator from North 
  Carolina.......................................................    29
Statement of Hon. Tommy G. Thompson, Secretary, Department of 
  Health and Human Services......................................    32
    Prepared statement...........................................    36
Opening statement of Senator Mike DeWine.........................    46
Opening statement of Senator Richard J. Durbin...................    46
Opening statement of Senator Judd Gregg..........................    48
Opening statement of Senator Herb Kohl...........................    49
Statement of Jonathan Tucker, Ph.D., director, Chemical & 
  Biological Weapons Nonproliferation Program, Monterey Institute 
  of International
  Studies........................................................    52
    Prepared statement...........................................    55
Statement of Stephen Cantrill, M.D., associate director, 
  Department of Emergency Medicine, Denver Health Medical Center.    62
    Prepared statement...........................................    64
Statement of Jerome M. Hauer, managing director, Crisis and 
  Consequences Management, Kroll Associates......................    66
Statement of Patricia Quinlisk, M.D., M.P.H., medical director 
  and State epidemiologist, Iowa Department of Health............    68
    Prepared statement...........................................    71
Statement of Rex Archer, M.D., M.P.H., director, Kansas City 
  Health Department..............................................    79
    Prepared statement...........................................    81

                       Tuesday, October 23, 2001

Opening statement of Senator Tom Harkin..........................    93
Opening statement of Senator Arlen Specter.......................    95
Statement of Jeffrey P. Koplan, M.D., M.P.H., Director, Centers 
  for Disease Control and Prevention, Department of Health and 
  Human Services.................................................    98
    Prepared statement...........................................   104
Statement of James T. Caruso, Deputy Assistant Director, 
  Counterterrorism Division, Federal Bureau of Investigation, 
  Department of Justice..........................................   109
Statement of Bob Kramer, president and chief operating officer, 
  Bioport Corporation............................................   123
    Prepared statement...........................................   125
Statement of Mary Kuhn, vice president of operations, Bayer 
  Corporation....................................................   129
    Prepared statement...........................................   131
Statement of Barbara Hunt, R.N., M.P.A., district health officer, 
  Washoe County Health Department, Reno, Nevada..................   133
    Prepared statement...........................................   135
Statement of Hilary Koprowski, M.D., president, Biotechnology 
  Foundation, Inc., Philadelphia, PA, professor, Department of 
  Microbiology and Immunology, director, Center of Neurovirology 
  and Biotechnology Foundation Laboratories at Thomas Jefferson 
  University.....................................................   136
    Prepared statement...........................................   137
Statement of Thomas P. Monath, M.D., vice president for Research 
  and Medical Affairs, Acambia, Inc..............................   138
    Prepared statement...........................................   140
Statement of Mary J.R. Gilchrist, Ph.D., director, University of 
  Iowa Hygienic Laboratory.......................................   141
    Prepared statement...........................................   143

                        Friday, November 2, 2001

Opening statement of Senator Tom Harkin..........................   155
Opening statement of Senator Arlen Specter.......................   156
Opening statement of Senator Robert C. Byrd......................   157
Opening statement of Senator Ted Stevens.........................   160
Statement of Anthony S. Fauci, M.D., Director, National Institute 
  of Allergy and Infectious Diseases, National Institutes of 
  Health, Department of Health and Human Services................   160
    Prepared statement...........................................   162
Statement of James W. LeDuc, Ph.D., Acting Director, Division of 
  Viral and Rickettsial Diseases, National Center for Infectious 
  Diseases, Centers for Disease Control and Prevention, 
  Department of Health and Human Services........................   164
    Prepared statement...........................................   165
Statement of Michael Friedman, M.D., chief medical officer for 
  biomedical preparedness, Pharmaceutical Research and 
  Manufacturers of America.......................................   171
    Prepared statement...........................................   172
Statement of M. Anita Barry, M.D., M.P.H., director, Communicable 
  Disease Control, Boston Public Health Commission, and member, 
  National Association of County and City Health Officials.......   177
    Prepared statement...........................................   179

                      Thursday, November 29, 2001

Opening statement of Senator Tom Harkin..........................   201
Opening statement of Senator Arlen Specter.......................   202
Opening statement of Senator Ted Stevens.........................   204
Statement of Jeffrey P. Koplan, M.D., M.P.H., Director, Centers 
  for Disease Control and Prevention, Department of Health and 
  Human Services.................................................   205
    Prepared statement...........................................   207
Statement of Anthony S. Fauci, M.D., Director, National Institute 
  of Allergy and Infectious Diseases, National Institutes of 
  Health.........................................................   210
    Prepared statement...........................................   211
Opening statement of Senator Herb Kohl...........................   218
Opening statement of Senator Mary L. Landrieu....................   224
    Prepared statement...........................................   226
Statement of Ken Alibek, M.D., president, Advanced Biosystems, 
  Inc............................................................   229
    Prepared statement...........................................   231
Statement of Joseph Barbera, M.D., associate professor and co-
  director, Institute for Crisis, Disaster, and Risk Management, 
  the George Washington University...............................   233
    Prepared statement...........................................   235
Statement of Joseph LeValley, senior vice president for planning 
  and systems development, Mercy Medical Center of Des Moines, 
  Des Moines, Iowa...............................................   237
    Prepared statement...........................................   239







                              BIOTERRORISM

                              ----------                              


                       WEDNESDAY, OCTOBER 3, 2001

                           U.S. Senate,    
    Subcommittee on Labor, Health and Human
     Services, and Education, and Related Agencies,
                               Committee on Appropriations,
                                                    Washington, DC.
    The subcommittee met at 10:35 a.m., in room 216, Hart 
Senate Office Building, Hon. Tom Harkin (chairman) presiding.
    Present: Senators Harkin, Byrd, Kohl, Murray, Durbin, 
Landrieu, Specter, Gregg, and DeWine.

                Opening statement of Senator Tom Harkin

    Senator Harkin. Good morning. The hearing of the 
Appropriations Subcommittee on Labor, Health and Human 
Services, and Education, and Related Agencies, will come to 
order.
    History will note that on September 11, 2001, our freedom 
was attacked. These attacks have made us realize that a free 
America must be a vigilant America. Vigilance requires that we 
prepare to meet the likely threats posed by our enemies. While 
I do not want to overstate its likelihood, or incite 
unnecessary panic, we must take a hard look at the threat posed 
by biological weapons and our Nation's preparedness to meet 
that threat.
    This is not science fiction fantasy. Iraq had a biological 
weapons program, although we have no evidence that it was 
successful. They had already shown a willingness to use 
chemical weapons on combat against their own citizens. I 
believe we are not far from the day when a nation or 
organization will possess both biological weapons and chemical 
weapons and the will to use them, so the time for us to prepare 
is now.
    Preparedness requires an investment in our public health 
infrastructure on the local, State, and Federal level. They 
must have the resources and expertise needed to respond to an 
array of terrorist actions. It is no longer a matter of public 
health, it is a matter of national defense.
    Imagine how we would meet a biological attack, given our 
Nation's current state of readiness. On May 20, a western 
State's department of public health begins receiving reports 
that increasing numbers of people are seeking medical attention 
at a city's area hospital for coughing and fever during the 
previous evening. By early afternoon on May 20, 500 persons 
with these symptoms have received medical care, and 25 have 
died.
    The State declares a public health emergency. Hospitals and 
clinics around the area who just days before were dealing with 
what appeared to be just an unusual case of influenza are 
recalling staffs, but hospital staffs are beginning to call in 
sick. More and more people and resources are scarce. The 
State's Governor then restricts travel, including bus, rail, 
and air travel into and out of the affected area. All 
antibiotics that can be used to prevent or treat the plague are 
commandeered. Citizens are told to seek treatment at a medical 
facility if they're feeling ill. By the end of that day, 783 
cases of pneumonic plague have occurred, and 123 people have 
died.
    On day 2, May 21, a cable news network reports that a 
national crash effort is underway to move large quantities of 
antibiotics to the region. A push pack of needed medical 
supplies from the National Pharmaceutical Stockpile arrives in 
the city, but there are great difficulties moving antibiotics 
from the stockpile delivery point to the persons who need it 
for treatment. Out-of-State cases now begin to be reported. The 
CDC notifies bordering States of the epidemic.
    On day 3, May 22, hospitals cannot manage the influx of 
sick patients. By noon, there are 3,060 United States and 
international cases of the plague and 795 have died.
    On the day 4, May 23, there are conflicting reports of the 
number of sick and dead. Some reports show an estimated 3,700 
cases of pneumonic plague, with 950 deaths. Others are 
reporting over 4,000 cases, and more than 2,000 deaths.
    The good news from this? This was an exercise, just an 
exercise. In this scenario, an aerosol of plague, (Y. pestis) 
bacilli was released at the Denver Performing Arts Center, and 
we can see the results of this. Clearly, we are not 
sufficiently prepared, but we have made some progress.
    Several years ago, this subcommittee, under the leadership 
of Senator Specter from Pennsylvania, began to put more and 
more effort into protecting us from bioterrorism. Over the past 
2 years, we have appropriated $545 million to the Center for 
Disease Control for this purpose. That investment has improved 
the detection, treatment, and containment of a potential 
bioterrorist attack by strengthening the Federal, State, and 
local partnerships that are the first and even second lines of 
defense. In addition, two of our distinguished witnesses, 
Senators Kennedy and Frist, led the effort to pass the Public 
Health Threats and Emergencies Act. That legislation will 
further strengthen our efforts.
    In the near term, we will put forward a plan on how to 
allocate the $20 billion in anti-terrorism funds we approved 2 
weeks ago. It is my hope that this hearing will help us focus 
on how a portion of those funds can be used to combat 
bioterrorism. Should the unthinkable happen, our local public 
health departments will be the first line of defense. Unlike a 
conventional or chemical weapons attack, a biological weapon 
can be launched and can strike without even a sound.
    It will be our emergency room personnel and urgent care 
providers who will recognize the attack and counter it. That 
requires training and effective surveillance systems that can 
put pieces of information together in a meaningful plan. That 
is how public health threats are tracked and contained.
    For example, in New York, a doctor who had recently 
attended a public health seminar on the importance of this type 
of tracking and reporting had the presence of mind to report 
two unusual cases of encephalitis to the public health 
department. That information led to the identification of the 
West Nile virus outbreak.
    In the case of biological weapons, we will require trained 
personnel and equipment to first detect the attack, the ability 
to treat a large number of exposed individuals, and immediate 
access to the necessary pharmaceuticals, whether it be 
vaccines, antibiotics, or something else.
    We have made some progress in meeting the threat, but how 
much further do we need to go to protect Americans from a 
biological attack? That is the question we must address today.
    We have a very distinguished and knowledgeable panel of 
witnesses, who I know will add a great deal to this hearing, 
and I want to thank them for joining us. Before we begin with 
our first distinguished panel, I would ask unanimous consent 
that a number of statements from various experts who asked to 
testify today, but who were unable to be accommodated, be 
inserted into the record.
    [The statements follow:]
     Prepared Statement of the American Pharmaceutical Association
    The American Pharmaceutical Association (APhA), the national 
professional society of pharmacists, is pleased that the Committee is 
addressing the important issue of bioterrorism and ways to prepare for 
and provide a response to a biological or chemical terrorist attack. 
APhA is the first established and largest professional association of 
pharmacists in the United States. APhA's 50,000 members include 
practicing pharmacists, pharmaceutical scientists, pharmacy students, 
pharmacy technicians, and others interested in advancing the 
profession. Pharmacy is the third largest health profession in America. 
The Association is extremely proud of the role our pharmacist members 
played in meeting the needs of individuals who, in the aftermath of the 
terrorist attacks, were stranded away from home or working on rescue 
efforts and were in need of medications or other healthcare needs.
    The roots of pharmacy's involvement with public health initiatives 
go back well over a century. Pharmacists have served as local, 
decentralized extenders of public health departments, playing a major 
role in the distribution and administration of vital vaccines, 
medications, supplies and health care services.\1\ The nation's 
pharmacists have demonstrated a serious commitment to preventing 
disease and stand ready to serve the needs of our nation in the event 
of a biological or chemical attack. Indeed, the profession recognizes 
the deadly threat that an attack of this nature would pose with the 
population of our nation at risk of fatal infection with little notice. 
When an attack occurs, time will be short to mount a preventive program 
to preserve the public's health. Pharmacists' accessibility in every 
community provides an excellent opportunity to reach individuals in 
need of preventive care, healthcare services, medications and supplies, 
vaccines, and information. Pharmacists want to actively participate in 
whatever response or preventive plan is implemented, and are available 
to assist in preparedness efforts and response to bioterrorism. APhA 
pledges its services and communications vehicles to help mobilize this 
vital resource.
---------------------------------------------------------------------------
    \1\ Pharmacy in History, American Institute of the History of 
Pharmacy; Vol. 41, pgs. 137-149, 1999.
---------------------------------------------------------------------------
    Pharmacists' contributions to such efforts can include: Monitoring 
for and surveillance of signs and symptoms of a possible biological or 
chemical attack. Pharmacists are a trusted source of health care 
information for the public. Patients often seek the advice of 
pharmacists, even before going to a physician, when they require health 
information. The initial symptoms presented by several potential 
biological agents that could be utilized against our citizenry resemble 
those of the flu. Many patients may attempt to self medicate and will 
seek a remedy from their local pharmacy shelf before going to the 
physician's office or hospital. As one of the most accessible health 
care professionals, pharmacists are in an excellent position to assist 
in monitoring any patterns of symptoms or diseases reported by 
patients. Pharmacists' involvement in this area can help to serve as an 
early warning that a bioterrorism attack has occurred.
    The pharmacist is an expert in medication use, both prescription 
and over-the-counter. This expertise is invaluable in determining which 
pharmaceuticals should be stored and which can be used as second and 
third line agents if the supply of first line agents is limited.\2\
---------------------------------------------------------------------------
    \2\ Supplement to the Journal of the American Pharmaceutical 
Association, September/October 2000.
---------------------------------------------------------------------------
    The resources and talents of the nation's pharmacists may be 
extended beyond dispensing necessary medications and working with 
patients to make those medications work. For example, pharmacists in 31 
states may administer vaccines and provide general support for 
immunization programs. There is substantial evidence that pharmacists 
are readily accessible, trusted professionals who can motivate the 
public to be vaccinated and enhance vaccine delivery. These 
capabilities will be helpful in a national infectious disease 
emergency. Here are some of the practical ways pharmacists could help:
    Community pharmacists at more than 52,000 neighborhood pharmacies 
can educate the public and, in 31 states, actually immunize them. In 
many rural areas, a pharmacist is the only health professional 
conveniently located to patients. The nation's community pharmacies 
could serve as 52,000 bases of operation and communication for 
immunization programs coordinated by state health departments.
    Pharmacists in hospitals and other health systems can educate, 
motivate, support, and immunize inpatients and outpatients in these 
settings. As medication experts, pharmacists link the clinical, 
logistic, and administrative functions of hospitals and health systems.
    Consultant pharmacists can enhance immunization delivery to 
residents of nursing homes and other institutions. Consultant 
pharmacists review residents' drug regimens monthly and are already 
integral contributors to health quality in these settings.
    Pharmacists are trained to take any of three roles in support of 
the national preparedness plan. These three roles are:
    Motivating: Pharmacists can distribute literature, display posters, 
perform one-on-one counseling, speak to local civic groups, and similar 
activities. Scientific studies demonstrate that 50 percent to 94 
percent of the people to whom a pharmacist recommends immunization 
accept this recommendation.\3\ In the confusion and uncertainty 
possible in any national immunization campaign, pharmacists can be 
voices of reason and sources of factual information and advice.
---------------------------------------------------------------------------
    \3\ Spruill et al., 1982; Grabenstein et al., 1986; Morton et al., 
1988; Grabenstein et al., 1990.
---------------------------------------------------------------------------
    Hosting: In 1997, more than 5 million doses of influenza vaccine 
were administered at more than 15,000 pharmacies across the country, 
more than one-quarter of all pharmacies. Even in the pharmacies where 
pharmacists are not yet trained to immunize, nurses or other vaccine 
providers could administer vaccines or establish vaccine supply depots. 
These sites are equipped to store refrigerated medications, are widely 
dispersed in urban, suburban, and rural settings, near population 
centers of diverse sizes. Most are open long hours and have large 
parking lots that could accommodate large patient flows. Further, given 
that more than 95 percent of pharmacies already have electronic 
communications capabilities, pharmacies could serve as communication 
centers for sending and receiving instructions and data between state 
health authorities and field workers during a pandemic. In addition, 
pharmacists can serve as information resources to consumers, media, and 
other health care professionals.
    Immunizing: Estimates are that there are currently more than 3,000 
immunizing pharmacists, delivering more than 300,000 doses of vaccine 
to adults during recent flu seasons. Pharmacists are authorized to 
administer drugs in 31 states, corresponding to a population of over 
135 million people. Additional states are considering empowering 
pharmacists with this authority to advance the public health. 
Pharmacists could be enlisted to administer vaccine dose(s) during 
bioterrorism events, reporting to state authorities, as well as 
providing areas for vaccine and medication storage and distribution.
    APhA has made available to its members educational programming 
focusing on bioterrorism at Association annual meetings. Additionally, 
a bioterrorism resource center located on APhA's homepage 
(www.aphanet.org) was developed to assist pharmacists and consumers 
with education about and preparing for a bioterrorism attack.
    All of these actions will be greatly facilitated by having Congress 
express interest in including the nation's pharmacists in plans to 
defend the nation against these threats.
    Thank you for the opportunity to provide comments on this important 
issue. The American Pharmaceutical Association and its members stand 
ready to assist the government in any way possible to prepare for and 
respond to bioterrorism.
    Contact information: American Pharmaceutical Association 2215 
Constitution Avenue, NW Washington, DC 20037 (202) 429-7575.
                                 ______
                                 
