S. Hrg. 107-507
THE STATE OF PUBLIC HEALTH PREPAREDNESS FOR TERRORISM INVOLVING WEAPONS
OF MASS DESTRUCTION: A SIX-MONTH REPORT CARD
=======================================================================
HEARING
before the
COMMITTEE ON
GOVERNMENTAL AFFAIRS
UNITED STATES SENATE
ONE HUNDRED SEVENTH CONGRESS
SECOND SESSION
__________
APRIL 18, 2002
__________
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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
Michael A. Alexander, Professional Staff Member
Michelle McMurray, Congressional Fellow for Senator Lieberman
Richard A. Hertling, Minority Staff Director
Jayson P. Roehl, Minority Professional Staff Member
Morgan P. Muchnick, Minority Professional Staff Member
Darla D. Cassell, Chief Clerk
C O N T E N T S
------
Opening statement:
Page
Senator Lieberman............................................ 1
Senator Collins.............................................. 3
Senator Cleland.............................................. 4
Senator Bunning.............................................. 7
Senator Akaka................................................ 8
WITNESSES
Thursday, April 18, 2002
Hon. Tommy G. Thompson, Secretary, U.S. Department of Health and
Human Services, accompanied by Jerry Hauer..................... 10
Margaret A. Hamburg, M.D., Vice President for Biological
Programs, Nuclear Threat Initiative............................ 36
Thomas V. Inglesby, M.D., Deputy Director, Johns Hopkins Center
for Civilian Biodefense Strategies............................. 38
Thomas L. Milne, Executive Director, Governance Support Team,
National Association of County and City Health Officials
(NACCHO)....................................................... 40
Alphabetical List of Witnesses
Hamburg, Margaret A., M.D.:
Testimony.................................................... 36
Prepared statement with an attachment........................ 54
Inglesby, Thomas V., M.D.:
Testimony.................................................... 38
Prepared statement........................................... 67
Milne, Thomas L.:
Testimony.................................................... 40
Prepared statement........................................... 74
Thompson, Hon. Tommy G.:
Testimony.................................................... 10
Prepared statement........................................... 41
Appendix
Article entitled ``Public Health Preparedness,'' Science
magazine, February 22, 2002, submitted by Dr. Hamburg.......... 66
Chart entitled ``Bioterrorism Funding for Selected HHS Agencies''
(submitted by Sen. Cleland).................................... 83
Chart entitled ``Federal Bioterrorism Preparedness and Response
Activities'' (submitted by Senator Cleland).................... 84
Chart entitled ``Sources of Formal Authorities and
Responsibilities of Various Federal Agencies In the Event of
Bioterrorism--Executive Documents'' (submitted by Senator
Cleland)....................................................... 85
Chart entitled ``Sources of Formal Authorities and
Responsibilities of Various Federal Agencies In the Event of
Bioterrorism--Statutory Authorites'' (submitted by Senator
Cleland)....................................................... 86
Questions for the Record and Responses from:
Hon. Thompson................................................ 87
Dr. Hamburg.................................................. 91
Dr. Inglesby................................................. 95
Mr. Milne.................................................... 99
THE STATE OF PUBLIC HEALTH PREPAREDNESS FOR TERRORISM INVOLVING WEAPONS
OF MASS DESTRUCTION: A SIX-MONTH REPORT CARD
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THURSDAY, APRIL 18, 2002
U.S. Senate,
Committee on Governmental Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 9:35 a.m., in
room SD-342, Dirksen Senate Office Building, Hon. Joseph I.
Lieberman, Chairman of the Committee, presiding.
Present: Senators Lieberman, Cleland, Akaka, Dayton,
Carper, Collins, and Bunning.
OPENING STATEMENT OF CHAIRMAN LIEBERMAN
Chairman Lieberman. The hearing will come to order. Good
morning and thanks to all of you for being here.
Today, the Committee on Governmental Affairs examines the
Public Health System's readiness for a terrorist attack
involving biological, chemical, or radiological weapons. This
hearing, which was specifically requested by our friend and
colleague, Senator Cleland of Georgia, follows up on a session
the Committee held last October that exposed a public health
system underprepared to respond to a series of biological
attacks that had occurred in the form of anthrax sent through
the U.S. mail.
I thank Senator Cleland particularly because he has led the
way on so many of these issues. You arrived just in time to
hear me praising you. It could not be better timing or more
well deserved, thanking you for your thoughtful and impassioned
work to increase the security of the American people at home.
In particular, I want to recognize Senator Cleland's efforts to
strengthen our country's ability to respond to biological
weapons by crafting legislation that would establish a much
needed central coordinating office at the Centers for Disease
Control.
Senator Cleland will, I am pleased to say, assume the
chairmanship of the hearing as we go forward and I must leave
to go on to other commitments.
Let me go back to the anthrax attacks of last fall. Five
Americans lost their lives because of their exposure to anthrax
last fall. It was a vicious, fast-acting terror weapon that we
knew very little about. But our ignorance of anthrax and how it
works was compounded by bureaucratic labyrinths that prevented
critical information from getting to those who might have
helped save lives. Fortunately, the anthrax attack, deadly as
it was, was on a relatively small scale. Had it been a wider
attack, I think it is clear that the public health system would
have been quickly overwhelmed.
Today, we are gathered here to ask for a 6-month assessment
of the Federal Government's ability to prepare for and respond
to a future attack, and specifically for an update on the
coordination between public health and law enforcement
agencies, which ran afoul of each other in the midst of last
year's terror.
We are very pleased and grateful to have Secretary of
Health and Human Services Tommy Thompson return as a witness
today to speak about the progress his Department has made on
these fronts.
The first thing that we all learned about a biological or
chemical attack is that it differs from a conventional
terrorist attack and, therefore, requires a different response.
A biological attack would probably follow a more insidious
course. It is a stealth attack, in effect, that might make
itself known slowly and perhaps only intermittently and in
places that are disparate, such as doctors' offices, health
care clinics, or hospital emergency rooms.
As an oversight committee, it is our duty to ask if the
government is prepared to protect American lives should the
unthinkable occur, and the answer today, I believe, is that
despite some promising progress, Americans are still at risk.
Ten major agencies and dozens of bureaus, including the Defense
Department and the intelligence agencies, are responsible for
threat assessments, surveillance of disease outbreaks, the
protection of food and water supplies, developing and
stockpiling vaccines, and assisting State and local governments
in planning, training, and responding to attack. Secretary
Thompson's Department alone has six different agencies involved
in response preparation to bioterrorism and chemical terrorism.
The problem is that each of these dozens of offices, as is
commonly the case throughout government, communicates with its
own particular constituency but too frequently fails to speak
and coordinate with other agencies involved in the same
undertakings. I must say that if we have learned anything from
our examination of homeland security in this Committee over the
last 6 months, it is that poor communication and coordination
among Federal agencies and between Federal, State, and local
governments is clearly one of the greatest impediments to
adequately protecting the public.
I know that Secretary Thompson and the administration are
aware of the daunting task before them. Since October, the
administration has set aside over $1 billion to help States
respond to public health emergencies resulting from terrorism
and it has requested an additional $4.3 billion in the fiscal
year 2003 budget, which is an increase of 45 percent over the
current fiscal year, and all of it to prevent, identify, and
respond to bioterrorist attacks.
Last fall, Secretary Thompson appointed a special assistant
to coordinate the agency's bioterrorism programs and HHS has
developed a central command center where it can monitor
information about bioterrorist attacks and respond accordingly.
As I understand it, the administration also plans to expand
CDC's health alert network, which would connect every county
health system in America to CDC through the Internet, and half-
a-billion dollars is slated for a program to help local
hospitals.
Despite these steps, the Federal Government, I conclude, is
still a long way from where we need it to be, and in the longer
term, we need to build a more robust public health system with
aggressive health surveillance programs to detect the onset of
illnesses, and we need better coordination and better support
for State and local governments and their health care systems.
So it is up to us. Only the Federal Government can ensure
that the necessary programs and structures are in place to
protect the American people from a biological, chemical, or
radiological attack and we must work together, Executive
Branch, Legislative Branch, and private sector and nonprofit
private sector. We must work together to make sure we are
operating from a position of strength and unity to fulfill our
duty in this new post-September 11 age to protect the American
people.
Senator Collins.
OPENING STATEMENT OF SENATOR COLLINS
Senator Collins. Thank you, Mr. Chairman, and thank you for
calling this hearing to look at the progress that has been made
since the anthrax attacks last fall and to assess what remains
to be done to strengthen the Public Health System's ability to
prepare for and respond to a biological or chemical attack.
The tragic events of last September and October were a
powerful reminder of just how vulnerable our Nation is to
terrorism and how woefully underprepared much of our public
health system was to respond to such an attack. Moreover, the
attacks have heightened our fears that we could face an even
more devastating attack in the future, including the
possibility of a mass casualty attack with a deadly biological
agent like smallpox.
Bioterrorism is unlike any other form of terrorism. While
explosions or chemical attacks cause immediate and visual
casualties, the intentional release of a biological agent, such
as smallpox, may at first go unnoticed and, thus, could be far
more insidious. It causes a ripple effect that unfolds over the
course of days or weeks. If not contained, it can spread to
others who were not initially exposed, causing a major epidemic
and posing a real threat to the survival of our population.
The long-term threat of biological weapons is very real.
Moreover, future advances in technology will not only make
these weapons more dangerous, but also make them more
accessible and affordable to those who would do us harm. Tragic
as they were, the anthrax attacks in the fall were, in effect,
a dress rehearsal for what we may very well face in the future.
It is, therefore, extremely important that we take a close
look at what happened last fall, as we are doing in this
morning's hearing, and analyze dispassionately what went well
and what did not.
The hearing held by this Committee 6 months ago in the wake
of the terrorist attacks revealed our Nation's lack of
preparedness to cope with an attack using a biological or
chemical weapon. Witnesses identified a number of weaknesses as
well as a number of factors that are critical to the rapid
detection and response to such an attack. I remember the
testimony that we had about the alert public health lab in
Florida that identified that the first exposure was, in fact,
anthrax. Had that sample been sent elsewhere, who knows whether
the initial case would have been identified as anthrax as
quickly as it was.
Witnesses told us that we need alert health providers who
are trained to recognize the symptoms and signs of a biological
attack, as well as trained to treat such diseases. We need a
core of well trained public health professionals engaged in
disease surveillance. We need an adequate supply of necessary
drugs and vaccines, something that I know that the Secretary
has taken considerable steps to bring about. We need seamless
coordination and communication, as the Chairman indicated, in
order to avoid the problems that we saw last fall. We need a
network of up-to-date public laboratories. And we need strong
safeguards to protect our Nation's food and water supplies.
In addition to strengthening our Federal response, we must
remember those who are going to be the first responders, our
emergency medical personnel, our fire fighters, our police
officers, and our labs throughout the country. Those are the
people who stand on the first line of defense in the event of
any major biological or chemical attack. We must ensure that
they have the capacity to identify the signs of an attack and
the resources to be prepared.
I am, therefore, pleased to have helped to draft the
Bioterrorism Preparedness Act, which passed the Senate last
December and is now in conference. This bill takes major steps
not only to strengthen our Federal response, but to provide
additional substantial new funding to States, local
governments, and hospitals.
Mr. Chairman, our world was forever changed on September
11, and unfortunately, the threats of terrorist attacks that
were once unimaginable are today horrifyingly real. But just as
the terrorist attacks of September and October have caused us
great concern and considerable pain, they have also
strengthened our resolve. I am confident that we are making
progress and I look forward to hearing the Secretary's
testimony this morning and I thank you for holding this
important hearing.
Chairman Lieberman. Thank you very much, Senator Collins.
Senator Cleland, thank you again for your leadership in
bringing this hearing together.
OPENING STATEMENT OF SENATOR CLELAND
Senator Cleland. Thank you very much, Mr. Chairman. May I
just say that I first got into this whole issue of biological
and chemical warfare about 3 years ago in hearing former
Secretary of Defense James Schlesinger talk about the new
threats we faced. As a fellow member of the Armed Services
Committee, you might have been there, too.
It struck me--I shall never forget what he said. We were
discussing nuclear weapons and the scientific challenge that
produced. You had to have some skill, you had to have some
talented people, and you had to have a delivery system,
probably a missile system. But Jim Schlesinger said that, in
terms of biological and chemical weapons, he said you can make
a biological weapon if you can brew beer and you can make a
chemical weapon if you can make fertilizer.
