S. Hrg. 107-213
FEDERAL EFFORTS TO COORDINATE AND
PREPARE THE UNITED STATES FOR
BIOTERRORISM: ARE THEY READY?
=======================================================================
JOINT HEARING
before the
GOVERNMENTAL AFFAIRS
COMMITTEE
UNITED STATES SENATE
and the
INTERNATIONAL SECURITY, PROLIFERATION
AND FEDERAL SERVICES SUBCOMMITTEE
ONE HUNDRED SEVENTH CONGRESS
FIRST SESSION
__________
OCTOBER 17, 2001
__________
Printed for the use of the Committee on Governmental Affairs
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____________________________________________________________________________
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COMMITTEE ON GOVERNMENTAL AFFAIRS
JOSEPH I. LIEBERMAN, Connecticut, Chairman
CARL LEVIN, Michigan FRED THOMPSON, Tennessee
DANIEL K. AKAKA, Hawaii TED STEVENS, Alaska
RICHARD J. DURBIN, Illinois SUSAN M. COLLINS, Maine
ROBERT G. TORRICELLI, New Jersey GEORGE V. VOINOVICH, Ohio
MAX CLELAND, Georgia PETE V. DOMENICI, New Mexico
THOMAS R. CARPER, Delaware THAD COCHRAN, Mississippi
JEAN CARNAHAN, Missouri ROBERT F. BENNETT, Utah
MARK DAYTON, Minnesota JIM BUNNING, Kentucky
Joyce A. Rechtschaffen, Staff Director and Counsel
David M. Berick, Professional Staff Member
Hannah S. Sistare, Minority Staff Director and Counsel
William ``Bill'' M. Outhier, Minority Investigative Counsel
Darla D. Cassell, Chief Clerk
------
INTERNATIONAL SECURITY, PROLIFERATION AND FEDERAL SERVICES SUBCOMMITTEE
DANIEL K. AKAKA, Hawaii, Chairman
CARL LEVIN, Michigan THAD COCHRAN, Mississippi
ROBERT G. TORRICELLI, New Jersey TED STEVENS, Alaska
MAX CLELAND, Georgia SUSAN M. COLLINS, Maine
THOMAS R. CARPER, Delaware GEORGE V. VOINOVICH, Ohio
JEAN CARNAHAN, Missouri PETE V. DOMENICI, New Mexico
MARK DAYTON, Minnesota ROBERT F. BENNETT, Utah
Richard J. Kessler, Staff Director
Sherri Stephan, Professional Staff Member
Mitchel B. Kugler, Minority Staff Director
Eric E. Desautels, Minority Professional Staff Member
Brian D. Rubens, Chief Clerk
C O N T E N T S
------
Opening statements:
Page
Senator Lieberman............................................ 1
Senator Thompson............................................. 4
Senator Akaka................................................ 5
Senator Collins.............................................. 19
Senator Levin................................................ 22
Senator Durbin............................................... 25
Senator Carnahan............................................. 30
Prepared statement:
Senator Bunning.............................................. 75
WITNESSES
Wednesday, October 17, 2001
Hon. Tommy G. Thompson, Secretary, U.S. Department of Health and
Human Services................................................. 7
Michael D. Brown, Acting Deputy Director and General Counsel,
Federal Emergency Management Agency............................ 34
Hon. Deborah J. Daniels, Assistant Attorney General, Ofice of
Justice Programs, U.S. Department of Justice................... 37
Henry L. Hinton, Jr., Managing Director, Defense Capabilities and
Management, U.S. General Accounting Office..................... 40
Anna Johnson-Winegar, Ph.D., Deputy Assistant to the Secretary of
Defense for Chemical and Biological Defense, U.S. Department of
Defense........................................................ 42
Gary W. McConnell, Director, Georgia Emergency Management Agency,
on behalf of the National Emergency Management Association..... 53
Maureen E. Dempsey, M.D., F.A.A.P., Director, Missouri Department
of Health and Senior Services.................................. 58
Margaret A. Hamburg, M.D., Vice President for Biological
Programs, Nuclear Threat Initiative............................ 62
Amy E. Smithson, Ph.D., Director, Chemical and Biological Weapons
Nonproliferation Project, The Henry L. Stimson Center.......... 66
Alphabetical List of Witnesses
Brown, Michael D.:
Testimony.................................................... 34
Prepared statement........................................... 89
Daniels, Hon. Deborah J.:
Testimony.................................................... 37
Prepared statement........................................... 96
Dempsey, Maureen E., M.D., F.A.A.P.:
Testimony.................................................... 58
Prepared statement........................................... 143
Hamburg, Margaret A., M.D.:
Testimony.................................................... 62
Prepared statement........................................... 152
Hinton, Henry L., Jr.:
Testimony.................................................... 40
Prepared statement........................................... 107
Johnson-Winegar, Anna, Ph.D.:
Testimony.................................................... 42
Prepared statement........................................... 124
McConnell, Gary W.:
Testimony.................................................... 53
Prepared statement with an attachment........................ 132
Smithson, Amy E., Ph.D.:
Testimony.................................................... 66
Prepared statement........................................... 164
Thompson, Hon. Tommy G.:
Testimony.................................................... 7
Prepared statement........................................... 77
Appendix
Chart submitted by Mr. Hinton entitled ``Examples of Coordination
Activities on Bioterrorism Among Federal Departments and
Agencies''..................................................... 123
Letter from the U.S. Department of Justice responding to question
posed by Senator Akaka to Ms. Daniels, dated June 25, 2002..... 176
Meryl Ness, M.D., prepared statement............................. 178
FEDERAL EFFORTS TO COORDINATE AND PREPARE THE UNITED STATES FOR
BIOTERRORISM: ARE THEY READY?
----------
WEDNESDAY, OCTOBER 17, 2001
U.S. Senate,
Committee on Governmental Affairs,
and the Subcommittee on International
Security, Proliferation, and Federal Services,
Washington, DC.
The Committees met jointly, pursuant to notice, at 9:37
a.m., in room SD-342, Dirksen Senate Office Building, Hon.
Joseph I. Lieberman, Chairman of the Committee, presiding.
Present: Senators Lieberman, Thompson, Akaka, Levin,
Dayton, Carnahan, Durbin, Domenici, and Collins.
OPENING STATEMENT OF CHAIRMAN LIEBERMAN
Chairman Lieberman. The hearing will come to order. I thank
all of you for being here, particularly our witnesses.
This morning, this Committee will try to provide answers to
the urgent question of whether our government at all levels is
organized adequately to respond to biological and chemical
attacks on the American homeland. Senator Thompson, who will be
here in a few moments, and I are pleased to hold this hearing
in conjunction with the Subcommittee on International Security,
Proliferation, and Federal Services and its able Chairman and
Ranking Member, Senator Akaka of Hawaii and Senator Cochran of
Mississippi.
As we are now painfully and, in this Capitol Hill area,
personally aware, the past week has brought one story after
another of anthrax attacks, biological attacks, endangering
hundreds of innocent civilians and actually infecting over a
dozen people, and by this morning's calculation, actually, a
significant number more throughout the United States.
Here on Capitol Hill, a wing of the Hart Building was
quarantined. Senators and staff were undergoing testing and
mail delivery came to a halt when anthrax was identified in a
package delivered to the Majority Leader's office. We have
received word today, which I presume will be dealt with in an
announcement that will be made this morning, that a number of
members of Senator Daschle's staff are now known to have been
infected by the anthrax that came to his office and they are
being treated appropriately.
These incidents and the countless false alarms and hoaxes
people are experiencing daily have put many Americans into an
understandable state of high anxiety over this threat to our
public health.
This morning, I hope, and am confident, that we can calmly
discuss the facts, offer reassurance to the public that the
Federal Government is on duty and rapidly improving our
preparedness to respond to whatever may come. The sad fact is
that we have now entered an era when the previously
theoretical, with regard to chemical and biological attacks,
has become altogether real.
Although it is clear to me that our government still has a
lot of work to do, the reassuring fact is that the response of
our Public Health System over the last 2 weeks is just about
what we would have hoped it would be. There has been quick
detection, identification, treatment, and containment of the
problem and that has clearly and thankfully minimized the
casualties.
I want particularly to commend our first witness, Secretary
of Health and Human Services Tommy Thompson, for his leadership
in responding to this crisis, in calming a tense Nation, and in
urgently acting to improve our response systems to this now
very real threat.
The Governmental Affairs Committee is an oversight
committee. We are charged with the specific mandate to ensure
that the Federal Government is organized effectively to fulfill
its responsibilities. In today's hearing, therefore, we are
going to focus on the organizational aspect of this new threat,
and that is the question of whether we are organized and
coordinated adequately, since there are scores of Federal
bureaus and departments that are involved and will continue to
be involved in responding to bioterrorism or chemical
terrorism.
Ten major agencies and dozens of bureaus, including the
Defense Department and the intelligence agencies, are
responsible for, among other things, threat assessments,
surveillance of disease occurrences, surveillance of food and
water supplies, developing and stockpiling vaccines, and
assisting State and local governments in planning, training,
and responding.
Secretary Thompson's Department itself has six different
agencies involved in bioterrorism and chemical terrorism, which
is why, Mr. Secretary, I think it made such good sense and was
an act of real leadership for you to appoint a Department
coordinator last July, before the current threats became real.
This morning, we are also going to look at coordination
between the Federal Government and State and local governments
and their public health systems because these are the people on
the front lines of homeland defense and they will be called
upon to respond first.
The possibility of a biological or chemical attack poses a
completely different kind of threat, requiring a different kind
of response, from a different set of responders than the one we
witnessed on the dark day of September 11. That day, events
were visibly and immediately seen by, in fact, millions of
people on television and the catastrophe required conventional
fire, rescue, and medical capabilities, obviously on a large
and huge scale.
On the other hand, a biological or chemical attack might
well unfold in a very different way. It might not be
immediately visible. It could emerge slowly in different
locations, in neighborhoods, offices, workplaces, in mailrooms,
doctor's offices, clinics, emergency rooms, and public health
department laboratories. And a completely different set of
people, mostly medical personnel, would be the first to
respond. They would be our first line of defense.
Some biological agents, such as smallpox, are contagious
and would spread rapidly throughout the population. A
government exercise simulating a biological attack conducted
earlier showed that such diseases could, in fact, greatly
challenge State and local medical capabilities to respond.
But there is some better news here and that is that we do
have systems and equipment in place to respond to an attack of
this sort, and as we are going to hear today, the Federal
Government has really begun to organize the pieces that will be
needed to contain biological or chemical attacks that might
occur on a large scale.
The Health and Human Services Department is, for instance,
developing an Internet-based surveillance system to gather data
on disease incidents that would allow a real-time analysis. The
Pentagon is developing civil support teams within the National
Guard in every State. And State and local officials are
increasingly well trained to deal with these attacks.
But the systems that are in place clearly need to be
strengthened. Real preparation for these types of attacks did
not even begin at the Federal level until the late 1990's, so
many agency plans and programs are still incomplete. There is
duplication and overlap because of traditional government
stovepipe structures and the inevitable turf battles that
accompany this kind of overlap. Add to this the fact that there
does not appear to be one single central executive agency
involved and it is hard not to conclude that the Federal
Government has a series of organizational decisions to make,
and quickly.
Federal support for State and local governments and health
care systems must also grow to meet the growing challenge.
These are the agencies that employ the local heroes, the
emergency medical technicians, the police, the fire fighters,
and the hospital emergency room workers.
While Federal funding for response to terrorist attacks
involving biological and chemical weapons has increased in the
past 3 or 4 years, not enough of that, from what I can see, is
reaching the State and local levels. We need, therefore, to
build a robust Public Health System now, capable of aggressive
surveillance programs, early warning systems to quickly detect
the onset of illnesses and then respond immediately. We need
adequate inventories of the appropriate pharmaceuticals and we
need better coordination and support for State and local
governments and their health care systems.
It seems to me that, ultimately, only the Federal
Government can ensure that the capabilities to protect our
citizens in the event of biological and chemical attack are in
place, and I hope this hearing and, in fact, this Committee can
help the Federal Government do that as quickly as possible.
Senator Thompson.
OPENING STATEMENT OF SENATOR THOMPSON
Senator Thompson. Thank you very much, Mr. Chairman, and I
thank Secretary Thompson for being with us. I, too, want to
commend him for the steadying influence he has had on all of
this. It is a delicate balance that he and others in the
administration have to walk in telling the truth to the
American people on the one hand and not being unduly alarmist
on the other, and frankly, I think you are doing an excellent
job of that.