  Prepared Statement of the American Society of Clinical Pathologists
    In light of the tragic events of September 11, 2001, we appreciate 
you holding this hearing to address the issue of bioterrorism. We hope 
the following comments will provide you with some specific suggestions 
on how to improve the public health infrastructure and prepare for 
potential biological and chemical attacks.
    As the world's largest organization representing laboratory 
personnel, the American Society of Clinical Pathologists' 75,000 board 
certified pathologists, clinical scientists, certified technologists 
and technicians, are the individuals most likely to first receive 
patient specimens for etiologic agents that are likely to be used in 
bioterrorism and toxins that may be used as chemical weapons. These 
professionals must provide prompt and accurate laboratory test results 
so that a potential outbreak can be detected, provide support for 
hospitals and clinics caring for affected patients, and assist in the 
development of an integrated epidemiologic network, especially for law 
enforcement purposes.
    Bioterrorist events will likely present as outbreaks of acute 
febrile illnesses or as unusual infectious diseases with no readily 
apparent point source. Therefore, clinicians will rely heavily upon 
laboratory tests for diagnostic clues as to the etiologic agent. 
Laboratory professionals must be trained to identify microbial 
pathogens likely to be used for bioterrorism, to safely collect, 
transport, and process specimens containing biological agents 
associated with bioterrorist acts, to follow chain of custody and other 
legal requirements, and to have familiarity with needs of mass disaster 
support services.
    Unfortunately, there is growing concern over the serious shortage 
of medical laboratory personnel in our nation's health care system. In 
the United States, vacancy rates for seven of ten key laboratory 
medicine positions are at an all time high. Since the early 1980s, the 
number of accredited educational programs for laboratory positions has 
decreased significantly, and laboratory professionals who entered the 
workforce in the 1960s and 1970s will be retiring soon.
    To assist in reversing this shortage, we respectfully request two 
amendments to the legislation offering appropriations for the Public 
Health Improvement Act, Public Law 106-505. Specifically, we ask that 
the legislation allow schools and programs of allied health to qualify 
for grants. The ``Public Health Threats and Emergencies; Education of 
Medical and Public Health Personnel'' program already allows grants to 
be given to state or local public health agencies to train laboratory 
personnel in the recognition or identification of resistance in 
pathogens. Similarly, we ask that schools and programs be eligible for 
grants in order to train medical laboratory personnel in disciplines 
that recognize or identify a potential biological agent. The ``Public 
Health Threats and Emergencies; Public Health Countermeasures to a 
Bioterrorist Attack'' program allows states, hospitals, clinics, or 
primary care facilities to qualify for grants to enhance the ability of 
personnel to recognize the symptoms and epidemiological characteristics 
of exposure to a potential weapon. The Centers for Disease Control and 
Prevention should implement these training initiatives, and provide 
grants to schools and programs that train medical laboratory personnel 
and to other public or private non-profit entities. We suggest 
appropriating $25 million for education training grants. The 
Association of Public Health Laboratories concurs with this approach.
    Also, in order to protect the health of the citizens of the United 
States from bioterrorism, emerging infectious diseases, foodborne 
diseases, and environmentally associated diseases, it is imperative to 
establish a national system of laboratories to help detect, coordinate, 
and control these threats. A national laboratory system is where public 
health, hospital and independent laboratories throughout the United 
States would build a collaborative infrastructure, to assure that 
timely and accurate laboratory information can be shared. The Centers 
for Disease Control and Prevention has determined that ``maintaining 
and developing a national laboratory system that is efficient at 
detecting and timely in reporting is critical to minimize the negative 
impact of disease or other adverse public health events in the 
community.'' A national laboratory system is intended to assure the 
availability of consistent public health laboratory capacity regardless 
of the location.
    Development of a national laboratory system is already underway 
with the establishment of four demonstration projects in Nebraska, 
Minnesota, Michigan and Washington state, but much more needs to be 
accomplished to weave an effective national system, and quickly. A 
national laboratory system would permit partnership building among 
clinical laboratories, public health laboratories, and the government. 
It would assess staffing and capacity needs, provide guidance for 
training in bioterrorism specimens, and create voluntary standards for 
the public health infrastructure.
    To carry out this function, we respectfully request $50 million for 
the national laboratory system. To maintain the system, an additional 
$50 million should be authorized for future years.
    The American Society of Clinical Pathologists also supports funding 
the Centers for Disease Control and Prevention at $500 million for 
building and upgrading state and local public health capacity.
    Thank you for the opportunity to comment on this critical public 
health concern. If you have questions or need additional information, 
please contact the American Society of Clinical Pathologists at (202) 
347-4450.
                                 ______
                                 
Prepared Statement of the Commissioned Officers Association of the U.S. 
                         Public Health Service
                              introduction
    The Commissioned Officers Association (COA) of the U.S. Public 
Health Service appreciates the interest of this Subcommittee in the 
very important issue of bioterrorism. We are pleased that this 
Subcommittee recognizes the vulnerability of the nation to acts of 
bioterrorism by fringe groups and rogue nations, and is willing to take 
a leadership role in seeing to it that the various governmental 
agencies (local, state and federal) are asking the necessary questions 
and taking the necessary steps to ensure the nation is prepared if the 
unthinkable should occur.
    COA believes the threat of bioterrorism is a serious one, and the 
Federal Government must have a clear, coherent and coordinated plan to 
deal with potential incidents that could impact upon the safety and 
health of large numbers of Americans. COA also strongly supports the 
enhancement of the Nation's public health infrastructure at all levels 
of government. In our view, such an effort is necessary irrespective of 
the magnitude of the bioterrorism threat we may face. Too often the 
bulk of Federal health funds has been expended for direct health care 
costs or to support biomedical research, while Federal expenditures for 
public health programs have lagged far behind. Consequently, we would 
urge this Subcommittee to examine not only the ability of our public 
health agencies to respond to bioterrorism, but also to review their 
ability to meet the current demands being placed upon them.
        the commissioned corps of the u.s. public health service
    In our view any planning that takes place with regard to response 
to an incident of bioterrorism ``must'' take into consideration the 
capabilities of the Commissioned Corps of the U.S. Public Health 
Service. This view has been supported on a number of occasions, most 
recently by Secretary Thompson in testimony before the Senate 
Appropriations Committee, Subcommittee on Commerce, Justice, State, and 
the Judiciary this past May 9th. In that hearing he stated:

    ``In order to advance an orderly and comprehensive approach to the 
many issues involved in such preparation (for a bioterrorism event), I 
will appoint a special assistant within the Immediate Office of the 
Secretary to lead the department's bioterrorism initiative. This person 
will report to me directly. I plan to call a national meeting of HHS 
agencies to evaluate the status of bioterrorism activities and report 
back to Congress on our efforts. In addition, the new special assistant 
will support the Surgeon General's efforts to revitalize the Public 
Health Service Commissioned Corps and its Readiness Force. Let me 
assure you that this is a top priority for me and for my entire 
department.''

