[Senate Hearing 107-213]
[From the U.S. Government Publishing Office]
S. Hrg. 107-213
FEDERAL EFFORTS TO COORDINATE AND
PREPARE THE UNITED STATES FOR
BIOTERRORISM: ARE THEY READY?
=======================================================================
JOINT HEARING
before the
GOVERNMENTAL AFFAIRS
COMMITTEE
UNITED STATES SENATE
and the
INTERNATIONAL SECURITY, PROLIFERATION
AND FEDERAL SERVICES SUBCOMMITTEE
ONE HUNDRED SEVENTH CONGRESS
FIRST SESSION
__________
OCTOBER 17, 2001
__________
Printed for the use of the Committee on Governmental Affairs
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WASHINGTON : 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
David M. Berick, Professional Staff Member
Hannah S. Sistare, Minority Staff Director and Counsel
William ``Bill'' M. Outhier, Minority Investigative Counsel
Darla D. Cassell, Chief Clerk
------
INTERNATIONAL SECURITY, PROLIFERATION AND FEDERAL SERVICES SUBCOMMITTEE
DANIEL K. AKAKA, Hawaii, Chairman
CARL LEVIN, Michigan THAD COCHRAN, Mississippi
ROBERT G. TORRICELLI, New Jersey TED STEVENS, Alaska
MAX CLELAND, Georgia SUSAN M. COLLINS, Maine
THOMAS R. CARPER, Delaware GEORGE V. VOINOVICH, Ohio
JEAN CARNAHAN, Missouri PETE V. DOMENICI, New Mexico
MARK DAYTON, Minnesota ROBERT F. BENNETT, Utah
Richard J. Kessler, Staff Director
Sherri Stephan, Professional Staff Member
Mitchel B. Kugler, Minority Staff Director
Eric E. Desautels, Minority Professional Staff Member
Brian D. Rubens, Chief Clerk
C O N T E N T S
------
Opening statements:
Page
Senator Lieberman............................................ 1
Senator Thompson............................................. 4
Senator Akaka................................................ 5
Senator Collins.............................................. 19
Senator Levin................................................ 22
Senator Durbin............................................... 25
Senator Carnahan............................................. 30
Prepared statement:
Senator Bunning.............................................. 75
WITNESSES
Wednesday, October 17, 2001
Hon. Tommy G. Thompson, Secretary, U.S. Department of Health and
Human Services................................................. 7
Michael D. Brown, Acting Deputy Director and General Counsel,
Federal Emergency Management Agency............................ 34
Hon. Deborah J. Daniels, Assistant Attorney General, Ofice of
Justice Programs, U.S. Department of Justice................... 37
Henry L. Hinton, Jr., Managing Director, Defense Capabilities and
Management, U.S. General Accounting Office..................... 40
Anna Johnson-Winegar, Ph.D., Deputy Assistant to the Secretary of
Defense for Chemical and Biological Defense, U.S. Department of
Defense........................................................ 42
Gary W. McConnell, Director, Georgia Emergency Management Agency,
on behalf of the National Emergency Management Association..... 53
Maureen E. Dempsey, M.D., F.A.A.P., Director, Missouri Department
of Health and Senior Services.................................. 58
Margaret A. Hamburg, M.D., Vice President for Biological
Programs, Nuclear Threat Initiative............................ 62
Amy E. Smithson, Ph.D., Director, Chemical and Biological Weapons
Nonproliferation Project, The Henry L. Stimson Center.......... 66
Alphabetical List of Witnesses
Brown, Michael D.:
Testimony.................................................... 34
Prepared statement........................................... 89
Daniels, Hon. Deborah J.:
Testimony.................................................... 37
Prepared statement........................................... 96
Dempsey, Maureen E., M.D., F.A.A.P.:
Testimony.................................................... 58
Prepared statement........................................... 143
Hamburg, Margaret A., M.D.:
Testimony.................................................... 62
Prepared statement........................................... 152
Hinton, Henry L., Jr.:
Testimony.................................................... 40
Prepared statement........................................... 107
Johnson-Winegar, Anna, Ph.D.:
Testimony.................................................... 42
Prepared statement........................................... 124
McConnell, Gary W.:
Testimony.................................................... 53
Prepared statement with an attachment........................ 132
Smithson, Amy E., Ph.D.:
Testimony.................................................... 66
Prepared statement........................................... 164
Thompson, Hon. Tommy G.:
Testimony.................................................... 7
Prepared statement........................................... 77
Appendix
Chart submitted by Mr. Hinton entitled ``Examples of Coordination
Activities on Bioterrorism Among Federal Departments and
Agencies''..................................................... 123
Letter from the U.S. Department of Justice responding to question
posed by Senator Akaka to Ms. Daniels, dated June 25, 2002..... 176
Meryl Ness, M.D., prepared statement............................. 178
FEDERAL EFFORTS TO COORDINATE AND PREPARE THE UNITED STATES FOR
BIOTERRORISM: ARE THEY READY?
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WEDNESDAY, OCTOBER 17, 2001
U.S. Senate,
Committee on Governmental Affairs,
and the Subcommittee on International
Security, Proliferation, and Federal Services,
Washington, DC.
The Committees met jointly, pursuant to notice, at 9:37
a.m., in room SD-342, Dirksen Senate Office Building, Hon.
Joseph I. Lieberman, Chairman of the Committee, presiding.
Present: Senators Lieberman, Thompson, Akaka, Levin,
Dayton, Carnahan, Durbin, Domenici, and Collins.
OPENING STATEMENT OF CHAIRMAN LIEBERMAN
Chairman Lieberman. The hearing will come to order. I thank
all of you for being here, particularly our witnesses.
This morning, this Committee will try to provide answers to
the urgent question of whether our government at all levels is
organized adequately to respond to biological and chemical
attacks on the American homeland. Senator Thompson, who will be
here in a few moments, and I are pleased to hold this hearing
in conjunction with the Subcommittee on International Security,
Proliferation, and Federal Services and its able Chairman and
Ranking Member, Senator Akaka of Hawaii and Senator Cochran of
Mississippi.
As we are now painfully and, in this Capitol Hill area,
personally aware, the past week has brought one story after
another of anthrax attacks, biological attacks, endangering
hundreds of innocent civilians and actually infecting over a
dozen people, and by this morning's calculation, actually, a
significant number more throughout the United States.
Here on Capitol Hill, a wing of the Hart Building was
quarantined. Senators and staff were undergoing testing and
mail delivery came to a halt when anthrax was identified in a
package delivered to the Majority Leader's office. We have
received word today, which I presume will be dealt with in an
announcement that will be made this morning, that a number of
members of Senator Daschle's staff are now known to have been
infected by the anthrax that came to his office and they are
being treated appropriately.
These incidents and the countless false alarms and hoaxes
people are experiencing daily have put many Americans into an
understandable state of high anxiety over this threat to our
public health.
This morning, I hope, and am confident, that we can calmly
discuss the facts, offer reassurance to the public that the
Federal Government is on duty and rapidly improving our
preparedness to respond to whatever may come. The sad fact is
that we have now entered an era when the previously
theoretical, with regard to chemical and biological attacks,
has become altogether real.
Although it is clear to me that our government still has a
lot of work to do, the reassuring fact is that the response of
our Public Health System over the last 2 weeks is just about
what we would have hoped it would be. There has been quick
detection, identification, treatment, and containment of the
problem and that has clearly and thankfully minimized the
casualties.
I want particularly to commend our first witness, Secretary
of Health and Human Services Tommy Thompson, for his leadership
in responding to this crisis, in calming a tense Nation, and in
urgently acting to improve our response systems to this now
very real threat.
The Governmental Affairs Committee is an oversight
committee. We are charged with the specific mandate to ensure
that the Federal Government is organized effectively to fulfill
its responsibilities. In today's hearing, therefore, we are
going to focus on the organizational aspect of this new threat,
and that is the question of whether we are organized and
coordinated adequately, since there are scores of Federal
bureaus and departments that are involved and will continue to
be involved in responding to bioterrorism or chemical
terrorism.
Ten major agencies and dozens of bureaus, including the
Defense Department and the intelligence agencies, are
responsible for, among other things, threat assessments,
surveillance of disease occurrences, surveillance of food and
water supplies, developing and stockpiling vaccines, and
assisting State and local governments in planning, training,
and responding.
Secretary Thompson's Department itself has six different
agencies involved in bioterrorism and chemical terrorism, which
is why, Mr. Secretary, I think it made such good sense and was
an act of real leadership for you to appoint a Department
coordinator last July, before the current threats became real.
This morning, we are also going to look at coordination
between the Federal Government and State and local governments
and their public health systems because these are the people on
the front lines of homeland defense and they will be called
upon to respond first.
The possibility of a biological or chemical attack poses a
completely different kind of threat, requiring a different kind
of response, from a different set of responders than the one we
witnessed on the dark day of September 11. That day, events
were visibly and immediately seen by, in fact, millions of
people on television and the catastrophe required conventional
fire, rescue, and medical capabilities, obviously on a large
and huge scale.
On the other hand, a biological or chemical attack might
well unfold in a very different way. It might not be
immediately visible. It could emerge slowly in different
locations, in neighborhoods, offices, workplaces, in mailrooms,
doctor's offices, clinics, emergency rooms, and public health
department laboratories. And a completely different set of
people, mostly medical personnel, would be the first to
respond. They would be our first line of defense.
Some biological agents, such as smallpox, are contagious
and would spread rapidly throughout the population. A
government exercise simulating a biological attack conducted
earlier showed that such diseases could, in fact, greatly
challenge State and local medical capabilities to respond.
But there is some better news here and that is that we do
have systems and equipment in place to respond to an attack of
this sort, and as we are going to hear today, the Federal
Government has really begun to organize the pieces that will be
needed to contain biological or chemical attacks that might
occur on a large scale.
The Health and Human Services Department is, for instance,
developing an Internet-based surveillance system to gather data
on disease incidents that would allow a real-time analysis. The
Pentagon is developing civil support teams within the National
Guard in every State. And State and local officials are
increasingly well trained to deal with these attacks.
But the systems that are in place clearly need to be
strengthened. Real preparation for these types of attacks did
not even begin at the Federal level until the late 1990's, so
many agency plans and programs are still incomplete. There is
duplication and overlap because of traditional government
stovepipe structures and the inevitable turf battles that
accompany this kind of overlap. Add to this the fact that there
does not appear to be one single central executive agency
involved and it is hard not to conclude that the Federal
Government has a series of organizational decisions to make,
and quickly.
Federal support for State and local governments and health
care systems must also grow to meet the growing challenge.
These are the agencies that employ the local heroes, the
emergency medical technicians, the police, the fire fighters,
and the hospital emergency room workers.
While Federal funding for response to terrorist attacks
involving biological and chemical weapons has increased in the
past 3 or 4 years, not enough of that, from what I can see, is
reaching the State and local levels. We need, therefore, to
build a robust Public Health System now, capable of aggressive
surveillance programs, early warning systems to quickly detect
the onset of illnesses and then respond immediately. We need
adequate inventories of the appropriate pharmaceuticals and we
need better coordination and support for State and local
governments and their health care systems.
It seems to me that, ultimately, only the Federal
Government can ensure that the capabilities to protect our
citizens in the event of biological and chemical attack are in
place, and I hope this hearing and, in fact, this Committee can
help the Federal Government do that as quickly as possible.
Senator Thompson.
OPENING STATEMENT OF SENATOR THOMPSON
Senator Thompson. Thank you very much, Mr. Chairman, and I
thank Secretary Thompson for being with us. I, too, want to
commend him for the steadying influence he has had on all of
this. It is a delicate balance that he and others in the
administration have to walk in telling the truth to the
American people on the one hand and not being unduly alarmist
on the other, and frankly, I think you are doing an excellent
job of that.
Last Friday, we held a hearing to discuss the structure of
the new Homeland Security Office in the administration. Today,
we look a little closer at some of the more specific challenges
that the Director of that office will face with regard to
biological and chemical attacks.
Concerns about these issues are not new. Two months ago,
the International Security, Proliferation, and Federal Services
Subcommittee held a hearing to discuss our level of
preparedness for a biological attack. There have been over ten
different hearings held in Congress this year on the biological
and chemical threat and the Federal Government's response
capabilities. Moreover, in the ``Government at the Brink''
report I released earlier this year, I noted that combatting
terrorism was an area of potential overlap and fragmentation,
issues that I believe we will be discussing more today.
While these concerns may not be new, there is a new sense
of urgency. There have been anthrax attacks now in three
States, as well as here in Washington. Our Committee office was
shut down yesterday and again today because of its proximity to
Senator Daschle's office, and our staff has had to undergo
testing. Mr. Chairman, your own personal office has been shut
down.
Clearly, we no longer have the luxury of time to deal with
the bioterrorism threat and our government's response. The
challenge we have before us is to determine how we can, at the
Federal level, best prepare our country for chemical and
biological attacks.
As a Nation, we do have certain priorities in this area.
First, ensuring that local officials are prepared for an
attack. Especially in dealing with a biological attack, the
first responders on the first line will be the local medical
personnel and community public health officials. How well
trained and ready they are will be the biggest factor in our
success or failure in dealing with these attacks.
Second, the Federal Government must provide proper support
to local first responders in the event of an attack. That
support could come in the form of response teams,
pharmaceutical supplies, law enforcement, as well as other
efforts.
And third, the Federal Government can continue to provide
research to aid in the surveillance, detection, and treatment
for biological and chemical attacks.
The good news is that there are many Federal agencies
working on all of these issues. The bad news is that there are
many Federal agencies working on all of these issues. As GAO
recently stated in a report, coordination of Federal terrorism
research preparedness and response programs is fragmented.
Several different agencies are responsible for various
coordination functions, which limits accountability and hinders
unity of effort.
I think it is probably appropriate to point out that this
is not true just with regard to this issue of terrorism. It is
endemic throughout government. We are just simply following a
familiar pattern.
In our ``Government at the Brink'' report, we listed
examples of program overlap and fragmentation and we listed and
discussed in some detail with numbers problem areas: Border
patrol; combatting terrorism was second; community development;
drug control, prevention and treatment; early childhood
development; economic development; education; environmental
programs; Federal land management; Federal property management;
financial regulation; food safety; foreign relations;
homelessness; international trade; and law enforcement--at
least 45 different Federal agencies conduct Federal criminal
investigations; military acquisitions; military health care;
nuclear health and safety; people with disabilities, research
and development; rural development; satellite control systems;
statistical programs; teen pregnancy prevention; and youth
programs. All of these have overlap and duplication problems.