That really shocked me. It put me on notice that, in many
ways, for terrorists particularly, working off of a low-tech
agenda, that the biological and chemical attack was in many
ways the poor man's atom bomb, the poor man's weapon of mass
destruction. And so I became concerned that the country was not
quite adequately prepared to deal with this, in a sense,
stealth or under-the-radar attack.
We went through September 11 of last year and we had the
attack on the World Trade Center and the Pentagon. We scrambled
the jets. Now we are prepared militarily in a second's notice
to scramble more jets. Secretary of Defense Rumsfeld has
created a four-star command looking after the continental
United States, Mexico, and Canada, stationed near the NORAD
headquarters in Colorado. We have nerve centers in the Pentagon
and the situation room in the White House that addresses itself
to an instantaneous response to literally a military or
terrorist attack.
My problem is that I do not think we are that well prepared
in terms of a biological or a chemical attack and I have been
searching for a strategy, searching for the elements of quick
response, coordination, cooperation, and communication in our
strategy for defending our homeland in case of a biological or
chemical attack.
I would like to thank Secretary Tommy Thompson for being
here, a friend, and a great public servant.
The state of our public health preparedness for terrorism,
I think, is lacking in many ways. We are a country looking for
a strategy in how to deal with this issue. I am grateful to
you, Mr. Chairman and Senator Thompson, for calling this
hearing to assess the progress we have made to date to ensure
that our commitment to implementing a strong homeland defense
against bioterrorism does not wane.
Even as the anthrax crisis of last fall recedes, and
Senator Collins mentioned a health agency in Florida that found
that it was anthrax down there in Boca Raton. The interesting
story about that is that the doctor reported it to the public
health entity in the State of Florida, the State public health
operation in Jacksonville, which had just had an employee get
training at the CDC on anthrax. They forwarded the spores to
the CDC and at 3:30 a.m., the CDC said, it is anthrax.
So in many ways, that kicked off this whole discussion of
how does all this work? How does the public health sector work?
What is the role of the CDC? What is the role of HHS? What is
the role of the FBI, and the law enforcement agencies?
In so many ways, our homeland and its defense as an issue
looms as ominously as ever over our heads. I am pleased to
continue our ongoing dialogue with Secretary Thompson on the
matter of bioterrorism preparedness. I, and I think I speak for
all of my colleagues, as well, would like to express our
gratitude to you and to your entire team at HHS for your
efforts to guide our Nation through a very, very difficult
time.
At the outset, I would just like to express my strong
conviction that combatting the threat of bioterrorism will
demand the commitment and full cooperation of us all, of every
relevant resource. Congress and the Executive Branch must work
together toward our common goal, and let me signal to you this
morning, Mr. Secretary, my unequivocal desire to work with you
and the Department of Health and Human Services and the
administration and the Office of Homeland Security and other
relevant Federal, State, and local authorities to build a
strong national defense and a strategy to deal with
bioterrorism.
I would like to commend you and the administration for a
number of steps you have already taken. In the next fiscal
year, the administration has proposed dedicating an
unprecedented $4.3 billion to HHS's bioterrorism initiative, a
45-percent increase. Mr. Secretary, you have named Dr. D.A.
Henderson, the pioneering former Centers for Disease Control
and Prevention official who led the campaign to eradicate
smallpox, an eminently qualified expert on bioterrorism, to
head the new Office of Public Health Preparedness. We are
looking forward to seeing how that office relates to the other
entities involved in bioterrorism. I think the existence of a
coordinating office such as this one is actually essential as a
step forward in coordinating the bioterrorism response.
I am particularly interested this morning in hearing more
from you, Mr. Secretary, on three issues I would like to
explore in depth within the larger subject of our discussion,
which bear strongly on our Nation's preparedness to deal with
the public health consequences of terrorism involving weapons
of mass destruction.
First, I believe we in the Congress have got to provide you
and your Department with whatever resources you need and think
are necessary to protect our country from bioterrorism. We made
a good start when we finalized the budget for the current
fiscal year by increasing bioterrorism funds in HHS ten-fold. I
must express my concurrence with Senator Frist's guarded
assessment, however, that while that is ``enough to take us
from an unprepared state to a more prepared state,'' we cannot
yet say that the public health sector is actually adequately
prepared to deal with the public health implications of
terrorism with weapons of mass destruction.
We must keep in mind that we started this race to catch up
a lagging public health infrastructure just 3 years ago, and
then from a virtual standstill. I think it is, therefore, worth
asking whether the administration's proposed increase for
bioterrorism defense, significant though it is, is actually
sufficient. The magnitude of the threat and the potentially
catastrophic consequences of underestimating our needs demand
that we ask that question, and I will detail several specific
resourcing concerns when we reach the question and answer
period.
Second, Mr. Secretary, I look forward to receiving the
specific details of HHS's One Department initiative. As I
understand it, under the initiative, the Department would
consolidate each of the public affairs and legislative liaison
offices of all the agencies within HHS into one office for each
function under the Secretary. I certainly share a desire to
address the communication challenge, particularly in terms of,
shall we say, an attack when confusion reigns.
I remember one old sergeant down at Fort Benning told me
that war was the most socially disorganized human endeavor. So
when one is under attack, the ability to speak clearly in
communications, we put a premium on that. It can actually
lessen the fear and lessen the terror.
I do have concerns that this proposal, though, while
potentially improving the consistency of communication, might
have at the same time the undesirable and unintended effect of
actually slowing the movement of information from public health
experts in the Federal Government to their State and local
counterparts, and so I am eager to hear more details from you.
Finally, I believe that today, we have got to address the
coordination and communication failures that encumbered the
interaction between public health officials and their law
enforcement partners in last fall's anthrax crisis. We are not
looking here for a witch hunt. We are just looking to figure
out exactly where we are and move forward.
My interest this morning is not in placing blame for past
failures or in revisiting old ground, but we cannot afford to
suffer again the profound disconnect between public health and
law enforcement that we saw last fall. I would very much like
to hear from you, Mr. Secretary, about what has been done since
then to strengthen protocols of coordination and cooperation
and communication between public health entities and law
enforcement, and I proposed some legislation last year to deal
with that and we can get into that.
May I say, in addition, I would just like to offer for your
consideration and input, Mr. Secretary, a proposal I introduced
in the Senate last week to address what I see as an urgent need
for a single center in the Federal Government whose sole
mandate is to counter the threat of domestic terrorism, in
other words, help the country prepare and then help the country
respond. This legislation would create a dedicated National
Center for Bioterrorism Preparedness and Response in the CDC.
Why the CDC? It has got 8,000 employees and they are
located in 39 different countries around the world. It probably
is the finest single public health network in the world and
certainly is a great asset to this Nation, and it operates
based on several centers that are within CDC. So much of CDC's
time now is taken up with planning, executing, and helping to
respond to bioterrorism, somewhere around, I think, 40 percent
of their time now, except there is no center there to focus
their energies and to actually help focus monies and to
actually help us all understand how the monies are being spent
and see if they are being spent wisely.
In closing, Mr. Secretary, I would like to convey to you my
empathy for the difficult task before you. I used to be head of
the Veterans' Administration under President Carter. I have sat
in your seat many times, not with your specific
responsibilities, but I understand the challenges that you face
and we look forward to hearing from you this morning. Thank you
very much for being here.
Chairman Lieberman. Thank you, Senator Cleland. Thanks very
much.
Senator Bunning.
OPENING STATEMENT OF SENATOR BUNNING
Senator Bunning. Thank you, Mr. Chairman, and welcome,
Secretary Thompson and all other witnesses today.
The anthrax attacks on the Capitol last year gave us a
firsthand experience in dealing with a bioterrorist attack and
we got to see exactly where our weaknesses were. To put it
bluntly, we have a long way to go in ensuring that our Nation
can respond to a large-scale biological or chemical attack. We
need better communications, as everyone has said, between the
Federal, State, and local governments. We need more training
for first responders and we need to be able to swiftly identify
the illnesses that are the cause of the attack.
One of the most important things we need during a crisis is
honesty. Those responding to a terrorist attack need to be able
to admit they do not know everything. The American people are
very savvy and the Federal Government will lose all credibility
if conflicting and inaccurate information is given. During a
public health crisis, it is critical that people have faith in
their government that the government is being straight with
them.
The President has made preparing for a biological attack a
very high priority. As you well know, and it has been stated,
in his 2003 budget, the President has requested $5.9 billion,
of which $1 billion is already up front, to prepare for such an
attack. This money would help State and local governments
prepare, conduct more research and development, enhance the
safety of our food supply, and improve our Federal response
capabilities.
All of these are extremely important and I hope that
sometime in the near future, we will begin to feel comfortable
that our responders are trained, our hospitals are equipped,
and that we can handle any attack that might come.
I want to thank our witnesses for being here today and I
look forward to gaining their perspective on this important
issue. Thank you, Mr. Chairman.
Chairman Lieberman. Thanks, Senator Bunning.
Senator Akaka of Hawaii has also been very active in a
leadership role in regard to the threat of bioterrorism and I
am happy to call on him.
OPENING STATEMENT OF SENATOR AKAKA
Senator Akaka. Thank you very much, Mr. Chairman. Thank you
for holding today's hearing on an issue that has occupied the
Committee's attention well before the terrorist attacks on
September 11 and the anthrax mailings last fall.
As Chairman of the Subcommittee on International Security,
Proliferation, and Federal Services, I want you to know that I
appreciate the work we have done together in this Committee on
Federal efforts to prepare for acts of terrorism. I also wish
to thank the Secretary for joining us today. I read your
statement with interest, and I want to commend you for moving
so quickly in enhancing your efforts and facing the issue of
biological and chemical acts of terrorism. As you said, we have
lots to do, and we will do it. What I am saying now, we will
try to do it together.
Secretary Thompson. Thank you.
Senator Akaka. Thank you, Mr. Secretary.
A clear refrain from the hearings we have held was that a
cultural divide existed between the law enforcement and public
health communities. It was evident then that the United States
lacked a cohesive strategy to respond to terrorist attacks
involving weapons of mass destruction. The following points
were apparent from our joint hearing in October.
Local first responders lack the resources to respond
quickly. Emergency responders must be able to communicate and
coordinate seamlessly in the event of terrorist attacks with
WMD. Local public health officials lack the capability to
detect and identify harmful biological agents rapidly.
At the October hearing, Secretary Thompson and I agreed
that current methods were not adequate to deliver continuous
monitoring of the air, water, and food supplies of the United
States. We are not effectively coordinating biological agent
detection research at Federal agencies and academic and
industrial laboratories. The Federal Government is not
unprepared to deal with WMD terrorism, but preparedness levels
are not uniform across the United States.
Much deserved attention has been paid to our crumbling
public health sector. However, efforts to improve our public
health infrastructure will not automatically trickle down to
the medical community. Adequate WMD terrorism training of
health care professionals has been hindered by a lack of
economic incentives for hospitals and clinics. Local and
community hospitals should have the best training and
information in order to protect and treat Americans.
I recently introduced legislation, Mr. Chairman, to support
the development of technologies to minimize the impact of
bioterrorism by alerting authorities and medical personnel to a
biological threat before symptoms occur. Another bill I
introduced will use existing capabilities in the national
disaster medical system to strengthen bioterrorism preparedness
and to expand WMD emergency training opportunities for health
care professionals. This legislation will continue the dual
national goals of advanced biological agent detection
technologies and improved emergency medical response training.
Again, I want to welcome the Secretary to the panel and our
other witnesses today for our hearing and I look forward to
learning what the Department of Health and Human Services has
done in its enhancement in the past 6 months to improve our
public health and professional medical response to potential
terrorist attacks with weapons of mass destruction.
Thank you very much, Mr. Chairman.
Chairman Lieberman. Thank you, Senator Akaka.
Senator Dayton, would you like to make an opening
statement?
Senator Dayton. Mr. Chairman, thank you very much. I would
not. I would just like to hear from the witness and I would
like to thank him for his continuing excellent service to our
Nation following up on his distinguished service as governor.
Chairman Lieberman. Thank you, Senator Dayton.
Secretary Thompson, on behalf of all of us, thanks for the
job you are doing, thanks for being here, and we now look
forward to your testimony.