    Congress has also noted that the Commissioned Corps has much to 
offer in the area of bioterrorism. In 1998 the Senate Armed Services 
Committee, in the Committee Report that accompanied the Department of 
Defense Authorization Act for fiscal year 1999, observed: ``The 
Committee notes the efforts underway within the Department of Defense 
to develop the means to respond to acts of terrorism involving weapons 
of mass destruction. In this regard, the committee directs the 
Secretary of Defense to ensure the assessment of needs and capabilities 
includes an analysis of the capabilities that exist within the 
Commissioned Officer Corps of the U.S. Public Health Service, who, as 
members of the uniformed services, might be easily integrated into 
Department of Defense plans to respond to emergencies involving weapons 
of mass destruction.''
    The Commissioned Corps has a history of deploying with the military 
that goes well beyond mobilization in times of war. In such instances 
the uniform and rank structure of the Commissioned Corps, as noted by 
the Senate Armed Services Committee, has indeed facilitated the 
relationship among the services.
    This Committee came to a similar conclusion. In the report 
accompanying the Appropriations Bill for the Departments of Labor, HHS 
and Education for fiscal year 1999, the Committee stated: ``In 
developing plans for bioterrorism countermeasures, the Committee notes 
the standing personnel and reserves of the Public Health Service are a 
valuable resource that ought to be well-integrated.''
    The Commissioned Corps, as a uniformed service, brings some unique 
capabilities to the public health and emergency response arenas, making 
these officers especially well-suited for the public health response 
required in the aftermath of a bioterrorism incident. As noted in a 
February 1998 Report prepared by a Special Advisory Committee of 
esteemed public health professionals headed by Former Surgeon General 
C. Everett Koop, ``. . . expertise which is resident in the Corps to 
deal with biological and chemical agents is a critical resource that 
can be called upon in the event of terrorist attack.'' Tab A briefly 
describes some of the important characteristics of the Commissioned 
Corps, among them:
  --public health training and experience;
  --on call 24 hours a day, like their military counterparts;
  --available for assignment to accommodate changing public health 
        needs and priorities;
  --an exceptional track record in the area of emergency response;
  --presence in 49 of 50 states, with large concentrations of officers 
        in nearly every region of the country, thereby allowing for an 
        expedited response.
    The Commissioned Corps is also a rich source of epidemiologists 
whose expertise will be critical as part of a bioterrorist response.
    In August 1997 Minnesota's former governor, Arne H. Carlson sent a 
letter to then-DHHS Secretary Shalala praising the outstanding 
assistance provided by Commissioned Corps task forces to the citizens 
of Minnesota in the aftermath of the devastating spring floods. 
Governor Carlson noted that one of the lesser publicized, but serious 
impacts of the flooding was an estimated 2500 flooded private wells, 
requiring the restoration of safe water supplies for many of 
Minnesota's citizens. He observed that ``(t)he three task forces 
entered the state fully equipped and thoroughly organized to operate 
with a minimum of state involvement'', and they brought the long, dirty 
and sometimes dangerous work to a successful conclusion in six weeks. 
Tab B further details the emergency response capability of the 
Commissioned Corps based upon actual experience since the late 1980's.
    One special component of the Commissioned Corps (cited by Secretary 
Thompson in his May 9th testimony before the Senate Appropriations 
Committee, Subcommittee on Commerce, Justice, State, and the Judiciary) 
is the Commissioned Corps Readiness Force (CCRF), which was created by 
the Office of the Surgeon General in 1994 to improve the DHHS ability 
to respond to public health emergencies. The CCRF is a cadre of nearly 
1500 PHS active duty officers who are uniquely qualified by virtue of 
their education, skills and experience to respond to public health 
emergencies, and who can be mobilized quickly for this purpose.
    The Commissioned Corps is also a vital part of the Nation's 
emergency response capacity through its role with Disaster Medical 
Assistance Teams (DMATs), which consist of both federal and private 
sector personnel. One of these DMATs (PHS-1) is comprised primarily of 
Commissioned Corps Officers (approximately 80 percent). This team has 
been stationed at high profile national events to provide the initial 
public health response in the event of a bioterrorism incident.
    In 1999 the first National Symposium on Medical and Public Health 
Response to Bioterrorism was held in Arlington, VA. During a panel 
discussion of a smallpox scenario, Mr. Jerome H. Hauer, then Director, 
Office of Emergency Management, New York City, stated that in the event 
of a smallpox outbreak in New York, he would require hundreds of 
investigators in the metropolitan area. In addition, he noted the 
requirement for personnel to provide smallpox vaccinations, observing 
that the vaccination process is complex, and the average health care 
provider is not trained in this area.
    Mr. Hauer's needs can most certainly be met by the Commissioned 
Corps. With hundreds of public health professionals stationed within a 
short drive of New York City, a rapid response can be achieved. The 
variety of locations nationwide where Commissioned Corps officers are 
stationed permits the mobilization of a large number of Commissioned 
Corps officers anywhere in the country in a very short period of time. 
Furthermore, with some improvements to the administration and training 
of the inactive reserve component of the Commissioned Corps (discussed 
below), an additional response capacity, or a backfill capacity, as 
circumstances require can be made available. The medical expertise also 
resides within the Commissioned Corps to staff alternate care 
facilities as needed (e.g. hospitals to handle small pox cases).
    While the Commissioned Corps is currently the best available source 
of public health expertise, a few modest initiatives will make it even 
better. Some of the initiatives may require legislation, while others 
may simply require policy changes within the Department of Health and 
Human Services. Clearly, however, oversight from this Committee is 
crucial to ensure that the necessary steps are taken. The following are 
some of the actions that would enhance the ability of the Commissioned 
Corps to respond to a bioterrorism incident:
  --Clarification of the ability to mobilize the Commissioned Corps 
        under a single operational control in the event of an incident 
        involving a weapon of mass destruction.--The Surgeon General, 
        the uniformed leader of the Commissioned Corps, administers the 
        Corps and as such is responsible for formulating Commissioned 
        Corps policy. However, Commissioned Officers are assigned to 
        agencies both within and outside the Department of Health and 
        Human Services. This diversity in assignments is a clear 
        advantage, and one of the great strengths of the Commissioned 
        Corps. However, those agencies to which officers are assigned 
        retain significant control over the work performed by their 
        officers. There should be no question that the Surgeon General 
        has authority to direct all PHS officers to respond to a 
        bioterrorism incident, regardless of the agency to which the 
        officers are assigned.
  --Provide additional training.--The public health background these 
        officers bring to the bioterrorism scenario is a significant 
        advantage. However, it is important that, as in any specialized 
        area, the officers receive ongoing training to develop/maintain 
        their expertise.
  --Formalize the Inactive Reserve program.--This issue was touched 
        upon above. Unlike the inactive reserve components of the other 
        services, the Commissioned Corps program has been run on an 
        informal basis, with a somewhat loose affiliation by the 
        members. Nearly all members of the PHS inactive reserve have 
        served at least two years on active duty and thus are familiar 
        with Federal programs and procedures. The potential of this 
        program has been recognized by many in Congress, including the 
        House Appropriations Committee that directed a study to 
        ascertain the viability of establishing an Office of Reserve 
        Coordination to administer the program. Without question the 
        inactive reserve program, and public health in general, could 
        be dramatically enhanced if even modest resources were 
        committed to the maintenance of the reserve program and to the 
        training and utilization of inactive reserve officers.
    Once again, the Commissioned Officers Association very much 
appreciates this opportunity to submit its views to this distinguished 
Subcommittee. We look forward to addressing further details of these 
and other issues with you and the Subcommittee staff.
                                 ______
                                 