We follow a familiar pattern in our country, it seems. We
ignore for a long time clear and present dangers. We have been
having hearings and being told about these things for at least
a decade, and during all that time, we add program on program
on program. Then we get our attention and we want to go in and
do something fast and we begin to consolidate, but just with
regard to that particular area that we are having a problem
with at that particular point. So we are following a particular
pattern here.
But other problems exist. The Federal Government tends to
spend most of its resources at the Federal level rather than on
the front lines. As one of our witnesses today, Dr. Smithson,
noted in her book on this subject, just 3.7 percent, or $315
million of the overall $8.4 billion counter-terrorism budget in
2000 went to the front lines in the form of training, equipment
grants, and planning assistance. She says, ``Bluntly put, an
absurdly small slice of the funding pie has made its way beyond
the beltway.'' We are spending a great deal of money on this
problem and we will need to make sure it is spent more
efficiently.
Also, the large number of Congressional committees
asserting jurisdiction in this area has resulted in several
different agencies receiving authorization for activities that
overlap.
So I look forward to hearing from our witnesses today and I
hope we can discuss not only what problems may exist with
regard to coordination and fragmentation in our fight against
biological and chemical terrorism, but also ways that we can
improve the efficiency and effectiveness of the Federal
response to such attacks. Thank you, Mr. Chairman.
Chairman Lieberman. Thank you, Senator Thompson, for that
statement.
I would like to now call on the Chairman of the relevant
Subcommittee, Senator Akaka.
OPENING STATEMENT OF SENATOR AKAKA
Senator Akaka. Thank you very much, Mr. Chairman. I am
delighted to be here and I want to thank you for holding this
joint hearing. I want to welcome our Secretary, Mr. Thompson,
and add my commendation to what you are doing for bringing
better understanding to the problems that we are facing and
bringing also a calming effect on the people of our country and
I thank you for that.
The Subcommittee on International Security, Proliferation,
and Federal Services, which I Chair, has been working on
bioterrorism for a long time. In July, the Subcommittee had a
hearing on FEMA's role in managing bioterrorist attacks and the
impact of public health concerns on bioterrorism preparedness.
Representatives from FEMA and HHS discussed the activities
underway by dedicated Federal employees across the government
to prepare our communities for a biological crisis.
We learned that, contrary to current press reports, the
Federal Government is not unprepared, as evidenced by the rapid
response of the CDC and FBI to the anthrax exposures in Florida
and New York. However, preparedness levels are not uniform or
consistent across the United States. There are considerable and
serious problems. While not unprepared, we are clearly under
prepared.
Today, I plan to introduce three bills that will deal with
some of these problems. I would welcome any of my colleagues
that would like to join me in these initiatives. We lack the
tools to monitor the air, water, and food supply continuously
in order to detect rapidly the presence of biological agents.
One bill will increase our efforts to develop the necessary
tools to minimize the impact of bioterrorism by reducing the
number of people exposed and alerting authorities and medical
personnel to a threat before symptoms occur.
The second measure addresses a part of the larger question
as to how our health care workers are prepared and trained for
bioterrorism or any biological crisis. Senator Rockefeller and
I propose using the existing emergency communications
infrastructure, disaster training program, and community
partnerships within the Nation's 173 VA hospitals to train both
VA hospital staff and local health care providers.
The third piece of legislation addresses a related but
distinct set of concerns, the safety of our agriculture. I will
introduce the Biosecurity Agricultural Terrorism Act of 2001.
This bill will enhance Federal efforts to prevent, prepare,
plan, respond, and recover from acts of agricultural terrorism.
It would do the same for naturally occurring agricultural
epidemics by prioritizing efforts, authorizing funding, and
establishing new policy guidelines. The measure addresses risks
and gaps in our law on foreign biosecurity, agricultural
monitoring and surveillance, response and recovery efforts,
vaccine treatment research, and other aspects of biosecurity.
Our proposals address several critical parts of the puzzle
we are to solve. A complex Federal interagency process governs
our preparation for bioterrorism and naturally occurring
medical crises. The Nation's response to current threat must
strengthen and augment existing Federal programs, minimize
confusion or duplicity in program efforts, and work to prepare
all communities, from the largest city to the smallest rural
town, for biological incidents.
During our hearing in July, Dr. Tara O'Toole of the Johns
Hopkins Center for Bio-Defense Studies cautioned that we may
have spent too much time asking who is in charge. Identifying
one single agency that commands all resources is not as
essential for responding to deliberate or natural outbreaks
where the first line responders practice constantly in their
primary responsibility, and that is caring for patients. We
must ensure that these new first line responders, doctors and
nurses, have the training, tools, and resources necessary to
respond immediately to an incident and the capacity to cope
with the several hours or days it will take before Federal help
can arrive.
Again, I would like to thank our distinguished Chairman for
convening today's hearing and our witnesses for taking the time
to be with us today. Thank you very much.
Chairman Lieberman. Thanks very much, Senator Akaka.
With the indulgence of the Members of the Committee, I
would like to now go to Secretary Thompson. When we go to the
first round of questions, we will add extra time for each
Senator so that the Senator can make an opening statement if he
or she wishes before asking questions.
I also will note for my colleagues that I received a note
that at 10:30, there is a meeting, a bipartisan caucus for all
Senators who wish to attend regarding the latest developments
in this matter right here on Capitol Hill, particularly in the
Hart Building, with regard to employees of Senator Daschle's
office. But it would be my current intention to continue,
certainly to hear Secretary Thompson's testimony and to allow
Members of the Committee to question you, and hopefully we can
get briefed later on as our colleagues will be at 10:30.
Secretary Thompson, again, you just seem to me to be the
right man in a tough job at the right time. I appreciate what
you have done and look forward to your testimony and we all
look forward to working with you in the days and months ahead.
TESTIMONY OF HON. TOMMY G. THOMPSON,\1\ SECRETARY, U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Mr. Thompson. Thank you very much, Mr. Chairman. It is an
honor for me to appear in front of your distinguished
Committee. Senator Thompson and Senator Akaka, it is an honor
to appear in front of this joint Committee and all
distinguished Members of this body.
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\1\ The prepared statement of Mr. Thompson appears in the Appendix
on page 77.
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Thank you very much for inviting me to discuss the role of
the Department of Health and Human Services and the Federal
Government's efforts to coordinate, prepare for, and respond to
a biological or chemical terrorist attack.
In the wake of September 11 and the recent anthrax cases in
Florida, New York, and here on the Hill, there are significant
questions about our preparedness, our overall coordination
within government, and, yes, our ability to respond. Let me
make one thing clear. The administration is absolutely
committed to responding to bioterrorism quickly in a
coordinated and effective manner.
Our recent efforts on September 11 demonstrate that
commitment. By the end of that painful morning, I had ordered
activation of the entire National Disaster Management System,
including notification of all of its 7,000 volunteer health
workers and 2,000 hospitals. Those 7,000 volunteer medical
personnel are distributed to 90 medical teams throughout the
United States. We were able to get 50 tons of medical supplies
to New York City in about 7 hours. Our schedule is 12 hours. We
did it in 7 hours, and even with the airlines shut down. Within
a couple of days of the terrorist attack, we had 700 doctors
and specialists on the ground in New York and Pennsylvania and
in the Pentagon.
Let me say how very proud I am of the Department of Health
and Human Services, whose committed health care professionals
and support staff made a decisive difference in bringing help
and healing to so many people in the wake of the attack on
America.
So, as I have stated before, the Department of Health and
Human Services is prepared to respond. But as I have also said,
there is more we must do to strengthen our ability to respond.
We need to get stronger. Coordination with our Federal, State,
and local partners is without question an area that I take
personally, very seriously.
At the Federal level, President Bush has made bioterrorism
preparedness a priority, first asking Vice President Cheney to
develop a coordinated domestic preparedness plan, and recently
creating the Office of Homeland Security.
Let me outline for you this morning what steps we are
already taking. HHS is the lead Federal agency for the public
health response to any biological or chemical attack. We are
working vigorously with our Federal partners to coordinate
domestic preparedness, the Departments of Defense, Justice, and
Veterans' Affairs, and, of course, the Federal Emergency
Management Administration, commonly referred to as FEMA.
We have also made great progress in utilizing the
expertise, the resources, and the technical support within the
Federal Government. For example, HHS works with the VA on
purchasing drug purchases to supplement our Department's
pharmaceutical supply. Together, HHS and VA are building the
stockpile effectively.
And we have partnered with the Department of Defense in
creating our National Medical Response Teams, which are
specialized teams capable of treating thousands of individuals
exposed to chemical, biological, radiological, or nuclear
attack.
As many of you know, I was particularly concerned about
this issue when I came to Washington. I was told many times
that our bioterrorism efforts needed substantial improvement. I
read the GAO reports that have already been alluded to this
morning by Senator Thompson and regarded them as the measure
against which our efforts could be and should be evaluated. Our
work over the past 9 months had been performed in light of the
reports' recommendations.
I moved our bioterrorism preparedness efforts into my
immediate office upon being selected Secretary of Health and
Human Services and I appointed the gentleman on my right, Dr.
Scott Lillibridge of CDC, one of the Nation's leading experts
on bioterrorism, to head the Office for National Security and
Bioterrorism. His office is on my floor in the HHS building.
And I went out and assembled a team of experts from
throughout the Department of Health and Human Services, led by
Dr. Lillibridge, that now are working 24 hours a day, 7 days a
week, to coordinate the Department's activities in responding
to public health needs. They are working out of a conference
room that we have remodeled just a few steps from my office so
I can be continually updated on the latest developments. They
also are coordinating HHS's communications with the other
departments within the Federal Government to ensure that all of
us have the latest information available.
We also have assembled a team from other agencies who are
also spending time in our conference room.
I have announced several weeks ago that I also was creating
an advisory committee to my office headed by Dr. D.A.
Henderson, who is the individual that led the fight to
eradicate smallpox, to advise the Department on bioterrorism
activities and State and local preparedness. And since I have
announced him, he has been in my office every day. I do not
know if he has a real job or if this is his full-time job, but
he is there every single day helping us.
I am also reaching out to State and local governments, as
well as public health officials. For example, this past
Saturday, I called together via the teleconference all the
States' public health departments, our experts at CDC, and
those in my immediate office to discuss State and local
preparedness for combatting bioterrorism.
Tomorrow, Dr. Jeff Koplan of the CDC and myself will be
doing a simultaneous video conference and webcast with members
of the American Medical Association and the American Hospital
Association to be able to answer questions from physicians,
nurses, and other health professionals concerning how to
recognize and also how to treat anthrax.
Then on Friday, I will be speaking to our Nation's
governors, also by teleconference, and discuss with them how to
rapidly improve our capacity for responding to bioterrorism.
And next week, I will be doing the same with our country's
mayors on the same subject.
Continuing to improve and better coordinate the efforts at
the local, State, and Federal levels is truly the best way to
ensure an effective response, and at the same time reassure the
public. We are also working aggressively to strengthen our
readiness and response, but we need your help, Senator and all
Members of this Committee, as well as the entire Congress.
Bioterrorism has not, and I want to underscore this, has
not been a high fiscal priority in the past and we need to move
aggressively. That is why the President is today requesting an
additional $1.5 billion to combat terrorism, to strengthen our
ability to prevent and respond to a bioterrorism attack.
President Bush's request will result in more than a six-fold
increase above the $300 million Congress appropriated in fiscal
year 2001. President Bush has from his first days in office
made a serious commitment to addressing the issue of
bioterrorism, and the President's fiscal year 2002 budget
provides HHS anti-bioterrorism initiative with $345 million,
which is also a 20 percent increase over the previous year.
But with the events of September 11--none of us could have
expected that--the President has called for an additional $1.5
billion in Federal funding for those areas most critical to our
ability to respond to bioterrorist threats. Let me outline the
areas in which we are focusing our efforts.
First, pharmaceuticals. We must accelerate the production
of vaccines and antibiotics and we must invest in essential
programs to ensure the speedy and the orderly distribution of
antibiotics and other supplies in the event of a biological
event. The President's proposal includes $1.2 million for this
activity and will be used to prepare for all contingencies.
These funds include $643 million to expand the National
Pharmaceutical Stockpile and $509 million to speed the
development and the purchase of smallpox vaccine. The
President's request also includes funding to make sure the
stockpile is ready, for the immediate shipment and the
deployment and use by trained professionals.
We are going to add four more push packs. Each one of the
push packs are now located in eight strategic locations. Each
of those consists of 50 tons of pharmaceutical supply. We want
to increase that by four, and that will add an additional 200
tons of medical supplies. These push packs include no less than
84 separate types of supplies. They include things like
antibiotics, include Cipro, needles and IVs, a tablet counting
machine, oxygen mask, and so on.
Second, let me emphasize again that much of this new money
is also needed to build on our partnership with local and State
governments, an issue that all of you on this Committee are
passionate about and I thank you from the bottom of my heart
for that passion.
For example, the President is calling for $88 million to
expand HHS's capacity to respond to bioterrorist incidents,
including $20 million for CDC's rapid response and advanced
technology and specialty labs, which they badly need, which
provide quick identification of suspected agents as well as
technical assistance to State labs.
Also included in this amount is $20 million to support
additional expert epidemiologists and these teams that can be
sent to States and cities to help them respond quickly to
infectious diseases. One of those teams was in the Capitol last
night until 2 o'clock this morning working with the Majority
Leader, along with Scott Lillibridge, and I was in contact with
them up until midnight, when I left contact.
And then respond quickly to infectious diseases, the
outbreaks and other public health risks. I believe every State
should have at least one federally funded epidemiologist who
has graduated from the Epidemic Intelligence Special Service
training program at CDC.
The President is also asking for $50 million to strengthen
also the Metropolitan Medical Response System, which will be
able to increase the number of large cities that are able to
fully develop their MMRS units. These are the medical and
public safety response units. We have 97 right now. We would
like to go to 122 with the extra money. It is imperative that
we work closely with cities to ensure that their MMRS units
have the proper equipment and, yes, proper training.
We are also providing $50 million to assist hospitals and
emergency departments in preparing for and responding to
incidents requiring mass immunization and treatment, and we are
providing $10 million to augment State and local preparedness
by providing training to State health departments on
bioterrorism and emergency response.
The President is also requesting $40 million to support
early detection surveillance to identify potential bioterrorism
agents, which include web-based disease notification to the
health community nationwide, which is so important in order to
hook up with the local communities, local health departments,
and the State health departments. This effort will also provide
for the expansion of a very successful health alert network. We
have 37 States hooked up right now. We want to get to all 50,
and then we would like to hook up to the local health
departments. It is going to help provide early detection of
disease to 75 percent of the Nation's 3,000 counties.