TESTIMONY OF HON. TOMMY G. THOMPSON,\1\ SECRETARY, U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES, ACCOMPANIED BY JERRY
HAUER
Secretary Thompson. Thank you very much, Chairman
Lieberman. It is an honor to be in front of you. It is a real
honor for me to get an opportunity to tell this Committee what
the Department of Health and Human Services is doing and has
done and will continue to do. Senator Thompson, who is not
here, Senator Collins, Senator Cleland, Senator Akaka, Senator
Dayton, and Senator Bunning, it is my privilege to be in front
of you today and thank you so very much for inviting me.
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\1\ The prepared statement of Secretary Thompson appears in the
Appendix on page 41.
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All of you have been staunch supporters of our efforts on
the homefront in this war. We share a commitment and a passion
to ensuring that Americans can live their lives in safety and
security. Let me begin by thanking you so very much for your
dedication and your patriotism.
Building America's preparedness for a bioterrorism attack
is absolutely of paramount importance to the security of our
country. Should an attack occur, the President is absolutely
committed to making sure that we are ready to handle it quickly
and successfully. Over the past 6 months, the President has put
forth bold plans to build America's homeland security. We
appreciate the support of Congress for the administration's
supplemental request last year and we appreciate your continued
support as we work out a 2003 budget.
As you know, the Department of Health and Human Services
and my office have been working at breakneck speed to build our
bioterrorism preparedness, particularly since the attacks of
September 11. This has included everything from enhancing our
pharmaceutical stockpiles to building a stronger public health
infrastructure, which all of us have to admit was in disarray
and now needs to be bolstered, built, and completed. The
speeding up of research and to do medicine and diagnostic
tools. We continue to get stronger each and every day and I am
extremely proud, Mr. Chairman and Members, to be able to come
to you today to report on the progress that we have made with
your support.
Today, I would like to update you on some of the measures
that the Department of Health and Human Services has taken
already to bolster our overall preparedness and our ability to
respond. Let me begin with our efforts in strengthening the
partnership between the Federal, the State, and the local
governments. In short, we are building a much more cohesive
public health system and doing so faster than many people
thought possible.
Within just 3 weeks after the President signed the
supplemental appropriation on January 10, our Department,
working almost around the clock, put together a program in
structure for dispensing $1.1 billion to the States for public
health system improvements. We are quite confident that no
Federal program of similar size has been created so quickly or
that money of this caliber was moved out of the Federal coffers
so quickly after our legislation became law. But it is a sign
of our commitment and our passion to build correctly, but build
rapidly.
By January 31, we gave States 20 percent of their share, 3
weeks after the signing of the law, of the $1.1 billion program
and asked them to get back to us by April 15, which was this
week, a comprehensive plan for how they would spend the
remaining 80 percent to be able to build a stronger, more
unified public health system in their respective State. The
vast majority of the States gave us the proposed plans. They
came in this week. And the CDC and HRSA are beginning to review
them. We have given about 12 States and territories a dozen
extensions.
The very infusion of this unprecedented level of money into
States is going to force cooperation and the strengthening of
our Nation's health system, and I would like to report that we
are going to analyze and critique and get back to the States
within 30 days all of the reports and give out the remaining 80
percent of the money. That is how fast we are moving.
States, counties, and communities, law enforcement,
hospitals, and the medical community are all going to have to
come together, and we are forcing them to develop that
cohesive, comprehensive public health system that will be able
to handle a bioterrorism event, and those efforts are going to
be linked and coordinated with the Federal Government, and that
is what the comprehensive plan is all about.
And to further strengthen our public health system, the
budget for 2003 provides for another $518 million specifically
to build up hospital preparedness. We had $135 million in the
supplemental bill that went out to hospitals under HRSA. Now we
are requesting an additional $518 million to build upon that
comprehensive, especially in the area of surge capacity for
regional hospitals. We expect this money to be used to upgrade
the capacity of hospitals, outpatient facilities, emergency
medical service systems, as well as poison control centers to
care for victims of bioterrorism.
In addition, the CDC is going to provide support for a
series of exercises to train public health and hospital workers
on how to treat and be able to control bioterrorism outbreaks
together. So, as you can see, one of our highest priorities
right now is building a stronger and a much more coordinated
public health system that works closely together in a time of
crisis. And again, we are moving as fast as possible and
getting stronger as each day passes.
A crucial part of bioterrorism preparedness is the
development of vaccines and the maintenance of the National
Pharmaceutical Stockpile. We are purchasing enough antibiotics
to treat up to 20 million individuals for exposure to anthrax.
We are purchasing sufficient smallpox--and I would like to
point out, when I took over, there was only an order for 40
million doses of smallpox vaccine to be delivered either in
2004 or in 2005. Since I took over, we have increased that 40
to 54 million from one company, 155 million from another
company, and we have 15.4 million in our stockpile which can be
distilled down five-to-one for 77 million, plus we just picked
up an additional 85 million doses from Aventis Pasteur, which
will give us well over 286 million doses of vaccine, enough for
every man, woman, and child, by October of this year. Nobody
thought it could be done.
We are purchasing also additional push packages, going from
400 tons of medical equipment in antibiotics and other
medicines, from 400 tons to 600 tons, from eight push packages,
which are now strategically located around the United States
and in Hawaii, to 12. So we will have much more medicine
supplies available and be able to move it. Our plan is to be
able to move it within 12 hours, but we were able to move
within 7 hours to the City of New York on September 11. That is
how fast we are able to respond.
We found that one of the problems was we can move it faster
than the local units of government can handle it once it
reaches the tarmac at a particular community. So we are now, in
our comprehensive planning, we are finding ways in how we can
bolster that so not only can we move it rapidly, but the local
individuals will be able to dispense and be able to break it
down faster to get it to the hospitals and to the areas where
it is needed.
We are also taking aggressive steps to improve laboratory
security and to be able to protect our food supply that you,
Senator, and I have discussed many times, and accelerate the
research necessary.
While we are doing a great deal right now to strengthen our
infrastructure, we have also made it clear that improving our
bioterrorism readiness will be an ongoing endeavor. That is why
the President has put forth a bioterrorism budget for HHS of
$4.3 billion, which is a 45 percent increase.
Mr. Chairman, this is the largest one-time investment in
the American public health system ever. We are absolutely doing
what it takes to make America secure and we are working to
ensure that our efforts are coordinated from the highest levels
of the Federal Government to the most local levels of health
care delivery.
And along with the new monies I just mentioned for
hospitals, the President's budget provides $1.7 billion for the
National Institutes of Health for research into new vaccines
and diagnostics. We are ready for smallpox, but we want to go
to the next level for anthrax. We want to develop a new vaccine
that is better than the one that is currently being used. We
are also looking for ways for plague, botulism, the hemorrhagic
fever viruses, and tularemia. The FDA is also going to see an
increase for its review of vaccines and diagnostics and the CDC
will see increases for the security of its facilities, as well
as updating their badly needed lab capacity.
Nine-hundred-and-forty million dollars for State and local
organizations to continue their laboratory capacity, increase
epidemiological expertise. We want to get an epidemiologist in
every community that has a county of over 150,000. Provide for
better electronic communication and more distance learning. And
support expanded focus on cooperative training between public
health agencies and local hospitals. This includes funding for
the Laboratory Response Network, which we have set up, which
improves a system now of over 80 public health laboratories
specifically. And to be able to develop for identifying
pathogens that could be used for bioterrorism.
We are working to connect every major county and
metropolitan region with the Health Alert Network. We are at 68
percent capacity right now. We think by the end of this year,
with this new money, we can go from 68 percent to 90 percent of
the population in the United States to be covered by the Health
Alert Network.
Five-hundred-and-eighteen million dollars under the
Hospital Preparedness Program to support outbreak response and
control. It includes funding for the training of public health
and hospital staffs. The increased focus on local and State
preparedness serves to provide the funding where it best serves
the interests of this great Nation.
One-point-seven billion dollars for research. The NIH is
researching for better anthrax, as I indicated, plague, the
hemorrhagic fever viruses, and so on.
Ninety-eight million dollars, and thanks to you, all of
you, for supporting this, in order to keep our food supply. I
have testified in front of this Committee and others that I am
more worried about food pathogens right now because we only
inspect less than one percent of the food coming into our
Nation. We only have 125 food inspectors, ladies and gentlemen,
for 175 ports of entry. It tells us that this is an area that
we have to look at. We have been able now, because of your
support, to be able to double the number of inspectors we have
at FDA. Our budget proposal is going to support a substantial
increase in this number of safety inspections for FDA-regulated
products that are imported into this country.
A-hundred-and-eighty-four million dollars to upgrade our
Federal laboratory facilities and capabilities. This includes
money for the completion of a second infectious disease
laboratory, an environmental laboratory, an infectious disease
bioterrorism laboratory in Fort Collins, one that they can only
do research once in a while because of the decrepit conditions
of that particular laboratory. I have pictures that I would
like to show the Committee and you could see why it is badly
needed for this particular laboratory.
We are going to have an environmental toxicology lab and a
communication and training facility in Atlanta. This funding
will enable the CDC to handle the most highly infectious,
Senator Cleland, and lethal pathogens in the world.
We hope the Senate will continue to support the
administration's effort to strengthen our public health system
throughout the Nation. We need this partnership in a bipartisan
way and I thank you for your past support.
Here at HHS, we are strengthening our coordination, as
well. When I first arrived a little more than a year ago, I
began elevating the bioterrorism efforts into my office and
found that there was nobody there when I came in that actually
coordinated our activities. I named Scott Lillibridge, Dr.
Lillibridge from CDC, as my special assistant on bioterrorism.
This was the first time that bioterrorism had been given such
attention at the highest levels of HHS.
Since then, we now have created--I took one of my hearing
rooms, my big conference room right across from the Secretary's
office and I have turned that into the Office of Public Health
Bioterrorism, which we are able to monitor things 24 hours a
day, 7 days a week from all over the country. We are able to
deploy personnel and medicines from there at a minute's notice,
which has the task--this office has the task of coordinating
and overseeing the bioterrorism preparedness and the response
activities of all the various agencies within HHS.
This office coordinates our efforts and makes sure that HHS
is coordinated with also the other Federal departments, State
and local governments, and other stakeholders. It also makes
sure that our efforts are well executed.
I have assembled a virtual bioterrorism dream team to staff
this office. Dr. D.A. Henderson, an internationally acclaimed
leader in public health, is the Director, and working side by
side and also with me today is Jerry Hauer, a world renown
emergency response expert who we were fortunate to get from New
York City. Also on the team is retired Major General Dr. Philip
Russell, one of the Nation's preeminent virologists, and Dr.
Mike Asher, one of our Nation's leading laboratory experts.
We also have strong relationships with our Federal
counterparts, most notably homeland security. Tom Ridge and I
have a very strong working and personal relationship going back
to our days as governors. We and other teams have worked
flawlessly together and I am very pleased with our working
relationships also with Justice, the FBI, and the Department of
Defense. In fact, the Department of Defense, with all their
surgeon generals, were over this week in my Department and we
were planning how we could interact their research and their
medical teams with our medical teams. We work closely together
and we share information effectively.
The President is creating a strong and united team for
defending our homeland and preparing for our response to an
emergency.
Mr. Chairman, you also requested that I mention a component
of the President's management agenda that involves the
consolidation efforts within the Department. In this budget, we
are taking further steps to coordinate a variety of activities
by consolidating our human resource, our building and
facilities management functions, as well as public affairs and
legislative affairs functions. These functions are very
splintered right now, even within each agency.
Mr. Chairman and Members, we have over 50 public relations
departments. We have over 46 personnel departments. We have
over 200 different computer systems. We have five bookkeeping
systems. We have some of our computers that have 30-year-old
software, and we are trying to bring this now into an
integrated system, and that is what the management is all
about.
By consolidating and coordinating these operations, we will
make sure that we are managing the taxpayers' dollars more
efficiently and speaking to Congress and the American public in
a clear, confident, accurate, honest, straightforward, and
efficient manner.
It is a common sense effort to make sure that when we
communicate, it makes sense to the American people and the
members of the House and the Senate. And in times of national
emergency, clarity and accuracy are absolutely essential.
In summary, our comprehensive effort shows that we are
using all our resources at our disposal, from Federal agencies
to States and localities, to build the strongest defense and
response to bioterrorism. We are doing this quickly and
smartly.