 Prepared Statement of the Association of State and Territorial Health 
                               Officials
    The Association of State and Territorial Health Officials (ASTHO) 
appreciates this opportunity to provide comments to the U.S. Senate 
Subcommittee on Labor, Health and Human Services, and Education 
Appropriations on public health preparedness particularly for potential 
terrorist attacks using biological or chemical agents.
    ASTHO represents the state and territorial public health agencies 
of the U.S. states, the U.S. territories, and the District of Columbia. 
ASTHO's members are the chief executive officers of the health agencies 
of these jurisdictions. In response to the tragic events of September 
11, ASTHO has established an Anti- terrorism Preparedness Task Force to 
provide expert information and advice on relevant preparedness policy 
and programmatic, and legislative priorities.
    For years, public health professionals have identified the need for 
strengthening the United States' public health infrastructure as a 
major national issue. Public health surveillance capabilities provide 
an early warning system for our nation. However, challenges such as 
emerging infectious diseases continue to tax this system. The terrorist 
events of September 11 have further shown that disaster preparedness 
and strengthening the public health system's ability to identify and 
respond to such disasters must be a top national priority.
    Within the past few days, members of Congress have proposed 
appropriations in excess of $1.6 billion to improve the nation's 
bioterrorism preparedness, with a major portion of those funds devoted 
to critical public health response programs through state and local 
health agencies. We fully endorse this proposed allocation as a 
critical down payment for future vigilance against a tragic threat that 
is here to stay.
    Ten days after the September 11th tragedies, ASTHO produced a 
special closed circuit satellite telecast to discuss public health 
infrastructure in the context of emergency preparedness. The 
conference, moderated by ASTHO's President Dr. Georges Benjamin of 
Maryland, featured presentations from state health commissioners in 
several of the affected states (E. Anne Peterson, MD, MPH, Virginia; 
George T. DiFernando, Jr., MD, MPH, New Jersey; and Robert S. 
Zimmerman, Jr., Pennsylvania); HHS Deputy Secretary Claude Allen; 
Jeffrey Koplan, MD, MPH, Director of the Centers for Disease Control 
and Prevention (CDC); and Elizabeth M. Duke, Ph.D., Acting 
Administrator of the Health Resources and Services Administration 
(HRSA). The discussion focused on the public health response to the 
terrorist events: the successes, challenges, and unresolved issues. Dr. 
Koplan listed seven critical areas of public health capacity that must 
be strengthened to ensure national preparedness against a biological or 
chemical threat:
    (1) public health workforce;
    (2) laboratory capacity;
    (3) epidemiology and surveillance;
    (4) secure and accessible information systems;
    (5) communication;
    (6) effective policy and evaluation; and
    (7) preparedness and response capacity.
    We believe these key areas are absolutely essential to preparedness 
planning and require additional resources to assure their availability. 
States are at different stages of preparedness in each of these seven 
critical areas. Therefore the states will have different priority 
needs.
    In addition, resources and leadership are needed at the federal 
level to support state planning and coordination and development of a 
national strategy for preparedness. We encourage Congress to utilize 
and build upon the expertise, experience, and leadership that CDC has 
demonstrated in recent years in developing our nation's public health 
response to bioterrorism.
                        critical response areas
Public health workforce
    A well-trained, fully prepared public health workforce is the 
foundation of our public health system. The public health workforce 
includes a range of disciplines such as physicians, nurses, dentists, 
social workers, nutritionists, environmental health specialists, 
epidemiologists, veterinarians, laboratorians, health educators, 
disease investigators, and outreach workers. These professionals work 
to improve the public's health through prevention, education, research, 
and policy development.
    The current public health workforce is not sufficiently trained to 
meet the growing needs of emerging infectious diseases, new vaccines, 
and more far-reaching prevention efforts, in addition to planning for 
potential threats of terrorism or emergencies such as a global pandemic 
influenza. A Status Report recently prepared by CDC on the Public 
Health's Infrastructure indicates that as of 1997, 78 percent of local 
health officers did not have graduate degrees in public health.\1\ 
Moreover, many public health professionals lack opportunities for 
continuing education in their fields due to insufficient budgets, staff 
shortages, and proximity to education and training programs.\2\ If we 
are to be fully prepared to respond, these trends must be reversed.
---------------------------------------------------------------------------
    \1\ A Status Report, ``Public Health's Infrastructure'' prepared 
for the Appropriations Committee of the United States Senate by the 
Department of Health and Human Services and the Centers for Disease 
Control and Prevention, 2000.
    \2\ Ibid.
---------------------------------------------------------------------------
    The Status Report also shows that the governmental portion of the 
public health workforce includes nearly 500,000 professionals deployed 
at the local, state, and national levels. With the increasingly complex 
patterns of disease, interventions, technology and partnerships; 
advanced education and training are becoming increasingly important.\3\ 
At the same time, hiring freezes and low salaries have hindered the 
ability of health agencies to recruit and retain talented public health 
officials. The average tenure of a state health official is less than 
two years.
---------------------------------------------------------------------------
    \3\ Ibid.
---------------------------------------------------------------------------
Laboratory capacity
    Active surveillance depends on the ability of the public health 
laboratory to rapidly and accurately analyze and identify samples 
submitted to them for analysis. For example, in 1997, the Colorado 
State Public Health Laboratory was responsible for determining that an 
outbreak of E. coli O157: H7 had occurred and that contaminated 
hamburger patties were the source of infection. Their rapid response 
prevented serious cases of hemolytic uremic syndrome that frequently 
result from this infection from occurring across the nation as a result 
of the largest recall of contaminated meat products in our nation's 
history.
    Public health laboratories are ideally suited for the critical role 
of identifying biological agents. Unfortunately, some state public 
health laboratories are not equipped to detect the most likely 
biological agents such as anthrax and smallpox. State laboratory 
facilities need to be upgraded with appropriate equipment and trained 
personnel.
    Laboratory personnel in all 50 states and territories should have 
access to advanced training in both the identification of bioterrorist 
agents, using the newest detection techniques, and in handling the 
agents safely. Responding to these issues is not a short-term 
proposition. Laboratory support for public health programs requires 
ongoing investment in new techniques, new equipment, methods 
development and documentation, staff training, and quality assurance 
procedures.
    Another related issue pertains to the need to train hospital and 
private clinical laboratory personnel to recognize an unusual pathogen, 
a critical public health role in emergency preparedness. The importance 
of timely detection cannot be overemphasized. In the case of many 
biologic agents, the time lag between exposure to the pathogen and the 
onset of symptoms may vary from hours to weeks. An effective response 
will depend jointly on the ability of the clinician to identify and 
accurately diagnose an uncommon disease or toxic response and on a 
surveillance system for collecting and organizing information from 
clinicians and laboratories.
    Three excellent programs currently exist within CDC to enhance 
laboratory capacity and coordination but not all states receive funding 
to support these efforts. ASTHO recommends enhancement of these 
programs: the Laboratory Response Network, the National Laboratory 
System, and the development of a Chemical Terrorism Preparedness 
program to include all states.
Epidemiology and surveillance
    Epidemiology and surveillance programs of state health agencies 
detect outbreaks of common diseases or rare occurrences of unusual 
diseases. Epidemiological investigation determines when and where the 
exposure took place and whether cases are still occurring. To conduct 
such surveillance, state health agencies need adequate numbers of 
epidemiologists trained to recognize both natural and intentional 
events and to institute appropriate measures to control them.
    In additional to trained personnel, there is also a need for 
electronic reporting capabilities. An electronic disease reporting 
system enhances state and local surveillance partnerships which are 
critical throughout the detection and response process. An electronic 
system would connect reporting entities, such as hospitals, private 
laboratories, physician offices and local health agencies with state 
and national public health officials. Such systems require not only 
technology but also support in the areas of technical support persons, 
hardware, and software.
Secure and accessible information systems
    The ability to rapidly communicate with state and local health 
agencies is critical in responding to bioterrorist and infectious 
disease outbreaks. Rapid communication was an essential component of 
the coordinated response to the September 11 attacks in Virginia, New 
York, and Pennsylvania.
    All states need state of the art computer systems with high speed 
Internet access. Satellites for distance learning are essential and 
videoconference capability is also greatly needed to improve the 
ability to disseminate information routinely and in the event of an 
emergency. Information is only as reliable as the data management that 
supports it. Upgrading information systems is an ongoing challenge. 
Many states' analyses of their data systems show major gaps in 
infrastructure. Weaknesses exist particularly in linking databases, in 
assuring the security necessary to increasing web applications, and in 
interactions with the provider community, the source of much public 
health data. Three systems have been developed by CDC to begin to 
address the aforementioned gaps; however, these systems are not fully 
implemented.
    The first of these three systems, the Epidemic Information Exchange 
(Epi-X), was designed to instantly notify public health practitioners 
of urgent public health events and request assistance from CDC on- 
line. Epi-X assists bioterrorism preparedness efforts by providing a 
secure communication channel for public health officials. Future 
enhancements of the system include providing secure communications for 
multi-state outbreak-response teams, links between disease surveillance 
programs and the Health Alert Network, and improved software to 
automate the recognition of similar disease outbreaks across 
jurisdictions.
    The National Electronic Disease Surveillance System (NEDSS) assists 
in the management of surveillance systems and allows the public health 
community to respond more quickly to public health threats. When 
completed, NEDSS will electronically integrate and link together a wide 
variety of surveillance activities and will facilitate more accurate 
and timely reporting of disease information to CDC and state and local 
health agencies. To accelerate NEDSS deployment, additional resources 
are needed to strengthen state data security infrastructure, fast-track 
the availability of the NEDSS Base System, and enhance NEDSS 
functionality at the state level.
    The Health Alert Network serves as the backbone for the public 
health communication strategy developed by CDC. This network will 
ensure communications capacity at all local and state health agencies. 
The Health Alert Network was operational 24 hours per day, seven days 
per week during September 11 to September 28 to provide critical 
information to state and local health agencies about the response and 
recovery activities associated with the terrorist attacks. Additional 
resources are needed to accelerate the development, coordination, and 
full implementation of these systems.
Communication
    The importance of effective communication in times of emergencies 
cannot be overstated. Just as states and local health agencies need 
effective information systems, they also need up to date information 
and appropriate messages to share. Health officials are on the front 
lines and their message and communication approach will not only 
coordinate response, but will also reassure a fearful public.
    Communication channels must be established before an emergency 
takes place, and must be inclusive of all partners involved in the 
response. Rapid, reliable information and communication among federal, 
state, and local public heath authorities, health care delivery 
systems, police, firefighters, emergency management services (EMS), 
emergency personnel, and others is essential.
Effective policy and evaluation
    The events of September 11 have served to increase our 
understanding of the need for sound public health policy. Issues of 
conflicting legislative and regulatory provisions across state lines 
could impede the ability of public health to respond to critical health 
needs in the event of a bioterrorist event. The ASTHO Task Force on 
Anti-terrorism Preparedness will help identify many of the specific 
issues encountered during the days after the tragic events and will be 
prepared to make recommendations as to policy and even legislative 
needs in this regard in the near future.
    CDC, in partnership with ASTHO, the National Association of County 
and City Health Officials (NACCHO), the National Association of Local 
Boards of Health, the Public Health Foundation and the American Public 
Health Association, has developed the National Public Health 
Performance Standards Program. Three assessment tools have been 
designed specifically for state and local health agencies and local 
boards of health. These assessment tools provide performance measures 
by which the public health system, including public and private 
partners who contribute to the public's health, can be evaluated.
    Specific to bioterrorism preparedness evaluation, the Bioterrorism 
Preparedness and Response Core Capacity Project, which is co-chaired by 
CDC, ASTHO and NACCHO, is in the process of identifying core capacities 
for bioterrorism and emergency response preparedness.
    States also have taken steps to evaluate their public health 
systems. For example, Washington State has begun to assess how well 
prepared its public health system is to respond to a major public 
health threat or emergency. The state has developed and tested 
performance standards for the public health system, evaluating how well 
its 34 local health jurisdictions and state department of health can 
perform in five key areas of public health practice. The state has also 
established a baseline assessment of county-level preparedness 
capacities examining the processes, procedures, and relationships 
necessary to effectively detect and respond to public health 
emergencies. This is typical of the types of exercises underway in 
other states.
Preparedness and response
    Successful preparation for weapons of mass destruction emergencies 
will depend on the development of a well-orchestrated plan to be used 
in responding to an event. The implementation of that plan will vary, 
depending on the nature of the attack. If the incident involves 
biological agents, public health officials as well as emergency room 
personnel and critical care unit personnel will be key players and 
first responders. If the incident involves chemical or explosive 
agents, public health officials would be complementary to the 
management of the emergency. Regardless of the nature of the attack, 
the responsibilities of public health officials will include 
identification of existing assets and assessment of needs, resource 
allocation for preparedness, stockpiling of supplies, medical training 
for treatment, and communication with the public.
Planning and coordination
    Planning and coordination go hand in hand with all areas previously 
mentioned. If the response to a biological threat or chemical attack 
has not been well planned, it carries the potential of being 
ineffective. States are currently working to better define and test the 
roles of various entities, including local health agencies, state 
laboratories, emergency responders, hospitals, and others to establish 
policy to address unexpected events. Pre-emergency response planning 
forges better communications between public health and emergency 
response sectors, which in many states operate independently. 
Improvements in infrastructure made now to address the major elements 
of emergency preparedness planning can have immediate and lasting 
benefits.
    Emergency planning for bioterrorism requires special emphasis on 
certain functions not normally included in disaster plans. Examples 
include special surveillance operations, delivery of vaccines and 
antimicrobial agents, and other mitigation efforts. The widespread 
nature of adverse health effects due to the disruption of critical 
human infrastructure will require the expansion of the typical disaster 
management team. Public health officials bring essential contributions 
to such strategic planning teams.
National strategy
    There is sufficient crossover and concurrence in each of these 
seven areas to necessitate appropriate coordination at the national 
level. In the event of a bioterrorist event, the magnitude of the 
problem, essential treatment and prevention measures, and environmental 
impact are continually assessed. If an infectious agent is involved, 
public health officials may have to house ill individuals in isolation 
units in hospitals, or in make-shift facilities, attended by medical 
personnel who are protected by specialized clothing, or who have 
received advance immunization. Public health officials may also be 
forced to place a large number of individuals in quarantine and 
temporarily close large public gathering places and transport centers. 
Massive distribution of stockpiled vaccine and medical treatments such 
as antibiotics will also be necessary. Assurance of safe food and water 
supplies will be especially critical. These are just a few of the many 
issues that require a strong national strategy.
Addressing the threat of smallpox and anthrax
    The threat of a terrorist attack using smallpox remains unlikely, 
but health officials recognize that it is prudent to be prepared. It is 
important to move as rapidly as possible to accelerate production of 
smallpox vaccine. In addition, a plan should be developed outlining the 
appropriate course of action in the event of a smallpox attack, 
including the use of vaccine. Planning and resource allocation must be 
undertaken to ensure that vaccine delivery and administration and other 
appropriate actions are immediate, efficient, and effective.
    ASTHO makes this recommendation on the basis of the following 
assessments: (a) while the probability of such an event appears low, a 
smallpox attack by terrorists is nonetheless a credible possibility; 
(b) the threat of smallpox is a threat that we do have the ability to 
substantially mitigate or even abrogate through effective use of 
vaccine; (c) smallpox is a threat for which there are really no good 
alternatives to vaccination for effective response; and (d) smallpox is 
a threat that carries the potential for great harm and global spread if 
there is not an effective response.
    ASTHO also encourages expeditious exploration of methods to provide 
protection to civilian populations in the event of terrorist use of 
anthrax. ASTHO encourages CDC to develop rational, reasonable, and 
balanced communications tools concerning smallpox and anthrax which are 
suitable for the general public and can be shared with all state health 
agencies. ASTHO encourages Congress to provide additional resources as 
needed to support these recommended activities.
Conclusions and closing recommendations
    The Department of Health and Human Services, through CDC, has been 
leading the effort to upgrade national public health capabilities to 
address any potential bioterrorist event. CDC has initiated a 
cooperative agreement program for state and major local health agencies 
to help upgrade their capabilities. Eligible applicants can request 
support under the following five focus areas: Preparedness Planning and 
Readiness Assessment; Surveillance and Epidemiology Capacity; 
Laboratory Capacity-Biologic Agents; Laboratory Capacity-Chemical 
Agents; and the Health Alert Network. These funds have enabled state 
and local health agencies to link and integrate their preparedness 
activities and local and county preparations for crisis and consequence 
management of a terrorist event. ASTHO commends the Congress for making 
these resources available. However, all states are not funded in all 
areas and additional resources are urgently needed to address the 
concerns outlined in this document.
    ASTHO urges the Subcommittee to assure that:
  --The federal government assumes an appropriate leadership role in 
        strengthening the national public health infrastructure and 
        capacity;
  --The federal government makes the necessary resources available for 
        public health workforce training, preparedness planning, and 
        readiness assessment at the state and local health agency level 
        to assist in the development and implementation of plans to 
        address public health issues following a biologic or chemical 
        terrorist attack;
  --Public health agencies at the local, state and federal levels are 
        sufficiently enhanced to detect, monitor, and contain disease 
        outbreaks. Rapid detection of a biological attack can prevent a 
        local epidemic from becoming a national epidemic;
  --Sufficient resources are provided to develop medical counter-
        measures against a bioterrorist attack, including funding to 
        speed up vaccine production and to stockpile antibiotics; and
  --Our nation's hospitals are properly equipped and health 
        professionals are properly trained to respond to bioterrorism.
    The public health system is the vital link in our ability to 
preserve and protect human life when disaster strikes. Services we all 
count on must be present in the event of a major epidemic, a 
bioterrorism incident, exposure to a chemical hazard, radiological 
release or contamination of food and water supplies. We thank the 
Subcommittee for its understanding of the vital importance of a 
national policy and appropriate resources to strengthen public health's 
capacity to identify and respond to bioterrorist events, and its 
recognition that by doing so, public health's overall capacity to 
protect our nation's health and well-being will be enhanced.
    We look forward to working with the Subcommittee to assure the 
availability of the critical funding needed to address each of these 
urgent issues.