Last Friday, we held a hearing to discuss the structure of
the new Homeland Security Office in the administration. Today,
we look a little closer at some of the more specific challenges
that the Director of that office will face with regard to
biological and chemical attacks.
Concerns about these issues are not new. Two months ago,
the International Security, Proliferation, and Federal Services
Subcommittee held a hearing to discuss our level of
preparedness for a biological attack. There have been over ten
different hearings held in Congress this year on the biological
and chemical threat and the Federal Government's response
capabilities. Moreover, in the ``Government at the Brink''
report I released earlier this year, I noted that combatting
terrorism was an area of potential overlap and fragmentation,
issues that I believe we will be discussing more today.
While these concerns may not be new, there is a new sense
of urgency. There have been anthrax attacks now in three
States, as well as here in Washington. Our Committee office was
shut down yesterday and again today because of its proximity to
Senator Daschle's office, and our staff has had to undergo
testing. Mr. Chairman, your own personal office has been shut
down.
Clearly, we no longer have the luxury of time to deal with
the bioterrorism threat and our government's response. The
challenge we have before us is to determine how we can, at the
Federal level, best prepare our country for chemical and
biological attacks.
As a Nation, we do have certain priorities in this area.
First, ensuring that local officials are prepared for an
attack. Especially in dealing with a biological attack, the
first responders on the first line will be the local medical
personnel and community public health officials. How well
trained and ready they are will be the biggest factor in our
success or failure in dealing with these attacks.
Second, the Federal Government must provide proper support
to local first responders in the event of an attack. That
support could come in the form of response teams,
pharmaceutical supplies, law enforcement, as well as other
efforts.
And third, the Federal Government can continue to provide
research to aid in the surveillance, detection, and treatment
for biological and chemical attacks.
The good news is that there are many Federal agencies
working on all of these issues. The bad news is that there are
many Federal agencies working on all of these issues. As GAO
recently stated in a report, coordination of Federal terrorism
research preparedness and response programs is fragmented.
Several different agencies are responsible for various
coordination functions, which limits accountability and hinders
unity of effort.
I think it is probably appropriate to point out that this
is not true just with regard to this issue of terrorism. It is
endemic throughout government. We are just simply following a
familiar pattern.
In our ``Government at the Brink'' report, we listed
examples of program overlap and fragmentation and we listed and
discussed in some detail with numbers problem areas: Border
patrol; combatting terrorism was second; community development;
drug control, prevention and treatment; early childhood
development; economic development; education; environmental
programs; Federal land management; Federal property management;
financial regulation; food safety; foreign relations;
homelessness; international trade; and law enforcement--at
least 45 different Federal agencies conduct Federal criminal
investigations; military acquisitions; military health care;
nuclear health and safety; people with disabilities, research
and development; rural development; satellite control systems;
statistical programs; teen pregnancy prevention; and youth
programs. All of these have overlap and duplication problems.
We follow a familiar pattern in our country, it seems. We
ignore for a long time clear and present dangers. We have been
having hearings and being told about these things for at least
a decade, and during all that time, we add program on program
on program. Then we get our attention and we want to go in and
do something fast and we begin to consolidate, but just with
regard to that particular area that we are having a problem
with at that particular point. So we are following a particular
pattern here.
But other problems exist. The Federal Government tends to
spend most of its resources at the Federal level rather than on
the front lines. As one of our witnesses today, Dr. Smithson,
noted in her book on this subject, just 3.7 percent, or $315
million of the overall $8.4 billion counter-terrorism budget in
2000 went to the front lines in the form of training, equipment
grants, and planning assistance. She says, ``Bluntly put, an
absurdly small slice of the funding pie has made its way beyond
the beltway.'' We are spending a great deal of money on this
problem and we will need to make sure it is spent more
efficiently.
Also, the large number of Congressional committees
asserting jurisdiction in this area has resulted in several
different agencies receiving authorization for activities that
overlap.
So I look forward to hearing from our witnesses today and I
hope we can discuss not only what problems may exist with
regard to coordination and fragmentation in our fight against
biological and chemical terrorism, but also ways that we can
improve the efficiency and effectiveness of the Federal
response to such attacks. Thank you, Mr. Chairman.
Chairman Lieberman. Thank you, Senator Thompson, for that
statement.
I would like to now call on the Chairman of the relevant
Subcommittee, Senator Akaka.
OPENING STATEMENT OF SENATOR AKAKA
Senator Akaka. Thank you very much, Mr. Chairman. I am
delighted to be here and I want to thank you for holding this
joint hearing. I want to welcome our Secretary, Mr. Thompson,
and add my commendation to what you are doing for bringing
better understanding to the problems that we are facing and
bringing also a calming effect on the people of our country and
I thank you for that.
The Subcommittee on International Security, Proliferation,
and Federal Services, which I Chair, has been working on
bioterrorism for a long time. In July, the Subcommittee had a
hearing on FEMA's role in managing bioterrorist attacks and the
impact of public health concerns on bioterrorism preparedness.
Representatives from FEMA and HHS discussed the activities
underway by dedicated Federal employees across the government
to prepare our communities for a biological crisis.
We learned that, contrary to current press reports, the
Federal Government is not unprepared, as evidenced by the rapid
response of the CDC and FBI to the anthrax exposures in Florida
and New York. However, preparedness levels are not uniform or
consistent across the United States. There are considerable and
serious problems. While not unprepared, we are clearly under
prepared.
Today, I plan to introduce three bills that will deal with
some of these problems. I would welcome any of my colleagues
that would like to join me in these initiatives. We lack the
tools to monitor the air, water, and food supply continuously
in order to detect rapidly the presence of biological agents.
One bill will increase our efforts to develop the necessary
tools to minimize the impact of bioterrorism by reducing the
number of people exposed and alerting authorities and medical
personnel to a threat before symptoms occur.
The second measure addresses a part of the larger question
as to how our health care workers are prepared and trained for
bioterrorism or any biological crisis. Senator Rockefeller and
I propose using the existing emergency communications
infrastructure, disaster training program, and community
partnerships within the Nation's 173 VA hospitals to train both
VA hospital staff and local health care providers.
The third piece of legislation addresses a related but
distinct set of concerns, the safety of our agriculture. I will
introduce the Biosecurity Agricultural Terrorism Act of 2001.
This bill will enhance Federal efforts to prevent, prepare,
plan, respond, and recover from acts of agricultural terrorism.
It would do the same for naturally occurring agricultural
epidemics by prioritizing efforts, authorizing funding, and
establishing new policy guidelines. The measure addresses risks
and gaps in our law on foreign biosecurity, agricultural
monitoring and surveillance, response and recovery efforts,
vaccine treatment research, and other aspects of biosecurity.
Our proposals address several critical parts of the puzzle
we are to solve. A complex Federal interagency process governs
our preparation for bioterrorism and naturally occurring
medical crises. The Nation's response to current threat must
strengthen and augment existing Federal programs, minimize
confusion or duplicity in program efforts, and work to prepare
all communities, from the largest city to the smallest rural
town, for biological incidents.
During our hearing in July, Dr. Tara O'Toole of the Johns
Hopkins Center for Bio-Defense Studies cautioned that we may
have spent too much time asking who is in charge. Identifying
one single agency that commands all resources is not as
essential for responding to deliberate or natural outbreaks
where the first line responders practice constantly in their
primary responsibility, and that is caring for patients. We
must ensure that these new first line responders, doctors and
nurses, have the training, tools, and resources necessary to
respond immediately to an incident and the capacity to cope
with the several hours or days it will take before Federal help
can arrive.
Again, I would like to thank our distinguished Chairman for
convening today's hearing and our witnesses for taking the time
to be with us today. Thank you very much.
Chairman Lieberman. Thanks very much, Senator Akaka.
With the indulgence of the Members of the Committee, I
would like to now go to Secretary Thompson. When we go to the
first round of questions, we will add extra time for each
Senator so that the Senator can make an opening statement if he
or she wishes before asking questions.
I also will note for my colleagues that I received a note
that at 10:30, there is a meeting, a bipartisan caucus for all
Senators who wish to attend regarding the latest developments
in this matter right here on Capitol Hill, particularly in the
Hart Building, with regard to employees of Senator Daschle's
office. But it would be my current intention to continue,
certainly to hear Secretary Thompson's testimony and to allow
Members of the Committee to question you, and hopefully we can
get briefed later on as our colleagues will be at 10:30.
Secretary Thompson, again, you just seem to me to be the
right man in a tough job at the right time. I appreciate what
you have done and look forward to your testimony and we all
look forward to working with you in the days and months ahead.
TESTIMONY OF HON. TOMMY G. THOMPSON,\1\ SECRETARY, U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Mr. Thompson. Thank you very much, Mr. Chairman. It is an
honor for me to appear in front of your distinguished
Committee. Senator Thompson and Senator Akaka, it is an honor
to appear in front of this joint Committee and all
distinguished Members of this body.
---------------------------------------------------------------------------
\1\ The prepared statement of Mr. Thompson appears in the Appendix
on page 77.
---------------------------------------------------------------------------
Thank you very much for inviting me to discuss the role of
the Department of Health and Human Services and the Federal
Government's efforts to coordinate, prepare for, and respond to
a biological or chemical terrorist attack.
In the wake of September 11 and the recent anthrax cases in
Florida, New York, and here on the Hill, there are significant
questions about our preparedness, our overall coordination
within government, and, yes, our ability to respond. Let me
make one thing clear. The administration is absolutely
committed to responding to bioterrorism quickly in a
coordinated and effective manner.
Our recent efforts on September 11 demonstrate that
commitment. By the end of that painful morning, I had ordered
activation of the entire National Disaster Management System,
including notification of all of its 7,000 volunteer health
workers and 2,000 hospitals. Those 7,000 volunteer medical
personnel are distributed to 90 medical teams throughout the
United States. We were able to get 50 tons of medical supplies
to New York City in about 7 hours. Our schedule is 12 hours. We
did it in 7 hours, and even with the airlines shut down. Within
a couple of days of the terrorist attack, we had 700 doctors
and specialists on the ground in New York and Pennsylvania and
in the Pentagon.
Let me say how very proud I am of the Department of Health
and Human Services, whose committed health care professionals
and support staff made a decisive difference in bringing help
and healing to so many people in the wake of the attack on
America.
So, as I have stated before, the Department of Health and
Human Services is prepared to respond. But as I have also said,
there is more we must do to strengthen our ability to respond.
We need to get stronger. Coordination with our Federal, State,
and local partners is without question an area that I take
personally, very seriously.
At the Federal level, President Bush has made bioterrorism
preparedness a priority, first asking Vice President Cheney to
develop a coordinated domestic preparedness plan, and recently
creating the Office of Homeland Security.
Let me outline for you this morning what steps we are
already taking. HHS is the lead Federal agency for the public
health response to any biological or chemical attack. We are
working vigorously with our Federal partners to coordinate
domestic preparedness, the Departments of Defense, Justice, and
Veterans' Affairs, and, of course, the Federal Emergency
Management Administration, commonly referred to as FEMA.
We have also made great progress in utilizing the
expertise, the resources, and the technical support within the
Federal Government. For example, HHS works with the VA on
purchasing drug purchases to supplement our Department's
pharmaceutical supply. Together, HHS and VA are building the
stockpile effectively.
And we have partnered with the Department of Defense in
creating our National Medical Response Teams, which are
specialized teams capable of treating thousands of individuals
exposed to chemical, biological, radiological, or nuclear
attack.
As many of you know, I was particularly concerned about
this issue when I came to Washington. I was told many times
that our bioterrorism efforts needed substantial improvement. I
read the GAO reports that have already been alluded to this
morning by Senator Thompson and regarded them as the measure
against which our efforts could be and should be evaluated. Our
work over the past 9 months had been performed in light of the
reports' recommendations.
I moved our bioterrorism preparedness efforts into my
immediate office upon being selected Secretary of Health and
Human Services and I appointed the gentleman on my right, Dr.
Scott Lillibridge of CDC, one of the Nation's leading experts
on bioterrorism, to head the Office for National Security and
Bioterrorism. His office is on my floor in the HHS building.
And I went out and assembled a team of experts from
throughout the Department of Health and Human Services, led by
Dr. Lillibridge, that now are working 24 hours a day, 7 days a
week, to coordinate the Department's activities in responding
to public health needs. They are working out of a conference
room that we have remodeled just a few steps from my office so
I can be continually updated on the latest developments. They
also are coordinating HHS's communications with the other
departments within the Federal Government to ensure that all of
us have the latest information available.
We also have assembled a team from other agencies who are
also spending time in our conference room.