We are providing $15 million to support increased capacity
in no less than 78 laboratories in 45 States. This funding will
enhance our ability to identify and detect all critical
biological agents, and we are implementing a new hospital
preparedness effort to ensure that our health facilities have
the equipment and training they need in order to respond to
mass casualty incidents.
Third, in addition to purchasing pharmaceuticals, we are
committed to the development and the approval of new vaccines
and new therapies. For example, the Food and Drug
Administration is working closely with the manufacturer of
ciprofloxacin, commonly known by the brand name Cipro, to make
certain that firm, Bayer, can safely and rapidly increase its
production of that drug, which is used in the treatment of
anthrax victims. I was in contact with Bayer yesterday and they
have announced, as of yesterday, they will be able to produce
200 million tablets within the next 90 days.
Let me also announce that the FDA is officially approving
today the use of two additional generic antibiotics for the
treatment of anthrax, doxycycline, and penicillin. Because
these drugs are available in generic forms and produced by
several manufacturers, they will be relatively inexpensive and
readily available. The FDA's approval will include instructions
on what dose to use and how long to treat the inhalation form
of anthrax, and I would like to quickly point out that we have
found that of all the anthrax that we have received so far and
been tested, all of them are sensitive not only to Cipro, but
also to doxycycline and also to penicillin. So let me again
stress that there is no need for anyone to stockpile any drugs.
We have the drugs that we need and they will be available
whenever and wherever they are needed.
The fourth, food safety. The President is also requesting
$62 million to enhance the frequency and the quality of
imported food, to order inspections, and be able to modernize
the import data system to enable us to detect tainted food.
This funding will also provide for 410 new FDA inspectors to
help ensure that our food is better protected.
In addition, the administration will be sending to Congress
legislation to strengthen our ability to protect the Nation's
food supply. This measure will require prior notice of imported
food shipments, enhancing our ability to inspect food, allowing
for detention of foods suspected of being tainted, and
providing the flexibility for the FDA to approve drugs and
other treatments for dealing with illnesses resulting from
pathogens on our food.
Much of the initial burden for providing the effective
medical response to a terrorist attack, of course, rests with
local governments. If the disease outbreak reaches any
significant magnitude, however, local resources will be
stretched, and very quickly, and the Federal Government will be
required to provide protective and responsive measures for the
affected populations. In the testimony I have submitted to the
Committee, Mr. Chairman, I have outlined the specifics of how
the various departments and the agencies are working together
in a coordinated effort.
So, Mr. Chairman, let me again emphasize that the
administration is taking aggressive steps to make sure that our
country is well protected from bioterrorism, and let me once
again tell the American people the following: One, anthrax is
not contagious.
Two, the government at all levels is responding to
bioterrorist threats and responding well.
Third, our postal system is being monitored very carefully.
People should exercise caution, and if something seems
suspicious, use good judgment. But there is no reason not to
send and receive letters and packages.
Fourth, be vigilant and cautious, but do not let the
terrorists win by frightening us unduly. Do not let them scare
you into not living your life. That would help our enemies
achieve what they are trying to do, and that is terrorize
American citizens.
Contemplating bioterrorism is very unpleasant, but it is
imperative, and under the leadership of this Committee, this
Congress, and President Bush, we are taking all the steps
necessary to keep America safe in an era when biological and
chemical attacks are as possible as they are unthinkable.
I want to thank you, Mr. Chairman, both Mr. Chairmen and
the Ranking Minority Member and all Members on this Committee
for giving me this opportunity to talk about this subject. Now
I will be more than happy to answer any questions you have.
Chairman Lieberman. Thank you very much, Secretary
Thompson, for a reassuring and very helpful statement.
I wonder if I might suggest to my colleagues that Senator
Thompson and I and Senator Akaka have 5 minutes on a first
round of questioning, since we got to give an opening
statement, and we will give every other Member of the
Committee, shall I say at least 8 minutes, and we will go in
order of arrival, which would mean, just for the information of
Members, after Senator Akaka, it will be Senator Domenici, then
Senator Levin, Senator Collins, Senator Dayton, Senator
Carnahan, and then Senator Durbin.
Mr. Secretary, just to bring it home, and it really is
right here, I wonder whether you or Dr. Lillibridge have any
information you want to convey to the Committee about what has
now been determined as to the infection caused by the anthrax
sent to Senator Daschle's office.
Mr. Thompson. I would be more than happy to, Senator
Lieberman. I believe it has already been publicized--we are
waiting for Senator Daschle to make that notice first, but
there are over 20 individuals on the staff that have the
anthrax within their system, that tested preliminarily
positive. We have provided at the present time 1,200 bottles of
Cipro. One thousand individuals will be tested. We are going to
have six nurses on hand, two pharmacists, and a doctor, and 750
tests are going to be conducted by NIH and all this is being
done as we speak right now, Mr. Chairman.
Chairman Lieberman. Is it correct to infer that the reason
why such a large number in Senator Daschle's office were
infected, larger than in the other instances where anthrax has
been mailed to an office, was because of what we have learned
was the pure and more refined state of the anthrax that was
sent to the Daschle office?
Mr. Thompson. You certainly can draw that conclusion, but
the tests have not been finalized, so I do not want to
speculate, but there is no question that this is a very serious
attempt at anthrax poisoning.
Chairman Lieberman. And all of the individuals, I presume,
were in the Daschle office or in the vicinity of----
Mr. Thompson. I am not sure about that.
Chairman Lieberman. Doctor, do you want to add anything
here?
Dr. Lillibridge. Sir, let me add two things. One is that I
would like to differentiate between being exposed and being
infected.
Chairman Lieberman. OK.
Dr. Lillibridge. We are telling the American people that
these people were exposed, but they are not currently infected.
They are, indeed, healthy and on medicine to prevent illness or
prevent from becoming infected.
Chairman Lieberman. Say a little more about the distinction
so we understand it.
Dr. Lillibridge. When we say exposed, that means they were
in an area perhaps where there was dust or a powder or in the
vicinity where a letter was opened up. They may have recovered
spores from their clothing or from their nasal passages. But
that is a far cry and that is very different from having a
bacteria set up housekeeping and creating infection and illness
in the human. They are not to that stage, and indeed, with
medical prophylaxis and a proper environmental follow-up, we do
not expect them to move to that stage.
Chairman Lieberman. That is a very important distinction.
Mr. Thompson. Of all the anthrax so far, we have only had
four that have actually become infected.
Chairman Lieberman. Infected.
Mr. Thompson. Two in Florida and two in New York.
Chairman Lieberman. That is a very important distinction.
So at this point, as far as the two of you know, none of the
individuals in Senator Daschle's office----
Mr. Thompson. That is correct.
Chairman Lieberman [continuing]. Are actually infected?
Mr. Thompson. Absolutely. And it is too early and they are
on the necessary antibiotics and they should not become
infected.
Chairman Lieberman. As we learned yesterday in the briefing
that Senators received, it takes a pretty significant number of
anthrax spores to actually become infected.
Mr. Thompson. Different amounts between the three different
types of anthrax. Cutaneous infection results from a break in
the skin. Ingestion--you have different tainted food from
animals that could get into your system, causing
gastrointestinal problems, which would take less than
inhalation. Inhalation anthrax, they have figured, has to have
10,000 spores enter your system in order for one to become
infected, and that is a lot.
Chairman Lieberman. It is very important for people to hear
that, particularly since the number of those exposed is larger
than in any other case that we have had thus far.
Mr. Thompson. That is correct.
Chairman Lieberman. I wonder if either of you, and I just
want to use this as a moment to try to help convey information
that will be helpful to us and perhaps the public.
Mr. Thompson. That is very good and I appreciate this.
Chairman Lieberman. No, I thank you. I wonder if you have
anything to say about what we can determine about the fact that
this anthrax in Senator Daschle's office was presumably more
pure and refined than that sent to the other offices. Are there
any conclusions we can draw about who was sending it, what was
done?
Mr. Thompson. That is being completely investigated by the
FBI, Senator. We have no knowledge of that at this point in
time. We are hopeful to be able to have the FBI make some
arrests and some breakthroughs, but at this point in time, it
is purely speculation. And the research in the labs, there is
research being done at Fort Detrick and also research being
done at our labs at CDC in Atlanta and all that research and
analysis will be coming forthwith to you and to other members
as soon as we get it.
Chairman Lieberman. A final question on my round for you
about the facts here, and about this, I think there is some
uncertainty, too. How difficult is it to obtain anthrax? There
have been times I have heard broadcasts where people have said
there are only three countries in the world that have it,
perhaps certainly the former Soviet Union, the United States
has some, I gather, in laboratories, and there have been
allegations of other countries, including Iraq, possibly having
it. But then I have also heard at different times that it
exists in labs around this country in some numbers and that,
therefore, that is another place that somebody sending these
packages could have obtained it. So I wonder if you can help us
understand how the people doing this might have obtained the
anthrax.
Mr. Thompson. Well, there is a lot of different anthrax. A
lot of it occurs naturally in the blood of animals that, once
the animal dies, gets emitted into the air. It is emitted in
culture. There are laboratories across America that have had
anthrax and have done research and experiments on it. It could
be done. There are other countries that have used anthrax and
tried to use it as a weapon. They are the ones that have
manufactured and milled it into a weapons grade and that, of
course, is the most dangerous part.
But this anthrax that we have right now, we are still doing
research on it. We do not know the exact strains or where it
comes from.
Chairman Lieberman. Is it fair to say that it is difficult
to obtain the kinds of anthrax that has been sent to people
around the country now in the last couple of weeks?
Mr. Thompson. It is more difficult for it to be able to be
used as a poison in a letter----
Chairman Lieberman. Right.
Mr. Thompson [continuing]. Because it clumps together.
Chairman Lieberman. Right.
Mr. Thompson. And to be able to allow it to go up into the
air requires some degree of scientific ability.
Chairman Lieberman. So that is what, I presume, was
noteworthy about what was sent to Senator Daschle, because the
analysis of it suggested that it had been refined to a greater
extent than is normally found.
Dr. Lillibridge. Mr. Chairman, let me make a few comments.
You asked, where might this organism come from? Where might you
recover anthrax bacteria? It is in the soil. It is a disease of
the animal population. Many labs around the world investigate
anthrax as it relates to the safety of herds and other kinds of
animal veterinary activities.
As for the sample in question, there are a number of tests
that are ongoing that will look at the size and the purity and
the sensitivity. I can tell you at this time, we are aware that
the sensitivity of this organism that was released in Senator
Daschle's office is sensitive to ciprofloxacin, doxycycline,
and penicillin--the common drugs that would be used to treat
any kind of outbreak of this nature. That is, in itself,
reassuring.
The issue of whether it is weaponized or where it came from
may take quite a bit of strain analysis and sophisticated
testing. That is ongoing with the Federal Bureau of
Investigation at the lead. It is our impression from a public
health safety standpoint that we have enough information in
terms of its sensitivity and its purity and isolation to make
sure this really is anthrax organism to guide our investigation
both environmentally and make public health recommendations. As
soon as that information becomes known, it will be made public
as best it can.
Chairman Lieberman. Fine. Just a final point of
clarification. I assume it is some distance from the naturally
occurring anthrax, that is, anthrax that occurs naturally in
the soil or in animals, from that to the kind of powder that
was sent to Senator Daschle's office.
Dr. Lillibridge. Let me just use the short answer for this.
I think it shows there has been some attempt to collect it,
perhaps refine it and make it more concentrated. That seems to
be certain.
Chairman Lieberman. OK. Thanks very much to both of you.
Senator Thompson.
Senator Thompson. Thank you, Mr. Chairman. Your last
statement was with regard to that found in Senator Daschle's
office?
Dr. Lillibridge. Yes, sir.
Senator Thompson. There was apparently some attempt to
refine it?
Dr. Lillibridge. Well, when you have a collection of
anthrax spores put into a package, that takes some effort to do
that. This organism is in the soil, but getting it into spore
form requires some degree of effort.
Senator Thompson. The GAO report of last month that someone
referred to said that processing biological agents into the
right particle size and delivering them effectively require
expertise in a wide range of scientific disciplines. Would you
agree with that, Doctor?
Dr. Lillibridge. Yes, sir.
Senator Thompson. So if, in fact, we do find that this was
more highly refined in terms of particle size, weaponized, I
guess is a good way of putting it, then that would indicate
someone had a wide range of scientific disciplines?
Dr. Lillibridge. Let me just extrapolate the process as you
go through this. As the investigation unfolds and moves into
either national security or law enforcement arenas, they will
begin looking at the strains, the match-up, what effort went
into manufacturing it, and see if they can pinpoint a source,
either a geographic location or a specific stockpile or a
specific strain that inhabits a certain part of the world.
Senator Thompson. This may be a little bit beyond----
Mr. Thompson. Senator Thompson, it has to be a certain size
in order for it to get into the body. If it is smaller than one
micron or larger than ten microns, it is not able to be inhaled
properly.
Senator Thompson. This is all a little premature, I
suppose, but indulge me with one more question. This may be
beyond your purview. I have read that in order to produce
especially large quantities of this powder form that would be
weapons grade, if you want to call it that, that it would
require substantial infrastructure. I have seen millions of
dollars spent to have that kind of production capability and
facilities. As a general proposition----
Mr. Thompson. That is absolutely----
Senator Thompson. Is that a correct assumption?
Mr. Thompson. That is our understanding, Senator.
Senator Thompson. With regard to the----
Mr. Thompson. To have a weapons grade, it could possibly
have a country behind it.
Senator Thompson. A country would probably be behind the
weapons grade?
Mr. Thompson. But we want to make sure that none of this is
a weapons grade.
Senator Thompson. You want to make sure that none of it--we
do not know yet with regard to this?
Mr. Thompson. Of the past one, it is still being tested.
Senator Thompson. Right. With regard to these large
stockpiles that we have developed and are in the process of
developing, is this going to have to be constantly replenished?
Are there expiration dates on all these drugs, as we commonly
understand them, and what budgetary impact will that have in
these huge numbers we are talking about?
Mr. Thompson. We have two different systems, Senator. In
the push packages, some of those will have to be replaced. But
we also have a vendor marketing inventory and part of the
agreement with the vendor's marketers is that their
responsibility is to restore items that have used up their
shelf life with new stuff and that is built right into the
contract, so it is an ongoing thing. So there are some of the
more durable things that are in the push package, but we also
have a different system, which is called VMI, and that is
brought up currently on a monthly basis and that is being
conducted and supervised by CDC.
Senator Thompson. I see.
Mr. Thompson. And that is built right into our contract.