Mr. Chairman, the Department of Health and Human Services
is absolutely committed to working with you, the Members of
this Committee, and Congress, as well as the other Federal
agencies, the law enforcement communities, and our State and
local public health partners to ensure the health and the
medical well-being of all of our fellow Americans. We have made
substantial progress to date in enhancing the Nation's
capability to respond to biological or chemical acts of
terrorism, but there is much more that we can do and will do to
strengthen that response.
In April 1861, as danger loomed before the Union, Abraham
Lincoln issued a two-sentence directive to the then-Governor of
Pennsylvania who had asked his opinion on what to do. He said,
``I think the necessity of being ready increases. Look to it.''
It is in that spirit of swift, effective preparation for the
unknown that we pursue our efforts. We will not rest and we
will not falter until America is as prepared as it possibly can
be.
So I thank you for your support, Mr. Chairman and Members,
very much for your time, as well, this morning. I would be
pleased now to answer any questions you or Members of the
Committee may have.
Chairman Lieberman. Thanks very much, Secretary Thompson,
for all you have done since last you were here. I think we all
agree that we have come some way and we have got a ways to go
to prepare our Nation to cope with chemical and terrorist
attacks.
If I asked you on a scale of one to ten, with ten being the
highest level of preparedness, where would you say we are now
as a Nation?
Secretary Thompson. Once the money is out, I would say we
are at six, going on seven.
Chairman Lieberman. OK, so we have come some ways, but we
have got to go some ways together yet.
Secretary Thompson. Absolutely.
Chairman Lieberman. I appreciate that, and that would be
about my estimate if you asked me that question.
Let me ask you about what you said about funding for
hospitals to meet surge capacity. First, just for the record
and for those who are listening, give us a little bit of a
definition of what surge capacity means in this case.
Secretary Thompson. Surge capacity means being able to take
care of a minimum of 500 to 1,000 individuals immediately in
case of an event such as a bioterrorism attack, such as
anthrax, such as a chemical spill, such as a chemical terrorist
attack, such as a nuclear attack.
What we are doing in that regard, is asking the local
health departments to meet with the State health departments
and for the State medical system to develop a regional surge
capacity right now, within their States, within their
comprehensive plans. Then 2 days ago, I met with the surgeons
general of the Department of Defense with regard to being able
to incorporate--to be able to move in some of their mobile
hospitals in case a more calamitous type of event takes place.
So we want to integrate with the Department of Defense. We
want to integrate with the State health departments so that we
have surge capacities in every region of the country taken care
of immediately. We want to make sure this year we are able to
have surge capacities in every State, hopefully up to 500, and
then, hopefully, up to 1,000 within the next 18 to 24 months.
Chairman Lieberman. So that is the goal now, that within
every State, we would have surge capacity up to 1,000 in every
State?
Secretary Thompson. Yes.
Chairman Lieberman. Do we have----
Secretary Thompson. Now, in the case of smallpox, that is
different, if I might.
Chairman Lieberman. Yes, please. That is exactly what I was
thinking about.
Secretary Thompson. With smallpox, what we would like to
do--we would like to be able to have a large area to be able to
quarantine. We may have a convention center. What we would do,
is go in and inoculate--vaccinate the first responders, the
medical personnel, and then those that would be sick, if, in
fact, there was ever a smallpox outbreak. We would then have
concentric circles around which we would vaccinate all those
individuals, and then we would build a larger circle, and that
is how it was worked out before. So, on chemical emergencies
and smallpox, we have different ways and different
opportunities as to how we would handle a surge capacity need.
Chairman Lieberman. I think, as I hear you answer the
question in that detail, that we have entered a surreal world
which you and I would not have guessed we would be talking
about a year ago, but it is where we are and I think it is very
important that you do exactly what you are doing, which is to
work through the scenarios that are worst case so we are ready
for them.
I hope that you will push both the administration and us in
Congress in terms of funding. As significant as the additional
funding requests by the President have been, if you decide that
we need more in the years ahead, I just think this has to be
now our No. 1 priority. We have to do whatever we can to meet
it.
Let me go on to a different area and that is the question
about the weakness in our preparedness because of the lack of
efficient mechanisms to communicate. One of our witnesses on
the next panel in his written testimony points out that the
Chief of Infectious Diseases at one of America's best hospitals
said that in the midst of the anthrax crisis, he had to get his
medical information from CNN. If we had another biological
attack today, would those communications problems be any less
severe, and if so, why?
Secretary Thompson. We have right now 68 percent of the
population covered by CDC's Health Alert Network. We are going
to be able to expand that this year, up from 68 percent of the
population being covered to 90 percent. My goal is to have
every health department eventually hooked up to the Health
Alert Network.
CDC, and I do not want to question the individuals who are
going to be following me in this testimony, but CDC puts out
weekly reports to doctors. Their medical report went out on
infectious diseases, especially on anthrax. We had weekly
communications with doctors and State medical societies and
hospitals and emergency workers hooked up with CDC. We are
going to be able to expand that, especially with the additional
money that is going out, and we are hopeful that we are going
to be able to get this information very quickly.
We are also going to be putting exercises out into the
States. The health departments--part of the comprehensive plan
is that the health departments have got to put an educational
program put out by CDC into the hands of emergency workers and
the emergency doctors, because that is where the problems would
first arise. So we are already taking that into consideration.
That is all part of the plans that the States put in.
We have also divided the country up into different areas so
that we can send experts in from CDC as well as from our
medical assistance teams. We have about 82 medical assistance
teams across America right now, about 7,000 personnel that we
can send in within hours after an event.
Chairman Lieberman. Is the communication network also going
to make use of existing media, television, radio, and
satellites?
Secretary Thompson. That is one of the new buildings that
is going to be built. Hopefully this year, the planning is
going to start for a new communication building on the CDC
campus. It is one of their next major capital expansions. Also,
we have a website that every day has got new information on it
through CDC and NIH and through the Department of Health and
Human Services.
Chairman Lieberman. Let me ask a final question before my
time expires. As you know, during the anthrax crisis, there was
some concern about exactly who was speaking for the
administration, which led to some confusing and conflicting
messages. In the event of an attack today, is it clear who
would oversee communication with the public?
Secretary Thompson. Yes. Right now, it would be our new
Center for Bioterrorism, which is headed by Dr. D.A. Henderson
and the doctors that I mentioned, in collaboration with CDC,
NIH, and FDA.
Chairman Lieberman. So that Dr. Henderson----
Secretary Thompson. That would be the health thing.
Chairman Lieberman. Right.
Secretary Thompson. But then the White House would have
their spokesperson and Homeland Security would have their
spokesperson. But as relates to health information coming out
of the Department, it would come out of our Center for
Bioterrorism Preparedness.
Chairman Lieberman. I presume, or let me ask, would there
be coordination between the three, between that center,
Governor Ridge, and the White House?
Secretary Thompson. Yes. There is right now and I am sure
there would continue to be. I cannot imagine--but as far as the
Department, it is well coordinated right now and it would all
go up through the Office of Public Health Preparedness.
Chairman Lieberman. Thanks, Secretary Thompson.
My time is up. I am going to yield to Senator Collins and I
am going to give the gavel to Senator Cleland, as I have got to
go off and participate in a debate on the floor. But I thank
you very much and look forward to continuing to work with you.
Secretary Thompson. Thank you very much, Mr. Chairman, for
being here, and thank you for calling us.
Chairman Lieberman. Senator Collins.
Senator Collins. Thank you. Secretary Thompson, let me
begin by thanking you for your strong and effective leadership.
I think we are very fortunate to have you serving in this
critical post at this very challenging time.
I also want to thank you for again recognizing this morning
the vulnerability of our Nation's food supply and the gaps in
the regulatory framework. As you know from our previous
discussions, back in 1998, I chaired hearings in the Permanent
Subcommittee on Investigations that looked at the safety of
imported foods. We did an in-depth investigation that revealed
the statistic that you quoted this morning, that fewer than 1
percent of imported food shipments are inspected, and we also
found that the system was very easily circumvented by
unscrupulous shippers.
For example, tainted food that was checked at the border
and inspected and rejected often was reshipped into the United
States through another port. There was port shopping because
the food was not required to be destroyed, nor was it clearly
marked as rejected.
That gives me great concern, because if the system was that
easily circumvented by an unscrupulous shipper, think what a
concerted, sophisticated terrorist network could do.
So I am very pleased that there are additional inspectors
on the way. I understand that the FDA intends to hire an
additional 670 employees, which will include inspectors,
scientists, and compliance officers. Given this significant
increase in the number of inspectors, do you have a goal for
how many inspections will be performed? There are a lot of
other steps that need to be taken that are included in the
legislation that has passed the Senate, but do you have a goal
for increasing the number of inspections?
Secretary Thompson. We do not have a goal, Senator. We are
going to address that when we get all our inspectors trained.
We also want new equipment because we have a very antiquated
system right now. You bring food in. It may be tainted. It has
to be taken off of a truck or off the airplane, then it has got
to be sent to a lab, maybe in Kansas, and then the shipment has
to be held, impounded until we get the lab analysis back. We
are trying to make sure that we have faster and better lab
analysis at the place that the food is taken off, to check it
and make sure it is not tainted.
We also, of course, as you know, support your language in
the legislation. It is very powerful language as far as
shipments coming into ports. We support you for your leadership
on that.
The conference committee is working on this particular bill
right now. There are a lot of good things in there. We want to
be able to reject food at the port of entry, send it back. We
want to be able to tell a company or an individual that has
sent in tainted food before, prevent them from shipping again.
We want to be able to track back where this food is coming
from.
All of these provisions are in the legislation. We are
hopeful that the conferees will be able to reach an agreement
and get it to us because we badly need those tools.
Senator Collins. I am very pleased to hear you endorse
those provisions, which I worked very hard to have included in
the bioterrorism bill. They have been subject to criticism by
some. I hope we can hold the line because I believe they are
absolutely essential if we are going to improve the safety of
imported food and close what I think is a real gap that makes
us extremely vulnerable.
I want to follow up on an issue that Senator Lieberman
raised. One of the major criticisms of our handling of the
anthrax attacks involved the problems of communication and
coordination. Obviously, we need to do everything we can to
improve communication among the various levels of government as
well as providing prompt and accurate information to help
professionals and hospitals. I, too, was struck by the
statement in the written testimony of the witness to come, who
is Chief of Infectious Diseases at one of our Nation's best
hospitals, and yet he said that he learned a lot of the medical
information from CNN.
Is part of the rationale behind the consolidation plan that
you have outlined today intended to improve the flow of
information and better ensure health care professionals are
receiving consistent, accurate, and clear information?
Secretary Thompson. The consolidation would not have much
of an impact on that because the information going out to the
emergency wards, going out to departments of health, and so on,
for medical personnel comes from CDC. That will continue. It
has to come from CDC because they are the experts and they are
the ones who get the information. It will be better coordinated
and it will be faster and better. But right now, we want to
make sure we get the Health Alert Network up.
What we are talking about in consolidation is to make HHS
more effective. We have over 50 public affairs departments,
divisions in the Department of Health and Human Services and it
is impossible to get a coordinated and correct dissemination of
the information that is necessary to the public out properly.
We want this to flow up in collaboration with CDC, NIH, FDA,
through the Office of Public Health Preparedness, which is
headed by Dr. D.A. Henderson, so that we are able to make sure
that it is correct, that it is straight, and is fast and gets
out there.
But as far as the medical information, that will come
through the Health Alert Network. It will come on the website
at CDC. It will come also from the direct communications from
the laboratories. We have a communications system set up with
80 laboratories across America, connected with CDC. All of
these things will still continue out of CDC.
Senator Collins. Thank you. My related question is actually
a suggestion that results from a conversation that I had
recently with medical director of the Anthem Blue Cross/Blue
Shield insurance company. He pointed out to me that Blue Cross/
Blue Shield has electronic links and E-mails to virtually every
doctor's office and hospital in the United States, and he
suggests that in the event of an emergency, it, too, might be a
network that the Department could use to disseminate
information.
I want to pass that on to you and I was interested to know
whether there are any discussions with Blue Cross/Blue Shield
or other insurers that might have the infrastructure that
perhaps the Federal Government lacks at this point.