I have announced several weeks ago that I also was creating
an advisory committee to my office headed by Dr. D.A.
Henderson, who is the individual that led the fight to
eradicate smallpox, to advise the Department on bioterrorism
activities and State and local preparedness. And since I have
announced him, he has been in my office every day. I do not
know if he has a real job or if this is his full-time job, but
he is there every single day helping us.
I am also reaching out to State and local governments, as
well as public health officials. For example, this past
Saturday, I called together via the teleconference all the
States' public health departments, our experts at CDC, and
those in my immediate office to discuss State and local
preparedness for combatting bioterrorism.
Tomorrow, Dr. Jeff Koplan of the CDC and myself will be
doing a simultaneous video conference and webcast with members
of the American Medical Association and the American Hospital
Association to be able to answer questions from physicians,
nurses, and other health professionals concerning how to
recognize and also how to treat anthrax.
Then on Friday, I will be speaking to our Nation's
governors, also by teleconference, and discuss with them how to
rapidly improve our capacity for responding to bioterrorism.
And next week, I will be doing the same with our country's
mayors on the same subject.
Continuing to improve and better coordinate the efforts at
the local, State, and Federal levels is truly the best way to
ensure an effective response, and at the same time reassure the
public. We are also working aggressively to strengthen our
readiness and response, but we need your help, Senator and all
Members of this Committee, as well as the entire Congress.
Bioterrorism has not, and I want to underscore this, has
not been a high fiscal priority in the past and we need to move
aggressively. That is why the President is today requesting an
additional $1.5 billion to combat terrorism, to strengthen our
ability to prevent and respond to a bioterrorism attack.
President Bush's request will result in more than a six-fold
increase above the $300 million Congress appropriated in fiscal
year 2001. President Bush has from his first days in office
made a serious commitment to addressing the issue of
bioterrorism, and the President's fiscal year 2002 budget
provides HHS anti-bioterrorism initiative with $345 million,
which is also a 20 percent increase over the previous year.
But with the events of September 11--none of us could have
expected that--the President has called for an additional $1.5
billion in Federal funding for those areas most critical to our
ability to respond to bioterrorist threats. Let me outline the
areas in which we are focusing our efforts.
First, pharmaceuticals. We must accelerate the production
of vaccines and antibiotics and we must invest in essential
programs to ensure the speedy and the orderly distribution of
antibiotics and other supplies in the event of a biological
event. The President's proposal includes $1.2 million for this
activity and will be used to prepare for all contingencies.
These funds include $643 million to expand the National
Pharmaceutical Stockpile and $509 million to speed the
development and the purchase of smallpox vaccine. The
President's request also includes funding to make sure the
stockpile is ready, for the immediate shipment and the
deployment and use by trained professionals.
We are going to add four more push packs. Each one of the
push packs are now located in eight strategic locations. Each
of those consists of 50 tons of pharmaceutical supply. We want
to increase that by four, and that will add an additional 200
tons of medical supplies. These push packs include no less than
84 separate types of supplies. They include things like
antibiotics, include Cipro, needles and IVs, a tablet counting
machine, oxygen mask, and so on.
Second, let me emphasize again that much of this new money
is also needed to build on our partnership with local and State
governments, an issue that all of you on this Committee are
passionate about and I thank you from the bottom of my heart
for that passion.
For example, the President is calling for $88 million to
expand HHS's capacity to respond to bioterrorist incidents,
including $20 million for CDC's rapid response and advanced
technology and specialty labs, which they badly need, which
provide quick identification of suspected agents as well as
technical assistance to State labs.
Also included in this amount is $20 million to support
additional expert epidemiologists and these teams that can be
sent to States and cities to help them respond quickly to
infectious diseases. One of those teams was in the Capitol last
night until 2 o'clock this morning working with the Majority
Leader, along with Scott Lillibridge, and I was in contact with
them up until midnight, when I left contact.
And then respond quickly to infectious diseases, the
outbreaks and other public health risks. I believe every State
should have at least one federally funded epidemiologist who
has graduated from the Epidemic Intelligence Special Service
training program at CDC.
The President is also asking for $50 million to strengthen
also the Metropolitan Medical Response System, which will be
able to increase the number of large cities that are able to
fully develop their MMRS units. These are the medical and
public safety response units. We have 97 right now. We would
like to go to 122 with the extra money. It is imperative that
we work closely with cities to ensure that their MMRS units
have the proper equipment and, yes, proper training.
We are also providing $50 million to assist hospitals and
emergency departments in preparing for and responding to
incidents requiring mass immunization and treatment, and we are
providing $10 million to augment State and local preparedness
by providing training to State health departments on
bioterrorism and emergency response.
The President is also requesting $40 million to support
early detection surveillance to identify potential bioterrorism
agents, which include web-based disease notification to the
health community nationwide, which is so important in order to
hook up with the local communities, local health departments,
and the State health departments. This effort will also provide
for the expansion of a very successful health alert network. We
have 37 States hooked up right now. We want to get to all 50,
and then we would like to hook up to the local health
departments. It is going to help provide early detection of
disease to 75 percent of the Nation's 3,000 counties.
We are providing $15 million to support increased capacity
in no less than 78 laboratories in 45 States. This funding will
enhance our ability to identify and detect all critical
biological agents, and we are implementing a new hospital
preparedness effort to ensure that our health facilities have
the equipment and training they need in order to respond to
mass casualty incidents.
Third, in addition to purchasing pharmaceuticals, we are
committed to the development and the approval of new vaccines
and new therapies. For example, the Food and Drug
Administration is working closely with the manufacturer of
ciprofloxacin, commonly known by the brand name Cipro, to make
certain that firm, Bayer, can safely and rapidly increase its
production of that drug, which is used in the treatment of
anthrax victims. I was in contact with Bayer yesterday and they
have announced, as of yesterday, they will be able to produce
200 million tablets within the next 90 days.
Let me also announce that the FDA is officially approving
today the use of two additional generic antibiotics for the
treatment of anthrax, doxycycline, and penicillin. Because
these drugs are available in generic forms and produced by
several manufacturers, they will be relatively inexpensive and
readily available. The FDA's approval will include instructions
on what dose to use and how long to treat the inhalation form
of anthrax, and I would like to quickly point out that we have
found that of all the anthrax that we have received so far and
been tested, all of them are sensitive not only to Cipro, but
also to doxycycline and also to penicillin. So let me again
stress that there is no need for anyone to stockpile any drugs.
We have the drugs that we need and they will be available
whenever and wherever they are needed.
The fourth, food safety. The President is also requesting
$62 million to enhance the frequency and the quality of
imported food, to order inspections, and be able to modernize
the import data system to enable us to detect tainted food.
This funding will also provide for 410 new FDA inspectors to
help ensure that our food is better protected.
In addition, the administration will be sending to Congress
legislation to strengthen our ability to protect the Nation's
food supply. This measure will require prior notice of imported
food shipments, enhancing our ability to inspect food, allowing
for detention of foods suspected of being tainted, and
providing the flexibility for the FDA to approve drugs and
other treatments for dealing with illnesses resulting from
pathogens on our food.
Much of the initial burden for providing the effective
medical response to a terrorist attack, of course, rests with
local governments. If the disease outbreak reaches any
significant magnitude, however, local resources will be
stretched, and very quickly, and the Federal Government will be
required to provide protective and responsive measures for the
affected populations. In the testimony I have submitted to the
Committee, Mr. Chairman, I have outlined the specifics of how
the various departments and the agencies are working together
in a coordinated effort.
So, Mr. Chairman, let me again emphasize that the
administration is taking aggressive steps to make sure that our
country is well protected from bioterrorism, and let me once
again tell the American people the following: One, anthrax is
not contagious.
Two, the government at all levels is responding to
bioterrorist threats and responding well.
Third, our postal system is being monitored very carefully.
People should exercise caution, and if something seems
suspicious, use good judgment. But there is no reason not to
send and receive letters and packages.
Fourth, be vigilant and cautious, but do not let the
terrorists win by frightening us unduly. Do not let them scare
you into not living your life. That would help our enemies
achieve what they are trying to do, and that is terrorize
American citizens.
Contemplating bioterrorism is very unpleasant, but it is
imperative, and under the leadership of this Committee, this
Congress, and President Bush, we are taking all the steps
necessary to keep America safe in an era when biological and
chemical attacks are as possible as they are unthinkable.
I want to thank you, Mr. Chairman, both Mr. Chairmen and
the Ranking Minority Member and all Members on this Committee
for giving me this opportunity to talk about this subject. Now
I will be more than happy to answer any questions you have.
Chairman Lieberman. Thank you very much, Secretary
Thompson, for a reassuring and very helpful statement.
I wonder if I might suggest to my colleagues that Senator
Thompson and I and Senator Akaka have 5 minutes on a first
round of questioning, since we got to give an opening
statement, and we will give every other Member of the
Committee, shall I say at least 8 minutes, and we will go in
order of arrival, which would mean, just for the information of
Members, after Senator Akaka, it will be Senator Domenici, then
Senator Levin, Senator Collins, Senator Dayton, Senator
Carnahan, and then Senator Durbin.
Mr. Secretary, just to bring it home, and it really is
right here, I wonder whether you or Dr. Lillibridge have any
information you want to convey to the Committee about what has
now been determined as to the infection caused by the anthrax
sent to Senator Daschle's office.
Mr. Thompson. I would be more than happy to, Senator
Lieberman. I believe it has already been publicized--we are
waiting for Senator Daschle to make that notice first, but
there are over 20 individuals on the staff that have the
anthrax within their system, that tested preliminarily
positive. We have provided at the present time 1,200 bottles of
Cipro. One thousand individuals will be tested. We are going to
have six nurses on hand, two pharmacists, and a doctor, and 750
tests are going to be conducted by NIH and all this is being
done as we speak right now, Mr. Chairman.
Chairman Lieberman. Is it correct to infer that the reason
why such a large number in Senator Daschle's office were
infected, larger than in the other instances where anthrax has
been mailed to an office, was because of what we have learned
was the pure and more refined state of the anthrax that was
sent to the Daschle office?
Mr. Thompson. You certainly can draw that conclusion, but
the tests have not been finalized, so I do not want to
speculate, but there is no question that this is a very serious
attempt at anthrax poisoning.
Chairman Lieberman. And all of the individuals, I presume,
were in the Daschle office or in the vicinity of----
Mr. Thompson. I am not sure about that.
Chairman Lieberman. Doctor, do you want to add anything
here?
Dr. Lillibridge. Sir, let me add two things. One is that I
would like to differentiate between being exposed and being
infected.
Chairman Lieberman. OK.
Dr. Lillibridge. We are telling the American people that
these people were exposed, but they are not currently infected.
They are, indeed, healthy and on medicine to prevent illness or
prevent from becoming infected.
Chairman Lieberman. Say a little more about the distinction
so we understand it.
Dr. Lillibridge. When we say exposed, that means they were
in an area perhaps where there was dust or a powder or in the
vicinity where a letter was opened up. They may have recovered
spores from their clothing or from their nasal passages. But
that is a far cry and that is very different from having a
bacteria set up housekeeping and creating infection and illness
in the human. They are not to that stage, and indeed, with
medical prophylaxis and a proper environmental follow-up, we do
not expect them to move to that stage.
Chairman Lieberman. That is a very important distinction.
Mr. Thompson. Of all the anthrax so far, we have only had
four that have actually become infected.
Chairman Lieberman. Infected.
Mr. Thompson. Two in Florida and two in New York.
Chairman Lieberman. That is a very important distinction.
So at this point, as far as the two of you know, none of the
individuals in Senator Daschle's office----
Mr. Thompson. That is correct.
Chairman Lieberman [continuing]. Are actually infected?
Mr. Thompson. Absolutely. And it is too early and they are
on the necessary antibiotics and they should not become
infected.
Chairman Lieberman. As we learned yesterday in the briefing
that Senators received, it takes a pretty significant number of
anthrax spores to actually become infected.
Mr. Thompson. Different amounts between the three different
types of anthrax. Cutaneous infection results from a break in
the skin. Ingestion--you have different tainted food from
animals that could get into your system, causing
gastrointestinal problems, which would take less than
inhalation. Inhalation anthrax, they have figured, has to have
10,000 spores enter your system in order for one to become
infected, and that is a lot.
Chairman Lieberman. It is very important for people to hear
that, particularly since the number of those exposed is larger
than in any other case that we have had thus far.
Mr. Thompson. That is correct.
Chairman Lieberman. I wonder if either of you, and I just
want to use this as a moment to try to help convey information
that will be helpful to us and perhaps the public.