Senator Thompson. Mr. Secretary, there has been a lot of
discussion, as you know, about Governor Ridge's position, the
authority that he has or should have. With regard to all of
these things that you and your Department are doing, how do you
see that fitting within his operation? How do you see your
relationship and your duties and responsibilities and all these
things that you are doing intersecting with what you understand
his responsibilities are going to be? Is that too broad a
question to answer?
Mr. Thompson. No, it is not.
Senator Thompson. Have you given some thought to it?
Mr. Thompson. It is a very valid question. I will give you
an example. As of 4 o'clock yesterday afternoon, we had a
meeting, various departments with Governor Ridge and we worked
out some difficulties. He was the coordinator and we threw out
questions and problems and we just had a roundtable discussion
and then he would delegate, ``Tommy, you take care of this one,
and Madam Secretary, you take care of that problem, sir, you
are responsible for this,'' and so on.
So his job is to coordinate and make sure that when we have
problems in the public health arena, we can go to somebody like
Tom Ridge and say, ``This is a problem. Can you assist us with
the FBI or with the CIA or with the Department of Defense and
help us along?'' It has been working out, I think, very
effectively so far.
Senator Thompson. How do you foresee budget determinations?
Would you expect him to have input in your decisions or would
he make certain decisions in certain areas with regard to your
Department? How do you see that playing out? Have you gotten
into that yet?
Mr. Thompson. Senator, we put in this request, and I talked
to Governor Ridge and I know that he talked to the President in
regards to this, as I did, and we all talked to OMB. I think
somebody from the President's Office, including Governor Ridge
and myself, talked to OMB, and as a result of that, the request
today of about $1.6 billion is in front of you.
Senator Thompson. Thank you. My time is expired. Thank you,
Mr. Chairman.
Chairman Lieberman. Thank you, Senator Thompson. Senator
Akaka.
Senator Akaka. Thank you very much, Mr. Chairman. Mr.
Secretary, I am pleased to hear the President's request for $40
million to support the early detection surveillance to identify
potential bioterrorism agents. This matches the authorization
in my bill.
Mr. Thompson. And I thank you for that, Senator.
Senator Akaka. I look forward to working with you to ensure
these funds are made available.
Senator Domenici. Mr. Chairman, could I ask the Senator to
yield for 30 seconds?
Senator Akaka. Certainly.
Chairman Lieberman. Go right ahead, Senator Domenici.
Senator Domenici. Mr. Chairman, we have a complication in
that there is a meeting with reference to a collateral issue at
10:30.
Chairman Lieberman. Correct.
Senator Domenici. I will come back, and if you are still
here, I would appreciate the opportunity to inquire. I just
wanted you, Mr. Secretary, to understand why I will not be
staying here and thank you for what you have been doing. You
are doing a great job.
Mr. Thompson. Thank you, Pete.
Chairman Lieberman. Thanks, Senator Domenici. We will be
here and await your return.
Senator Akaka. Thank you. Mr. Secretary, I believe that the
animal health community requires formal coordination with the
HHS and CDC and I am delighted to know you are both on the same
floor and there is much coordination. Currently, their
interaction is on a case-by-case or a need basis. Formal and
regular contact will ensure that animal health and agriculture
issues are addressed by HHS and FEMA disaster preparedness.
Federal efforts should also take advantage of the expertise
veterinarians have to offer, such as familiarity with anthrax.
In fact, in a National Public Radio report yesterday morning,
two out of the three anthrax specialists interviewed were
animal disease specialists. Veterinarians could also help in
detecting unusual biological events because many emerging
diseases appear in animals long before humans. Additionally,
animal diagnostic labs have the capacity to identify and
confirm the diseases.
The bill I am introducing today establishes a senior-level
official within HHS who has formal responsibility for regular
contact with the animal health community. Would you please
comment on current coordination efforts between HHS and the
animal health community and on my proposal.
Mr. Thompson. First off, let me just say I like the
proposal and I hope that it gets prompt action in the U.S.
Senate.
Second, we are trying to coordinate very closely with the
Department of Agriculture on food safety as well as animal
safety wherever we possibly can.
The third thing, your analysis that veterinarians may have
a tremendous amount of expertise in the disease of anthrax is
absolutely correct and we have, of course, several teams of
veterinarians that are involved with our Public Health System.
In fact, I think we sent four veterinarian teams to the City of
New York to take care of the search dogs and they were there
for several weeks taking care of the dogs while they were still
trying to find people alive in the rubble and our veterinarians
were there to take care of them.
Five, food safety. I know it is a big concern of yours as
well as my friend Senator Durbin's, and it is a real priority
for me. I know it is for the Secretary of Agriculture, and I
think we have to do a much better job than we have in the past
in this arena and I would be more than happy to discuss that
with you at any time.
Senator Akaka. In the event of a biological terrorism
event, clinical laboratories are likely to be overwhelmed with
samples.
Mr. Thompson. We are finding that right now, Senator, and
we have so many--we have thousands--I do not know how many, but
we have a lot of false starts in regards to the anthrax scare
and we are trying to deal with them through the Post Office
Department, through the FBI, and, of course, a lot of the
burden rests upon our laboratories that we have to take care
of.
Senator Akaka. I commend you on identifying that problem
and also again urge you, as you have been doing, to calm the
feelings of people by giving them the proper information on
these samples and medicines, as well.
I believe that many areas should begin developing regional
plans to assist neighboring cities or States in handling surge
diagnostic lab demands.
Mr. Thompson. Yes.
Senator Akaka. However, I am concerned that,
geographically, remote areas like Hawaii will be at risk, and
also our territories that are non-contiguous. We cannot forget
that the grounding of all air traffic during the terrorist
attacks on September 11 effectively isolated both Hawaii and
Alaska, and our territories, for several days. In fact, some
U.S. territories beyond Hawaii are having trouble getting their
medical samples analyzed because they must be flown to Honolulu
first.
My question is, does Hawaii have the laboratory capacity to
absorb a dramatically increased sample load in the event of a
biological crisis and what plans are in place to ensure that
remote areas have capacity to detect and identify human
diseases and plant and animal pathogens?
Mr. Thompson. Senator, I am not expert enough to talk about
a particular lab, but let me tell you the system, how we have
got it set up and how we are able to respond. We have connected
with Hawaii, with Alaska, and with our labs in CDC in Atlanta
and they are hooked up to the lab and we have put out the
notice and we are putting out information on a regular basis to
all the State health departments asking them to get involved
and if they see something suspicious, they are to get us the
tests, the tissues, and the blood samples as soon as possible
so we can make a confirmation of what the preliminary lab may
find in Hawaii or in Wisconsin or Alaska or Michigan, wherever
the case may be.
And then if we find that there is any type of biological
agent, we are able within hours to fly CDC teams to that
particular area to help put together a State or local plan and
to assist them. We have 7,000 medical professionals divided
into 90 teams throughout the United States, one of which is in
Hawaii, and they are able to respond very quickly. We have one
in D.C. that is able to respond to the Capitol within 90
minutes. These are individuals that are experts in biological,
chemical, and radiological kinds of attacks.
So we are able to respond and we also have medicines that
we can distribute very quickly to any locale in the United
States, including Hawaii.
Senator Akaka. Thank you very much.
Chairman Lieberman. Thank you, Senator Akaka. Senator
Collins.
OPENING STATEMENT OF SENATOR COLLINS
Senator Collins. Thank you, Mr. Chairman.
Mr. Secretary, I want to begin my comments by thanking you
for your tremendous leadership and strength during this very
difficult time. There is no one in whom I have more confidence
than I do you to guide our Nation and to manage our efforts to
deal with bioterrorism.
Mr. Thompson. Thank you. Thank you very much, Senator.
Senator Collins. In the past, an attack with a biological
agent like smallpox or anthrax seemed highly unlikely. Today,
such attacks not only seem frighteningly possible, but rather
the question has changed from ``if'' to ``when and where.''
Mr. Thompson. Right.
Senator Collins. Intellectually, we may understand that
more people die of the flu than of anthrax, but that is of
little comfort because people do not try to deliberately kill
us by exposing us to the flu. It is both disturbing and
unsettling to all of us that we were told yesterday that the
staffer who opened the mail in Senator Daschle's office and
discovered the anthrax-tainted letter did exactly the right
things, that she took exactly the right steps, and yet still
more than 20 members of his staff have tested positive for
exposure to anthrax. I think that is very unsettling to us all.
In most parts of the country, the first responders are not
likely to be officials from the CDC or highly-trained
epidemiologists who have the training to recognize anthrax and
to trace where the infection has come from. They are much more
likely to be the family doctor or the emergency room nurse or
the local police officer. I am very pleased to hear of your
efforts to educate our health care providers and those on the
front lines.
Last week, I attended a hearing at which Dr. Henderson,
whom you appointed to head your advisory committee, testified
along with several other public health experts about the
Florida response to the first case of anthrax, and to a person,
they testified that they felt in many ways it was fortuitous
that the physician had recognized that this might be a case of
anthrax, that there was a lab nearby that had the capability of
identifying anthrax, and that if this first case had happened
in many other parts of the country, it might not have been
detected as anthrax. That is of concern to me and suggests we
need to do more.
I know one of your goals is to make sure that every State
has a federally-trained epidemiologist. Could you tell us how
many States now lack a federally-trained epidemiologist?
Mr. Thompson. I think there are 17 that--it is either 13 or
17, I am not sure. But first, let me thank you for your
comments, and second, let me quickly point out that I think
that would be a giant step forward. Luckily, the individual
doctor in Florida had had training from CDC, as I understand
it, and knew exactly what to look for.
I think it would be a wonderful thing for this Congress to
be able to place in every health department maybe at least one
individual that has EIS training, like Scott Lillibridge does
from CDC, and also the regional areas would be the same, so
that we have that expertise out in the field. It would
strengthen the local and State health departments and Public
Health Systems tremendously and I thank you for your support of
that, Senator.
Senator Collins. I think that really is absolutely critical
because they are the ones who are on the front lines and are
going to have to make the right decisions before there is
likely to be Federal involvement.
The second issue that you brought up in your testimony was
your plan to have additional push packs, and I understand that
these are the collections of medical supplies. I commend you
for pushing for additional packages. I am concerned, however,
about how we know what to put in these push packs because today
it may be anthrax. Tomorrow it may be smallpox. The next day,
it may be another kind of chemical rather than biological agent
that is being used to attack our citizens. How do you decide
what kinds of pharmaceuticals or supplies to put into these
essential push packs that can be deployed on very short notice?
Mr. Thompson. Let me just quickly point out that we have a
panel of experts that explore that. We have two systems. We
have the push packs, in which there are eight strategically
located around the United States, 50 tons in each one. In order
to move them, it takes nine semi-trucks or a C-130 to move
them, and our plan is to move them within 12 hours. In the case
of New York, we were up there within 7 hours.
Then we have a second ancillary system called the VMI
system which is in the process of purchasing. We purchase
pharmaceuticals but we do not take delivery of them. We have
individuals that supervise them and keep them current, and that
is the VMI system.
So you have two different systems and you have a panel of
experts that analyze on a regular basis what should be in
either the VMI, and those are the ones that would have a
shorter shelf life, and then the ones in the push packages.
And the third thing is that we are continuing upgrading
that. As far as smallpox vaccine, that is a separate thing.
That is the third thing. That is being under supervision of
Wyeth and we have 15.4 million doses of vaccine. Right now, we
are looking at the smallpox and seeing whether or not we could
cut that 5-1 so that we could expand from 15.4 to 77 million
doses of vaccine for smallpox, and NIH is doing that analysis.
Right now, the preliminary analysis is that by cutting it
down from--we have tests going from 1-1, 5-1, 10-1, and 100-1,
and we have found that the effective rate is around 95 percent
on 5-1, but that is preliminarily. At 10-1 dilution, it is 70
percent effective, and 100-1 is 20 percent effective. So we
strongly think from the preliminary analysis with our doctors
at NIH and with the consultation of CDC that we could have that
reduced from 5-1 and still be very effective and increase the
number of doses for smallpox vaccine from 15.4 to 77 million
doses.
Senator Collins. Thank you. I see that my time is running
short. I just want to touch quickly on two other issues.
The first is the vulnerability of our food supply. I held
hearings a couple of years ago that showed that our system for
inspecting imported food was woefully inadequate, that less
than 1 percent of shipments of imported food were inspected,
but more troubling, that it was very easy for unscrupulous
shippers to circumvent the inspection process and to actually
reship tainted food that had been caught through the inspection
system. So I want to share with you the hearings that we held
and our findings and recommendations, some of which were
enacted but many of which were not because of lack of
resources, and I look forward to providing you with that
information.
Mr. Thompson. I appreciate that very much, Senator, and
anything you can help with in regards to improving the food
safety, I would appreciate it very much. Seventy-seven million
Americans last year had food poisoning, one out of four. Three
hundred and thirty-two thousand ended up in the hospital and
5,000 died because of food poisoning. So when you look at that
and compare that to only four individuals that have actually
been infected from anthrax, you can see that food safety and
food pathogens is a much bigger problem and I thank you.
Senator I wanted to correct something that I guess--
somebody sent me a note. I did not in any way imply that there
were countries behind this attack on Senator Daschle and that
it is weapons grade. The tests are still being done. I just
said that it is very potent.
Chairman Lieberman. Thanks, Mr. Secretary. I thought you
made that clear----
Mr. Thompson. I thought I did, too, but I wanted to----
Chairman Lieberman [continuing]. But I appreciate the extra
clarification.
Mr. Thompson. Thank you.
Senator Collins. I see my time has expired. Thank you, Mr.
Chairman.
Chairman Lieberman. Thanks, Senator Collins, for some
excellent questions. Senator Levin.
OPENING STATEMENT OF SENATOR LEVIN
Senator Levin. Thank you. First, let me thank you, Mr.
Secretary, for your extraordinarily solid, thoughtful
leadership. You and your agency have made a major contribution
to the security of this Nation and its well-being and,
hopefully, its calm consideration of the threat.
Actually, this last clarification of yours is something I
was going to ask you about and that has to do with the
difference between concentrated anthrax and weapons grade
anthrax, if you can tell us that. You indicated, I believe,
that it would take a state to produce the weaponized variety
because there are millions of dollars that might be involved in
the infrastructure to produce it. Would it also be safe to say,
however, that a well-financed terrorist organization, if it had
enough millions of dollars to produce the infrastructure, could
produce weapons grade anthrax?
Mr. Thompson. I think we are all learning and I do not know
if anybody knows for sure, but I think you can make that
supposition quite easily. Maybe, Scott, you would like to----
Senator Levin. Maybe one word on the difference between
concentrated and weapons grade, if you know it.