    Senator Harkin. Before I turn to our first panel, I will 
yield to our distinguished ranking member, Senator Specter, for 
his opening remarks.

               opening Statement of Senator Arlen Specter

    Senator Specter. Thank you very much, Mr. Chairman, and 
thank you for convening this important hearing, and for your 
leadership in this important field.
    Earlier this week, I held town meetings at Cheney and 
Lincoln Universities in Pennsylvania, and one of the key topics 
on the minds of the students and faculty there was what would 
happen in the case of an attack by biological weapons or 
chemical weapons. It is obvious that there is great concern in 
America today with the potential for weapons of mass 
destruction.
    When we have seen what the terrorists did on September 11, 
there is no doubt that they have the capacity and the evil to 
render unlimited damage on America to the maximum extent of 
their capabilities, and there is obvious concern that, as well-
financed as they are, and as sophisticated as they are, that 
they may have biological and chemical weapons and other weapons 
of mass destruction, so this is a matter of the utmost urgency.
    The issue is joined today with contrasting viewpoints, with 
Secretary of Health and Human Services Thompson being quoted 
earlier this week that the administration was: ``very confident 
that we could act and react to any kind of bioterrorist 
breakout,'' and Secretary Thompson insisting that the 
Government: ``can handle any contingency right now.''
    One of our witnesses today is Dr. Steven Cantrill, of the 
Department of Emergency Medicine of the Denver Health Medical 
Center, who categorically disagrees, saying: ``an additional 
concern is the illusion shared by many that our health care 
system could adequately deal with a significant weapons of mass 
destruction incident.''
    In this area, I must respectfully disagree with Secretary 
Thompson, and Dr. Cantrill goes on to say: ``this problem would 
only be partially alleviated by dispatching Federal resources 
to a specific locale, and could be of no help if terrorism 
opted to involve dozens of metropolitan areas simultaneously.''
    This subcommittee has responded with almost doubling the 
funding for bioterrorism from 1999 through the projections for 
the year 2002. We find that there is again a fragmentation of 
our efforts among the Department of Health and Human Services, 
the Department of Justice, the Department of Energy, the EPA, 
and emergency response.
    We now have a new leader coming into the field later this 
week, Governor Tom Ridge, announced as being the Secretary of 
Homeland Security, and now there are issues raised as to the 
scope of his authority, and a number of us are drafting 
legislation to try to put a number of the agencies and 
resources under his control, like Border Patrol, Coast Guard, 
Immigration, and Naturalization, and a significant hand in 
intelligence.
    Just having an agency in the Federal Government analogous 
to the National Security Advisor raises very serious questions 
as to whether that is enough authority on this very, very 
important matter. In a testimonial to the importance of this 
issue, we have four distinguished U.S. Senators here today. 
That is the most Senators this subcommittee has drawn in the 21 
years that I have been here, so we know, ipso facto, this is an 
important subject.
    Mr. Chairman, while we are having this hearing, down the 
hall there is a Subcommittee on Constitutional Law hearing on 
terrorism legislation which is probably of equal importance to 
what we are hearing today, so I am going to be shuttling back 
and forth, but I do welcome our colleagues here today, Senators 
Kennedy, Frist, Hagel, and Edwards, and look forward to their 
testimony.
    Thank you.
    Senator Harkin. Thank you. Now I would recognize the 
distinguished chairman of the full Appropriations Committee, 
Senator Byrd.

              Opening Statement of Senator Robert C. Byrd

    Senator Byrd. Thank you, Mr. Chairman. Thank you for 
holding this hearing. This is a very important hearing. I have 
been saying in the Armed Services Committee for a long time 
that we had better be thinking about chemical and biological 
weapons being used against us. While I think that debate was 
with respect to a nuclear attack and how a missile shield is 
important, this is as important, if not more so. So I 
congratulate you on holding this hearing, and I congratulate 
the ranking member, and these four eminent Senators who are on 
authorizing committees that are very important in this battle.
    I was just sitting here thinking about the nine plagues of 
Egypt. You recall, Moses sought to get the pharaoh to let our 
people go, and pharaoh was hard-nosed about it, so God threw 
Moses and these plagues upon Egypt. There were nine of them. 
Let me see if I can remember them in sequence. First was blood, 
the rivers turned to blood--you can write it down and check me.
    Blood, frogs, lice, flies, cattle, boils, hail, locusts, 
and darkness, nine plagues, so to translate that into today's 
language, and into today's modern life, that would be, I 
suppose, biological warfare in that day.
    I am concerned about biological warfare. Unlike an 
explosion, a cloud of microbes released from a small plane 
would not trigger alarm like dropping a bomb. Many of the 
initial symptoms in humans could first be mistaken as an 
ordinary cold or the flu.
    Most public health departments don't even have computers to 
track diseases, and yet several of the most dangerous 
biological warfare agents, plague, anthrax, and others, respond 
to antibiotics, so quick detection of an outbreak and rapid 
availability of drugs could save numerous lives. It is critical 
that adequate supplies of drugs be available, and that plans 
exist for their efficient distribution.
    Are we ready? We might ask the Secretary when he comes. I 
may not be here at that time. I am trying to get these 
appropriations bills moving, Senator Kennedy. It is like moving 
a stone uphill, but Sisyphus kept trying, and so I will 
continue to try.
    Unfortunately, public health experts believe that the 
Nation is currently tens of millions of vaccine doses short to 
effectively defend against a biological attack, and stockpiles 
of antibiotics and other medicine are inadequate. Just go over 
to Fairfax Hospital and look at the emergency room. I took my 
wife over there just a while back. She had pneumonia--we did 
not know it was pneumonia--then atrial fibrillation. She was in 
that emergency room all day, and I was right there with her. 
They cannot handle it. We do not have the infrastructure to 
handle the crowds that come to these hospitals.
    Fairfax Hospital is a great hospital. But they do not have 
the infrastructure. Hospitals have reduced in-patient care in 
recent years. They are unprepared to handle large numbers of 
critically ill patients. If you have not been there, go over to 
Fairfax Hospital or any of the other hospitals in the area. Go 
to the emergency rooms. That is where we are likely to go, 
those of us who are past 80. You have got a long time to wait.
    But the administration's belief is that Osama bin Laden and 
his Al Qaeda network may already have the means to use chemical 
and biological agents as terror weapons. A Department of 
Defense report released in January of 2001 indicated that Iraq, 
Iran, Syria, Sudan, and Libya all have active chemical or 
biological weapons programs.
    Now, Mr. Chairman, that completes my statement. Thank you 
for conducting this exercise. We're both on appropriations, and 
so is Mr. Specter, and the Senators here who are on the 
authorizing committees will be talking with us about 
appropriating. There is no more important problem facing us as 
appropriators, or as authorizers, than this one. Enough said.
    Thank you.
    Senator Harkin. Mr. Chairman, you really put it succinctly, 
and we appreciate you being here and thank you for your 
leadership on the full committee in this effort. I know I can 
speak from having served on this committee now for 17 years, 
that I know we can look to you for the guidance and the 
leadership necessary to put the funds out there to make sure we 
meet this emerging national threat, and we thank you for your 
leadership in this area.
    As our chairman said, as appropriators we look to our 
authorizers for guidance on how we spend this money. Regarding 
the $20 billion, we look to our authorizers to give us guidance 
and direction. We turn now to our distinguished first panel 
with those authorizers, and first I would recognize Senator 
Kennedy from Massachusetts.
    Senator Kennedy, along with Senator Frist, introduced the 
legislation last year which was the Public Health Threats and 
Emergencies Act. It was passed and signed into law, and 
basically was the first step to building up our first line of 
defense and our basic infrastructure. Senator Kennedy and 
Senator Frist, I want to applaud both of you for being way 
ahead of the curve on this. You had the foresight to do it.
    So Senator Byrd, I would just say we do have some basic 
legislation right now, thanks to Senator Kennedy and Senator 
Frist, to which we can look for the guidance on where we would 
want to put this money to build up that basic infrastructure.
    With that, I want to thank both of you, and we will go in 
order of seniority, and I will recognize Senator Kennedy first.
STATEMENT OF HON. EDWARD M. KENNEDY, U.S. SENATOR FROM 
            MASSACHUSETTS
    Senator Kennedy. Thank you very much, Mr. Chairman. If I 
could I'd like to submit my full statement in the record. I 
know the committee has a full schedule, so we will not take an 
undue amount of time.
    First of all, I want to thank this committee for their 
superb statements that have been made this morning. This is a 
committee that has responsibility for allocating resources, and 
it is quite clear, not only from the statements this morning 
but also the actions that have been taken in the past, 
particularly in terms of the support for the research and the 
development of various vaccines and antibiotics, that this 
committee has been ahead of the curve. That is why we 
particularly appreciate the chance to work with the committee 
in terms of ensuring that we are going to have adequate 
resources to try and meet our responsibilities to the American 
people.
    I want to first of all thank my colleague, Senator Frist, 
and my other colleagues as well, Senators Edwards and Hagel. 
Senator Frist and I embarked on a series of hearings in 1998 on 
this subject matter, and into 1999, and developed the 
legislation in 1999, and then passed it last year, and we have 
worked very closely together. It represented our best judgment 
and the judgment of the committee, and I enjoyed working with 
him.
    While we worked very closely on this legislation and will 
continue to do so, I thank Senator Edwards and Senator Hagel. 
They have given with their legislation an additional component 
in dealing with the agricultural challenge. That was not dealt 
with in our committee. We did not include it, but we noted it, 
and it is an extremely important aspect which they will speak 
to, as well as to their sense of the importance of the 
legislation.
    I want to also thank Secretary Thompson. He has been 
designated as the principal lead person for the administration. 
I have spent time with Secretary Thompson. He is very familiar 
with the General Accounting Office review, as well as other 
reviews about the inadequacies of our system, and the GAO has 
pointed out that there needed to be a great deal more 
coordination. There was fragmentation between the various 
agencies. He is addressing that issue. You will have more of a 
chance to get into that question. Also the GAO talks about the 
various gaps in our system, and I know you will hear from him 
on this issue. We address a number of those components that 
have been outlined in the GAO report, and that is why we are 
glad to be here.
    As has been mentioned here, the September 11 terrorist 
attack indicates that we may very well face a different kind of 
attack in the future, and we are here to mention very briefly 
at least how we believe the focus and attention of resources 
ought to be focused.
    First of all, we want to emphasize the area of prevention. 
The best way to assure the health and well-being of our 
citizens is to prevent a bioterrorist attack. That is going to 
be done as part of the administration's overall efforts in 
terms of the intelligence-gathering, information-gathering, the 
penetration of these various cells, as well as penetrating the 
free flow of resources that are going to various terrorist 
activity. That kind of aspect is underway at the present time, 
and it is something that is outside of what we are going to 
talk about, but it is of enormous importance.
    Second, we take note that as there has been the development 
of weapons of mass destruction, both biological and chemical, 
the principal source of the storage of this material is in the 
former Soviet Union. As we have made important progress with 
the former Soviet Union in terms of the storage of nuclear 
material, we are very hopeful that the administration is 
working on assuring that we are going to have adequate storage 
in the former Soviet Union with regards to biological weapons. 
Also the scientists and researchers that are very much involved 
in the development of that program, and a similar kind of a 
program that has been worked on in the Nunn-Lugar proposal, 
could also have application here. Those are issues for another 
time, but they are, we believe, of importance.
    The three items that I want to mention is, first, the 
issues of detection, second, the issues of treatment, and 
third, the issues of containment. This chart, which is 
difficult to read, Mr. Chairman, and then my colleague, Senator 
Frist, will go into greater details regarding how these 
particular features can be addressed in terms of the 
appropriations.
    The first item, in order to have detection of any attack, 
is improving the State and local disease surveillance. This is 
primarily the public health system. You will see that reflected 
in the high priorities we give to the public health system. 
That has been also a deficient area which has been identified 
by the GAO.
    We have not addressed again the issue of food safety. 
Secretary Thompson will. Again, we have a small part of food 
safety in our committee. Most of that is in the Agriculture 
Committee. The chairman of the committee is very familiar with 
this issue, but that is an important part of it.
    Next is the upgrading of the capacity of laboratories to 
identify biological weapons. There has to be an upgrading at 
the local level in terms of detection. That can be done in some 
parts of our country. Where it is being done, they have the 
ultimate in terms of the cutting edge technologies. We ought to 
make sure that those kinds of technologies are going to be 
available to communities all over the country.
    The first line of defense is going to be in our public 
health system. Our proposal, then, is to improve the detection 
of an attack.
    Second, our proposal will improve the treatment for victims 
of an attack. This comes by improving the ability of our 
hospitals to increase their emergency capacity. As Senator Byrd 
and others have pointed out, we have seen a contraction in the 
number of hospitals. That has been true in urban areas, it has 
been true in rural areas. We have gone in my own State of 
Massachusetts from 132 hospitals to 84 hospitals over the 
period of the last 5 years, and we know that in many of the 
urban areas people wait out in the corridors, even to go into 
the emergency rooms.
    This is going to be called upon as the first order of 
priority. There are a number of different ways that their 
assets can be extended. There is good planning in a number of 
our great medical centers about how to do that. We ought to 
share that information, but we ought to now have the kind of 
investment that permits them to do this in very short order. 
That is a feature of our proposal.
    Next is the development and enhancing of local and Federal 
medical response. This also includes training. Senator Frist, 
and many of us have heard him speak on this, will mention that 
in all the times he has been a doctor, in 25 years, he has not 
been able to detect smallpox, or has not had smallpox in front 
of him. We have to make sure we are going to have the training 
for the personnel to be able to detect this. This is training 
health professionals to diagnose and treat the victims of a 
bioterrorist attack.
    Finally, our proposal will improve the containment of an 
attack by providing better vaccines to limit the spread of 
infection, by improving the national pharmaceutical stockpile, 
and by increasing research in medications. You will have an 
opportunity to hear from the top of our research community. 
They can give you different guidance as to what needs help and 
support, and there are a variety of different undertakings even 
at the present time, but as we understand right at the outset, 
most of those products do not have a private market. It is 
going to take an investment by the Federal Government, and the 
Federal Government is going to have to invest in terms of 
stockpiling those products.
    Finally, I would like to just say, Mr. Chairman, the 
administration has approximately $350 to $400 million in their 
budget. Our budget recommendation is for an additional $1.4 
billion. That comes to about $1.8 billion. In terms of our 
recommendations this amounts now to about a sixfold increase. 
Money is not the answer to everything. We think that this is a 
prudent and reasonable kind of investment that can at least 
start us down the road to meet our first responsibilities.
    The final point I would like to mention, Mr. Chairman, I 
would hope as a Nation that we are not going to be frightened 
by this prospect. I think that that would be very, very 
dangerous. We know that there are individuals that are taking 
action, as has been pointed out. This is a national 
responsibility, and we would hope that you are going to deal 
with it in a responsible way, a serious way, and a way that 
underlines the importance of preparation.