Mr. Thompson. That is very good and I appreciate this.
Chairman Lieberman. No, I thank you. I wonder if you have
anything to say about what we can determine about the fact that
this anthrax in Senator Daschle's office was presumably more
pure and refined than that sent to the other offices. Are there
any conclusions we can draw about who was sending it, what was
done?
Mr. Thompson. That is being completely investigated by the
FBI, Senator. We have no knowledge of that at this point in
time. We are hopeful to be able to have the FBI make some
arrests and some breakthroughs, but at this point in time, it
is purely speculation. And the research in the labs, there is
research being done at Fort Detrick and also research being
done at our labs at CDC in Atlanta and all that research and
analysis will be coming forthwith to you and to other members
as soon as we get it.
Chairman Lieberman. A final question on my round for you
about the facts here, and about this, I think there is some
uncertainty, too. How difficult is it to obtain anthrax? There
have been times I have heard broadcasts where people have said
there are only three countries in the world that have it,
perhaps certainly the former Soviet Union, the United States
has some, I gather, in laboratories, and there have been
allegations of other countries, including Iraq, possibly having
it. But then I have also heard at different times that it
exists in labs around this country in some numbers and that,
therefore, that is another place that somebody sending these
packages could have obtained it. So I wonder if you can help us
understand how the people doing this might have obtained the
anthrax.
Mr. Thompson. Well, there is a lot of different anthrax. A
lot of it occurs naturally in the blood of animals that, once
the animal dies, gets emitted into the air. It is emitted in
culture. There are laboratories across America that have had
anthrax and have done research and experiments on it. It could
be done. There are other countries that have used anthrax and
tried to use it as a weapon. They are the ones that have
manufactured and milled it into a weapons grade and that, of
course, is the most dangerous part.
But this anthrax that we have right now, we are still doing
research on it. We do not know the exact strains or where it
comes from.
Chairman Lieberman. Is it fair to say that it is difficult
to obtain the kinds of anthrax that has been sent to people
around the country now in the last couple of weeks?
Mr. Thompson. It is more difficult for it to be able to be
used as a poison in a letter----
Chairman Lieberman. Right.
Mr. Thompson [continuing]. Because it clumps together.
Chairman Lieberman. Right.
Mr. Thompson. And to be able to allow it to go up into the
air requires some degree of scientific ability.
Chairman Lieberman. So that is what, I presume, was
noteworthy about what was sent to Senator Daschle, because the
analysis of it suggested that it had been refined to a greater
extent than is normally found.
Dr. Lillibridge. Mr. Chairman, let me make a few comments.
You asked, where might this organism come from? Where might you
recover anthrax bacteria? It is in the soil. It is a disease of
the animal population. Many labs around the world investigate
anthrax as it relates to the safety of herds and other kinds of
animal veterinary activities.
As for the sample in question, there are a number of tests
that are ongoing that will look at the size and the purity and
the sensitivity. I can tell you at this time, we are aware that
the sensitivity of this organism that was released in Senator
Daschle's office is sensitive to ciprofloxacin, doxycycline,
and penicillin--the common drugs that would be used to treat
any kind of outbreak of this nature. That is, in itself,
reassuring.
The issue of whether it is weaponized or where it came from
may take quite a bit of strain analysis and sophisticated
testing. That is ongoing with the Federal Bureau of
Investigation at the lead. It is our impression from a public
health safety standpoint that we have enough information in
terms of its sensitivity and its purity and isolation to make
sure this really is anthrax organism to guide our investigation
both environmentally and make public health recommendations. As
soon as that information becomes known, it will be made public
as best it can.
Chairman Lieberman. Fine. Just a final point of
clarification. I assume it is some distance from the naturally
occurring anthrax, that is, anthrax that occurs naturally in
the soil or in animals, from that to the kind of powder that
was sent to Senator Daschle's office.
Dr. Lillibridge. Let me just use the short answer for this.
I think it shows there has been some attempt to collect it,
perhaps refine it and make it more concentrated. That seems to
be certain.
Chairman Lieberman. OK. Thanks very much to both of you.
Senator Thompson.
Senator Thompson. Thank you, Mr. Chairman. Your last
statement was with regard to that found in Senator Daschle's
office?
Dr. Lillibridge. Yes, sir.
Senator Thompson. There was apparently some attempt to
refine it?
Dr. Lillibridge. Well, when you have a collection of
anthrax spores put into a package, that takes some effort to do
that. This organism is in the soil, but getting it into spore
form requires some degree of effort.
Senator Thompson. The GAO report of last month that someone
referred to said that processing biological agents into the
right particle size and delivering them effectively require
expertise in a wide range of scientific disciplines. Would you
agree with that, Doctor?
Dr. Lillibridge. Yes, sir.
Senator Thompson. So if, in fact, we do find that this was
more highly refined in terms of particle size, weaponized, I
guess is a good way of putting it, then that would indicate
someone had a wide range of scientific disciplines?
Dr. Lillibridge. Let me just extrapolate the process as you
go through this. As the investigation unfolds and moves into
either national security or law enforcement arenas, they will
begin looking at the strains, the match-up, what effort went
into manufacturing it, and see if they can pinpoint a source,
either a geographic location or a specific stockpile or a
specific strain that inhabits a certain part of the world.
Senator Thompson. This may be a little bit beyond----
Mr. Thompson. Senator Thompson, it has to be a certain size
in order for it to get into the body. If it is smaller than one
micron or larger than ten microns, it is not able to be inhaled
properly.
Senator Thompson. This is all a little premature, I
suppose, but indulge me with one more question. This may be
beyond your purview. I have read that in order to produce
especially large quantities of this powder form that would be
weapons grade, if you want to call it that, that it would
require substantial infrastructure. I have seen millions of
dollars spent to have that kind of production capability and
facilities. As a general proposition----
Mr. Thompson. That is absolutely----
Senator Thompson. Is that a correct assumption?
Mr. Thompson. That is our understanding, Senator.
Senator Thompson. With regard to the----
Mr. Thompson. To have a weapons grade, it could possibly
have a country behind it.
Senator Thompson. A country would probably be behind the
weapons grade?
Mr. Thompson. But we want to make sure that none of this is
a weapons grade.
Senator Thompson. You want to make sure that none of it--we
do not know yet with regard to this?
Mr. Thompson. Of the past one, it is still being tested.
Senator Thompson. Right. With regard to these large
stockpiles that we have developed and are in the process of
developing, is this going to have to be constantly replenished?
Are there expiration dates on all these drugs, as we commonly
understand them, and what budgetary impact will that have in
these huge numbers we are talking about?
Mr. Thompson. We have two different systems, Senator. In
the push packages, some of those will have to be replaced. But
we also have a vendor marketing inventory and part of the
agreement with the vendor's marketers is that their
responsibility is to restore items that have used up their
shelf life with new stuff and that is built right into the
contract, so it is an ongoing thing. So there are some of the
more durable things that are in the push package, but we also
have a different system, which is called VMI, and that is
brought up currently on a monthly basis and that is being
conducted and supervised by CDC.
Senator Thompson. I see.
Mr. Thompson. And that is built right into our contract.
Senator Thompson. Mr. Secretary, there has been a lot of
discussion, as you know, about Governor Ridge's position, the
authority that he has or should have. With regard to all of
these things that you and your Department are doing, how do you
see that fitting within his operation? How do you see your
relationship and your duties and responsibilities and all these
things that you are doing intersecting with what you understand
his responsibilities are going to be? Is that too broad a
question to answer?
Mr. Thompson. No, it is not.
Senator Thompson. Have you given some thought to it?
Mr. Thompson. It is a very valid question. I will give you
an example. As of 4 o'clock yesterday afternoon, we had a
meeting, various departments with Governor Ridge and we worked
out some difficulties. He was the coordinator and we threw out
questions and problems and we just had a roundtable discussion
and then he would delegate, ``Tommy, you take care of this one,
and Madam Secretary, you take care of that problem, sir, you
are responsible for this,'' and so on.
So his job is to coordinate and make sure that when we have
problems in the public health arena, we can go to somebody like
Tom Ridge and say, ``This is a problem. Can you assist us with
the FBI or with the CIA or with the Department of Defense and
help us along?'' It has been working out, I think, very
effectively so far.
Senator Thompson. How do you foresee budget determinations?
Would you expect him to have input in your decisions or would
he make certain decisions in certain areas with regard to your
Department? How do you see that playing out? Have you gotten
into that yet?
Mr. Thompson. Senator, we put in this request, and I talked
to Governor Ridge and I know that he talked to the President in
regards to this, as I did, and we all talked to OMB. I think
somebody from the President's Office, including Governor Ridge
and myself, talked to OMB, and as a result of that, the request
today of about $1.6 billion is in front of you.
Senator Thompson. Thank you. My time is expired. Thank you,
Mr. Chairman.
Chairman Lieberman. Thank you, Senator Thompson. Senator
Akaka.
Senator Akaka. Thank you very much, Mr. Chairman. Mr.
Secretary, I am pleased to hear the President's request for $40
million to support the early detection surveillance to identify
potential bioterrorism agents. This matches the authorization
in my bill.
Mr. Thompson. And I thank you for that, Senator.
Senator Akaka. I look forward to working with you to ensure
these funds are made available.
Senator Domenici. Mr. Chairman, could I ask the Senator to
yield for 30 seconds?
Senator Akaka. Certainly.
Chairman Lieberman. Go right ahead, Senator Domenici.
Senator Domenici. Mr. Chairman, we have a complication in
that there is a meeting with reference to a collateral issue at
10:30.
Chairman Lieberman. Correct.
Senator Domenici. I will come back, and if you are still
here, I would appreciate the opportunity to inquire. I just
wanted you, Mr. Secretary, to understand why I will not be
staying here and thank you for what you have been doing. You
are doing a great job.
Mr. Thompson. Thank you, Pete.
Chairman Lieberman. Thanks, Senator Domenici. We will be
here and await your return.
Senator Akaka. Thank you. Mr. Secretary, I believe that the
animal health community requires formal coordination with the
HHS and CDC and I am delighted to know you are both on the same
floor and there is much coordination. Currently, their
interaction is on a case-by-case or a need basis. Formal and
regular contact will ensure that animal health and agriculture
issues are addressed by HHS and FEMA disaster preparedness.
Federal efforts should also take advantage of the expertise
veterinarians have to offer, such as familiarity with anthrax.
In fact, in a National Public Radio report yesterday morning,
two out of the three anthrax specialists interviewed were
animal disease specialists. Veterinarians could also help in
detecting unusual biological events because many emerging
diseases appear in animals long before humans. Additionally,
animal diagnostic labs have the capacity to identify and
confirm the diseases.
The bill I am introducing today establishes a senior-level
official within HHS who has formal responsibility for regular
contact with the animal health community. Would you please
comment on current coordination efforts between HHS and the
animal health community and on my proposal.
Mr. Thompson. First off, let me just say I like the
proposal and I hope that it gets prompt action in the U.S.
Senate.
Second, we are trying to coordinate very closely with the
Department of Agriculture on food safety as well as animal
safety wherever we possibly can.
The third thing, your analysis that veterinarians may have
a tremendous amount of expertise in the disease of anthrax is
absolutely correct and we have, of course, several teams of
veterinarians that are involved with our Public Health System.
In fact, I think we sent four veterinarian teams to the City of
New York to take care of the search dogs and they were there
for several weeks taking care of the dogs while they were still
trying to find people alive in the rubble and our veterinarians
were there to take care of them.
Five, food safety. I know it is a big concern of yours as
well as my friend Senator Durbin's, and it is a real priority
for me. I know it is for the Secretary of Agriculture, and I
think we have to do a much better job than we have in the past
in this arena and I would be more than happy to discuss that
with you at any time.
Senator Akaka. In the event of a biological terrorism
event, clinical laboratories are likely to be overwhelmed with
samples.
Mr. Thompson. We are finding that right now, Senator, and
we have so many--we have thousands--I do not know how many, but
we have a lot of false starts in regards to the anthrax scare
and we are trying to deal with them through the Post Office
Department, through the FBI, and, of course, a lot of the
burden rests upon our laboratories that we have to take care
of.
Senator Akaka. I commend you on identifying that problem
and also again urge you, as you have been doing, to calm the
feelings of people by giving them the proper information on
these samples and medicines, as well.
I believe that many areas should begin developing regional
plans to assist neighboring cities or States in handling surge
diagnostic lab demands.
Mr. Thompson. Yes.