Dr. Lillibridge. Let me make two statements on this. First
of all, the issue for health really is not so much whether it
is concentrated or weapons grade, if the investment has been
made in dissemination and the process to mill it down and make
it distribute easily.
The distinction between concentrated and weapons grade, as
we understand it, is that concentrated is what you do to simply
get spores close together so you can put them in an envelope
and mail them out. There are a number of ways technically to do
that, depending on the investment, the time and effort, and the
amount of risk you want to take at your local lab certainly
would factor in.
The issue of weaponization or weapons grade is often used
in the literature to evoke large industrial investment in
preparing samples for dissemination. It includes milling down
the spores so they are easy to disseminate. It involves coating
the spores so they stay in the air a little longer. It involves
research into dissemination devices, different ways to move it
to the population. We do not have any of that information on
this particular sample at this time.
Senator Levin. Thank you. I want to talk about smallpox for
a minute. Our former colleague, Sam Nunn, took part in an
exercise called ``Dark Winter,'' and I do not know if you have
seen the video tape----
Mr. Thompson. Yes, we have.
Senator Levin. The major finding of that study was that the
Nation was very unprepared for such an attack, and so I want to
ask you about what kind of preparations, in fact, have been or
are in the process of being made. You just discussed the dosage
issue and that is very helpful information.
In addition to seeing whether or not we can divide our 15
million doses into smaller doses, can you answer or address two
issues. One, are we also attempting to produce more, and if so,
what is the time line for that? And second, whatever number of
doses we have, whether it is 15 million or 75 million or
whatever number, what is the plan prior to any attack? Are we
going to start immunizing people before evidence of an attack,
given the very different nature of smallpox, or what are our
plans in that area?
Mr. Thompson. Well, thank you very much for the question,
Senator Levin. Let me point out first that when Dark Winter was
being conducted, we took that experiment, that example, along
with the GAO report, and when I appointed Scott Lillibridge, I
said, you have got to take all of these things, find out the
deficiencies we have and start correcting them, and that is why
we brought Scott Lillibridge and brought in a team into the
Secretary's office to address those inadequate situations and
we are knocking them down as we go along.
We have accelerated, of course, since September 11 and are
doing a lot more, and even though the terrorist attack was
terrible for America, one good thing that came out of it, the
consequence of that is that we are much better prepared to deal
with a bioterrorism attack and we are getting stronger each and
every day.
In regards to smallpox, I am happy to report that we are
meeting with a lot of the pharmaceutical companies. In fact, we
are going to be discussing smallpox with four of them very
soon, and we have talked to them in the past. We are going to
talk to them again about purchases. We are looking to expand
and purchase 300 million doses of vaccine, Senator Levin.
Acambis is the company that has a contract currently with CDC
to produce 40 million doses. They were not going to start
producing until 2005. They now have accelerated that to 2002.
We have also talked to some other companies and we think
that we will be able to purchase some smallpox vaccine and
start manufacturing yet this year, Senator Levin, and we should
be able to have, provided Congress goes along with the
appropriation, the necessary dollars and be able to have the
300 million doses by the end of next year.
Senator Levin. Is it safe to say or is it accurate to say
that smallpox, if it could be obtained by a terrorist, would be
a more threatening substance than anthrax?
Mr. Thompson. There is no question because it is infectious
and contagious and anthrax is not.
Senator Levin. Is it also your plan to begin inoculations
prior to any evidence of attack?
Mr. Thompson. That was the second question. I apologize I
did not answer it, Senator. We do not believe at this point in
time that inoculation is the right thing because there are some
serious side effects to inoculation of smallpox. There will be
some fatalities, some inflammation of the brain, some other
maladies that will come as a result of taking a smallpox
vaccine.
We may sometime in the future, with consultation with
Congress, set aside some of the 300 million doses of vaccine
for voluntary vaccination if, in fact, Americans want to do it,
but that decision has not been made. But we do want a stockpile
of 300 million and that is what we are asking Congress for the
appropriation to do.
Senator Levin. Thank you. Having been a governor, which is
a tremendous asset to you, I think, in your work and working
with local and State officials as a governor now is surely
going to give you some really important experience in your
current work. But as a former governor, you have also had
knowledge in terms of how you structure an Executive Branch and
I want to follow up on some of Senator Thompson's questions
relative to that structure. You commented a bit on it.
There are a number of proposals in front of this Committee.
One is to create a separate agency. One is to create an office
in the Executive Branch of the President. I would like to ask
what your ideas are in this area.
Under the present system, as you have begun to work in it,
if there are differences between agencies on who should do what
particular function, does Governor Ridge have the power to make
a decision? I know he can make a recommendation and I know he
can seek to get some kind of a consensus, but in terms of
decisionmaking, if Governor Ridge says, ``It should be done
this way,'' and you or some other cabinet agency says, ``No, we
think it really should be done that way.'' Does he have the
power to decide or is it just the power to recommend to the
President?
Mr. Thompson. I cannot answer that, Senator Levin. I do
like your comments about being governor. I never in my life
thought that being governor, I was taking this job and was
going to become an expert on embryonic stem cells and
bioterrorism, but that has been the two examples that have
really been foisted upon me.
In regards to Governor Ridge, I think he has the power. I
think the President has given him that power to make the
decisions, beyond just making recommendations.
Senator Levin. Beyond, you say?
Mr. Thompson. Just making recommendations. I think just the
fact that the President says that he is going to be the
coordinator, I cannot imagine any cabinet officer would be dumb
enough to challenge that.
Chairman Lieberman. Secretary Thompson, Senator Levin, I
apologize for intervening. I just received a message and
request from Senator Daschle that we recess this hearing for
now and that the two of you come with us to the joint caucus of
Senators to be part of the briefing. I apologize to my
colleagues who have not had a chance to ask questions. I would
ask the patience of the witnesses on the second two panels. I
will definitely return and we will continue the hearing at that
time.
But for the moment, in response to a request from the
Majority Leader, I am recessing the hearing.
[Recess.]
Chairman Lieberman. This hearing of the Senate Governmental
Affairs Committee will now reconvene.
Secretary Thompson, thanks very much for staying here. I
know you have got other appointments. I do not know if I would
say we negotiated an agreement with Senator Daschle that we
would leave Dr. Lillibridge there and you would come back and
complete your testimony.
Mr. Thompson. I think Senator Daschle got the better part
of the deal over you, Senator Lieberman. [Laughter.]
Chairman Lieberman. We are very happy and grateful that you
have returned with us.
Senator Durbin, you were next. Thank you.
OPENING STATEMENT OF SENATOR DURBIN
Senator Durbin. Mr. Secretary, thank you very much for
returning. I really appreciate it under all these
circumstances. I want to ask about two specific areas, one,
immunizations, and the second, food safety. Let me start with
immunizations.
I think what you have told us is that you are gathering
together 300 million doses of smallpox vaccine, and I would
like to ask some further questions about what your plans are
for immunization. It is my understanding that, unlike anthrax,
where exposure can be treated successfully with antibiotics,
that exposure to smallpox is much more dangerous, much more
likely of infection, and, therefore, you virtually have to be
vaccinated in advance or you stand a high risk of being
infected with smallpox. So could you tell me what your vision
is in terms of this smallpox vaccine and how it will be used?
Mr. Thompson. Thank you. We are not going to gather. It is
going to be produced and we are in the process right now of
negotiating with the companies. There is one from Illinois, by
the way, that is involved in the negotiations. But there are
four companies that would like to get in the business of
producing the smallpox vaccine.
Two, we have accelerated the production from 2005 to 2002
and I can announce today that we are going to be able to
accelerate even further and we should be able to start
producing smallpox vaccine as early as this year, sometime in
November and December, and we will be able to produce 300
million doses of vaccine for smallpox within 12 months. So by
the end of next year, we will have 300 million doses of vaccine
within our inventory to be able to be used if, in fact,
smallpox ever turns up.
Three, the shot, vaccine, if you get it within 2 to 5 days,
it is still effective even after you have been exposed to
smallpox, but the earlier you can get the vaccination, the
better off you are.
Four, what we would do if a smallpox outbreak did occur, we
would go in and would quarantine the area. Then we would give
the vaccination to the first responders and the medical
personnel first, and then we would make a concentric circle and
go around and vaccinate all the individuals in that concentric
circle.
Senator Durbin. But this will not be like my first memory
of public health when I was a grade school kid and learned the
name Jonas Salk and we had a national effort to immunize
children across America. Your idea is not to move forward with
immunization unless and until there is evidence of outbreak?
Mr. Thompson. That is correct at this point in time. Now,
there may be a decision after we have it in stock that the
Congress and the Public Health System and the President will
decide that maybe we should make some of the 300 million doses
available for voluntary vaccination, but I do not believe that
you will see mandatory vaccination because of the side effects
of vaccination for smallpox. There will be some fatalities, not
many, but probably one out of every million doses, there will
be a fatality is what the experts predict. There will be some
inflammation of the brain in some cases, a few more than
fatalities. So there are some adverse side effects.
So mandatory vaccination, I do not think will take place
and it is not recommended by the specialists that I have talked
to. Dr. D.A. Henderson, who is going to be my science advisor,
is really the father of the eradication of smallpox and he does
not advise vaccination at this point in time.
Senator Durbin. Three hundred million doses will treat how
many people?
Mr. Thompson. Three hundred million.
Senator Durbin. So it is one immunization that is
necessary?
Mr. Thompson. One, but we have 15.4 million doses right now
of the old vaccine and tests are being conducted on that right
now in regards to diluting that 1-1, 5-1, and 10-1, and the
preliminary analysis is 5-1, which would give us 77 million
right now. If a smallpox epidemic occurred, we would have 77
million because the experts feel, even though the analysis has
not been completed, that it would be strong enough to protect
95 percent of the American public.
Senator Durbin. I would like to make one general
observation about immunization. Since I got into the subject a
few years ago and studied it, I was surprised to learn how many
children are not immunized, do not receive the basic
immunizations that we consider important for public health, and
I was also surprised to learn that 3.6 million children
currently that have health insurance are not covered for
immunizations, that health insurance does not cover
immunizations for over three million children in our country. I
hope that we can work together on that to extend that umbrella
so that kids in Chicago and Milwaukee and all over can get the
basic----
Mr. Thompson. Senator Durbin, you are absolutely correct.
Preventative health, that is No. 1. Vaccination is the best way
to prevent some disastrous disease and it saves money for the
insurance company.
Senator Durbin. Anthrax vaccine, is that being considered,
as well?
Mr. Thompson. There is one company that produces anthrax
vaccine. It is called Bioport. It is in Michigan. They are
closed down right now for some problems and they are remodeling
and reconfiguring their factory to produce anthrax vaccine.
They have just applied for us to go in and to inspect it. We
got that application as of last Friday. They are going to
complete their renovations within the next 2 weeks. We will
then go in and make the inspection and if the inspection meets
FDA approval, which we think that it will, hope that it does,
they should be able to be in production by November 15.
They have an exclusive contract with the Department of
Defense. The Department of Defense purchases all the anthrax
vaccine that they have. They have approximately 5.2 million
doses of anthrax vaccine in inventory right now. Of that, about
3.3 million of it could be approved as an IND, a new drug,
which means that you could use it if somebody would sign and
say that it has not been completely tested and completely
approved.
So there is that 3.3 million. The Department of Defense has
some anthrax vaccine in their inventory, but they, of course, I
am sure, will be using it for the military. And the 3.3 million
or the 5.2 million which is in inventory which has not been
inspected by FDA will go to the Department of Defense.
Senator Durbin. First, let me commend you, because in your
opening statement, you have come to an issue which you have now
talked about several times on food safety. I believe there is a
need here for us to focus on two or three levels. First, what
you have suggested, take a look at the current laws. Where are
they inadequate to meet the current need, safety and security?
Second, find more and higher levels of cooperation between
the 12 different agencies of government that currently are
involved in this. I think what will evolve from that is my
ultimate goal, a single agency. But I am willing to stay on
board with you for the first two steps because they are
critically important.
Can you amplify any further your remarks about what we need
to do to make certain that food does not become a vehicle for
bioterrorism?
Mr. Thompson. Well, first, let me just say, Senator Durbin,
I thank you, because you have been a stalwart in trying to
protect the Nation's food supply. You have been a passionate
advocate and I applaud you for it. I am hopeful that as a
result of these bioterrorism attacks that we have had, that we
will address food safety in America. We have 750 inspectors at
FDA to inspect 56,000 establishments in America. Some of those
establishments are only being inspected 1 out of every 4 or 5
years. Those that cause problems are inspected annually. But it
still does not give me the sense of security that I would like
nor you would like and we do not--we have 132 points of entry
into America for food coming into America from other countries
and we only have 150 inspectors, and as you can tell just by
the sheer numbers, that is not enough.
Agriculture, on the other hand, has reduced the number of
ports of entry down to nine, and I think that this Congress
should take a look at reducing the number of ports of entry,
increasing the number of food inspectors, the laboratory
analysis. You and I talked about this coming over, and I was on
the border as of Monday going to a food inspection station in
El Paso, Texas, and take out a sample and then the sample has
got to be UPS-ed up to Kansas City where it is analyzed and
then the analysis is sent back. To me, that is not a very
effective way to inspect food in America.
Senator Durbin. Thank you. Thanks, Mr. Chairman.
Chairman Lieberman. Thanks, Senator Durbin.
Secretary Thompson, I just want to ask you a few more
questions and then we will thank you for being here, and this
comes back to the focus of this Committee on organization. As
we look at this, we see, as we mentioned before, literally
dozens of Federal agencies that have some part to play in
either preparing for or responding to a chemical or a
biological attack. The Justice Department has a State
assistance program. Federal Emergency Management has a State
assistance program. Your Department has a State assistance
program. There are research programs that are relevant in the
Defense Department, the Energy Department, even the Treasury
Department.
In your own Department, you have got several subdivisions
involved, Food and Drug, the Centers for Disease Control, NIH,
Office of Emergency Planning, and again, before I commended you
for asking Dr. Lillibridge to coordinate those programs.
So here is the concern or the criticism that I have heard,
which is that the question remains, who is in charge? In other
words, you have asserted a strong coordinating role, certainly
over the relevant agencies that come under you as Secretary of
HHS. But is this not still ultimately a kind of stovepipe
situation, where there may be some coordination, but there is
not clearly one person who is in charge of preparing America
for the possibility of a chemical or biological attack and then
coordinating the response to it?
Mr. Thompson. I think you are right. I do not think there
is one person. I think there are a lot of different individuals
involved. Our responsibility is the public health and I think
we do that quite well. We are making it much more responsive
than it has ever been before. By appointing one person to be
the coordinator, Scott Lillibridge, we have also put in place a
lot of other fine individuals, representatives from the various
agencies on a council working with Scott Lillibridge and they
report directly to me.