Secretary Thompson. Absolutely. We are working on that
right now. Jerry Hauer has met with the American Association of
Health Plans, has met with Blue Cross/Blue Shield, how we can
tap into their database. We are doing all these things. We also
got the pharmaceutical companies, through all of their agents,
distributing information to doctors' offices on various
pathogens and how to discern various infectious diseases, such
as anthrax poisoning. And so we are bringing all the private
sectors we possibly can, using them for the dissemination of
information across America to doctors.
In our plans, we are also going to be setting up
information and evaluations in emergency wards across America.
These are going to be put out by CDC through the State health
departments so that we get this information into the emergency
wards of our hospitals so that they will be able to be better
educated, be able to discern more quickly anything that might
come up. Then they would report that through the Health Alert
Network to CDC. They would report it to the laboratories. Those
laboratories are connected with CDC and it would be almost
instantaneous.
Senator Collins. Thank you, Mr. Secretary.
Senator Cleland [presiding]. Senator Carper, do you have
any comments, remarks, or questions?
Senator Carper. I have some questions, but I do not want to
go out of line. I think others were here before me.
Senator Cleland. Senator Bunning, do you have any comments
or questions?
Senator Bunning. First off, a lot of attention seems to be
focused on combatting bioterrorism in an urban setting.
However, much of Kentucky, as you might suspect, is not urban.
It is rural. How will combatting a bioterrorist attack in a
rural setting be different than in a city? Is there anything
you are doing to specifically help rural communities?
Secretary Thompson. Absolutely. What we are requiring in
our planning is we are requiring every State health department
to work with the local health departments, to work with the
local first responders, and the law enforcement officials to
develop these comprehensive plans that are coming in.
Kentucky has sent in their plan this week and their plan is
going to be evaluated first by CDC. It is also going to be
evaluated by HRSA for their hospitals. Then it goes to our
Office of Public Health Preparedness and they will evaluate it
and make suggestions, if needed, may approve it, may make
suggestions. We have also sent out templates to all the health
departments with regard to what are the best practices that we
have been able to find so they have something to work from.
In the case of Kentucky, they will be working on how to
make sure that rural areas in Kentucky are properly prepared,
working with the first responders, the public health
departments, as well as everybody else, and we have sent out
templates and we have got people from various States, both
rural and urban, coming in to offer consultation to us with
regard to these plans.
Senator Bunning. I understand that, Mr. Secretary, but as
far as our health care system and public health facilities in
Kentucky, most of the rural people have to come to urban areas
to get their health care public health services.
Secretary Thompson. Right.
Senator Bunning. Therefore, if some kind of bioterrorist
attack would occur, say, in Laurel County, in London, Kentucky,
the closest city is Lexington, which is about 65 or 70 miles. A
lot of infection can happen, if it happened to be smallpox, by
just going into Lexington. So are you telling me that----
Secretary Thompson. In the case of smallpox, we would
quarantine that area. We would move in immediately.
Senator Bunning. If you knew it was there.
Secretary Thompson. But we have to find out where it is,
and then we move in immediately.
Senator Bunning. You would quarantine the area that you
would find----
Secretary Thompson. Immediately.
Senator Bunning. Immediately.
Secretary Thompson. And we would send in people----
Senator Bunning. And try to spread out a--would it not be--
--
Secretary Thompson. We would be able to ship in medical
supplies, medical personnel, and experts from CDC within hours
after that takes place. That is what the Health Alert Network
is set up to do.
Senator Bunning. OK.
Secretary Thompson. That is what the laboratory analysis is
set up to accomplish.
Senator Bunning. Would it not be better if we inoculated
and vaccinated our first responders up front?
Secretary Thompson. We are looking at that right now,
Senator, but there are problems with the inoculation of the
smallpox vaccine.
Senator Bunning. Sure there are. I mean, if you did 270
million people, you would have 2,000 or 3,000 deaths.
Secretary Thompson. That is right.
Senator Bunning. I understand that.
Secretary Thompson. And there are some----
Senator Bunning. But if you are doing the first responders,
you are not doing 270 million people.
Secretary Thompson. And that is what we are looking at
right now. We have got a group of specialists from CDC and NIH
and from my office that are working on this right now, along
with State medical societies and input from other medical
personnel. They are evaluating right now whether or not first
responders should be inoculated.
Senator Bunning. Well, you are going to have to do it if
you have an attack.
Secretary Thompson. That is correct.
Senator Bunning. And as long as it is good for how many
years, an inoculation? It used to be 10 years. I do not know
what your new or improved version might be, but----
Secretary Thompson. The common position is it is good for
10 years, but there seems to be, from the experiments and the
evidence we have right now, it is longer than that, Senator
Bunning, that there is a residual reserve capability or
capacity to prevent smallpox.
Senator Bunning. I want to go back to a ``60 Minutes''
interview last September. You made a statement that the United
States was ``prepared to take care of any contingency, any
consequence that develops, for any kind of bioterrorism
attack.'' You also said that ``we would advise on television,
on radio, exactly what to do'' and that we would ``have people
there within hours to take care of it, set up an action plan
and we will implement it.''
In light of all that we have learned about our preparedness
to handle a bioterrorist attack during the anthrax attacks, do
you think making this generalized statement was a mistake or
just premature?
Secretary Thompson. I think that we are better prepared--of
course, we are much better prepared today than we were then. We
were much better prepared than a lot of people thought. There
are a lot of consequences that came in. The statement was too
broad. But I wanted to make sure that people were----
Senator Bunning. Well, I understand the calmness and the
assuring of the American people.
Secretary Thompson. But we responded very effectively,
Senator Bunning, and there were billions, in fact, trillions of
spores of anthrax that were sent through the mail--and it was
the great medical personnel that we had at CDC and the local
health departments that prevented a lot more deaths. Am I
satisfied with the five deaths? Absolutely not.
Senator Bunning. No one is satisfied, but I think that
attack was limited very well as it turned out.
Secretary Thompson. It was, and it was because of the
expertise that we had and the preparation that had been made by
the Department of Health and Human Services, CDC, and NIH. And
now we want to go to the next step.
There is no question, Senator, that the local and State
public health system in America needs a lot more infusion of
dollars and better preparation. That is why we are demanding
these plans be submitted, and we are hopeful with this planning
process and the $1.1 billion that we will be sending out that
we can build a local and State public health system that is
national in scope, that will be able to handle a bioterrorism
attack, and that is what we are getting prepared for. It is a
legacy that you can have and the Department can have and
America can have.
Senator Bunning. I pray for you, then, today and into the
future, because we not only have to be prepared, we are going
to have to be also very fortunate to be able to identify and
quickly treat any kind of a bioterrorism attack and I wish you
godspeed.
Secretary Thompson. Thank you very much, Senator, but if I
could just quickly respond, that is why we divided the country
up into medical assistance teams, individuals we can activate
quickly to be sent in at a very short period of time. That is
why we have expanded our push packages from 8 to 12, our
medical supplies, our medicines, our medical equipment from 400
tons to 600 tons, and we have reduced the time from 12 hours,
hopefully, down to 7 or 8 hours, that we can get 50 tons of
medical supplies into Kentucky within 5 to 6 hours after an
event. As soon as we are notified, we can dispatch that, and
that is what we are hopeful to be able to accomplish and that
is the planning that it is working on right now. And we are
fairly certain that we can deliver on this.
Senator Bunning. Thank you.
Secretary Thompson. But the problem is, once it gets there,
we have got to make sure that the local individuals are going
to be able to use that equipment, use the medical supplies, and
get it to the individuals quickly. And that is what the
planning process is all about.
Senator Bunning. Thank you. Senator Dayton.
Senator Dayton. Thank you, Mr. Chairman. I appreciate the
opportunity to speak. Thank you.
Mr. Secretary, first of all, I want to say that what you
have described here today is highly commendable. The speed with
which you have responded and the progress you have made in
terms of getting money out and getting supplies stockpiled, I
think, is just outstanding and I think our Nation owes you a
debt of gratitude for your efforts on our behalf, so thank you,
sir.
Secretary Thompson. It was the Department, sir, it was not
me.
Senator Dayton. I understand that, but it starts at the
top.
Secretary Thompson. Thank you.
Senator Dayton. But it is a team effort, so I agree with
you.
Since you referenced the Kentucky plan, I have to evidence
a parochial interest. Has Minnesota submitted a plan? I am not
sure of the status.
Secretary Thompson. Minnesota asked for a postponement this
week.
Senator Dayton. All right.
Secretary Thompson. Minnesota asked for an extension to May
15 to deliver their plan, Senator.
Senator Dayton. Thank you. You mentioned the money that you
have put out to the States and that you will be distributing
additionally. In terms of local governments and local hospital
units, public health facilities and the like, does that money
go through the States to the local or does any of that go
directly from your Department?
Secretary Thompson. It goes directly from CDC and HRSA to
the State health departments to implement their plan. They
received 20 percent. Minnesota has received 20 percent of their
amount of money. What is Minnesota going to receive? Minnesota
will go through the State health department.
But what we are forcing the State health departments to do,
in conjunction with the governor, is to work with the city
health departments, the county health departments, the
hospitals, the State medical system, the first responders, and
the law enforcement officials to develop a comprehensive plan
for the State of Minnesota, and we have sent out templates of
what we think a good plan should provide for. The State of
Minnesota will send that.
It will first be evaluated by CDC down in Atlanta. Then it
will be evaluated by HRSA. Then it comes up to Washington, DC,
where we have 11 teams to evaluate these plans after CDC and
HRSA. Experts--doctors and so on from around the country, come
in and evaluate the plans and make recommendations, and then
they will be in consultation with the State health department
officials about those corrections or modifications if there are
any. And then the money will go out, hopefully by May 15, to
those States that have submitted their plans and had them
approved.
We want the money to go out 30 days after a State has
submitted a plan, and that is why we set up 11 teams and that
is why CDC and HRSA are working this weekend to make the first
evaluation.
Senator Dayton. That is tremendous. Thank you.
Secretary Thompson. Minnesota is going to receive
$18,107,000.
Senator Dayton. If they get their plan in eventually?
Secretary Thompson. Yes.
Senator Dayton. Thank you. It refers more to Governor
Ridge's operation than your own, but I just want to ask the
same question. I have had some complaints and a lot of concern
by local officials in Minnesota that they feel they are out of
the loop. They feel they do not have access to information
regarding these developments and what their roles are supposed
to be. Is that, as it relates to your department, then, the
responsibility of the States to communicate with local units of
government, as well, or is there a way in which they can
directly access information, web pages, answering service, or
anything?
Secretary Thompson. The way we have got it set up, Senator,
we have a web page both at NIH, at CDC, HRS, and the Department
of Health and Human Services to get out the information. We
have the Health Alert Network, which now is connected with 68
percent of the counties and the population of America. And by
the year's end, with the money that is going to be sent out,
that should go up to 90 percent.
Then we have what is called the laboratory network in which
we have 80 laboratories, all the State laboratories plus some
other laboratories, hooked up so that they have instant
analysis, can communicate back and forth with one another and
with CDC.
And then if an incident breaks out, we will send an expert
or experts from CDC immediately. If something would happen in
St. Paul and there was an evaluation that there was anthrax, we
would then send that to the State lab, send it to the CDC lab,
get an evaluation. But in the meantime, we would send a team of
experts from Atlanta to St. Paul to work with the local health
department in St. Paul in the hospital, the emergency work to
go over that patient to find out what needs to be done.
Senator Dayton. The reference was made to CNN as a source
of information. I would say that I received in the first 12
hours a good part of my information from CNN and what I found,
and I think other members of Congress found, too, is that our
normal communication lines were ruptured or were so overloaded
that communication was extremely difficult, sometimes
impossible.
You talk about the lines of communication you have
established with States and with the public health centers that
would be called upon in an emergency. How have you adapted that
to the very real possibility that these traditional lines of
communication might once again be disrupted or even ruptured?
Secretary Thompson. Senator, we think we have taken that
into consideration through the planning process and through the
Health Alert Network, by expanding that through the websites
and through the conference calls.
At the height of the anthrax, we used to have weekly
conference calls with CDC and with my office and sometimes with
public health department officials. Anybody could call in and
be connected. It happened either on a Thursday or a Friday. We
also did it with the State medical societies. We did it with
the emergency doctors. And those are the kinds of things, when
there is an emergency, we would start that once again. But in
the meantime, when there is not an emergency, we use the Health
Alert Network, the web pages, and what is put out by CDC on a
weekly basis on updates on medical analysis.