                           prepared statement

    Some steps have been taken, other steps are needed, more 
steps are needed, a greater investment is needed, but the 
American people ought to understand this is serious. It is 
dangerous, but at least we have an understanding about what 
needs to be done in the very early stages of it, and that 
hopefully this committee and the Congress are prepared to make 
the kind of investment that is going to be a meaningful down 
payment to give the kind of protection the American people 
deserve.
    [The statement follows:]
            Prepared Statement of Senator Edward M. Kennedy
    Thank you, Senator Harkin, and thank you also Senator Specter for 
holding today's hearing on this topic of special importance--improving 
the nation's preparedness for bioterrorism. Your own leadership in 
providing resources for public health and medical research has already 
done a great deal to strengthen the nation's preparedness to meet this 
challenge. It's a privilege to be here today with Senator Frist.
    September 11th was a turning point in America's history. For two 
centuries, the continental United States was spared from foreign 
attack. The vicious air attacks of September 11th shattered that 
security. In the aftermath, we must clearly strengthen our ability to 
defend the American people against all forms of terrorist attacks.
    One of the most destructive ways an enemy could attack the nation 
would be to use a biological weapon. The difficulty of mounting a 
biological attack has given the nation a reprieve--but none of us knows 
how long that reprieve will last.
    Over the past two years, Senator Frist and I have held hearings on 
the dangers of bioterrorism. As we learned at those hearings, a 
biological weapon could unleash destruction on a very broad scale, and 
we need to be better prepared. A substantially increased investment 
must be a major part of the nation's response, and I am confident this 
committee will provide it. This investment is a sound price to pay for 
the greater security it will bring to every American and every 
community in the nation.
    Our first priority must be to prevent an attack from ever 
occurring, and we are moving quickly to strengthen our intelligence 
capacity and take other needed steps to do so.
    We also need to work with nations that have stocks of dangerous 
biological agents to ensure that they do not fall into the hands of 
terrorists. Russia currently holds the largest supply of potential 
biological weapons. I've spoken with Secretary Thompson about the 
situation in Russia, and I believe there's a real opportunity to make 
progress in securing and destroying these dangerous biological 
materials. We've worked with Russia on containing nuclear weapons. Now 
we must work together on preventing the spread of biological weapons.
    But we must also enhance our preparedness for a bioterrorist 
attack. Americans need not live their lives in fear of a biological 
attack, but building strong defenses is the right thing to do.
    If a bioterrorist attack does occur, the keys to responding 
effectively lie in three key concepts: immediate detection, immediate 
treatment and immediate containment.
    Unlike the assaults on New York and Washington, a biological attack 
would not be accompanied by explosions and police sirens. Instead, 
terrorists could release a lethal bioweapon in a crowded shopping mall 
or subway station. They might expose millions to the deadly microbes by 
spraying a biological weapon over a city.
    In the days that followed, victims of emergency room, complaining 
of mild fevers, aches in the joints or perhaps a sore throat. Doctors 
need to be well aware of the symptoms of a bioterrorist attack, or 
precious hours will be lost as doctors try to diagnose their patients.
    In Boston, a recently installed electronic communication system 
would allow physicians to report unusual symptoms rapidly to local 
health officials so that an epidemic could be identified quickly. Too 
often, however, as a CDC report has stated: ``Global travel and 
commerce can move microbes around the world at jet speed, yet our 
public health surveillance systems still rely on a `Pony Express' 
system of paper-based reporting and telephone calls.''
    In addition, public health laboratories need the training, the 
equipment and the personnel to identify anthrax, plague, smallpox or 
other potential biological weapons as quickly as possible.
    Emergency care facilities will also be essential. Boston, New York 
and a few other communities have plans to convert National Guard 
armories and other public buildings into temporary medical facilities, 
and other communities need to be well prepared too. Even cities with 
extensive plans need more resources to ensure that those plans will be 
effective when they are needed.
    It has been an honor to work with Senator Frist on legislation to 
enhance the country's preparedness for bioterrorism. Congress enacted 
that initial legislation last November, and it has already served one 
of its intended purposes. That legislation gave the Secretary of HHS 
the authority to act decisively to protect the public health during a 
bioterrorist attack or other health emergency. Secretary Thompson used 
this new authority wisely to send medical supplies and personnel to New 
York, where they were so urgently needed, and I commend him for his 
prompt and effective action.
    To improve detection, treatment and containment of a bioterrorist 
attack at the state and local level, the legislation authorized 
investments in disease surveillance, food safety, and new research 
initiatives to diagnose such attacks. The Act also called for new 
investments in hospital preparedness, so that medical facilities will 
have the planning and resources needed to assist victims. To improve 
containment, the legislation called for federal supplies of vaccines 
and antibiotics to be available quickly to assist local public health 
officials in containing an epidemic. Federal stockpiles of vaccines and 
antibiotics will be essential to contain any outbreak and save lives.
    Under the leadership of Secretary Thompson and Secretary Shalala, 
much has been done to improve the nation's readiness. We are better 
prepared now, but we need to be even more prepared. Senator Frist and I 
look forward to working with our colleagues on this committee and in 
Congress to achieve these extremely important goals.