Especially during this period of time, we are meeting every
morning, every afternoon about updated intel that is coming in
and our responses. We also talk about the problem areas that we
still see and assign people to try and fix them and report back
to us when they are fixed, or if they cannot be, why not and if
they need more resources.
So we have, I think, a well-coordinated operation in the
Department of Health and Human Services, but when you look at
the totality of it, I think that is what Governor Ridge has
been set up to accomplish, is to bring us all together, report
to him. And yesterday, we had a meeting in the White House, and
that meeting went extremely well, with all the various agencies
dealing with bioterrorism coming in to talk about problem areas
as well as common sense solutions.
Chairman Lieberman. I think in your answer you have just
gone ahead and responded to my next question, which was, should
there be one person to coordinate across the various
departments? I take it you have answered that.
Mr. Thompson. Yes.
Chairman Lieberman. At this point, then, I was then going
to ask you, who should it be, and I believe you have said that
it should be Governor Ridge as the head of the new National
Homeland Security Agency.
Mr. Thompson. That is correct.
Chairman Lieberman. We have an ongoing discussion here and
with the administration about the powers that Governor Ridge
should have. I am going to leave that for another day, but I
think you may know that I feel, ultimately, he needs some kind
of budgetary authority to make sure that everybody is working
together. And at some point, and you and he as governors, I
think, can appreciate this particularly where we have got a
crisis now as urgent as the threat of chemical and biological
attack, you have got to have somebody who can say, hey, this is
it. This is what I decide. Do it. That is what you did as a
governor, that is what he did as a governor, and that is what I
think we need here, but that is another question.
Last year, we had a very troubling, interesting, and
educational, I suppose I would say, experience, beginning in
Connecticut, and going around the country, with the outbreak of
West Nile virus. My staff on the Committee here did an
excellent investigation. I was very proud of them. It helped me
to understand it. It took weeks for the Public Health System to
correctly identify the disease. It had not been seen before in
the United States. In fact, at the outset, if I remember
correctly, CDC and other health officials misidentified the
disease as St. Louis encephalitis.
I am not saying this to criticize CDC. That was not an easy
call. But I am raising it to show how difficult it can be in a
broader case of a larger scale chemical or biological attack to
identify the disease as it begins to appear in doctors' offices
or hospitals all over the country.
I wanted to ask you if you have any thoughts about what we
might do at the Federal Government level to improve our
ability, not just on the science, but I guess in one sense to
share information as it may begin to pop up in individual
offices around the country or even a separate geographic area
before we actually have a sense that something pretty bad is
happening?
Mr. Thompson. I think what we need to do, Senator, and you
raise a very valid point. Even though--I am not sure, but I
heard the CDC finally did determine it was----
Chairman Lieberman. They did. They absolutely did. At the
outset, they----
Mr. Thompson. They made a mistake.
Chairman Lieberman. But again, very understandable because
it had not been seen before.
Mr. Thompson. And that is the problem, especially now with
anthrax and the hemorrhagic viruses and so on. They are very
complex and you do not see them every day so you do not have
the knowledge.
Chairman Lieberman. Sure.
Mr. Thompson. So there are certain things you have to do.
You have to really educate the emergency doctors and the
emergency individuals that deal with patients so that they have
some basic information on what to look for.
Second, we have got to strengthen the local health
departments.
Third, we have got to strengthen the State health
departments and we have got to connect them all with CDC, and
there has to be education going from CDC down to all of these
various agencies in order to get a uniformity of instructions
and support throughout the system. And I also think it would be
very valuable if individuals that have gone to CDC and have
been educated as EIS specialists, as you know, and have them
assigned to every State health department and the larger
regional health departments so that they can help advise, put
on these educational programs for the local and State health
departments. I think it would be very beneficial to all of us.
Chairman Lieberman. I appreciate that, and anything you
could do to bring that about, including, and I think is
implicit in what you are saying--I do not have a specific idea,
but some kind of real-time information sharing so that people
can see that similar cases are suddenly turning up in a lot of
different doctors' offices.
Mr. Thompson. That is why we have set up now a 24-hour
hotline at CDC for local health people to call in during this
period of time.
Chairman Lieberman. Right.
Mr. Thompson. I can assure you it is being widely used.
Chairman Lieberman. Thank you. Senator Carnahan, welcome
back. I believe you would like to speak and have some
questions.
Senator Carnahan. Yes, if it is all right, I would like to
make an opening statement.
Chairman Lieberman. Please.
OPENING STATEMENT OF SENATOR CARNAHAN
Senator Carnahan. First of all, I would like to compliment
the Secretary for his rapid and comprehensive response. I think
your demeanor, your advice, all have caused the American people
to have a lot more awareness and a lot more confidence and I
thank you for that.
Since September 11, the Senate has focused on responding to
attacks on our Nation, and now that the Senate itself is under
attack, and I applaud Senator Daschle for responding to this
incident with calm and with resolve. But we are now taking the
next necessary steps to protect ourselves against any future
attacks. We must also act with speed to ensure that our Nation
is prepared, as well. Future attacks may affect many more
people. They may also affect livestock and the food and water
supply.
Unfortunately, many places in the country do not currently
have the capability to respond as quickly and thoroughly as the
United States Capitol, and that is why we are here today. We
must ask the difficult questions. We must address our
vulnerabilities. And we must ensure that we are ready to
respond to an attack anywhere in the United States.
Our best weapon, of course, is public awareness. Rumors and
misinformation just play into the hands of the terrorists. They
create fear and insecurity. We should arm our citizens with
scientific and accurate information.
Today, I am announcing my introduction of S. 1548, the
Bioterrorism Awareness Act. The bill would create an integrated
website containing accurate, scientifically-based information
about bioterrorism. The website will serve as the official
Federal Government source of information for the public.
Currently, there is information on bioterrorism on a variety of
Federal websites. Since the bioterrorism information on these
websites can be very difficult to find, I think where it would
be well for us to select a central location that the public can
go to get accurate bioterrorism information geared specifically
to their needs.
For example, we need to be sure that our doctors know how
to recognize the symptoms of a bioterrorism outbreak. There
will be a section on the website with information geared toward
health care professionals. Another section of the website will
be geared to help farmers and other personnel involved in the
Nation's food supply system to protect themselves, their
livestock, and the Nation's food supply in the case of an
attack.
States are key players in our country's ability to respond
effectively to a bioterrorist attack, and I am pleased that in
a later panel we will have Dr. Maureen Dempsey, Director of the
Missouri Department of Health and Senior Services, here to
testify and to share the State perspective. States need
sufficient resources to prepare for, detect, and respond to
bioterrorist attacks.
To give States these resources, I have signed on as an
original cosponsor to the State Bioterrorism Preparedness Act
sponsored by Senator Evan Bayh. It will give State Public
Health Agencies the resources to have surveillance systems in
place so that they are equipped to detect any pattern of
unusual illness that could indicate a biological attack. This
is just one example of what the bill would support.
In addition, I have asked the Appropriations Committee to
provide $2.5 million for the St. Louis University Center for
Research and Education on Bioterrorism and Emerging Infections.
The SLU Center for Research and Education on Bioterrorism is
the only CDC Public Health Preparedness Center devoted to
bioterrorism preparedness, training, and education. Its work is
more important now than ever before. The funding should help
the center meet the increased demands for its considerable
expertise.
Certainly, we need to be vigilant in this struggle. Given
the resources, I know that our law enforcement officials as
well as our public health authorities can get the job done, but
we need to act quickly and effectively.
Thank you, Mr. Chairman, for calling this very timely and
important hearing and I have one question for the Secretary. In
the last month, we have seen what a powerful role the media can
play in relaying information to the public. The media has the
ability either to calm our fears or to increase our anxiety.
What has HHS done to educate the media on how to communicate to
the public during a bioterrorist attack in such a way that it
minimizes people's fears?
Mr. Thompson. Thank you very much, Senator. Let me
compliment you on the introduction of your bill. It is badly
needed and I hope that you will get bipartisan support for it
and I applaud you for doing that.
Second, what we did first was we wanted to make sure that
we contacted the State health departments and local health
departments. We have what is called the Health Alert Network
and we are hooked up with, at the present time, 37 States. We
have just given out enough grants to have us hooked up to all
50 States. I would like to be able to expand that in the future
so that the HAN, the Health Alert Network, could be expanded
into the counties. There is money in the appropriation bill for
that, and I think that would be the best way in order to get
information.
We also set up a 24-hour hotline in regards to giving
information out and receiving information from local health
departments and doctors, from hospitals and so on who could
call up and give us information and ask questions.
Third, Jeff at CDC, Dr. Koplan, and myself spoke to all of
the health departments on a teleconference last Saturday and we
answered their questions and we are going to do the same thing
tomorrow for the American Medical Association and the American
Hospital Association and get out information through the
teleconference. On Friday, I am talking to all the governors on
a teleconference about what they can do and how they can report
to their constituents on bioterrorism, and next week, we are
going to do the same thing with the country's mayors. Those
mayors who want to hook up on a teleconference, we are going to
be able to do that, or through a webpage.
Finally, last night, we had an informational meeting with
the print press in which we had three doctors and myself answer
their questions over the telephone. There were a lot of press
on, I do not know how many, and we have been holding briefing
meetings through my press office with the press about the
status and things like this. But it is very hard to knock down
all the rumors. We are getting thousands of rumors, as you can
well imagine, and it is difficult to be able to answer all of
those rumors, but we are trying to do the best job we possibly
can.
I would just like to leave you with one thing and that is
that we have to make sure that people understand, even with all
of the individual exposures on anthrax, there still are only
four cases, two in Florida and two in New York, and even though
you are exposed, it is not a disease that can be conveyed to
another individual. It is one that can be treated with
antibiotics, and I am happy to be able to report that of all
the things that we have seen on anthrax, all of them have been
sensitively proven that antibiotics work, and it is not only
ciprofloxacin, it is doxycycline, it is penicillin. By allowing
generic drugs for doxycycline and penicillin, they should be
very reasonably priced so that individuals, if the need be, can
purchase it.
I would not in any way encourage people to horde these
pharmaceutical drugs because the government has got plenty in
supply to be able to take care. We will have enough right now
to handle 2 million Americans with Cipro and other antibiotics
for 60 days and we are asking the Congress to allow us to
purchase and give us the money to purchase an additional 10
million for 10 million individuals, enough supply to handle
then 12 million individuals in America. We are purchasing
vaccine for smallpox and we feel that we will have enough of
that within the year to treat 300 million Americans.
Senator Carnahan. That is exactly the message we need to
hear in America today. Thank you very much, Mr. Secretary.
Mr. Thompson. Thank you very much.
Chairman Lieberman. Thank you, Senator Carnahan.
Secretary Thompson, thanks very much. You have been not
only cooperative and informative, but really reassuring. Again,
I appreciate the fact that you are there, that you are doing
the job you are. I thank you for the specific announcements
that you have made today, the ones that you have just
mentioned, that the American people can be sure that their
government is prepared, and insofar as the Senator first said a
while ago, but we may be under-prepared, we are moving rapidly
to close that gap.
For our part on this Committee, I hope that we can be
supportive in helping you assert your leadership and making
sure that all the agencies and offices of the Federal
Government that have any responsibility or programs for
chemical and biological warfare are well coordinated and
directed, and I think you are right that Governor Ridge is now
the person to do that.
Anyway, thank you, God bless you, and good luck in your
work.
Mr. Thompson. Thank you so very much. Thank you for holding
the hearing.
Chairman Lieberman. Thank you.
We will now call the second panel. Michael Brown is the
Acting Deputy Director of the Federal Emergency Management
Agency. Deborah Daniels is Assistant Attorney General, Office
of Justice Programs, U.S. Department of Justice. Henry L.
Hinton, Jr., is the Managing Director of Defense Capabilities
and Management, U.S. General Accounting Office. Anna Johnson-
Winegar is Deputy Assistant to the Secretary for Biological and
Chemical Defense at the U.S. Department of Defense.
I wonder if I might also call to take a chair at the end of
the table Gary McConnell, who is the Director of the Georgia
Emergency Management Agency, who is testifying on behalf of the
National Emergency Management Association. Why do you not pull
right up in that comfortable chair, Mr. McConnell. I gather
that you have got plane pressure. How soon do you have to
leave?
Mr. McConnell. Mr. Chairman, I will be here as long as you
need for me to. I just need to get back to Atlanta at my
earliest convenience, but if I can get out of here by 1:30 or 2
o'clock, I will be fine.
Chairman Lieberman. Oh, you do? OK. If this panel moves,
maybe we will wait and bring you on on the third panel.
Mr. McConnell. OK, sir.
Chairman Lieberman. If not, I will call you earlier.
I thank you all for your patience under these unusual
circumstances. The testimony you prepared will be submitted in
full as part of the record. To the extent that you can keep
your remarks to 5 minutes, I would appreciate it, but if you
feel like you have some more to say and you need to say it, we
will not physically remove you from the premises, I assure you.
[Laughter.]
Mr. Brown, please proceed.
TESTIMONY OF MICHAEL D. BROWN,\1\ ACTING DEPUTY DIRECTOR AND
GENERAL COUNSEL, FEDERAL EMERGENCY MANAGEMENT AGENCY
Mr. Brown. Thank you, Mr. Chairman, Members of the
Committee. I really appreciate the opportunity to be here today
and speak on behalf of Director Allbaugh and all of the workers
in New York City, the Pentagon, and here at headquarters of the
Federal Emergency Management Agency.
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\1\ The prepared statement of Mr. Brown appears in the Appendix on
page 89.
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What I would like to do is give you a very broad overview
of FEMA's preparedness response activities to both natural and
manmade disasters and how those programs make FEMA uniquely
fitted to deal with the consequences of terrorism, regardless
of the type of terrorism.
But first, I want to talk about the immediate response to
the attacks at the Pentagon and the World Trade Center. On the
day of the attacks, September 11, I was in Big Sky, Montana,
preparing to give a speech about terrorism at 11 o'clock that
morning when I received a phone call that said, ``Turn on your
television. We are under attack.'' I turned on the television
and realized immediately that I needed to get out of Big Sky,
Montana, along with Director Allbaugh. We jumped a military
plane and came back to DC, after finding a military plane that
could get us back there.
But I thought about that speech and the three things that I
wanted to say in that speech on September 11 are equally
applicable today, and it is probably a speech that I could give
anywhere else in the country, any other time in the future.
Three things.