Senator Dayton. Thank you, Mr. Secretary. Thank you, Mr.
Chairman.
Senator Cleland. Senator Carper, do you have any comments
or questions?
Senator Carper. I do. Governor, welcome.
Secretary Thompson. Senator, how are you?
Senator Carper. I am fine. How are you, my friend?
Secretary Thompson. Good, my friend.
Senator Carper. Glad that you could be with us today. We
have gathered in our capital today, and this week, volunteer
firemen and firewomen from around the country. About 250 will
be at the National Fire Institute dinner this evening. I think
the President is going to come to address them. We are having a
ceremony honoring one of our fallen in Delaware, literally in
the Capitol this afternoon. In some respects, they are our
first line of defense in all kinds of emergencies, as you know.
I would just ask, is there any message or anything that you
would especially want me to convey to them on your behalf?
Secretary Thompson. I would just say thank you. Thank you
for the tremendous job that the men and women of the fire
departments, volunteer as well as the paid officials, did
during September 11. They were the calming influence in all
communities across America. They truly did a yeoman's job and
we are in their debt and I just would like to say thank you.
Senator Carper. I will be happy to convey that.
We had a hearing about, I want to say about 6 months ago
when we were reeling with September 11 and then the anthrax
attacks and have had an opportunity to do a whole lot. You have
been very busy, your folks have, as well, and we thank you for
your stewardship and for your leadership in some difficult
times.
I know that Senator Kennedy and Senator Frist have
introduced legislation, I think it is called the Bioterrorism
Preparedness Act. You may have commented on it in your
testimony. I would ask you, could you share with me a thought
or two that you have on what is good about it and maybe how it
perhaps should be changed?
Secretary Thompson. I think it is a wonderful piece of
legislation right now. It sets up an Assistant Secretary for
Biopreparedness Emergency in the Office of the Secretary. That
office is currently being handled by Dr. D.A. Henderson. Jerry
Hauer is the second in command there.
It also allows us to do a lot for food inspections. It
allows us to reject food that has been tainted in the past from
a supplier, from a country. It also allows us to trace back the
tainted food to the supplier. It also allows us to expand our
inspections by giving us some additional personnel that we
badly need. It also allows us to have a much better coordinated
effort in bioterrorism through the Department of Health and
Human Services.
There is another big thing that the Senate, Senator
Feinstein was very active in, and this was, of course, on the
agents, the special agents. We had a meeting in the White House
about it this week and what we are going to do is we are going
to set up a register in the Department of Health and Human
Services for all these agents, and then the Department of
Agriculture has some of their own agents. We have duplication.
And so the Department of Agriculture is going to have a list
and be able to find out what agents are being utilized for
laboratory investigations, what is being transported, and so
on. The Department of Justice will have the opportunity to have
instant access to the registers in the Department of Health and
Human Services and the Department of Agriculture.
Right now, the law is, Senator, that we can only--the only
thing we monitor is the transportation, the transporting of
these bio-agents. We do not know how they are used. We do not
know if they have been used. We do not know what is in
stockpile or so on. And this information, now, that this
legislation is going to give us, is going to help us a great
deal.
Senator Carper. Good. In Delaware, we have been working
over the last couple of years to put into place a disease
tracking system. There is a name for it, the Delaware
Electronic Reporting System. It would----
Secretary Thompson. It is the best in the country, I might
add, Tom.
Senator Carper. Thanks for saying that. I wish I could take
credit. Well, I will take credit for it. [Laughter.]
Secretary Thompson. It happened while you were governor, so
take credit for it.
Senator Carper. One of the things I learned as governor is
when things go wrong, accept the blame. When things go right,
share the credit, so in this case we will give the credit to a
lot of other folks.
But I know that your Department is working on, I think, a
similar national monitoring system and I was just wondering,
how is it going? How far are you along there?
Secretary Thompson. We have taken the template from
Delaware and we have sent that to all the 50 State health
departments saying this is a good example of how to be able to
accomplish this objective. And so we have done that in many
different areas, in communications, emergency preparations, and
surge capacities, and we are sending that out and we are
hopeful that they will use these templates to be able to build
a very positive, comprehensive plan. But Delaware should get
the credit because we have used it and I thank you for it.
Senator Carper. Thank you. Thanks for sharing that credit.
I have heard some people argue that a system like the one
we are talking about, at least on a national level, would not
enable us to detect future attacks like last fall's anthrax
attacks. I do not know if you agree, and if you do, does this
mean it is maybe a less worthwhile investment for us to make as
a Nation?
Secretary Thompson. What was that, Tom?
Senator Carper. There are some who said that a system like
we have in Delaware and that we are trying to spread across the
country would not enable us to detect attacks like the anthrax
attacks of this past fall. I do not know if you agree with that
assessment, but whether you do or not, I wonder if that tempers
at all your beliefs as to whether or not this is a worthwhile
investment.
Secretary Thompson. I think it is a very worthwhile
investment and that is why we are trying to get it incorporated
in all the State plans because we think it is important, that
information.
We also are looking for new innovations, Senator, on how to
detect bioterrorism agents. There are some new innovations out
there and we are hopeful to be able to maybe in the future get
them in public buildings and the Capitol, and so on and so
forth, that could discern if there is anthrax in the area. They
have not been perfected yet. There are some out there, but
there are a lot of innovations, a lot of new things that are
coming to the Department, not only to our Department but the
Department of Defense, and hopefully they will be able to
discern when there is an agent in the vicinity.
Senator Carper. I am struck by the number of usually fairly
small businesses, small technology businesses, just in my own
State who have been to see me to say, we have this technology,
we have this device which we think is quite effective, whether
it is detecting anthrax or some other agent. We have tried to
provide a forum for them through the administration with the
help of the Small Business Administration so that they may have
an opportunity to present to the administration and the
relevant agencies what they have worked on and what they have
developed.
I am just seeing what has come out of one little State. I
cannot imagine what must be coming out of the rest of the
country. My suspicion is that in Minnesota and Georgia and
other places, that Senator Cleland and Senator Dayton are
hearing from their businesses who are coming up with similar
kinds of models that, frankly, we had not thought much about in
recent years.
Secretary Thompson. I think it is very positive.
Senator Carper. The last subject is quite a different
subject and I will just mention this as an aside. The
administration was kind enough, I suspect with your urging, to
invite a number of us in the Senate and in the House who were
interested in next steps in welfare reform to a forum at the
White House this afternoon that I am not going to be able to
attend. I mentioned earlier we have a ceremony honoring one of
our fallen fire fighters that will be in the Capitol literally
right in the time frame that the event at the White House will
be occurring on welfare reform. Do not judge my absence as a
lack of interest.
Secretary Thompson. I know.
Senator Carper. We look forward to working with you on it.
Thanks.
Secretary Thompson. Thank you very much, Senator Carper.
Senator Cleland. I thank all of the Members of the
Committee for involving themselves in this discussion today,
and again, Mr. Secretary, we thank you very much for your help
here.
I just want to get into some basic, fundamental conflicts,
if you will, challenges, problems that we need to work out
together, and I would like to just say again, I would like to
work it out with you, with the Members of the Committee.
Congressman John Lewis has said it beautifully, that we may
have come to this country in different ships, but we are all in
the same boat now, so we are in the same boat here.
I was just sitting here thinking about the difference, the
dramatic difference, I think, between, shall we say, a
military/terrorism attack on the country and when that attack
goes biological. First of all, I think an attack on the country
requires some delivery system. We saw that initially the al
Qaeda went after us at the Khobar Towers with a car bomb, then
later with a truck bomb at the World Trade Center, the two
embassies in Africa, then ultimately a boat bomb against the
U.S.S. Cole, and finally a plane bomb against the World Trade
Center and the Pentagon.
So some overt attack to create mass destruction or
confusion, which is the object of terrorism, which makes it so
terrifying, requires some kind of delivery system. But if you
take that attack biological, that really is very difficult to
detect. The delivery system for killing 100,000 people could be
one envelope delivered to Senator Patrick Leahy's office. The
anthrax spores there, I am told, were enough to kill 100,000
people.
Secretary Thompson. That is true.
Senator Cleland. So I think we have a new ballgame when the
attack goes biological or chemical and it is interesting how
there is really a dichotomy in law and a dichotomy in many ways
in practice that we have now and that we have got to resolve
and work out somehow that led to some of the problems, the
initial problems with responding to anthrax.
In many ways, I could boil it down this way. One part of
our law, based on Presidential directive, says, in effect, the
FBI is the lead dog, the lead agent, and HHS is in support of
FEMA, a back-up agency, in terms of biological help. The other
part of our law, which is actually in law, authorizes the
Secretary of HHS to actually initiate certain things--we can
get into that--to include investigations.
It is interesting, too, we have a FBI and then we have a
bug FBI. The bug FBI is the CDC. They have the epidemiological
investigative service. So when things get buggy, they are the
agent, in many ways, of expertise. They have been around 50
years there in the CDC.
Secretary Thompson. That is right.
Senator Cleland. What I am trying to do is try to make
sense of these great assets and instill or work out some kind
of better coordination, cooperation, and communication.
First of all, I think we have got to acknowledge some of
the problems. Last fall with the anthrax attack, a bug attack
which, thank God, the CDC quickly identified, therein, though,
once the CDC identified it, it became this tug of war between
public health agencies and law enforcement agencies. Just some
examples.
In Trenton, New Jersey, the FBI and public health agencies
could not agree on who should take environmental samples, so
they both did. In Washington, DC, health officials first
learned that there was contamination in several Federal
agencies from the news media, I guess CNN.
In New York, law enforcement officials knew but failed to
notify city health officials that a suspicious letter had been
sent to NBC News until after the first case of infection
surfaced. When the FBI took over in Florida after the CDC had
identified the substance as anthrax, when the FBI took over in
Florida, press briefings by public health officials halted at
the FBI's request.
Another example. Samples collected by the FBI in
Washington, particularly in terms of the Daschle letter, were
sent to military laboratories, Army labs at Fort Detrick,
Maryland, for analysis, not to CDC.
Finally, a Canadian study on anthrax showed that anthrax
spores could escape sealed envelopes in large quantities. At
least half-a-dozen U.S. agencies knew about this study prior to
the anthrax attacks, but because of individual stovepiping of
information, turf battles, budget battles, the CDC did not
know. The CDC had received, interestingly enough, an E-mail
regarding that study on October 9, before the Daschle letter
arrived and before anyone at Brentwood fell ill, but no one
there read it until November.
The problem is, I think we have a problem. Senator Nunn has
indicated something of interest. He played the President in an
exercise called Dark Winter put on by Johns Hopkins in June of
last year, about 90 days before the attack here on September
11. That was a drill on a smallpox attack in America, and out
of that, Senator Nunn testified before the Congress some
challenges.
He said, ``you have got an inherent conflict between health
and law enforcement,'' and he said, ``and to the extent that
they have not coordinated beforehand and do not know each other
beforehand, before the occurrence took place, you would have a
horror show because law enforcement has one set of goals and
health officials have another set of goals.''
What are those goals? Well, law enforcement deals in
secrecy. I understand the FBI wants to keep things secret. The
public health entities, from the CDC on down, deal in openness.
They want to disclose and disseminate information.
I am concerned that the protocols of response, of
communication and coordination between Federal responders in
the event of a bioterrorism attack are not clear.
As I mentioned, executive documents seem fairly
straightforward. The U.S. Government interagency domestic
terrorism concept of operation plan, called CONPLAN, issued in
2001, sets forth how the Federal Government will respond to a
terrorist incident and how the various Federal agencies are to
coordinate with one another in the event of such an incident.
The CONPLAN draws on and is in accordance with authorities
established in two Presidential directives, Directives 39 and
62, the Federal response plan, including a lot of backup.
The CONPLAN designates the FBI as the lead Federal agency
for crisis management in the event of domestic terrorism. FEMA
is designated as the lead Federal agency for consequence
management to ensure that there is only one overall lead
Federal agency at a time. And then HHS is in a support role
under the CONPLAN.
Now, interestingly enough, another directive that you are
caught in is law. It seems that a law, the Public Health
Threats and Emergencies Act, gives explicit authorization to
the Secretary of HHS to declare a public health emergency on
your own, in effect, and in the event of such declaration, to
do whatever is necessary to respond to it, including
conducting, not merely supporting but conducting your own
investigations into the cause and means and steps to be taken.