Senator Akaka. However, I am concerned that,
geographically, remote areas like Hawaii will be at risk, and
also our territories that are non-contiguous. We cannot forget
that the grounding of all air traffic during the terrorist
attacks on September 11 effectively isolated both Hawaii and
Alaska, and our territories, for several days. In fact, some
U.S. territories beyond Hawaii are having trouble getting their
medical samples analyzed because they must be flown to Honolulu
first.
My question is, does Hawaii have the laboratory capacity to
absorb a dramatically increased sample load in the event of a
biological crisis and what plans are in place to ensure that
remote areas have capacity to detect and identify human
diseases and plant and animal pathogens?
Mr. Thompson. Senator, I am not expert enough to talk about
a particular lab, but let me tell you the system, how we have
got it set up and how we are able to respond. We have connected
with Hawaii, with Alaska, and with our labs in CDC in Atlanta
and they are hooked up to the lab and we have put out the
notice and we are putting out information on a regular basis to
all the State health departments asking them to get involved
and if they see something suspicious, they are to get us the
tests, the tissues, and the blood samples as soon as possible
so we can make a confirmation of what the preliminary lab may
find in Hawaii or in Wisconsin or Alaska or Michigan, wherever
the case may be.
And then if we find that there is any type of biological
agent, we are able within hours to fly CDC teams to that
particular area to help put together a State or local plan and
to assist them. We have 7,000 medical professionals divided
into 90 teams throughout the United States, one of which is in
Hawaii, and they are able to respond very quickly. We have one
in D.C. that is able to respond to the Capitol within 90
minutes. These are individuals that are experts in biological,
chemical, and radiological kinds of attacks.
So we are able to respond and we also have medicines that
we can distribute very quickly to any locale in the United
States, including Hawaii.
Senator Akaka. Thank you very much.
Chairman Lieberman. Thank you, Senator Akaka. Senator
Collins.
OPENING STATEMENT OF SENATOR COLLINS
Senator Collins. Thank you, Mr. Chairman.
Mr. Secretary, I want to begin my comments by thanking you
for your tremendous leadership and strength during this very
difficult time. There is no one in whom I have more confidence
than I do you to guide our Nation and to manage our efforts to
deal with bioterrorism.
Mr. Thompson. Thank you. Thank you very much, Senator.
Senator Collins. In the past, an attack with a biological
agent like smallpox or anthrax seemed highly unlikely. Today,
such attacks not only seem frighteningly possible, but rather
the question has changed from ``if'' to ``when and where.''
Mr. Thompson. Right.
Senator Collins. Intellectually, we may understand that
more people die of the flu than of anthrax, but that is of
little comfort because people do not try to deliberately kill
us by exposing us to the flu. It is both disturbing and
unsettling to all of us that we were told yesterday that the
staffer who opened the mail in Senator Daschle's office and
discovered the anthrax-tainted letter did exactly the right
things, that she took exactly the right steps, and yet still
more than 20 members of his staff have tested positive for
exposure to anthrax. I think that is very unsettling to us all.
In most parts of the country, the first responders are not
likely to be officials from the CDC or highly-trained
epidemiologists who have the training to recognize anthrax and
to trace where the infection has come from. They are much more
likely to be the family doctor or the emergency room nurse or
the local police officer. I am very pleased to hear of your
efforts to educate our health care providers and those on the
front lines.
Last week, I attended a hearing at which Dr. Henderson,
whom you appointed to head your advisory committee, testified
along with several other public health experts about the
Florida response to the first case of anthrax, and to a person,
they testified that they felt in many ways it was fortuitous
that the physician had recognized that this might be a case of
anthrax, that there was a lab nearby that had the capability of
identifying anthrax, and that if this first case had happened
in many other parts of the country, it might not have been
detected as anthrax. That is of concern to me and suggests we
need to do more.
I know one of your goals is to make sure that every State
has a federally-trained epidemiologist. Could you tell us how
many States now lack a federally-trained epidemiologist?
Mr. Thompson. I think there are 17 that--it is either 13 or
17, I am not sure. But first, let me thank you for your
comments, and second, let me quickly point out that I think
that would be a giant step forward. Luckily, the individual
doctor in Florida had had training from CDC, as I understand
it, and knew exactly what to look for.
I think it would be a wonderful thing for this Congress to
be able to place in every health department maybe at least one
individual that has EIS training, like Scott Lillibridge does
from CDC, and also the regional areas would be the same, so
that we have that expertise out in the field. It would
strengthen the local and State health departments and Public
Health Systems tremendously and I thank you for your support of
that, Senator.
Senator Collins. I think that really is absolutely critical
because they are the ones who are on the front lines and are
going to have to make the right decisions before there is
likely to be Federal involvement.
The second issue that you brought up in your testimony was
your plan to have additional push packs, and I understand that
these are the collections of medical supplies. I commend you
for pushing for additional packages. I am concerned, however,
about how we know what to put in these push packs because today
it may be anthrax. Tomorrow it may be smallpox. The next day,
it may be another kind of chemical rather than biological agent
that is being used to attack our citizens. How do you decide
what kinds of pharmaceuticals or supplies to put into these
essential push packs that can be deployed on very short notice?
Mr. Thompson. Let me just quickly point out that we have a
panel of experts that explore that. We have two systems. We
have the push packs, in which there are eight strategically
located around the United States, 50 tons in each one. In order
to move them, it takes nine semi-trucks or a C-130 to move
them, and our plan is to move them within 12 hours. In the case
of New York, we were up there within 7 hours.
Then we have a second ancillary system called the VMI
system which is in the process of purchasing. We purchase
pharmaceuticals but we do not take delivery of them. We have
individuals that supervise them and keep them current, and that
is the VMI system.
So you have two different systems and you have a panel of
experts that analyze on a regular basis what should be in
either the VMI, and those are the ones that would have a
shorter shelf life, and then the ones in the push packages.
And the third thing is that we are continuing upgrading
that. As far as smallpox vaccine, that is a separate thing.
That is the third thing. That is being under supervision of
Wyeth and we have 15.4 million doses of vaccine. Right now, we
are looking at the smallpox and seeing whether or not we could
cut that 5-1 so that we could expand from 15.4 to 77 million
doses of vaccine for smallpox, and NIH is doing that analysis.
Right now, the preliminary analysis is that by cutting it
down from--we have tests going from 1-1, 5-1, 10-1, and 100-1,
and we have found that the effective rate is around 95 percent
on 5-1, but that is preliminarily. At 10-1 dilution, it is 70
percent effective, and 100-1 is 20 percent effective. So we
strongly think from the preliminary analysis with our doctors
at NIH and with the consultation of CDC that we could have that
reduced from 5-1 and still be very effective and increase the
number of doses for smallpox vaccine from 15.4 to 77 million
doses.
Senator Collins. Thank you. I see that my time is running
short. I just want to touch quickly on two other issues.
The first is the vulnerability of our food supply. I held
hearings a couple of years ago that showed that our system for
inspecting imported food was woefully inadequate, that less
than 1 percent of shipments of imported food were inspected,
but more troubling, that it was very easy for unscrupulous
shippers to circumvent the inspection process and to actually
reship tainted food that had been caught through the inspection
system. So I want to share with you the hearings that we held
and our findings and recommendations, some of which were
enacted but many of which were not because of lack of
resources, and I look forward to providing you with that
information.
Mr. Thompson. I appreciate that very much, Senator, and
anything you can help with in regards to improving the food
safety, I would appreciate it very much. Seventy-seven million
Americans last year had food poisoning, one out of four. Three
hundred and thirty-two thousand ended up in the hospital and
5,000 died because of food poisoning. So when you look at that
and compare that to only four individuals that have actually
been infected from anthrax, you can see that food safety and
food pathogens is a much bigger problem and I thank you.
Senator I wanted to correct something that I guess--
somebody sent me a note. I did not in any way imply that there
were countries behind this attack on Senator Daschle and that
it is weapons grade. The tests are still being done. I just
said that it is very potent.
Chairman Lieberman. Thanks, Mr. Secretary. I thought you
made that clear----
Mr. Thompson. I thought I did, too, but I wanted to----
Chairman Lieberman [continuing]. But I appreciate the extra
clarification.
Mr. Thompson. Thank you.
Senator Collins. I see my time has expired. Thank you, Mr.
Chairman.
Chairman Lieberman. Thanks, Senator Collins, for some
excellent questions. Senator Levin.
OPENING STATEMENT OF SENATOR LEVIN
Senator Levin. Thank you. First, let me thank you, Mr.
Secretary, for your extraordinarily solid, thoughtful
leadership. You and your agency have made a major contribution
to the security of this Nation and its well-being and,
hopefully, its calm consideration of the threat.
Actually, this last clarification of yours is something I
was going to ask you about and that has to do with the
difference between concentrated anthrax and weapons grade
anthrax, if you can tell us that. You indicated, I believe,
that it would take a state to produce the weaponized variety
because there are millions of dollars that might be involved in
the infrastructure to produce it. Would it also be safe to say,
however, that a well-financed terrorist organization, if it had
enough millions of dollars to produce the infrastructure, could
produce weapons grade anthrax?
Mr. Thompson. I think we are all learning and I do not know
if anybody knows for sure, but I think you can make that
supposition quite easily. Maybe, Scott, you would like to----
Senator Levin. Maybe one word on the difference between
concentrated and weapons grade, if you know it.
Dr. Lillibridge. Let me make two statements on this. First
of all, the issue for health really is not so much whether it
is concentrated or weapons grade, if the investment has been
made in dissemination and the process to mill it down and make
it distribute easily.
The distinction between concentrated and weapons grade, as
we understand it, is that concentrated is what you do to simply
get spores close together so you can put them in an envelope
and mail them out. There are a number of ways technically to do
that, depending on the investment, the time and effort, and the
amount of risk you want to take at your local lab certainly
would factor in.
The issue of weaponization or weapons grade is often used
in the literature to evoke large industrial investment in
preparing samples for dissemination. It includes milling down
the spores so they are easy to disseminate. It involves coating
the spores so they stay in the air a little longer. It involves
research into dissemination devices, different ways to move it
to the population. We do not have any of that information on
this particular sample at this time.
Senator Levin. Thank you. I want to talk about smallpox for
a minute. Our former colleague, Sam Nunn, took part in an
exercise called ``Dark Winter,'' and I do not know if you have
seen the video tape----
Mr. Thompson. Yes, we have.
Senator Levin. The major finding of that study was that the
Nation was very unprepared for such an attack, and so I want to
ask you about what kind of preparations, in fact, have been or
are in the process of being made. You just discussed the dosage
issue and that is very helpful information.
In addition to seeing whether or not we can divide our 15
million doses into smaller doses, can you answer or address two
issues. One, are we also attempting to produce more, and if so,
what is the time line for that? And second, whatever number of
doses we have, whether it is 15 million or 75 million or
whatever number, what is the plan prior to any attack? Are we
going to start immunizing people before evidence of an attack,
given the very different nature of smallpox, or what are our
plans in that area?
Mr. Thompson. Well, thank you very much for the question,
Senator Levin. Let me point out first that when Dark Winter was
being conducted, we took that experiment, that example, along
with the GAO report, and when I appointed Scott Lillibridge, I
said, you have got to take all of these things, find out the
deficiencies we have and start correcting them, and that is why
we brought Scott Lillibridge and brought in a team into the
Secretary's office to address those inadequate situations and
we are knocking them down as we go along.
We have accelerated, of course, since September 11 and are
doing a lot more, and even though the terrorist attack was
terrible for America, one good thing that came out of it, the
consequence of that is that we are much better prepared to deal
with a bioterrorism attack and we are getting stronger each and
every day.
In regards to smallpox, I am happy to report that we are
meeting with a lot of the pharmaceutical companies. In fact, we
are going to be discussing smallpox with four of them very
soon, and we have talked to them in the past. We are going to
talk to them again about purchases. We are looking to expand
and purchase 300 million doses of vaccine, Senator Levin.
Acambis is the company that has a contract currently with CDC
to produce 40 million doses. They were not going to start
producing until 2005. They now have accelerated that to 2002.
We have also talked to some other companies and we think
that we will be able to purchase some smallpox vaccine and
start manufacturing yet this year, Senator Levin, and we should
be able to have, provided Congress goes along with the
appropriation, the necessary dollars and be able to have the
300 million doses by the end of next year.
Senator Levin. Is it safe to say or is it accurate to say
that smallpox, if it could be obtained by a terrorist, would be
a more threatening substance than anthrax?
Mr. Thompson. There is no question because it is infectious
and contagious and anthrax is not.
Senator Levin. Is it also your plan to begin inoculations
prior to any evidence of attack?