First, this administration recognizes that the first
individuals to respond to the 911 phone calls are the local and
State emergency managers, the fire departments, emergency
medical services, and law enforcement. Those truly are the
first responders. When someone dials 911, they do not call
Washington, DC. They call their local officials.
Second, we rely upon and must rely upon the wisdom and the
experience of those at the State and local levels as we prepare
and work toward a national plan that includes the active
participation of all levels of government.
And third, and probably most importantly, the Federal
Government must provide a comprehensive national strategy to
prepare for terrorist attacks. Our goal, our strategy must be
to provide the best resources, the best education, the best
guidance, and the best training to the State and local
officials to enable them to respond when, indeed, they are
called in that 911 phone call.
I often think of duty honoring country when reflecting on
the events of September 11. The response that day and every day
demonstrates the true heroism of all of those who responded,
fire fighters, policemen, emergency medical technicians, the
emergency managers, all who placed themselves in danger to
respond and help those in need. Many of those heroes tragically
lost their lives that day, rushing to the scene to save lives,
rescuing the trapped and the injured. They were, in fact, being
the first responders. Our hearts hurt with them and for the
innocent families who lost loved ones. Now we must, however, be
prepared for long-term recovery efforts and stand united and
ready to assist those who were injured both physically and
emotionally.
The level of cooperation and professionalism by the
Federal, State, and local agencies and emergency responders in
responding to New York and the Pentagon have been absolutely
outstanding. The American people can and should be proud of the
work that they have done in helping the Nation recover from
those incidents.
At FEMA, our mission is to reduce the loss of life and to
reduce damage to property, and that mission applies to all
hazards, to all disasters, whether those disasters are manmade
or whether they are natural disasters. When a disaster
overwhelms the response capabilities of State and local
governments, the President may sign an emergency or major
disaster declaration. On September 11, the President did that.
Declarations were signed immediately and response of the
Federal Government was immediate.
As in response to other presidentially declared disasters
and emergencies, FEMA utilized the Federal Response Plan to
coordinate the government's response activities to those
disasters. We use this tool, on average over the past 10 years,
53 times a year in responding and coordinating the Federal
Government's response to a disaster. The Federal Response Plan
provides the framework for 26 different Federal departments and
agencies, as well as the American Red Cross, to respond and
support the efforts of State and local governments.
These Federal agencies are organized into interagency
functions based on their authorities and their expertise and
the needs of the counterparts at the State and local
government. For example, as we heard from Secretary Thompson,
HHS is the lead support agency for health and medical needs.
Since 1992, the Federal Response Plan has been used exactly
under this mechanism to respond to disasters, regardless of the
cause. To the Members of this Committee, you are familiar with
the response that FEMA has in natural disasters, whether it be
floods in Ohio or fires in New Mexico, tornadoes in Oklahoma,
whatever it is. You are accustomed to how we respond. That is
exactly how we responded in New York.
The Federal Response Plan worked in New York City just as
it worked in Oklahoma City in 1995. The effectiveness of the
Federal Response Plan has clearly been demonstrated, and that
is why the Federal Response Plan must be used to identify
Federal resources and response capabilities for the threat of
biological terrorism.
Immediately following the attacks on September 11,
President Bush recognized the need to respond quickly and
accurately, to make certain that the Federal Response Plan was
working the way it was supposed to. The President convened
three different working groups to respond to those disasters, a
military or foreign policy response group, a protection
response group, and the group that he asked me to chair, the
consequence management working group.
That group is responsible and is still working today--and,
in fact, Senator, we are meeting this afternoon on another
issue--was responsible for identifying those issues, those
holes, if you want to call them that, in the Federal Response
Plan and how do we fix those. We identified those holes and we
divided them into three categories, first, those holes that we
needed to fix immediately, that we had to fix today. Then those
holes that we need to fix in the next 30 or 60 days, and then
the long-term fixes that we could put off and deal with in a
longer-term situation.
The result of that consequence management working group you
are seeing today. You are seeing, as Secretary Thompson
indicated, the push packs being increased, the vaccine issue
being addressed, the issue of what we are going to do with the
antibodies. All of those issues were addressed by the working
group and briefed to the President and the President had
decision papers directing us exactly what to do with those
issues. That is how the Federal Response Plan is supposed to
work, and, indeed, how it did work.
We see Governor Ridge as the President's spokesman for all
issues regarding terrorism. Yesterday, for example, Governor
Ridge asked FEMA to take the lead in organizing a joint
information center to coordinate all of the efforts going on
between FEMA, Health and Human Services, FBI, Department of
Justice, all of the agencies, so there can be one centralized
location for the administration to put out the message of what
they are doing and what the response should be and how the
American public can respond. We intend to put together packets
for the American public so they will have information that is
helpful to them in responding to this new crisis. Clearly,
groups such as HHS will be involved in that effort.
The threat of a biological attack presents unique
challenges to this country's response system. The first
responders in a biological event shift, as I think Senator
Collins mentioned earlier, from the fire fighter and the
policeman to the doctors, to the Public Health Service, to
those people that will now need to respond in an emergency
situation.
The Department of Health and Human Services is a critical
link between the health and medical community and the larger
Federal response. In all disasters, FEMA works closely with
HHS, the Public Health Service, and the Centers for Disease
Control to make certain that we have the assets and the
response mechanism that we need in this type of incident. In
New York and in the Pentagon, that is exactly what occurred.
Again, as the lead agency with responding and coordinating
a response to a disaster, whether manmade or natural, we have
tasked HHS to put together to the Federal Response Plan a
Bioterrorism Annex so the Federal Response Plan will have in
place for future agencies, for future people working in those
agencies, the response and coordinated effort that they must
have.
Just like Secretary Thompson, Director Allbaugh and I met
yesterday with Governor Ridge to provide him with information
about this very response mechanism. In Director Allbaugh's
testimony yesterday before the Senate Committee on Environment
and Public Works, he stated that he could think of no greater
person than Tom Ridge for the position of the Director of
Homeland Security. FEMA is committed to working with Governor
Ridge in that respect and will implement the strategy that he
asks us to do so.
We kind of see Governor Ridge as the conductor of this
great orchestra, telling us what we need to do and how to do
it. He has the power because he speaks on behalf of the
President of the United States. As Director Allbaugh will also
serve on the Homeland Security Council, FEMA will support the
office to any extent that the governor asks us.
We believe that FEMA is ready, able, and willing to
respond, as seen in New York. We are ready, willing, and able
to respond in any future incidents and believe we have the
mechanism to do so.
Mr. Chairman, thank you for convening this meeting so that
we can discuss about the organizational issues facing the
government at this time.
Chairman Lieberman. Thanks, Mr. Brown. I look forward to
the question and answer period with you.
Ms. Daniels, thank you for being here on behalf of the
Department of Justice.
TESTIMONY OF HON. DEBORAH J. DANIELS,\1\ ASSISTANT ATTORNEY
GENERAL, OFFICE OF JUSTICE PROGRAMS, U.S. DEPARTMENT OF JUSTICE
Ms. Daniels. Thank you, Mr. Chairman and Senator Akaka. I
am pleased to have this opportunity to talk about the Office of
Justice Programs' (OJP) efforts related to bioterrorism and our
coordination with the Department of Health and Human Services
on this critical issue.
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\1\ The prepared statement of Ms. Daniels appears in the Appendix
on page 96.
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As you know, since 1998, OJP's Office for Domestic
Preparedness, to which I will refer as ODP for short, has been
working to help State and local public safety personnel acquire
the specialized training and equipment they need to safely
respond to and manage domestic terrorism incidents,
particularly those involving weapons of mass destruction. Of
course, these efforts have taken on new urgency in the
aftermath of the September 11 attacks.
And as the Senators have suggested this morning, State and
local personnel are on the front lines. They are typically
first on the scene of any emergency and first to respond in the
event of a terrorist attack. ODP is working to ensure that
these brave men and women are well prepared and as well
equipped as possible for these potentially catastrophic events.
Over the past 3 years, ODP has worked to develop and
implement a national program to enhance the capacity of State
and local agencies to respond to domestic terrorism incidents.
We provide coordinated training, equipment acquisition,
technical assistance, and support for national, State, and
local exercises to address a wide range of potential threats,
including chemical, biological, radiological, nuclear, and
explosive weapons.
We also support the efforts of the Department of Health and
Human Services, particularly the U.S. Public Health Service and
the Centers for Disease Control, to deliver training and
equipment assistance to the public health and medical
communities, and we have worked with HHS to test the Nation's
bioterrorism response capacity through the use of field
exercises. This partnership has been beneficial to both HHS and
to our Office for Domestic Preparedness. Whereas ODP has taken
the lead in reaching the public safety and emergency response
community, we have deferred to HHS to lead the preparedness
effort for public health and medical personnel.
ODP's domestic preparedness activities are concentrated in
the areas of training and technical assistance, equipment,
planning, and field exercises. We provide over 30 direct
training and technical assistance courses and programs to
enhance the capacity of State and local jurisdictions to
prepare for and to respond to terrorist attacks on U.S. soil.
Since 1998, we have provided training to over 77,000
emergency responders in 1,355 jurisdictions in all 50 States
and the District of Columbia. We have also completed over 2,000
deliveries of technical assistance to State and local response
agencies, and we are completing delivery of the Nunn-Lugar-
Domenici training program to the remaining 52 of the Nation's
120 largest cities that did not receive all elements of the
program from the Department of Defense before the transfer of
the program to the Justice Department. This training will
include a biological weapons tabletop exercise and briefings on
the U.S. Public Health Service's Metropolitan Medical Response
System, to which Secretary Thompson referred.
ODP is also working with all 50 States, the District of
Columbia, and the five U.S. territories to help them develop
comprehensive 3-year domestic preparedness strategies. These
strategies are based on integrated threat, risk, and public
health assessments that are conducted at the local level. They
will identify the specific level of response capability
necessary for a jurisdiction to respond effectively to a
terrorist incident involving weapons of mass destruction.
Once assembled and analyzed, these plans will present a
comprehensive picture of equipment, training, exercise, and
technical assistance needs across the Nation. In addition, they
will identify Federal, State, and local resources within each
State that could be utilized in the event of an attack. We
anticipate receiving the majority of these strategies by
December 15 of this year. We then will work with each State and
territory to implement assistance specifically tailored to the
needs identified in their own plans.
The Attorney General recently wrote to each governor
stressing the urgency of completing these assessments. He has
directed ODP to place the highest priority on analyzing these
strategies and helping States to meet the identified needs as
quickly as possible.
To give you an idea where we have been in terms of
providing dollar assistance, in fiscal year 1999, States
received a total of $54 million in initial planning and
equipment funds under the program. They are scheduled to
receive an additional $145 million in fiscal year 2000 and 2001
funds as their plans are completed. In addition, from 1998
through this year, we have provided a total of $242 million in
equipment grants for 157 local jurisdictions, the 50 States,
the District of Columbia, and the five U.S. territories under
the County and Municipal Agency Equipment Program. These funds
are helping to ensure that State and local personnel have the
specialized equipment they need to safely and effectively
respond to biological, chemical, or other hazardous incidents.
And as indicated in my written testimony that I have
submitted, OJP, the Office of Justice Programs as a whole,
makes available additional millions to each State in the form
of block grants that can be utilized for law enforcement
equipment for first responders.
Finally, Mr. Chairman and Senator Akaka, ODP provides
funding and technical assistance to state and local
jurisdictions to support local and regional interagency
exercises. These exercises test crisis resistance, identify
procedural difficulties, and provide a plan for corrective
action to improve crisis and consequence management response
capabilities without the penalties that might be incurred in a
real crisis.
In May 2000, we conducted TOPOFF, the largest exercise of
its kind, involving separate locations and a multitude of
Federal, State, and local agencies. TOPOFF simulated
simultaneous chemical and biological attacks around the country
and provided valuable lessons for the Nation's emergency
response communities.
ODP has begun planning for the Congressionally mandated
TOPOFF 2 exercise, which will be conducted in the spring of
2003, and we are working with the Department of Energy to
establish a Center for Exercise Excellence at the Nevada test
site that will help to ensure the operational consistency of
weapons of mass destruction exercises nationwide.
ODP actively coordinates its programs with other Federal
agencies to ensure that the highest quality training and
technical assistance is provided to the Nation's emergency
response community while also eliminating duplication of
Federal resources. For example, we helped to establish TRADE,
the Training Resources and Data Exchange working group. TRADE
includes representatives from the National Fire Academy, the
FBI, FEMA, the EPA, the Department of Energy, HHS, and
specifically the CDC. TRADE is already working on a number of
joint initiatives that will enhance the coordination of
training delivery resources in accordance with State
strategies.
These and other joint endeavors will greatly enhance the
capacity of the Nation as a whole to respond safely and
effectively to incidents of terrorism involving weapons of mass
destruction, including biological agents. We are committed to
continuing build on the efforts already underway to ensure that
States and local jurisdictions have the training and resources
they need as a vital link in our Nation's response to
terrorism.
Once again, Mr. Chairman, I want to thank you for the
opportunity to describe the efforts of the Office for Domestic
Preparedness in this vitally important area and, of course,
will be pleased to respond to any questions the Senators have.
Thank you.
Chairman Lieberman. Thanks, Ms. Daniels. Let me just take
the liberty to ask you to speak a moment more about the TOPOFF
exercise, how it was conducted and, just briefly, what the
conclusions were about our state of preparedness.
Ms. Daniels. Mr. Chairman, TOPOFF was conducted at multiple
sites. There were multiple exercises so that we could literally
test our preparedness to respond to multiple events, including
biological terrorist attacks.
Chairman Lieberman. So you simulated biological attacks in
different regions of the country?
Ms. Daniels. Correct. I believe that in Denver, the
biological exercise occurred.
Chairman Lieberman. And chemical exercises elsewhere, was
that----
Ms. Daniels. Portsmouth, New Hampshire. My experts are
behind me. Thank you.
Chairman Lieberman. Right.
Ms. Daniels. And there has been an analysis that has been
conducted that is contributing to the preparation for TOPOFF 2,
and I think some valuable lessons were learned and have been
disseminated to those who are responsible for preparing for
potential events in the future.
Chairman Lieberman. To the best of your recollection, would
you say that the conclusion from those TOPOFF exercises
simulated attacks was that we were--to use a formulation that
we are involved in here now--adequately prepared, under-
prepared, or unprepared?
Ms. Daniels. My understanding, Mr. Chairman, is that at the
time the TOPOFF 1 exercise took place, I think it clarified
some interesting gaps in our preparedness at that time. There
has been time in the interim, I think, to deal with those gaps
and I would hope that we could say that we are close to at
least being adequately prepared for the future.