It seems under the CONPLAN, the HHS can do only those kinds
of things in support, based on request. But the law, the Public
Health Threats and Emergencies Act, in effect, says you have
authority whenever the public health is in danger.
I think somehow we have got to clarify this. I think you
are caught in a bind. There are very real scenarios under which
the interest of law enforcement and public health do conflict.
May I say that the FBI, as the lead Federal agency, is
generally the first agency to obtain new information. If it
decides that a new piece of information has a bearing on public
health, it then communicates that to health authorities. As a
number of experts have noted, the FBI is not a public health
agency. They may not necessarily know what information can be
of significance to public health officials.
I would like to know, what is your understanding now of the
relationship between the roles of law enforcement and public
health in the event of a bioterrorist attack on our country? Do
you feel that you have sufficient authority under the law to
initiate action, whether through the CDC or some other agency
under your command, to, in effect, declare a public health
emergency and begin preparing to deal with it?
Secretary Thompson. As you know, Senator, I did declare a
public health emergency on September 11, and did use that
power. But I think it does need clarifying. I think you are
absolutely correct. There seems to be some confusion, and so in
order to have a more comprehensive way of getting the
information out, we have set up what is called advisory
committees. These are the committees set up by the State and
local health departments and government, emergency management
agencies, emergency medical services, Office of Rural Health,
police, fire department, emergency rescue and occupational
health workers, Red Cross and other voluntary organizations,
the hospital community, community health centers, and other
health care providers. These are the advisory committees that
we have asked the States to put in their comprehensive plans so
in case of an emergency, in case of a bioterrorist attack,
these committees would come together and be able to distill the
information and be able to speak with one voice.
But at the Federal level, I think there is some confusion
and if we could sit down with the Department of Justice and
Office of Homeland Security, I think we could work it out. But
there is very good cooperation. I do not want you to in any way
imply from my answer that there is not good cooperation right
now.
For instance, we have somebody from CDC, and I do not know
if you know this, Senator Cleland, that meets with the FBI
every week with regard to new evaluations on anthrax. So we
have one of our experts from CDC that meets with an FBI team
weekly on their analysis. Jerry Hauer meets with them every
other week with regard to the investigation on anthrax. And I
meet with the Director and other members monthly as to new
developments on anthrax. At the height of it, we met weekly.
So there is great cooperation now, but in the law, in the
emergency rules, there is some confusion that I think needs to
be clarified.
Senator Cleland. And it does seem to me that in case of a
bioterrorism attack, a chemical attack, you have the agencies,
the resources to deal with it and you ought to be the lead dog.
There are other entities involved. I am not sure they make it
better or worse for you to take the lead. There is now the
Office of Homeland Security to coordinate with and now there is
Dr. Henderson in your new office that you have created. You
have got the CDC. You have got the NIH. You have got FEMA. You
have got the FBI.
I think that is my problem, is that we have got about 20
different agencies involved in bioterrorism and what I am
trying to do is kind of sort out the protocol here before the
next attack. In other words, make sure people basically
understand their role and responsibilities when the next time
the popcorn hits the fan so that we do not have to go through
the drills that we went through last fall.
Secretary Thompson. FEMA now defers to the Department of
Health and Human Services on anything and everything that deals
with bioterrorism, and so that has been--it is not in the rule,
it is not in executive order, but that is common practice. And
the FBI has been very cooperative. In fact, I have just been
corrected. We have a full-time official from CDC working in the
FBI right now on the anthrax question.
Senator Dayton. Mr. Chairman, could I just excuse myself? I
am sorry to have to leave. I have a press conference call with
the Minnesota press. I apologize for having to go. Mr.
Secretary, thank you.
Senator Cleland. Thank you very much.
Secretary Thompson. Thank you, Senator Dayton.
Senator Cleland. In the National Journal, HHS spokesman
Kevin Keene is quoted as acknowledging that under the
Department's consolidation plan, one agency or one voice or
something like that, which is a noble enterprise, but I think
we are concerned, I am concerned about whether or not this will
add an additional layer of review by the Secretary's office. I
mean, I understand about speaking with one voice. I also am
interested in speaking with a medical or expert voice as
opposed to a political voice.
I just want to get your understanding of whether or not
what you are trying to do is going to speed up, where speed is
of the essence and communications is of the essence, or slow
down information that your Department has that needs to be
disseminated to the public.
Secretary Thompson. I think it is going to speed it up and
I think it is going to be much more effective, Senator. We do
not in any way want to infringe upon the scientific utilization
of the media. In fact, we encourage it. We want to make sure
that CDC continues to have the Health Alert Network, continues
to have their Public Affairs Department, continues to put out
their MMWR on a weekly basis with information. We want them to
continue to set up the conference calls with regard to how we
get the information out. All of this is not going to be touched
at all.
What we are trying to do--we have got 50 different public
affairs departments, 50 public affairs offices within the
Department of Health and Human Services. In the case of a
bioterrorism thing, we want to make sure that what is going on
in CDC, at NIH, and FDA is coordinated with the new office, and
hopefully the Assistant Secretary for Public Health
Preparedness, and that is headed by Dr. D.A. Henderson, so that
we are able to speak clear, concise, straightforward, directly,
and quickly about the effect.
What we did during the height of the anthrax things, we had
people like Dr. D.A. Henderson, Dr. Tony Fauci from NIH, Jeff
Copeland from CDC, myself, and other individuals who weekly met
with the press and we had a teleconference call for any updates
with regard to bioterrorism.
We would incorporate that so that CDC, NIH, FDA, and the
new office or Assistant Secretary's Office for Public Health
Preparedness would be able to coordinate their message and get
it out quickly, and usually by a doctor.
Senator Cleland. Maybe I am just a little stream of
consciousness thinking here. When the Secretary of Defense
briefs the public, the press, on, say, military operations, he
always has, in effect, the Chairman of the Joint Chiefs
standing there to answer ``military expertise'' questions.
It does seem like that in the homeland defense arena, the
strategy for defending our homeland, if it becomes a biological
issue, there are a number of bugs out there that we can be
attacked with. It seems to me your great agency, particularly
in the CDC, has the capability to draw upon some expert that
knows about that and, in effect, becomes your equivalent of the
Chairman of the Joint Chiefs of Staff standing there answering
questions about that particular bug or device or gas.
Secretary Thompson. That is why we put Jeff Copeland out
just about--we made him available every week with regard to
talking to CNN and talking to the press. We also made available
the Surgeon General, David Satcher, and Dr. D.A. Henderson.
They were the spokespeople, and Tony Fauci from NIH. Those were
the spokespersons for the Department as relates to the medical
provisions of bioterrorism.
Senator Cleland. Experts in the field like Dr. Tara
O'Toole, whose colleague Tom Inglesby we will hear from in the
second panel, keep telling us that we need to have medical
professionals out there answering questions and disseminating
information.
Secretary Thompson. I agree with that.
Senator Cleland. It is interesting that in 1993, during the
hanta virus outbreak, then-Secretary of HHS Donna Shalala
deferred and let C.J. Peters, the Chief of Special Pathogens at
the CDC, take the lead and be the voice of the public health
establishment. I am sure you get that point.
Budget issues--in 2000, the Congress committed to a 10-year
master plan for revitalizing the CDC's World War II era
facilities. I have visited those facilities. How did it get to
be World War II? Well, first of all, in many ways, you had a
little public health operation down there just off the field of
a Naval air station and they were basically an Army operation
dealing with malaria, and in many ways, that is how that grew
there. Actually, back in the 1960's, it was Mr. Woodruff of
Coca-Cola fame who worked with Emory to donate some land across
from Emory and that became, in effect, the CDC headquarters. So
it just kind of grew, but now very much in need of a master
plan to bring it into the 20th Century and out of the World War
II era facilities.
In 2000, we put together about $175 million for buildings
and facilities, actually in fiscal year 2001. Last year, after
the anthrax attacks, we put together about $250 million. The
President came to the CDC and praised the CDC for its work.
That compressed the 10-year plan to about 5 to 7 years, which
we felt was proper for the country to begin getting on top of
the master plan because we could not wait another 10 years for
some terrorist attack.
It seemed to me that the Congress committed at that time to
maintaining a funding level of $250 million per year
specifically for CDC in campus buildings and facilities until
the plan was complete. After we passed that legislation, we
allocated an additional $46 million for security.
The administration has proposed a total of just $90 million
specifically for the CDC's master plan 2003, and I expressed my
concern to you over this meager funding level and you were kind
enough to write back. In your response, you wrote that the
administration proposes $184 million for buildings, facilities,
and security in fiscal year 2003 across the board, which when
combined with $296 million the CDC received for buildings,
facilities, and security last year brings a 2-year total to
$490 million, seemingly close to the needed $200 million per
year.
However, the master plan that Congress committed to is for
the upgrading and revitalization of the CDC's buildings and its
facilities at its headquarters in Atlanta. Funds for needed
security upgrades are not figured into it. Neither are funds
for projects that are not located at the headquarters in
Atlanta.
Of the $184 million the administration has proposed for
fiscal year 2003, $74 million is for the construction of an
entirely new facility in Fort Collins, Colorado, and $20
million for security. That leaves just $90 million for master
plan-related projects, a lower amount even than the $175
million Congress appropriated 2 years ago that will be required
to keep us on a 10-year plan.
My question is, where does the administration's proposed
budget for the CDC put us in terms of implementing the 10-year
plan?
Secretary Thompson. Senator, let me tell you that I totally
agree with the need to upgrade the CDC campus. I have been
there. In fact, I spent a week there as I move my office around
to various divisions. One week out of the month, I spend the
week in Atlanta at CDC.
There are three campuses at CDC, as you know. There are 24
other rented buildings. A lot of the buildings on those
campuses are old, dilapidated, a lot of laboratories, and a lot
of security problems. There is no question that the $250
million is needed. But when you are fighting a war both
internationally and domestically through homeland security, you
have given so much in dollars, you have to put together the
best plan possible.
We are putting $74 million into Fort Collins, which is a
CDC building, which is badly needed. I do not know if you have
seen the pictures, but it is absolutely badly needed. In fact,
some of the research cannot be done during some of the months
of the year because of ventilation and because some of the
encroachment of mice and rats and snakes that get into the
building. So that was a top priority. We had to do the $74
million for Fort Collins.
We have to build a new laboratory, a level four laboratory,
at Fort Detrick, and we have to remodel some labs at NIH in
Montana for NIH. So we looked at the amount of dollars that we
had. We stretched them as far as we could go and that is what
we ended up with.
All I can tell you is that I fully support, and hopefully,
next year, we will be able to do more for CDC. They need to
consolidate and we need to get out of that rental space and we
need to consolidate those buildings on three campuses. But with
the dollars that we had, we put together the budget. We thought
there were higher priorities this year because CDC got a nice
tranche of money last year for buildings, and hopefully, next
year, we will be able to do a better job.
Senator Cleland. You can understand the fact that I feel
strongly about this and will continue to push in the Senate----
Secretary Thompson. I know you do, and I compliment you on
it, Senator----
Senator Cleland [continuing]. For additional monies for the
CDC----
Secretary Thompson [continuing]. And I want to work with
you on it.
Senator Cleland [continuing]. To stick to that effort that
Congress committed itself to and the President, I thought,
signed onto to collapse the 10-year master plan into about a 5-
year plan because we cannot wait on the next terrorist attack.
I would like to just bounce off you this idea, this concept
that I put forward, the National Center for Bioterrorism
Preparedness and Response in the CDC. Again, most of the CDC's
budget is broken down into allocations to centers----
Secretary Thompson. Right.
Senator Cleland [continuing]. In an effort to enhance
coordination, cooperation, and communication, and
accountability for these $6 billion or so we are spending on
bioterrorism among 20 different agencies. In an effort to put
together a nerve center that would operate 24 hours a day, 7
days a week, and be available to provide our first responders
and our citizen with what we need out there, you can understand
that after looking at the master plan, I considered that it
would be a logical step to put together a center there.
Now, what do we mean by a center? One of the concepts that
I had in mind is the concept by Jeff Koplan, the former CDC
Director, about a $65 million center to address the most urgent
security deficiencies in the agency. The current headquarters
facility and emergency operations center are located in
buildings less than 30 feet from a major street. The new, in
effect, center, bioterrorism center, would be located in a
secure spot and house a secure compartmental information
facility for communicating with the Secretary of HHS, the White
House, and intelligence agencies during an emergency.