Mr. Thompson. That was the second question. I apologize I
did not answer it, Senator. We do not believe at this point in
time that inoculation is the right thing because there are some
serious side effects to inoculation of smallpox. There will be
some fatalities, some inflammation of the brain, some other
maladies that will come as a result of taking a smallpox
vaccine.
We may sometime in the future, with consultation with
Congress, set aside some of the 300 million doses of vaccine
for voluntary vaccination if, in fact, Americans want to do it,
but that decision has not been made. But we do want a stockpile
of 300 million and that is what we are asking Congress for the
appropriation to do.
Senator Levin. Thank you. Having been a governor, which is
a tremendous asset to you, I think, in your work and working
with local and State officials as a governor now is surely
going to give you some really important experience in your
current work. But as a former governor, you have also had
knowledge in terms of how you structure an Executive Branch and
I want to follow up on some of Senator Thompson's questions
relative to that structure. You commented a bit on it.
There are a number of proposals in front of this Committee.
One is to create a separate agency. One is to create an office
in the Executive Branch of the President. I would like to ask
what your ideas are in this area.
Under the present system, as you have begun to work in it,
if there are differences between agencies on who should do what
particular function, does Governor Ridge have the power to make
a decision? I know he can make a recommendation and I know he
can seek to get some kind of a consensus, but in terms of
decisionmaking, if Governor Ridge says, ``It should be done
this way,'' and you or some other cabinet agency says, ``No, we
think it really should be done that way.'' Does he have the
power to decide or is it just the power to recommend to the
President?
Mr. Thompson. I cannot answer that, Senator Levin. I do
like your comments about being governor. I never in my life
thought that being governor, I was taking this job and was
going to become an expert on embryonic stem cells and
bioterrorism, but that has been the two examples that have
really been foisted upon me.
In regards to Governor Ridge, I think he has the power. I
think the President has given him that power to make the
decisions, beyond just making recommendations.
Senator Levin. Beyond, you say?
Mr. Thompson. Just making recommendations. I think just the
fact that the President says that he is going to be the
coordinator, I cannot imagine any cabinet officer would be dumb
enough to challenge that.
Chairman Lieberman. Secretary Thompson, Senator Levin, I
apologize for intervening. I just received a message and
request from Senator Daschle that we recess this hearing for
now and that the two of you come with us to the joint caucus of
Senators to be part of the briefing. I apologize to my
colleagues who have not had a chance to ask questions. I would
ask the patience of the witnesses on the second two panels. I
will definitely return and we will continue the hearing at that
time.
But for the moment, in response to a request from the
Majority Leader, I am recessing the hearing.
[Recess.]
Chairman Lieberman. This hearing of the Senate Governmental
Affairs Committee will now reconvene.
Secretary Thompson, thanks very much for staying here. I
know you have got other appointments. I do not know if I would
say we negotiated an agreement with Senator Daschle that we
would leave Dr. Lillibridge there and you would come back and
complete your testimony.
Mr. Thompson. I think Senator Daschle got the better part
of the deal over you, Senator Lieberman. [Laughter.]
Chairman Lieberman. We are very happy and grateful that you
have returned with us.
Senator Durbin, you were next. Thank you.
OPENING STATEMENT OF SENATOR DURBIN
Senator Durbin. Mr. Secretary, thank you very much for
returning. I really appreciate it under all these
circumstances. I want to ask about two specific areas, one,
immunizations, and the second, food safety. Let me start with
immunizations.
I think what you have told us is that you are gathering
together 300 million doses of smallpox vaccine, and I would
like to ask some further questions about what your plans are
for immunization. It is my understanding that, unlike anthrax,
where exposure can be treated successfully with antibiotics,
that exposure to smallpox is much more dangerous, much more
likely of infection, and, therefore, you virtually have to be
vaccinated in advance or you stand a high risk of being
infected with smallpox. So could you tell me what your vision
is in terms of this smallpox vaccine and how it will be used?
Mr. Thompson. Thank you. We are not going to gather. It is
going to be produced and we are in the process right now of
negotiating with the companies. There is one from Illinois, by
the way, that is involved in the negotiations. But there are
four companies that would like to get in the business of
producing the smallpox vaccine.
Two, we have accelerated the production from 2005 to 2002
and I can announce today that we are going to be able to
accelerate even further and we should be able to start
producing smallpox vaccine as early as this year, sometime in
November and December, and we will be able to produce 300
million doses of vaccine for smallpox within 12 months. So by
the end of next year, we will have 300 million doses of vaccine
within our inventory to be able to be used if, in fact,
smallpox ever turns up.
Three, the shot, vaccine, if you get it within 2 to 5 days,
it is still effective even after you have been exposed to
smallpox, but the earlier you can get the vaccination, the
better off you are.
Four, what we would do if a smallpox outbreak did occur, we
would go in and would quarantine the area. Then we would give
the vaccination to the first responders and the medical
personnel first, and then we would make a concentric circle and
go around and vaccinate all the individuals in that concentric
circle.
Senator Durbin. But this will not be like my first memory
of public health when I was a grade school kid and learned the
name Jonas Salk and we had a national effort to immunize
children across America. Your idea is not to move forward with
immunization unless and until there is evidence of outbreak?
Mr. Thompson. That is correct at this point in time. Now,
there may be a decision after we have it in stock that the
Congress and the Public Health System and the President will
decide that maybe we should make some of the 300 million doses
available for voluntary vaccination, but I do not believe that
you will see mandatory vaccination because of the side effects
of vaccination for smallpox. There will be some fatalities, not
many, but probably one out of every million doses, there will
be a fatality is what the experts predict. There will be some
inflammation of the brain in some cases, a few more than
fatalities. So there are some adverse side effects.
So mandatory vaccination, I do not think will take place
and it is not recommended by the specialists that I have talked
to. Dr. D.A. Henderson, who is going to be my science advisor,
is really the father of the eradication of smallpox and he does
not advise vaccination at this point in time.
Senator Durbin. Three hundred million doses will treat how
many people?
Mr. Thompson. Three hundred million.
Senator Durbin. So it is one immunization that is
necessary?
Mr. Thompson. One, but we have 15.4 million doses right now
of the old vaccine and tests are being conducted on that right
now in regards to diluting that 1-1, 5-1, and 10-1, and the
preliminary analysis is 5-1, which would give us 77 million
right now. If a smallpox epidemic occurred, we would have 77
million because the experts feel, even though the analysis has
not been completed, that it would be strong enough to protect
95 percent of the American public.
Senator Durbin. I would like to make one general
observation about immunization. Since I got into the subject a
few years ago and studied it, I was surprised to learn how many
children are not immunized, do not receive the basic
immunizations that we consider important for public health, and
I was also surprised to learn that 3.6 million children
currently that have health insurance are not covered for
immunizations, that health insurance does not cover
immunizations for over three million children in our country. I
hope that we can work together on that to extend that umbrella
so that kids in Chicago and Milwaukee and all over can get the
basic----
Mr. Thompson. Senator Durbin, you are absolutely correct.
Preventative health, that is No. 1. Vaccination is the best way
to prevent some disastrous disease and it saves money for the
insurance company.
Senator Durbin. Anthrax vaccine, is that being considered,
as well?
Mr. Thompson. There is one company that produces anthrax
vaccine. It is called Bioport. It is in Michigan. They are
closed down right now for some problems and they are remodeling
and reconfiguring their factory to produce anthrax vaccine.
They have just applied for us to go in and to inspect it. We
got that application as of last Friday. They are going to
complete their renovations within the next 2 weeks. We will
then go in and make the inspection and if the inspection meets
FDA approval, which we think that it will, hope that it does,
they should be able to be in production by November 15.
They have an exclusive contract with the Department of
Defense. The Department of Defense purchases all the anthrax
vaccine that they have. They have approximately 5.2 million
doses of anthrax vaccine in inventory right now. Of that, about
3.3 million of it could be approved as an IND, a new drug,
which means that you could use it if somebody would sign and
say that it has not been completely tested and completely
approved.
So there is that 3.3 million. The Department of Defense has
some anthrax vaccine in their inventory, but they, of course, I
am sure, will be using it for the military. And the 3.3 million
or the 5.2 million which is in inventory which has not been
inspected by FDA will go to the Department of Defense.
Senator Durbin. First, let me commend you, because in your
opening statement, you have come to an issue which you have now
talked about several times on food safety. I believe there is a
need here for us to focus on two or three levels. First, what
you have suggested, take a look at the current laws. Where are
they inadequate to meet the current need, safety and security?
Second, find more and higher levels of cooperation between
the 12 different agencies of government that currently are
involved in this. I think what will evolve from that is my
ultimate goal, a single agency. But I am willing to stay on
board with you for the first two steps because they are
critically important.
Can you amplify any further your remarks about what we need
to do to make certain that food does not become a vehicle for
bioterrorism?
Mr. Thompson. Well, first, let me just say, Senator Durbin,
I thank you, because you have been a stalwart in trying to
protect the Nation's food supply. You have been a passionate
advocate and I applaud you for it. I am hopeful that as a
result of these bioterrorism attacks that we have had, that we
will address food safety in America. We have 750 inspectors at
FDA to inspect 56,000 establishments in America. Some of those
establishments are only being inspected 1 out of every 4 or 5
years. Those that cause problems are inspected annually. But it
still does not give me the sense of security that I would like
nor you would like and we do not--we have 132 points of entry
into America for food coming into America from other countries
and we only have 150 inspectors, and as you can tell just by
the sheer numbers, that is not enough.
Agriculture, on the other hand, has reduced the number of
ports of entry down to nine, and I think that this Congress
should take a look at reducing the number of ports of entry,
increasing the number of food inspectors, the laboratory
analysis. You and I talked about this coming over, and I was on
the border as of Monday going to a food inspection station in
El Paso, Texas, and take out a sample and then the sample has
got to be UPS-ed up to Kansas City where it is analyzed and
then the analysis is sent back. To me, that is not a very
effective way to inspect food in America.
Senator Durbin. Thank you. Thanks, Mr. Chairman.
Chairman Lieberman. Thanks, Senator Durbin.
Secretary Thompson, I just want to ask you a few more
questions and then we will thank you for being here, and this
comes back to the focus of this Committee on organization. As
we look at this, we see, as we mentioned before, literally
dozens of Federal agencies that have some part to play in
either preparing for or responding to a chemical or a
biological attack. The Justice Department has a State
assistance program. Federal Emergency Management has a State
assistance program. Your Department has a State assistance
program. There are research programs that are relevant in the
Defense Department, the Energy Department, even the Treasury
Department.
In your own Department, you have got several subdivisions
involved, Food and Drug, the Centers for Disease Control, NIH,
Office of Emergency Planning, and again, before I commended you
for asking Dr. Lillibridge to coordinate those programs.
So here is the concern or the criticism that I have heard,
which is that the question remains, who is in charge? In other
words, you have asserted a strong coordinating role, certainly
over the relevant agencies that come under you as Secretary of
HHS. But is this not still ultimately a kind of stovepipe
situation, where there may be some coordination, but there is
not clearly one person who is in charge of preparing America
for the possibility of a chemical or biological attack and then
coordinating the response to it?
Mr. Thompson. I think you are right. I do not think there
is one person. I think there are a lot of different individuals
involved. Our responsibility is the public health and I think
we do that quite well. We are making it much more responsive
than it has ever been before. By appointing one person to be
the coordinator, Scott Lillibridge, we have also put in place a
lot of other fine individuals, representatives from the various
agencies on a council working with Scott Lillibridge and they
report directly to me.
Especially during this period of time, we are meeting every
morning, every afternoon about updated intel that is coming in
and our responses. We also talk about the problem areas that we
still see and assign people to try and fix them and report back
to us when they are fixed, or if they cannot be, why not and if
they need more resources.
So we have, I think, a well-coordinated operation in the
Department of Health and Human Services, but when you look at
the totality of it, I think that is what Governor Ridge has
been set up to accomplish, is to bring us all together, report
to him. And yesterday, we had a meeting in the White House, and
that meeting went extremely well, with all the various agencies
dealing with bioterrorism coming in to talk about problem areas
as well as common sense solutions.
Chairman Lieberman. I think in your answer you have just
gone ahead and responded to my next question, which was, should
there be one person to coordinate across the various
departments? I take it you have answered that.
Mr. Thompson. Yes.
Chairman Lieberman. At this point, then, I was then going
to ask you, who should it be, and I believe you have said that
it should be Governor Ridge as the head of the new National
Homeland Security Agency.
Mr. Thompson. That is correct.