    Senator Harkin. Senator Kennedy, thank you for your very, 
very strong statement, and thank you for your leadership on 
this issue in getting the legislation passed last year.
    Now we turn to the cosponsor of that legislation, who has 
been a great source of information and guidance for all of us 
here in the Senate because of his strong medical background, 
and that is Senator Frist from Tennessee.
STATEMENT OF HON. BILL FRIST, U.S. SENATOR FROM 
            TENNESSEE
    Senator Frist. Thank you, Senators Harkin, Specter, and 
colleagues for holding this hearing on what is a pressing 
challenge for us all, and one of the most disturbing issues of 
our time, given the events of September 11, and that is the 
threat of germ weapons being used by terrorists.
    Let me open by saying we are all walking a fine line in 
terms of both the potential for being alarmist, and at the same 
time laying out the information that is important for us to 
recognize in terms of our vulnerability as a Nation and as a 
people. The threat is real. There is no question about that. 
The overall probability is low. Nobody can give a number. There 
is uncertainty around the number, but it is low, yet is 
increasing. Given the events of September 11, I believe that it 
is increasing quite dramatically.
    Bioweapons, germ weapons have huge consequence, much, much 
further than anything than we have ever seen in recent 
humanity, where we are talking about the potential destruction 
of millions, not thousands, not hundreds, not tens, and we are 
highly vulnerable. Again that is where we have to be very 
careful in terms of saying how vulnerable are we, but we are 
vulnerable not because we are unprepared today, and we will 
hear over the course of the day that in many ways we are very, 
very prepared, and have made tremendous progress, but that we 
are underprepared, and that there are certain gaps that we have 
a responsibility at this juncture to address.
    We will hear a lot from respected experts a little bit 
later in the subsequent panels, but I think the message that I 
would like to leave is the following, and that is that as 
Nation, with respect to germ weapons in the hands of terrorists 
whose stated goal, and we know that today, and we did not know 
that quite as well a year ago, whose stated goal is to cripple 
the United States of America, that we are vulnerable not 
because we are unprepared, but because we are underprepared, 
and it is our responsibility to identify those gaps and to fill 
those gaps, to reduce that vulnerability.
    Now, if our goal is to eliminate those gaps, it is 
important for this particular committee to address which gaps 
are significant, and in doing that, I would encourage you to 
look at least at what we started with in 1999, as Senator 
Kennedy laid out, and that is the Public Health Threats and 
Emergencies Act of 2000, because our specific purpose at that 
point in time was to develop a strategy and a framework that 
reflects coherency and comprehensiveness in terms of a national 
defense policy.
    It does this in addressing three different areas. One is 
prevention. Senator Kennedy spoke to the importance of that. 
The second is preparedness, how ready are we, and what is the 
responsibility there, and then the response, and these can be 
looked at discretely, but clearly work in an interrelated 
fashion.
    Why do I say the threat is increasing? Why do we act now, 
and why do we put such figures as $1.4 billion in addition now? 
The threat is increasing. If we look, Osama bin Laden has had 
public pronouncements that acquisition of biological and 
biochemical weapons of mass destruction are a religious duty of 
his. We know that now. We have not focused on it, but we know 
that now.
    Coupled with that is that just 3 weeks ago he used 
something we had never thought about as a weapons of mass 
destruction, and that is an airplane loaded with fuel. He has 
the money, again something new. We know that he has money, and 
we know that technology is out there, available.
    Senator Kennedy mentioned that during the 1980's the Soviet 
Union for that whole decade has more than 7,000 scientists 
working full-time on developing bio weapons that could be used 
for destructive purposes.
    Second, the threat has increased because of technology, and 
you will hear different people in the third panel talking about 
the technology there. Let me just say, from a hospital 
standpoint we use nebulizers all the time--we did not have them 
15 years ago--to aerosolize sprays. Perfumes are being 
aerosolized all the time. We know that from department stores. 
The aerosolization is just an example of how increasing 
technology has made it possible to distribute and deliver these 
biochemical, biological weapons, these germs in a way that just 
was not possible 10 years ago or 15 years ago.
    The third issue is that issue which Senator Kennedy 
mentioned, is that the expertise is out there, there is no 
question about it. Even since the 1980's the science, in terms 
of genetic recombinant issues, genetic engineering, it is there 
today, and if it is not there today, it will be there within 6 
months or a year. In certain areas the expertise is out there. 
It is out there probably to the highest bidder.
    What we have done is propose an additional $1.4 billion 
specifically, not to cover everything, but when you look at 
some of the list you will say, you are all over the place. But 
look at the original framework of prevention, preparedness, and 
response, and you will see that we are really putting that 
increased funding where gaps have been identified.
    We will hear again differing opinions about how prepared 
are we at the Federal level. In certain areas, we are very 
prepared, but without that local front line surge capacity at 
the hospitals, physicians who can recognize that rash which 
they have never seen, or never been trained to recognize 
before, or that cough, or that flu illness coming in being 
presented, out of the last thousand cases you have seen zero 
pneumonic plague, or pneumonic anthrax, to raise that bar up, 
if you cannot recognize it and detect it in an expeditious way, 
no matter how good the Federal response is, no matter how much 
money is spent at the Federal level, unless you have this 
vertical integration of Federal, State, and local coordination, 
it does not do any good. It does not do any good.
    Now, very quickly--and again, we do not need to go through 
what we have done overall, but regarding prevention, there are 
three areas. First, regarding intelligence, we have got to know 
who has access to things such as smallpox, anthrax, the more 
naturally occurring things like tularemia, and the nerve toxins 
that are out there.
    The issue of food has been mentioned and must be mentioned 
once again, and there are many people who think, we all know, 
we have underinvested in food safety. We have fewer than 1,000 
inspectors, 56,000 sites out there where we need to be doing 
inspections. We only inspect about 1 percent of the food that 
is imported into this country. We have underinvested in the 
past, and you will hear more about that today. It absolutely 
must be addressed.
    The third area as we look at prevention is this whole area 
of research. If we do not have a cure for smallpox, and 
smallpox has a 40 percent mortality rate today, and if we do 
not have a cure for that, we do have to invest in research so 
that we will have antiviral therapy. Anthrax has a 100 percent 
mortality rate if untreated, and as Senator Byrd pointed out, 
it has to be treated in the first 24 hours, so you have to be 
able to detect it--after 24 hours. We don't know that the 
vaccines that we have today are going to be entirely as good as 
we think, and we need a second generation that will have the 
advantages that we know will protect.
    The second issue of preparedness, again I do not need to go 
into too much, because we hear a lot about it at the Federal 
level. At the Federal level we are doing very well, I think, 
compared to 3 years ago. We can clearly do more. Most of the 
bulk of the funding of the more than $1 billion that we are 
saying should be put into the system is at the State and local 
level of preparedness, looking at medical surveillance, looking 
at medical epidemiology, addressing the issues of fax machines, 
Internet connections, so when one public health institution or 
unit identifies a rash which they suspect to be something, they 
can at least communicate broadly.
    The last area--and we will hear more about stockpiling, I 
want to mention is this issue of stockpiling again. We have 
done very well. We hear about how well we have done, but 
clearly we have a long way to go in terms of having an adequate 
response at the stockpiling level. We have specific funding in 
for that stockpiling, and to improve that stockpiling so we can 
really give the security to the American people that they 
deserve.
    In closing, let me just say that I think our most 
significant failure in this country as we look at this coherent 
strategy of prevention, of preparedness and response, is the 
lack of investment in our public health infrastructure. Our 
public health infrastructure is the front line. Without the 
front line, nothing else can click. Nothing else can work. That 
is the huge gap that we have underinvested in.
    The good news about it, it is dual use. If we do not ever, 
and I pray that we do not ever see a chemical or bioterrorist 
attack in the United States, if we never see that, it is dual 
use investment, because at the same time you are investing in 
that public health infrastructure you are addressing the 
potential for a flu outbreak, a flu epidemic, better treatment 
for HIV and AIDS, and the other viral illnesses are out there.

                           prepared statement

    Mr. Chairman, we sort of laid a template in the bill that 
we put forth last year that is now the law of the land. I would 
encourage this committee to use that as part of a coherent 
strategy as we go forward, in view of what I would argue is an 
increased threat of a bioterrorist attack. I think that we now 
need to identify those peculiar gaps that are out there, mainly 
at the State and at the local level, fill those gaps, and by 
doing that we will move from our underprepared state to a 
prepared state.
    Thank you.
    [The statement follows:]
                Prepared Statement of Senator Bill Frist
    Thank you, Senators Harkin and Specter, for calling today's hearing 
on one of the most pressing and disturbing issues of our time--the 
threat of germ weapons used by terrorists. That threat is real. 
Although the threat has low probability, I would argue strongly that 
there is an increasing probability--with huge consequences. Today, we 
remain highly vulnerable.
    You will hear from respected experts on these particular issues 
shortly. I will focus my comments on the following simple message: As a 
nation, with respect to biological weapons, we remain highly 
vulnerable, not because we are unprepared, but because we are under-
prepared.
    You will hear shortly from Secretary Thompson about the tremendous 
advances made by the Department of Health and Human Services over the 
past three years. Although we have made significant progress, there are 
still large gaps in our current approach. Our goal should be to 
eliminate these gaps and reduce the risk to our nation and our people.
    Part of the progress that has been made is tied to crucial 
legislation--the Frist-Kennedy ``Public Health Threats and Emergencies 
Act of 2000,'' a law which provides the strategy and framework for a 
coherent national biodefense policy. This bill addresses bioterrorism 
from three discrete but interdependent vantage points--prevention, 
maximizing our preparedness, and response.
    With this framework in place, we can identify shortcomings within 
our ability to prevent, to prepare, and to respond. As a critical first 
step, Senator Kennedy and I are strongly recommending today that 
Congress work together with the Administration to provide sufficient 
funding for the priorities specifically established in the Public 
Health Threats and Emergencies Act. Just a few months ago, Senator 
Kennedy and I wrote the members of this Committee earlier this year, 
requesting full funding for our legislation. Today, we outline what 
additional steps should be taken in light of the September 11 attacks.
    The threat of a bioterrorist attack is still remote, but it is 
higher today for a variety of reasons. First, Osama bin Laden has 
publicly pronounced that it is his religious duty to acquire weapons of 
mass destruction, including chemical and biological weapons. He has 
shown his disregard of human life, using weapons of mass destruction 
that we had never envisioned. Furthermore, he has the resources and 
motivation to use germ warfare.
    Additionally, the threat is increased because of the recent 
scientific and technological advances. Rapid advances in agent delivery 
technology such as aerosolization have made weaponization of germs, 
such as anthrax, much easier. Finally, the expertise of scientists 
expert in germ warfare is available. Through the 1980s, over 7,000 
scientists in the Soviet Union were part of a committed program to 
create and maximize the effectiveness of bioweapons. With the fall of 
the Soviet Union, these experts are unemployed and soliciting their 
expertise around the world.
    Now that we are all aware of this potential threat, we must 
concentrate on our response and invest approximately $1.4 billion 
specifically to fill the gaps in our current biodefense and 
surveillance system. We must take necessary actions to prevent the use 
of bioweapons, prepare our communities, and improve our capacity to 
respond. We have shared these documents with the subcommittee and I ask 
that these documents be included in the record following my statement.
                               prevention
    Our first national priority must be enhanced on-the-ground 
intelligence to know who has access to and is capable of deploying 
biochemical agents, which will require increased investment for general 
intelligence capabilities. Much of that work is already being done 
within the Department of Defense, in an effort to significantly 
increase our human intelligence capabilities. Within the Department of 
Health and Human Services, however, we must increase international 
surveillance and cooperation activities. With this investment, we can 
enhance our intelligence capabilities to monitor other country's 
bioterrorism capabilities; improve coordination of international 
surveillance activities; and reduce threats posed by the former Soviet 
Union.
    Bioterrorism has been successfully used only one time in our 
country and that was in 1984 in Oregon--and the method of delivery was 
food. We have underinvested in food safety. Less than 1 percent of all 
food imports are properly inspected. We have fewer than a thousand food 
inspectors expected to oversee 56,000 food sites. Given that two of the 
major biochemical agents--anthrax and tularemia--as well as a large 
number of disease-producing organisms may be transmitted through the 
food supply, we absolutely must do more to ensure the safety of our 
food.
    Finally, for those likely bioterrorist agents for which we have no 
treatment and for those infections for which we have inadequate 
vaccines, we must invest in research. Specifically, we need anti-viral 
therapies for smallpox and newer, improved and more powerful versions 
of an anthrax vaccine.
                              preparedness
    Even if we do all that we can to prevent a bioterrorism attack, our 
preparedness will ultimately define the impact if such an attack were 
to occur. Therefore, our proposal to bolster preparedness includes what 
we must do, and if implemented properly, will ensure that we are 
perched and ready to respond at every level--federal, state and local.
    As GAO reported last week, we must strengthen and better coordinate 
our federal bio- response program. As Secretary Thompson has stated, 
the federal government has already done a lot. We have a rapid response 
team of over 7000 health care providers for medical emergencies. We can 
deploy truckloads of therapeutics and medical supplies in ``12 Hour 
Push Packages''--the key component of the National Pharmaceutical 
Stockpile. However, we must do more to strengthen our resources. 
Currently, the stockpile has enough antibiotics to give complete 
prophylaxis to 2 million people after an anthrax exposure, but that 
number is not large enough. To expand the contents and number of the 
push packages as well as increase our drug and vaccine inventories, we 
are asking for a doubling of the amount currently being spent to supply 
and support the national stockpile.
    However, the federal preparedness is not sufficient unless our 
state and local agencies are also prepared. Unfortunately, our local 
preparedness is severely lacking today because it is inadequately 
underfunded. We have allowed our public health system--the front line 
of our defense--to deteriorate over the past 20 years. We must buttress 
our local response by upgrading local and state medical surveillance 
epidemiology; assuring adequate staffing and training of health 
professionals to diagnose and care for victims of bioterrorism; and 
improving our public health laboratories, many of which simply are not 
equipped to efficiently diagnose infections and other diseases 
associated with biochemical weapons. Finally, we must ensure that local 
entities are prepared to cope with the early situation--from 
recognition through diagnosis and initiation of treatment, until 
federal assistance in the form of push packages and other assistance 
can arrive.
    For all of these reasons, most of the funding in our proposal 
almost $1 billion--is directed to improve our state and local 
responsiveness, and this investment will take a few years to fully 
implement.
                                response
    Once preparedness is maximized, the key to response and mitigation 
of disaster rests principally with coordination and seamless crisis 
management. Therefore, our proposal ensures that we have the plans and 
resources developed for an appropriate response by ensuring adequate 
health care personnel and hospital preparedness. We must improve our 
disaster response medical systems, including strengthening the National 
Disaster Medical System, the Metropolitan Medical Response System, and 
the Epidemic Intelligence Service.
    Hospitals will be the natural destination for those who are victims 
of a bioterrorist attack and for those who seek relief from fear. 
However, only one in five hospitals have developed a plan for such a 
calamity. They are ill-prepared for the resulting surge capacity. We 
must ensure that local hospitals are equipped to provide appropriate 
crisis management structures--by ensuring that every hospital not only 
has a plan for dealing with a bioterrorist attack but also has 
appropriate surge capacity, decontamination units, and necessary 
supplies for the immediate needs. With all of the proposed preparation, 
we will be able to respond by implementing our detailed plans of 
action, deploying appropriately trained health care professionals and 
resources to care for thousands of individuals who will seek care, and 
providing up-to-date information regarding risk reduction.
    One of the marvelous things about this particular investment is its 
dual use--not just preparing for a rapid response to in the event of 
germ warfare but also strengthening a system that every single day 
contributes to the improved health of all Americans. Now is the time to 
strengthen our public health system and ensure that we can adequately 
prepare for and respond to potential bioterrorist attacks, natural 
infectious disease outbreaks, or other challenges to the public health.
    I commend the Administration for taking steps to address 
bioterrorism by not only increasing funding before the attacks of 
September 11, but also assigning Governor Ridge as the primary federal 
coordinator of such activities.
    The Frist-Kennedy Public Health Threats and Emergencies Act 
provides the appropriate framework for a comprehensive biodefense plan. 
Now is the time to fund this authorizing legislation. In view of the 
increased risks of a bioterrorist attack, we must act now to fill the 
gaps we have identified--gaps that if allowed to persist debilitate our 
response--and to move us from the under-prepared to the appropriately 
prepared state.