We have that kind of facility in the Pentagon for outright
attacks. We do not have that kind of nerve center and facility,
situation room, where everybody can be tied in and can
communicate to one another really in times of a bug attack or
bioterrorism attack or chemical attack, and it seems to me that
that would be a logical step that we would include in the 10-
year plan. Do you have any comment on that?
Secretary Thompson. Senator, I agree with you. I thought it
was a great idea. In fact, we were going to look at
reorganizing CDC to accomplish that administratively. But I was
dissuaded, not by people up here, but I was dissuaded by the
people in Atlanta that that was not a good idea, and they told
me the reasons why.
They said that we have bioterrorism in chronic diseases. We
have bioterrorism in infectious diseases. We have bioterrorism
activities in the National Center for Environmental Health. And
we have bioterrorism activities going on at ATSDR for the
Superfund. And we have bioterrorism activities going on with
the State health departments. We think if you consolidated all
of that into one center, that we would lose something in the
process.
So since they were the experts, I listened to them and I
went along with that. But I have to admit that what you are
saying has some merit to it and I would like to work with you
and see if we could accomplish both objectives.
Senator Cleland. I do not want to beat it to death. We are
going to have Dr. Inglesby in a few minutes, and his testimony
and statement says there is a need for experts from a variety
of scientific backgrounds, experts in experimental biology,
epidemiology, infectious disease medicine, anthrax vaccine
science, and immunology to work together on bioterrorism
events. That is his testimony. The CDC center would bring
together these experts.
Interestingly enough, in terms of an attack on this
country, biological agents could be combined with chemical
agents like sarin gas or weaponized in unknown ways. The
combined expertise at the center, I think, could help.
Dr. Jeff Koplan, the former Director of CDC, stated that,
``Dozens of staff representing several of the laboratories and
centers are dedicated to bioterrorism activities, but most do
not focus exclusively on bioterrorism.'' That is the point, I
think, you were making.
Secretary Thompson. Yes.
Senator Cleland. It is illogical to expect these staff to
be more proficient and effective as a team when 70 percent or
more of their time is spent on other duties and 30 percent or
less on bioterrorism.
I would just like to put some of these points in the
record, and we will hear from Dr. Inglesby in just a moment.
But it is something that I will continue to work on because
it does seem to make sense, and also from the private sector,
Bernie Marcus, the founder of Home Depot, along with Art Blanc,
just donated $4 million to the CDC for the very purpose of
equipping a nerve center like this, and I have noticed that
they did not turn that down. [Laughter.]
We will continue to press on in the vineyard.
Secretary Thompson. I congratulated him and thanked him
very much for that. We appreciate that.
Senator Cleland. You have been very kind and very
cooperative today. We thank you very much. We are in the same
boat, and thank you for grabbing your oar and paddling like the
dickens.
Secretary Thompson. Thank you, Senator Cleland, for having
this meeting and thank you for being here, and I want to
cooperate with you and work with you on that bioterrorism thing
and see if we can work it out so that we can come up with a
comprehensive plan.
Senator Cleland. Thank you, sir.
We will have a 10-minute break before the second panel.
[Recess.]
Senator Cleland. The Committee will come back to order. I
have been told that we will have a vote here momentarily, so
let me just move right along.
The Committee has heard an update from Secretary Thompson
on the Department of Health and Human Services' public health
preparedness for terrorism involving weapons of mass
destruction, particularly biological agents. Committee Members
have also addressed their concerns and proposals for
Congressional action.
We are very fortunate today to have our second panel of
bioterrorism and public health experts to respond to our
earlier discussion and to share your insights. I am very
pleased to introduce our panelists.
Dr. Margaret Hamburg is the Vice President for Biological
Programs at the Nuclear Threat Initiative, put together by Ted
Turner and run by Sam Nunn. Dr. Hamburg has testified at
earlier hearings and has been an invaluable resource on
bioterrorism and weapons of mass destruction.
Dr. Tom Inglesby is Deputy Director of the Johns Hopkins
Center on Civilian Biodefense Strategies, a wonderful
operation, and we thank you very much. Dr. Inglesby is also a
physician and specializes in infectious disease medicine. We
are glad to have you.
Tom Milne is Executive Director of the National Association
of County and City Health Officials and has 15 years of
experience as a local public health director in Washington
State. Welcome.
We look forward to hearing an update on public health
preparedness for bioterrorism. Dr. Hamburg, would you please
begin our discussion for our second panel.
TESTIMONY OF MARGARET A. HAMBURG, M.D.,\1\ VICE PRESIDENT FOR
BIOLOGICAL PROGRAMS, NUCLEAR THREAT INITIATIVE
Dr. Hamburg. Thank you very much, Mr. Chairman, for the
invitation today to speak today on the topic of the state of
public health preparedness for terrorism involving weapons of
mass destruction. Certainly, your leadership and commitment in
addressing this challenge come at a crucial time.
---------------------------------------------------------------------------
\1\ The prepared statement of Dr. Hamburg appears in the Appendix
on page 54.
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Since the events of the fall, considerable new money and
attention has been directed towards this problem and they are
vital. The response to the anthrax letter attacks surfaced many
critical concerns about public health preparedness,
particularly with respect to the issues of coordination and
communication that the Committee has indicated a strong
interest in.
It underscored the difficulties of understanding and
coordinating the complex interactions between different
agencies of government, different levels of government, and the
private sector, all of which have important roles to play.
Responding to this bioterrorist attack required new levels of
partnership between public health, medicine, law enforcement,
and the intelligence community. However, these communities did
not have enough previous experience working together and vast
differences in their professional cultures, missions, and needs
clashed.
The events of the fall also highlighted the pivotal role of
the media and how an open and constructive partnership with the
media is paramount in communicating important information to
the public and reducing the potential for confusion, fear, and
panic.
Last, the management of the crisis was complicated by the
fragmented and under-resourced infrastructure for public health
and an already strained health care system.
Many things must be done. I have submitted much more
detailed formal testimony for the record and I am also
submitting a recent editorial I did in Science magazine on
public health preparedness for the record.\1\
---------------------------------------------------------------------------
\1\ The Feb. 22, 2002 article entitled ``Public Health
Preparedness,'' from Science magazine submitted by Dr. Hamburg appears
in the Appendix on page 66.
---------------------------------------------------------------------------
I want to take my time now to mention a few broad concerns
related to the problems of coordination and communication.
First, a comprehensive and systematic evaluation of the
anthrax response should be undertaken. Surprisingly, this has
not yet been done, to the best of my knowledge. Looking within
and across the relevant agencies of government, levels of
government, and at the relationships of private sector
organizations, an informed analysis with identification of gaps
in preparedness and response and realistic recommendations for
improvement will be of enormous value. A number of entities
could undertake this, but there is some urgency to do so before
events fade from memory and new priorities overwhelm us, and it
cannot just be an individual agency by agency listing of
lessons learned but a true cross-cutting analysis.
Clearly, we need comprehensive integrated planning. As
Senator Cleland noted, we still need to more clearly define the
relative roles and responsibilities of different agencies
involved and the mechanisms by which they will interact and
work together and do this before we are in the midst of a
crisis.
In addition, we still have not adequately prepared top
officials to cope with this new type of security crisis. We
have not invested adequately in the planning exercises needed
to implement a coordinated response, and we have not adequately
educated the American people or developed strategies to
constructively engage the media to communicate critical
information about what is happening and how to protect
themselves.
The new Office of Homeland Security is clearly key to such
efforts, but there are concerns. It is difficult to imagine how
Governor Ridge can successfully bring together and coordinate
all the myriad agencies responsible for the different aspects
of homeland security without budgetary authority, or at a
minimum, budget review and sign-off authority, and cabinet-
level status making him at least co-equal to the other members
of the homeland security team.
In addition to the Executive Branch, coordination is needed
with respect to the activities here in Congress. I am told that
literally dozens of committees and subcommittees are involved,
and given the complex and multi-disciplinary nature of the
problem, it is not surprising that a wide array of committees
would have a role to play and completely appropriately.
Nonetheless, assuring the comprehensive and well-integrated
strategies needed will not occur unless there is equivalent
integration, coordination, and communication among committees
and leadership on the Hill, and I think this Committee is well
positioned to help serve that effort.
As noted by others, key to effective public health
preparedness is public health itself. It is an important pillar
in our national security framework and must be a full partner
at the table. The chair is closer today than it was before, but
it still is not full square there. Public health expertise must
be a prominent component of the new Office of Homeland
Security, and a public health official, in my view, should
become part of the White House National Security Council.
And on the ground, there is an urgent need to strengthen
and extend the core capacities of our public health system. Our
infrastructure----
Senator Cleland. Dr. Hamburg, we have a vote called. If you
do not mind, could you submit that for the record?
Dr. Hamburg. Certainly.
Senator Cleland. Dr. Inglesby, could you say some wonderful
things to us, and Mr. Milne? I would hate to leave here and let
you all hang. Could we move to Dr. Inglesby?
Dr. Hamburg. Certainly.
TESTIMONY OF THOMAS V. INGLESBY, M.D.,\1\ DEPUTY DIRECTOR,
JOHNS HOPKINS CENTER FOR CIVILIAN BIODEFENSE STRATEGIES
Dr. Inglesby. Senator Cleland, thank you and the other
distinguished Members of the Committee for this hearing.
---------------------------------------------------------------------------
\1\ The prepared statement of Dr. Inglesby appears in the Appendix
on page 67.
---------------------------------------------------------------------------
First, I would like to say that it is important to
understand that the anthrax attacks of 2001 produced an
extremely complicated set of management problems. CDC had to
act faster than it ever had acted before, had to work with
public health agencies like it had never done before,
communicate with clinicians and nurses like never before, on a
scale and a speed which was unprecedented. So there were
professionals in all of these agencies, public health agencies,
working around the clock, extremely dedicated, with the best
intentions and a number of good successes throughout the
crisis.
But with all this being said, in my analysis, there are at
least three categories of communication breakdowns that are
worth calling attention to as we figure out what to do as we
move forward. The three categories were the processes of
incoming communication, the processes for resolving scientific
issues during the crisis, and the processes of outgoing
communication.
I mean by incoming communication the processes by which
clinicians and doctors who are seeing illnesses or suspected
illnesses could communicate their concerns to public health
agencies and to the CDC. In addition to that, there were data
streams coming from a variety of directions regarding
environmental health data and laboratory data which were coming
forward at a pace and of a scale which had never been done
before. So simply the task of integrating the data and
processing it and forwarding it to public health decisionmakers
was a tremendous challenge for public health agencies.
The second category of issues regarded what you mentioned
before on the first panel, and that was the processes for
resolving the complicated science issues that arose during the
crisis. Most people look to CDC for their technical expertise
to resolve scientific questions, and that is absolutely
appropriate. But during the crisis, we saw science questions
that could not be solved by people within CDC alone, and CDC
certainly was aware of that and tried to develop processes to
answer questions.
But as an example, we ask the question: ``Who should get
the anthrax vaccine, if anyone? '' Of those affected by the
anthrax crisis? To answer that question, you needed to know how
likely it was that anthrax spores would cause disease after
weeks of being in the body dormant? How likely was it that you
could diagnose anthrax safely early after the infection begins?
How much anthrax vaccine do we have and when will we have more?
How safe are the existing anthrax vaccine stocks? All of these
questions mandate that we have a variety of scientific
competencies at the table, and you have mentioned those
already.
Senator Cleland. Dr. Inglesby, can we have you summarize
and move on to Mr. Milne?
Dr. Inglesby. Absolutely. So I think, in short, the highest
level recommendations I would submit for improving
communication: (1) improved connectivity between public health
agencies and the medical system. There is a breakdown there
that is real. Doctors and nurses are not part of the Health
Alert Network. So even if we resolve problems of the Health
Alert Network, doctors and nurses are still out of the loop.
(2) Clinical information needs to get around the system, as
well. Doctors and nurses have a responsibility for figuring out
how we are going to get information to each other, and that is
a separate problem. Once it is in our system, how do we get to
each other?
(3) How do we resolve science questions in the middle of a
crisis? How do we communicate better with the p