Chairman Lieberman. We have an ongoing discussion here and
with the administration about the powers that Governor Ridge
should have. I am going to leave that for another day, but I
think you may know that I feel, ultimately, he needs some kind
of budgetary authority to make sure that everybody is working
together. And at some point, and you and he as governors, I
think, can appreciate this particularly where we have got a
crisis now as urgent as the threat of chemical and biological
attack, you have got to have somebody who can say, hey, this is
it. This is what I decide. Do it. That is what you did as a
governor, that is what he did as a governor, and that is what I
think we need here, but that is another question.
Last year, we had a very troubling, interesting, and
educational, I suppose I would say, experience, beginning in
Connecticut, and going around the country, with the outbreak of
West Nile virus. My staff on the Committee here did an
excellent investigation. I was very proud of them. It helped me
to understand it. It took weeks for the Public Health System to
correctly identify the disease. It had not been seen before in
the United States. In fact, at the outset, if I remember
correctly, CDC and other health officials misidentified the
disease as St. Louis encephalitis.
I am not saying this to criticize CDC. That was not an easy
call. But I am raising it to show how difficult it can be in a
broader case of a larger scale chemical or biological attack to
identify the disease as it begins to appear in doctors' offices
or hospitals all over the country.
I wanted to ask you if you have any thoughts about what we
might do at the Federal Government level to improve our
ability, not just on the science, but I guess in one sense to
share information as it may begin to pop up in individual
offices around the country or even a separate geographic area
before we actually have a sense that something pretty bad is
happening?
Mr. Thompson. I think what we need to do, Senator, and you
raise a very valid point. Even though--I am not sure, but I
heard the CDC finally did determine it was----
Chairman Lieberman. They did. They absolutely did. At the
outset, they----
Mr. Thompson. They made a mistake.
Chairman Lieberman. But again, very understandable because
it had not been seen before.
Mr. Thompson. And that is the problem, especially now with
anthrax and the hemorrhagic viruses and so on. They are very
complex and you do not see them every day so you do not have
the knowledge.
Chairman Lieberman. Sure.
Mr. Thompson. So there are certain things you have to do.
You have to really educate the emergency doctors and the
emergency individuals that deal with patients so that they have
some basic information on what to look for.
Second, we have got to strengthen the local health
departments.
Third, we have got to strengthen the State health
departments and we have got to connect them all with CDC, and
there has to be education going from CDC down to all of these
various agencies in order to get a uniformity of instructions
and support throughout the system. And I also think it would be
very valuable if individuals that have gone to CDC and have
been educated as EIS specialists, as you know, and have them
assigned to every State health department and the larger
regional health departments so that they can help advise, put
on these educational programs for the local and State health
departments. I think it would be very beneficial to all of us.
Chairman Lieberman. I appreciate that, and anything you
could do to bring that about, including, and I think is
implicit in what you are saying--I do not have a specific idea,
but some kind of real-time information sharing so that people
can see that similar cases are suddenly turning up in a lot of
different doctors' offices.
Mr. Thompson. That is why we have set up now a 24-hour
hotline at CDC for local health people to call in during this
period of time.
Chairman Lieberman. Right.
Mr. Thompson. I can assure you it is being widely used.
Chairman Lieberman. Thank you. Senator Carnahan, welcome
back. I believe you would like to speak and have some
questions.
Senator Carnahan. Yes, if it is all right, I would like to
make an opening statement.
Chairman Lieberman. Please.
OPENING STATEMENT OF SENATOR CARNAHAN
Senator Carnahan. First of all, I would like to compliment
the Secretary for his rapid and comprehensive response. I think
your demeanor, your advice, all have caused the American people
to have a lot more awareness and a lot more confidence and I
thank you for that.
Since September 11, the Senate has focused on responding to
attacks on our Nation, and now that the Senate itself is under
attack, and I applaud Senator Daschle for responding to this
incident with calm and with resolve. But we are now taking the
next necessary steps to protect ourselves against any future
attacks. We must also act with speed to ensure that our Nation
is prepared, as well. Future attacks may affect many more
people. They may also affect livestock and the food and water
supply.
Unfortunately, many places in the country do not currently
have the capability to respond as quickly and thoroughly as the
United States Capitol, and that is why we are here today. We
must ask the difficult questions. We must address our
vulnerabilities. And we must ensure that we are ready to
respond to an attack anywhere in the United States.
Our best weapon, of course, is public awareness. Rumors and
misinformation just play into the hands of the terrorists. They
create fear and insecurity. We should arm our citizens with
scientific and accurate information.
Today, I am announcing my introduction of S. 1548, the
Bioterrorism Awareness Act. The bill would create an integrated
website containing accurate, scientifically-based information
about bioterrorism. The website will serve as the official
Federal Government source of information for the public.
Currently, there is information on bioterrorism on a variety of
Federal websites. Since the bioterrorism information on these
websites can be very difficult to find, I think where it would
be well for us to select a central location that the public can
go to get accurate bioterrorism information geared specifically
to their needs.
For example, we need to be sure that our doctors know how
to recognize the symptoms of a bioterrorism outbreak. There
will be a section on the website with information geared toward
health care professionals. Another section of the website will
be geared to help farmers and other personnel involved in the
Nation's food supply system to protect themselves, their
livestock, and the Nation's food supply in the case of an
attack.
States are key players in our country's ability to respond
effectively to a bioterrorist attack, and I am pleased that in
a later panel we will have Dr. Maureen Dempsey, Director of the
Missouri Department of Health and Senior Services, here to
testify and to share the State perspective. States need
sufficient resources to prepare for, detect, and respond to
bioterrorist attacks.
To give States these resources, I have signed on as an
original cosponsor to the State Bioterrorism Preparedness Act
sponsored by Senator Evan Bayh. It will give State Public
Health Agencies the resources to have surveillance systems in
place so that they are equipped to detect any pattern of
unusual illness that could indicate a biological attack. This
is just one example of what the bill would support.
In addition, I have asked the Appropriations Committee to
provide $2.5 million for the St. Louis University Center for
Research and Education on Bioterrorism and Emerging Infections.
The SLU Center for Research and Education on Bioterrorism is
the only CDC Public Health Preparedness Center devoted to
bioterrorism preparedness, training, and education. Its work is
more important now than ever before. The funding should help
the center meet the increased demands for its considerable
expertise.
Certainly, we need to be vigilant in this struggle. Given
the resources, I know that our law enforcement officials as
well as our public health authorities can get the job done, but
we need to act quickly and effectively.
Thank you, Mr. Chairman, for calling this very timely and
important hearing and I have one question for the Secretary. In
the last month, we have seen what a powerful role the media can
play in relaying information to the public. The media has the
ability either to calm our fears or to increase our anxiety.
What has HHS done to educate the media on how to communicate to
the public during a bioterrorist attack in such a way that it
minimizes people's fears?
Mr. Thompson. Thank you very much, Senator. Let me
compliment you on the introduction of your bill. It is badly
needed and I hope that you will get bipartisan support for it
and I applaud you for doing that.
Second, what we did first was we wanted to make sure that
we contacted the State health departments and local health
departments. We have what is called the Health Alert Network
and we are hooked up with, at the present time, 37 States. We
have just given out enough grants to have us hooked up to all
50 States. I would like to be able to expand that in the future
so that the HAN, the Health Alert Network, could be expanded
into the counties. There is money in the appropriation bill for
that, and I think that would be the best way in order to get
information.
We also set up a 24-hour hotline in regards to giving
information out and receiving information from local health
departments and doctors, from hospitals and so on who could
call up and give us information and ask questions.
Third, Jeff at CDC, Dr. Koplan, and myself spoke to all of
the health departments on a teleconference last Saturday and we
answered their questions and we are going to do the same thing
tomorrow for the American Medical Association and the American
Hospital Association and get out information through the
teleconference. On Friday, I am talking to all the governors on
a teleconference about what they can do and how they can report
to their constituents on bioterrorism, and next week, we are
going to do the same thing with the country's mayors. Those
mayors who want to hook up on a teleconference, we are going to
be able to do that, or through a webpage.
Finally, last night, we had an informational meeting with
the print press in which we had three doctors and myself answer
their questions over the telephone. There were a lot of press
on, I do not know how many, and we have been holding briefing
meetings through my press office with the press about the
status and things like this. But it is very hard to knock down
all the rumors. We are getting thousands of rumors, as you can
well imagine, and it is difficult to be able to answer all of
those rumors, but we are trying to do the best job we possibly
can.
I would just like to leave you with one thing and that is
that we have to make sure that people understand, even with all
of the individual exposures on anthrax, there still are only
four cases, two in Florida and two in New York, and even though
you are exposed, it is not a disease that can be conveyed to
another individual. It is one that can be treated with
antibiotics, and I am happy to be able to report that of all
the things that we have seen on anthrax, all of them have been
sensitively proven that antibiotics work, and it is not only
ciprofloxacin, it is doxycycline, it is penicillin. By allowing
generic drugs for doxycycline and penicillin, they should be
very reasonably priced so that individuals, if the need be, can
purchase it.
I would not in any way encourage people to horde these
pharmaceutical drugs because the government has got plenty in
supply to be able to take care. We will have enough right now
to handle 2 million Americans with Cipro and other antibiotics
for 60 days and we are asking the Congress to allow us to
purchase and give us the money to purchase an additional 10
million for 10 million individuals, enough supply to handle
then 12 million individuals in America. We are purchasing
vaccine for smallpox and we feel that we will have enough of
that within the year to treat 300 million Americans.
Senator Carnahan. That is exactly the message we need to
hear in America today. Thank you very much, Mr. Secretary.
Mr. Thompson. Thank you very much.
Chairman Lieberman. Thank you, Senator Carnahan.
Secretary Thompson, thanks very much. You have been not
only cooperative and informative, but really reassuring. Again,
I appreciate the fact that you are there, that you are doing
the job you are. I thank you for the specific announcements
that you have made today, the ones that you have just
mentioned, that the American people can be sure that their
government is prepared, and insofar as the Senator first said a
while ago, but we may be under-prepared, we are moving rapidly
to close that gap.
For our part on this Committee, I hope that we can be
supportive in helping you assert your leadership and making
sure that all the agencies and offices of the Federal
Government that have any responsibility or programs for
chemical and biological warfare are well coordinated and
directed, and I think you are right that Governor Ridge is now
the person to do that.
Anyway, thank you, God bless you, and good luck in your
work.
Mr. Thompson. Thank you so very much. Thank you for holding
the hearing.
Chairman Lieberman. Thank you.
We will now call the second panel. Michael Brown is the
Acting Deputy Director of the Federal Emergency Management
Agency. Deborah Daniels is Assistant Attorney General, Office
of Justice Programs, U.S. Department of Justice. Henry L.
Hinton, Jr., is the Managing Director of Defense Capabilities
and Management, U.S. General Accounting Office. Anna Johnson-
Winegar is Deputy Assistant to the Secretary for Biological and
Chemical Defense at the U.S. Department of Defense.
I wonder if I might also call to take a chair at the end of
the table Gary McConnell, who is the Director of the Georgia
Emergency Management Agency, who is testifying on behalf of the
National Emergency Management Association. Why do you not pull
right up in that comfortable chair, Mr. McConnell. I gather
that you have got plane pressure. How soon do you have to
leave?
Mr. McConnell. Mr. Chairman, I will be here as long as you
need for me to. I just need to get back to Atlanta at my
earliest convenience, but if I can get out of here by 1:30 or 2
o'clock, I will be fine.
Chairman Lieberman. Oh, you do? OK. If this panel moves,
maybe we will wait and bring you on on the third panel.
Mr. McConnell. OK, sir.
Chairman Lieberman. If not, I will call you earlier.
I thank you all for your patience under these unusual
circumstances. The testimony you prepared will be submitted in
full as part of the record. To the extent that you can keep
your remarks to 5 minutes, I would appreciate it, but if you
feel like you have some more to say and you need to say it, we
will not physically remove you from the premises, I assure you.
[Laughter.]
Mr. Brown, please proceed.
TESTIMONY OF MICHAEL D. BROWN,\1\ ACTING DEPUTY DIRECTOR AND
GENERAL COUNSEL, FEDERAL EMERGENCY MANAGEMENT AGENCY
Mr. Brown. Thank you, Mr. Chairman, Members of the
Committee. I really appreciate the opportunity to be here today
and speak on behalf of Director Allbaugh and all of the workers
in New York City, the Pentagon, and here at headquarters of the
Federal Emergency Management Agency.
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\1\ The prepared statement of Mr. Brown appears in the Appendix on
page 89.