    Senator Harkin. Thank you very much, Senator Frist, and 
Senator Kennedy.
    Just as a postscript, Senator Frist, I was back home this 
last weekend, and a friend of mine who is a doctor in Des 
Moines came up to me and said, how am I supposed to recognize 
it? He said, I have never been trained to recognize anthrax. He 
said, we need help out here to start to recognize it. That is 
one of the points you just made there. We need to get that 
information out and training out at the local level, so I 
appreciate your comments. This just happened to me this last 
weekend.
    I am now going to move to Senator Hagel and Senator 
Edwards, who just introduced new legislation, and I recognize 
the time constraints and how busy our Senators are, Senator 
Kennedy, Senator Frist, and please stay if you would like, but 
if you would like to leave, we would excuse you at this time.
    Senator Byrd. Mr. Chairman, in the event that these two 
Senators need to leave, they mentioned a figure of $1.4 
billion. How did you arrive at the $1.4 billion? How do you 
break that down, and how much of that needs to be appropriated 
immediately? Can it be broken down into phases that would help 
us to better understand it? I do not know how we can spend $1.4 
billion better than in this very exercise here.
    Senator Kennedy. Quickly, Senator, half of it is, as 
Senator Frist pointed out, for our public health services. 
Those resources will be invested in the States. That is the 
front line. That is on the basis of figures estimated by the 
public health service, and the particular organizations, the 
Public Health Laboratories, for example. This is basically how 
we got it, and it was rather a lean budget on that.
    You will find about another quarter or so of it is for the 
hospitals in terms of developing outreach programs, and the 
remaining third are listed here, and cover a number of the 
different kinds of programs that Senator Frist pointed out in 
terms of surveillance, the development of various vaccines, and 
the storage and purchase of those programs. This breakdown 
which is a part of our testimony is an activity sheet where we 
give the figures, the allocations of the $1.4 billion to each 
of probably 10 different initiatives, and we will be glad to 
submit to the committee the additional kinds of support for 
each of those.
    There are some provisions that are not on there. Food 
protection is not on here. The agricultural aspects are not on 
here. There is not a program on here, although the Secretary 
will probably talk about it, like the Nunn-Lugar programs, in 
order to try to do something over in the former Soviet Union in 
terms of the employment of some of those scientists, so those 
elements are not on here and probably may have to be added. but 
this is really the public health aspect of the program, and we 
have submitted it, and we will be glad to work with the staffs 
of the committee to give the particular justification.
    Senator Frist. Mr. Chairman, could I just add to that very 
briefly? The documents from this chart should be made a part of 
the record, and should be before you. There are certain 
elements up here, and you see that $635 million of the $1.4 
billion is for State and local preparedness capabilities. We 
absolutely must address that particular issue. Some of the $635 
million could be multiyear. It needs to be made available now, 
but it could be multiyear in terms of the way it is carried 
forth.
    What we have done is looked at what is needed and backed it 
forward, recognizing that we see this increased risk. If you go 
down that list, the second area, improving hospital response 
capabilities, the $295 million, it is important that it be 
addressed. We would recommend that it be provided this year. To 
carry out that program fully will take 2 to 3 years. Our staff 
will be working with the committee staff, because as you go 
down that list there are a few things on there that could be 
multiyear. It does not have to all be right now. If it is right 
now, we will obviously be able to go from an unprepared to a 
prepared state.
    Senator Byrd. Thank you.
    Senator Harkin. Mr. Chairman, since I have got your 
attention on this, we mentioned food safety, and I would like 
to just give you these figures. You might think about them, and 
you can write them down.
    Senator Byrd. My problem is, I cannot write. I cannot read 
my own writing after I get it down.
    Senator Harkin. I have the same problem.
    Senator Byrd. That is why I do not play the violin any 
more.
    Senator Harkin. That is a loss, because I have heard you 
play the violin in the past. But I want to give you these 
figures about food safety, and I have been harping on this for 
sometime. Last year, USDA received $712 million to inspect 
6,000 meat, poultry, egg product and import establishments. So 
they got $712 million to inspect 6,000 establishments. FDA 
received $260 million, one-third as much, to inspect 57,000 
food establishments and over 9,000 animal, drug and feed 
establishments, as well as a majority of food imported into the 
United States.
    Of the 7,000 food-borne illnesses that we detected, 85 
percent were linked to foods regulated by FDA. We have a gaping 
hole out there in our food safety, especially in terms of the 
importation of foods into this country. We just have a big, 
gaping hole there, and we have got to fill that. I would hope 
that we would look at some of that $1.4 billion in terms of 
that, and getting to the FDA and giving them the resources they 
need to do these inspections.
    Senator Durbin. Mr. Chairman, if I could just comment on 
that very briefly, one issue that I have been focused on is 
putting together one science-driven food safety inspection 
agency. We now have 12 different Federal agencies involved in 
food safety inspection, and 35 different laws. Senator Frist 
and Senator Kennedy, thanks for raising this issue.
    Next week, on October 10, we are going to have a hearing in 
the Government Affairs Committee that is going to focus on food 
safety and security. Believe me, this is a big undertaking, to 
finally harmonize this, and I look forward to working with you 
in trying to make sure we do the right thing.
    Senator Harkin. You have a been a leader on that, and we 
appreciate it, and we do need one central food agency. It is 
all spread out now. We need one agency to look at food safety 
in this country, and we need to combine those that are in USDA 
and FDA some how.
    Again, I thank the Senators, and please stay or leave as 
you so desire.
    Now I turn to Senator Edwards and Senator Hagel, who have 
introduced the Biological and Chemical Weapons Preparedness Act 
of 2001, and going down the line of seniority I would recognize 
my good friend and my neighbor from across the Missouri, 
Senator Hagel of Nebraska.
STATEMENT OF HON. CHUCK HAGEL, U.S. SENATOR FROM 
            NEBRASKA
    Senator Hagel. Mr. Chairman, thank you, and to you and to 
our Ranking Member, Senator Specter, we are very appreciative 
that you would put the focus on this, as has already been 
established this morning, because of its most critical nature, 
and to Chairman Byrd, thank you, because you will play a rather 
important role in all of this, and to our colleagues Senators 
Kennedy and Frist, I, too, would add my appreciation for their 
leadership and commitment to, in fact, as much as anyone could 
have, stay ahead of this issue.
    I am reminded, Mr. Chairman, when Wayne Gretzky, the great 
hockey player, was asked why was he so great, he responded by 
saying, well, I am not sure I was that great, but if there was 
anything I tried to do, it is that I tried to skate not where 
the puck was, but where I thought the puck would be. Certainly 
Senators Kennedy and Frist have skated to where they thought 
the puck would be, and they were right.
    In the interests of time, Mr. Chairman, I will submit a 
statement for the record. My colleague, Senator Edwards, has 
taken a very significant lead role on this issue through his 
committee assignments and his own interest in something very 
important, as one of the great challenges of our time, and I 
appreciate working with him. This issue has been referred to 
this morning by those who have spoken. It is a critical, 
integral part of our long-term war on terrorism.
    It is about, as we have heard, preparation, prevention, and 
defense, but, as Senators Kennedy and Frist have laid out, all 
the components of this now must come together. I hope that what 
Senator Edwards and I have done by introducing our legislation, 
which he will speak to in a more framed way, I suspect, is to 
move forward what is critically important to coordinate the 
local, State, and Federal responses, meaning that this 
coordination is going to be absolutely essential. It is going 
to require resources that it now does not possess. It is going 
to require infrastructure which we do not now have. It is going 
to require thinking that we have not applied before.
    So what Senators Kennedy and Frist have done is laid down a 
very important baseline. Senator Kennedy mentioned, as you did, 
Mr. Chairman of the Agriculture Committee, the need to deal 
with the agriculture piece here, and this is an area that 
Senator Edwards and I felt that we could contribute to by 
adding onto what Senators Kennedy and Frist have already done. 
We have done that, and we will be prepared to answer any 
questions.
    As to where we think some of this money should go, our 
overall number is $1.6 billion. We have that broken down, and 
we would be glad to share that with you whenever you would 
like.
    I would summarize my thoughts on this by saying, Mr. 
Chairman, as both Senators Frist and Kennedy have noted, that 
it is important that we not panic the American public. It is 
important that we speak plainly, directly, clearly, and 
honestly to the American public, as the President is doing, and 
as Secretary Thompson is doing. But we need to keep this in 
proportion, so that the American people can be assured, and as 
we continue our efforts here they will be assured, that we are 
dealing with this and they should have a high degree of 
confidence in what we are doing.
    As you all know, and many of you have been around here a 
lot longer than I have and have provided leadership to this 
great country, we are now confronted with the great challenge 
of our time. Not since World War II has our Nation been 
confronted with such enormity in the completeness of this 
challenge. I believe our country is up to it. I believe our 
leadership is up to it. I think we have seen some testament to 
that over the last 3 weeks in how our House and Senate, and our 
Democrats and Republicans have worked together on this. This 
certainly seems to be, regarding this area that we are dealing 
with this morning, a very clear example of how that is coming 
together.
    There is one last point I would make, which I think says it 
all, Mr. Chairman. You probably have seen the cover of Time 
Magazine this week. Time Magazine's cover, and a very, very 
good story about this issue, does not say it all, but it says 
an awful lot. It asks: How real is this threat? That is what we 
are talking about this morning. We all agree the threat is very 
real.
    Mr. Chairman, thank you.
    Senator Harkin. Thank you. I brought Newsweek, which asks: 
How scared should we be?
    It is almost the same cover.
    Well, thank you for your leadership in this area, Senator 
Hagel.
    Now I turn to Senator Edwards. Senator Edwards, I know you 
have spoken to me a number of times about this issue and your 
concern about it, and your focus on working with Senator Hagel 
to develop this legislation. So we do appreciate that, and we 
thank you for your leadership, and thank you for being here 
this morning.
STATEMENT OF HON. JOHN R. EDWARDS, U.S. SENATOR FROM 
            NORTH CAROLINA
    Senator Edwards. Mr. Chairman, thank you very much, and 
Senator Byrd, we thank you for your critical time on this 
issue. I think what this hearing shows, Mr. Chairman, is that 
the Senate is prepared to deal with not just the terrorist 
attacks of the past, but also the potential terrorist attacks 
of the future. I want to begin, as Senator Hagel did, by 
commending my colleagues Senators Kennedy and Frist, who have 
been leaders along with members of this subcommittee on this 
issue for years.
    We fully endorse their request for additional resources. I 
do believe, though, Mr. Chairman, in addition to additional 
resources, we are also going to need to see some changes in our 
policies to deal with the national security threat to our 
country.
    Let me start, Mr. Chairman, if I could, by asking you and 
others to picture in your mind's eye what a biological attack 
would look like. First, there would be no explosion. There 
would be no plane crash. There would be no catastrophic event 
of any type. Instead, it would be a silent attack. It may not 
be seen for days, or even weeks, and it would first show up, as 
Senator Byrd described, as a case that looked very much like a 
bad cold or the flu in a hospital on one side of town. Then you 
would have another case with a child on the other side of town, 
and then you would have a case out in the county somewhere at a 
hospital, or seen by a primary care provider.
    The critical question is, how much time passes before we 
recognize that there is something more than a cold or the flu 
going on, and the only people who can make that determination 
are your local emergency room personnel, the local health care 
providers, primary care physicians, and local nurses. Those are 
the people.