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What I would like to do is give you a very broad overview
of FEMA's preparedness response activities to both natural and
manmade disasters and how those programs make FEMA uniquely
fitted to deal with the consequences of terrorism, regardless
of the type of terrorism.
But first, I want to talk about the immediate response to
the attacks at the Pentagon and the World Trade Center. On the
day of the attacks, September 11, I was in Big Sky, Montana,
preparing to give a speech about terrorism at 11 o'clock that
morning when I received a phone call that said, ``Turn on your
television. We are under attack.'' I turned on the television
and realized immediately that I needed to get out of Big Sky,
Montana, along with Director Allbaugh. We jumped a military
plane and came back to DC, after finding a military plane that
could get us back there.
But I thought about that speech and the three things that I
wanted to say in that speech on September 11 are equally
applicable today, and it is probably a speech that I could give
anywhere else in the country, any other time in the future.
Three things.
First, this administration recognizes that the first
individuals to respond to the 911 phone calls are the local and
State emergency managers, the fire departments, emergency
medical services, and law enforcement. Those truly are the
first responders. When someone dials 911, they do not call
Washington, DC. They call their local officials.
Second, we rely upon and must rely upon the wisdom and the
experience of those at the State and local levels as we prepare
and work toward a national plan that includes the active
participation of all levels of government.
And third, and probably most importantly, the Federal
Government must provide a comprehensive national strategy to
prepare for terrorist attacks. Our goal, our strategy must be
to provide the best resources, the best education, the best
guidance, and the best training to the State and local
officials to enable them to respond when, indeed, they are
called in that 911 phone call.
I often think of duty honoring country when reflecting on
the events of September 11. The response that day and every day
demonstrates the true heroism of all of those who responded,
fire fighters, policemen, emergency medical technicians, the
emergency managers, all who placed themselves in danger to
respond and help those in need. Many of those heroes tragically
lost their lives that day, rushing to the scene to save lives,
rescuing the trapped and the injured. They were, in fact, being
the first responders. Our hearts hurt with them and for the
innocent families who lost loved ones. Now we must, however, be
prepared for long-term recovery efforts and stand united and
ready to assist those who were injured both physically and
emotionally.
The level of cooperation and professionalism by the
Federal, State, and local agencies and emergency responders in
responding to New York and the Pentagon have been absolutely
outstanding. The American people can and should be proud of the
work that they have done in helping the Nation recover from
those incidents.
At FEMA, our mission is to reduce the loss of life and to
reduce damage to property, and that mission applies to all
hazards, to all disasters, whether those disasters are manmade
or whether they are natural disasters. When a disaster
overwhelms the response capabilities of State and local
governments, the President may sign an emergency or major
disaster declaration. On September 11, the President did that.
Declarations were signed immediately and response of the
Federal Government was immediate.
As in response to other presidentially declared disasters
and emergencies, FEMA utilized the Federal Response Plan to
coordinate the government's response activities to those
disasters. We use this tool, on average over the past 10 years,
53 times a year in responding and coordinating the Federal
Government's response to a disaster. The Federal Response Plan
provides the framework for 26 different Federal departments and
agencies, as well as the American Red Cross, to respond and
support the efforts of State and local governments.
These Federal agencies are organized into interagency
functions based on their authorities and their expertise and
the needs of the counterparts at the State and local
government. For example, as we heard from Secretary Thompson,
HHS is the lead support agency for health and medical needs.
Since 1992, the Federal Response Plan has been used exactly
under this mechanism to respond to disasters, regardless of the
cause. To the Members of this Committee, you are familiar with
the response that FEMA has in natural disasters, whether it be
floods in Ohio or fires in New Mexico, tornadoes in Oklahoma,
whatever it is. You are accustomed to how we respond. That is
exactly how we responded in New York.
The Federal Response Plan worked in New York City just as
it worked in Oklahoma City in 1995. The effectiveness of the
Federal Response Plan has clearly been demonstrated, and that
is why the Federal Response Plan must be used to identify
Federal resources and response capabilities for the threat of
biological terrorism.
Immediately following the attacks on September 11,
President Bush recognized the need to respond quickly and
accurately, to make certain that the Federal Response Plan was
working the way it was supposed to. The President convened
three different working groups to respond to those disasters, a
military or foreign policy response group, a protection
response group, and the group that he asked me to chair, the
consequence management working group.
That group is responsible and is still working today--and,
in fact, Senator, we are meeting this afternoon on another
issue--was responsible for identifying those issues, those
holes, if you want to call them that, in the Federal Response
Plan and how do we fix those. We identified those holes and we
divided them into three categories, first, those holes that we
needed to fix immediately, that we had to fix today. Then those
holes that we need to fix in the next 30 or 60 days, and then
the long-term fixes that we could put off and deal with in a
longer-term situation.
The result of that consequence management working group you
are seeing today. You are seeing, as Secretary Thompson
indicated, the push packs being increased, the vaccine issue
being addressed, the issue of what we are going to do with the
antibodies. All of those issues were addressed by the working
group and briefed to the President and the President had
decision papers directing us exactly what to do with those
issues. That is how the Federal Response Plan is supposed to
work, and, indeed, how it did work.
We see Governor Ridge as the President's spokesman for all
issues regarding terrorism. Yesterday, for example, Governor
Ridge asked FEMA to take the lead in organizing a joint
information center to coordinate all of the efforts going on
between FEMA, Health and Human Services, FBI, Department of
Justice, all of the agencies, so there can be one centralized
location for the administration to put out the message of what
they are doing and what the response should be and how the
American public can respond. We intend to put together packets
for the American public so they will have information that is
helpful to them in responding to this new crisis. Clearly,
groups such as HHS will be involved in that effort.
The threat of a biological attack presents unique
challenges to this country's response system. The first
responders in a biological event shift, as I think Senator
Collins mentioned earlier, from the fire fighter and the
policeman to the doctors, to the Public Health Service, to
those people that will now need to respond in an emergency
situation.
The Department of Health and Human Services is a critical
link between the health and medical community and the larger
Federal response. In all disasters, FEMA works closely with
HHS, the Public Health Service, and the Centers for Disease
Control to make certain that we have the assets and the
response mechanism that we need in this type of incident. In
New York and in the Pentagon, that is exactly what occurred.
Again, as the lead agency with responding and coordinating
a response to a disaster, whether manmade or natural, we have
tasked HHS to put together to the Federal Response Plan a
Bioterrorism Annex so the Federal Response Plan will have in
place for future agencies, for future people working in those
agencies, the response and coordinated effort that they must
have.
Just like Secretary Thompson, Director Allbaugh and I met
yesterday with Governor Ridge to provide him with information
about this very response mechanism. In Director Allbaugh's
testimony yesterday before the Senate Committee on Environment
and Public Works, he stated that he could think of no greater
person than Tom Ridge for the position of the Director of
Homeland Security. FEMA is committed to working with Governor
Ridge in that respect and will implement the strategy that he
asks us to do so.
We kind of see Governor Ridge as the conductor of this
great orchestra, telling us what we need to do and how to do
it. He has the power because he speaks on behalf of the
President of the United States. As Director Allbaugh will also
serve on the Homeland Security Council, FEMA will support the
office to any extent that the governor asks us.
We believe that FEMA is ready, able, and willing to
respond, as seen in New York. We are ready, willing, and able
to respond in any future incidents and believe we have the
mechanism to do so.
Mr. Chairman, thank you for convening this meeting so that
we can discuss about the organizational issues facing the
government at this time.
Chairman Lieberman. Thanks, Mr. Brown. I look forward to
the question and answer period with you.
Ms. Daniels, thank you for being here on behalf of the
Department of Justice.
TESTIMONY OF HON. DEBORAH J. DANIELS,\1\ ASSISTANT ATTORNEY
GENERAL, OFFICE OF JUSTICE PROGRAMS, U.S. DEPARTMENT OF JUSTICE
Ms. Daniels. Thank you, Mr. Chairman and Senator Akaka. I
am pleased to have this opportunity to talk about the Office of
Justice Programs' (OJP) efforts related to bioterrorism and our
coordination with the Department of Health and Human Services
on this critical issue.
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\1\ The prepared statement of Ms. Daniels appears in the Appendix
on page 96.
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As you know, since 1998, OJP's Office for Domestic
Preparedness, to which I will refer as ODP for short, has been
working to help State and local public safety personnel acquire
the specialized training and equipment they need to safely
respond to and manage domestic terrorism incidents,
particularly those involving weapons of mass destruction. Of
course, these efforts have taken on new urgency in the
aftermath of the September 11 attacks.
And as the Senators have suggested this morning, State and
local personnel are on the front lines. They are typically
first on the scene of any emergency and first to respond in the
event of a terrorist attack. ODP is working to ensure that
these brave men and women are well prepared and as well
equipped as possible for these potentially catastrophic events.
Over the past 3 years, ODP has worked to develop and
implement a national program to enhance the capacity of State
and local agencies to respond to domestic terrorism incidents.
We provide coordinated training, equipment acquisition,
technical assistance, and support for national, State, and
local exercises to address a wide range of potential threats,
including chemical, biological, radiological, nuclear, and
explosive weapons.
We also support the efforts of the Department of Health and
Human Services, particularly the U.S. Public Health Service and
the Centers for Disease Control, to deliver training and
equipment assistance to the public health and medical
communities, and we have worked with HHS to test the Nation's
bioterrorism response capacity through the use of field
exercises. This partnership has been beneficial to both HHS and
to our Office for Domestic Preparedness. Whereas ODP has taken
the lead in reaching the public safety and emergency response
community, we have deferred to HHS to lead the preparedness
effort for public health and medical personnel.
ODP's domestic preparedness activities are concentrated in
the areas of training and technical assistance, equipment,
planning, and field exercises. We provide over 30 direct
training and technical assistance courses and programs to
enhance the capacity of State and local jurisdictions to
prepare for and to respond to terrorist attacks on U.S. soil.
Since 1998, we have provided training to over 77,000
emergency responders in 1,355 jurisdictions in all 50 States
and the District of Columbia. We have also completed over 2,000
deliveries of technical assistance to State and local response
agencies, and we are completing delivery of the Nunn-Lugar-
Domenici training program to the remaining 52 of the Nation's
120 largest cities that did not receive all elements of the
program from the Department of Defense before the transfer of
the program to the Justice Department. This training will
include a biological weapons tabletop exercise and briefings on
the U.S. Public Health Service's Metropolitan Medical Response
System, to which Secretary Thompson referred.
ODP is also working with all 50 States, the District of
Columbia, and the five U.S. territories to help them develop
comprehensive 3-year domestic preparedness strategies. These
strategies are based on integrated threat, risk, and public
health assessments that are conducted at the local level. They
will identify the specific level of response capability
necessary for a jurisdiction to respond effectively to a
terrorist incident involving weapons of mass destruction.
Once assembled and analyzed, these plans will present a
comprehensive picture of equipment, training, exercise, and
technical assistance needs across the Nation. In addition, they
will identify Federal, State, and local resources within each
State that could be utilized in the event of an attack. We
anticipate receiving the majority of these strategies by
December 15 of this year. We then will work with each State and
territory to implement assistance specifically tailored to the
needs identified in their own plans.
The Attorney General recently wrote to each governor
stressing the urgency of completing these assessments. He has
directed ODP to place the highest priority on analyzing these
strategies and helping States to meet the identified needs as
quickly as possible.
To give you an idea where we have been in terms of
providing dollar assistance, in fiscal year 1999, States
received a total of $54 million in initial planning and
equipment funds under the program. They are scheduled to
receive an additional $145 million in fiscal year 2000 and 2001
funds as their plans are completed. In addition, from 1998
through this year, we have provided a total of $242 million in
equipment grants for 157 local jurisdictions, the 50 States,
the District of Columbia, and the five U.S. territories under
the County and Municipal Agency Equipment Program. These funds
are helping to ensure that State and local personnel have the
specialized equipment they need to safely and effectively
respond to biological, chemical, or other hazardous incidents.
And as indicated in my written testimony that I have
submitted, OJP, the Office of Justice Programs as a whole,
makes available additional millions to each State in the form
of block grants that can be utilized for law enforcement
equipment for first responders.
Finally, Mr. Chairman and Senator Akaka, ODP provides
funding and technical assistance to state and local
jurisdictions to support local and regional interagency
exercises. These exercises test crisis resistance, identify
procedural difficulties, and provide a plan for corrective
action to improve crisis and consequence management response
capabilities without the penalties that might be incurred in a
real crisis.
In May 2000, we conducted TOPOFF, the largest exercise of
its kind, involving separate locations and a m