Chairman Lieberman. But probably for now, we would say we
are under-prepared? We are not unprepared.
Ms. Daniels. We are not unprepared.
Chairman Lieberman. Right. Thanks.
Mr. Hinton, thank you for being here. We are always glad to
see somebody from GAO. We consider you part of the Governmental
Affairs family.
TESTIMONY OF HENRY L. HINTON, JR.,\1\ MANAGING DIRECTOR,
DEFENSE CAPABILITIES AND MANAGEMENT, U.S. GENERAL ACCOUNTING
OFFICE
Mr. Hinton. Thank you, Mr. Chairman and Senator Akaka. I
appreciate the opportunity to be here today to discuss GAO's
work on efforts to prepare for and respond to chemical and
biological terrorist attacks. My comments today are based on
several of our recently issued reports, including our September
28 report on Federal research and preparedness activities to
counter biological terrorism. My colleague, Dr. Jan Heinrich,
who directed that work, is with me today, sitting right behind
me on my left. For this hearing, we also took a quick look at
50 Federal exercise evaluations to identify problems associated
with chemical and biological terrorism that needed to be
addressed.
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\1\ The prepared statement of Mr. Hinton appears in the Appendix on
page 107.
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I will briefly address three points, Mr. Chairman. First, I
will highlight some of the specific Federal programs and
coordination challenges to prepare for and respond to chemical
and biological agents or weapons. Second, I will point out some
of the problems identified in the evaluations of the
preparedness exercises. And finally, I will offer some
suggestions for Congress to consider for investing resources in
chemical and biological preparedness.
I want to echo a comment you made right at the onset of the
day's hearing, Mr. Chairman. The body of work that we have done
over the last several years shows that there has been progress
on many fronts. But as you said, and we agree, there is more to
be done.
Let me turn to the programs. The Federal Government has a
variety of programs to prepare for and respond to chemical and
biological terrorism. They include response teams, support
laboratories, training and equipment programs, and research
efforts. These programs face two coordination challenges, if I
could refer you to the graphic.\1\
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\1\ Chart referred to by Mr. Hinton appears in the Appendix on page
123.
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At the program level, our first graphic illustrates the
complex relationships among some of the key Federal departments
and agencies involved in just biological terrorism research and
preparedness activities. I am not going to go into the details
on that, but you can get the gist of the complex relationships
there.
Chairman Lieberman. It looks messy.
Mr. Hinton. At the operational level, our second graphic
identifies the Federal response teams available to provide
assistance to State and local first responders, if needed, for
chemical and biological terrorism. If you were to add the State
and local government activities to each graphic, the
relationships will be more complex and the coordination
challenge that much more extensive. A number of interagency and
intergovernmental plans and working groups are involved in
coordinating these activities.
Let me turn to our analysis of exercise evaluations, also
known as after-action reports. We identified a number of
problems that require solutions to improve preparedness. The
problems and their solutions fell into two categories.
One category was those problems and solutions that are
generally applicable to any type of a terrorist incident, major
accident, or natural disaster. For example, they covered issues
involving command and control, specifically the roles,
responsibilities of different agencies. The legal authority to
plan and carry out a response to a WMD terrorist incident were
not always clear, which resulted in a delayed and inadequate
response. In the communication area, interoperability
difficulties exist at the interagency and intergovernmental
level.
Last, in planning and operations, State and local emergency
operation plans did not always conform to Federal plans.
The other categories were those problems and solutions that
are applicable to both chemical and biological terrorist
events. Those problems included issues involving public health
surveillance, a topic that has come up this morning.
Specifically, the basic capacity for public health surveillance
for biological terrorism and emerging infectious diseases is an
urgent preparedness requirement at the local level. The
detection and identification of chemical and biological agents
was another problem frequently raised in exercise evaluations.
The capability of first responders and specialized response
teams to rapidly and accurately detect, recognize, and identify
chemical and biological agents and assess associated health
risks can be slow. Equipment and training was another problem.
First responders often lack specialized personal protective
equipment or chemical or biological detection kits. And
finally, problems were identified in the laboratories. Even a
small outbreak of an emerging disease was determined to strain
the resources. There is a need for broadening laboratory
capabilities, ensuring adequate staffing and expertise, and
improving the ability to deal with surging and testing needs.
Let me turn to the resource question, Mr. Chairman.
Congress faces competing demands for spending as it seeks to
invest resources to better prepare our Nation for chemical and
biological terrorism. As the Comptroller General recently
testified before this Committee, we believe a risk management
approach must be used. It should include a threat assessment to
determine which chemical and biological agents are of most
concern in order to focus finite resources on areas of greatest
need.
Our work shows that some of the solutions to improve the
response to chemical and biological terrorism have broad
applicability across a variety of contingencies, while other
response solutions are only applicable to a specific type of
attack. For example, efforts to improve public health
surveillance would be useful in any disease outbreak, whereas
efforts to provide vaccines for a specific disease would only
be useful if terrorists used that disease in a biological
attack.
Until the results from a risk management approach is
available, Congress may want to initially invest resources in
areas with broad applicability, and as threat information
becomes more certain, it may be more appropriate to invest in
efforts applicable to specific chemical or biological agents.
Mr. Chairman, that completes my statement and we stand
ready to answer any questions.
Chairman Lieberman. Excellent. Thank you.
Dr. Johnson-Winegar.
TESTIMONY OF ANNA JOHNSON-WINEGAR,\1\ PH.D., DEPUTY ASSISTANT
TO THE SECRETARY OF DEFENSE FOR CHEMICAL AND BIOLOGICAL
DEFENSE, U.S. DEPARTMENT OF DEFENSE
Dr. Johnson-Winegar. Thank you. Mr. Chairman and
distinguished Committee Members, I would like to briefly
describe for you the role of the Department of Defense.
---------------------------------------------------------------------------
\1\ The prepared statement of Dr. Johnson-Winegar appears in the
Appendix on page 124.
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As we all know, the tragic events of September 11 and the
more recent anthrax cases have heightened the public's
awareness of the threat posed by biological terrorism. The
Department of Defense has long considered the use of biological
weapons as a possible means by which State and non-state actors
might counter America's overwhelming conventional war-fighting
strength. This is often referred to as an asymmetric threat.
In response to this threat, Congress indeed directed the
Department of Defense to consolidate all our efforts in
chemical and biological defense, and since that consolidation
in 1994, and with the continued support of the Congress, I feel
that the Department of Defense has made significant progress in
fielding defensive equipment for our war fighters and we stand
ready to assist the civilian community through our technology
sharing, through technical advice, and as otherwise requested
by the appropriate authorities.
In order to meet the challenge of biological warfare across
the spectrum, our program must address the need for both
material improvement and operational concepts to address this
threat. In order to address this more thoroughly, we have
indeed documented gaps and deficiencies through the use of
exercises such as TOPOFF and there will be a continuing relook
and refocus of the prioritization of efforts within the
Department of Defense.
One of the lessons that we learned from the TOPOFF exercise
was that to work effectively during an actual crisis, various
governmental agencies must actually exercise together
beforehand or their cultural differences will possibly overcome
the plan. We will continue to work with the other agencies,
including the new Office of Homeland Security, to ensure good
working relationships. One specific area that we will focus on
is to help define what support the Department of Defense can
provide.
As you may know, the Department of Defense does, indeed,
have unique expertise and materiel. However, we are not charged
with lead Federal agent responsibilities as described in the
Federal Response Plan. In the area of domestic terrorism
medical response, the Department of Health and Human Services
takes charge and requests support as needed. In my testimony
today, I will outline the ways the Department of Defense can
provide materiel support to other organizations and how we help
to coordinate the efforts.
Requests for specific materiel may come to the Department
of Defense from a number of different avenues. These requests
are approved on a case-by-case basis, and indeed, my office has
dealt with a number of requests from other Federal agencies for
individual and collective protective equipment and access to
vaccine, while the operational support provided by the
Department of Defense is coordinated through the Army. The
Department will continue to provide the support within our
means and balance this against our main requirement, which is
to provide for the readiness of our military forces to
accomplish their war-fighting mission.
DOD can, indeed, offer many of its systems, either in the
field or otherwise, or expertise that may, indeed, prove useful
to the civilians. Our chemical and biological detection
equipment, for example, could be applied in many civilian
situations, as can many of the medical countermeasures that we
have developed. However, I caution that the provision of
materiel alone does not enhance one's capability. It needs to
be accompanied by valid operational concepts, training, and
maintenance.
The mission of the DOD's chemical and biological defense
program is to provide specific materiel to allow our Armed
Forces to be trained and equipped to conduct their operational
mission in an environment contaminated with chemical or
biological agents. Therefore, our Armed Forces are, indeed,
trained primarily for traditional war-fighting requirements.
However, we also maintain significant capabilities to support
homeland security through such operational units as the
Technical Escort Unit, the WMD Civil Support Teams, and the
Marines' Chemical and Biological Incident Response Force.
In order to enhance our Nation's overall capabilities, the
Department of Defense participates in many programs to support
the transition of military equipment and concepts to other than
DOD agencies. I would like to name a few of those.
Specifically, we participate as a member of the Technical
Support Working Group, which rapidly prototypes emerging
technologies for high-priority Federal interagency
requirements. We participate in the Interagency Board for
Equipment Standardization and Interoperability, known as the
IAB, which is a partnership with Federal, State, and local
agencies focused on the capabilities necessary for local
responders, that is fire, medical, and law enforcement, in
order to be able to cope with WMD terrorism. We also
participate in the Domestic Preparedness Program mandated under
the 1997 Nunn-Lugar-Domenici legislation, and indeed help to
train and equip many municipalities and have subsequently
transferred that program to the Department of Justice, as was
previously mentioned.
We have a number of interagency agreements with the
Department of Justice, Office of State and Local Domestic
Preparedness, to purchase specific equipment. We help provide
medical training programs from our U.S. Army Medical Research
Institute for Infectious Diseases, for biological agents, and
our Institute for Chemical Defense for chemical agents. And we
also participate in the White House Office of Science and
Technology Policy Program on Weapons of Mass Destruction
Research and Development Subgroup.
I think that these efforts represent just a small snapshot
of the Department of Defense efforts to address bioterrorism.
As the individual lead Federal agencies assess their needs, DOD
anticipates additional requests for our participation in these
groups.
The Department of Defense has established a set of
requirements for the successful completion of military
operations in chemical and biological environments. As you
know, we submit an annual report to the Congress documenting
our progress in meeting these requirements. My office
additionally continues to coordinate our efforts, and I would
particularly like to point out our coordination with the
Department of Energy, Department of Health and Human Services,
and the intelligence community, as is reported in our
Counterproliferation Program Review Committee.
DOD again, in conclusion, I believe, works regularly with
the lead Federal agents to coordinate requirements and
development efforts for biological terrorism. In addition to
coordination, there are a number of other mechanisms for the
Defense Department to provide assistance to other Federal,
State, and local agencies. In light of recent events, the
Department certainly anticipates a greater number of requests
for assistance. DOD will address these requests on a case-by-
case basis to make sure that public safety is enhanced and that
the DOD can still accomplish its war-fighting mission.
I would like to thank you for the opportunity to speak with
you today and for holding this hearing on what I feel
personally is a very important topic. I will be happy to answer
any of your questions.
Chairman Lieberman. Thanks, Doctor. Thanks to all of you.
As I listened to the references to the TOPOFF exercises, and,
in fact, as I listened to the reports of what each of the three
departments on this panel have been doing in regard to chemical
and biological, the possibility of chemical and biological
attacks, and including what Secretary Thompson testified to for
HHS, there is some comfort here in the sense that we have been
hearing, certainly here on Capitol Hill, for a long time,
warnings and concerns. We have all expressed ourselves, or a
lot of us have, about the possibility of chemical and
biological attacks against the United States.
And the good news here is that we, and you, and the Federal
Government together have created a series of programs to
prepare for and help us better respond to those attacks. So I
feel very strongly that we are right when we say America is not
unprepared for chemical and biological attacks. We are under-
prepared, and our fear on this Committee, mine certainly, is
that we are also under-organized, and I take that to be part of
what your conclusions, Mr. Hinton, were, GAO's.
I feel that as I hear the testimony that the three
departments have offered here on this panel, it seems to me
that Justice has a series of programs for State and local
governments to receive training and equipment. FEMA has
programs to do some of the same. HHS has programs. DOD has some
programs, a little bit different, but also reaching out to
State and local to help train, because those are the first
responders.
So my question, and maybe I will start with you, Mr. Brown,
is who is in charge? Maybe I ought to go about it in a slightly
different way. In the best of all worlds, should we be, for
instance, putting all of these various programs under FEMA as
the coordinating agency? And I will give you a chance to
respond, Ms. Daniels. Why does Justice have this authority?
Would that not be better if it came under FEMA as the central
response agency in the Federal Government?
Mr. Brown. Mr. Chairman, I think maybe the best way to
answer that question is to tell you what we have
organizationally.
Chairman Lieberman. Go ahead.
Mr. Brown. Having only been in FEMA now since Director
Allbaugh came on in February, I am amazed at the organizational
structure we have to respond to these types of, or frankly, any
kind of disaster. In our emergency support team operation, we
have literally desks and cubicles for every agency that needs
to be responding, so that whoever is in the field, if they have
cross-cutting issues that need to be addressed, those can be
addressed in the emergency support team function right here in
Washington, DC. We eventually move those out into the field,
like we are doing in New York right now, but there is a
mechanism in place to do that coordination in FEMA right now
and I think FEMA does it very, very well.
I think what Governor Ridge brings to the table is the
ability to say on a broader scale now, when things are not
working and need to be coordinated, and he made this point to
Director Allbaugh just the other day, training is a very
important component that he wants to work on and he wants to
make sure they are all working together. Because of his
authority under the directive of the President, he can now say
to all of us, we ought to start combining some of these
programs. We ought to see who is doing it the best and make
sure they are the ones taking the lead on that, and I think
that is going to happen. I can just tell that by the way
Governor Ridge is working things right now.
But to go back to my initial point, FEMA has that structure
set up now to coordinate all of those things. The emergency
support functions that all come together in times of disaster
and even non-disaster are in place to deal with those cross-
cutting issues.
Chairman Lieberman. And FEMA has the authority or the
cooperation of the other agencies so that, in fact, you have
not had problems in responding to crises?
Mr. Brown. Generally, yes.
Chairman Lieberman. OK.
Mr. Brown. I would say this, that when we have had a
problem, it has taken the sheer willpower of individuals to
conquer those problems. I think now Governor Ridge is in place
to help us do that. And I think the other thing that the
administration did to respond immediately to New York was to
create the Domestic Consequences Principals Committee, which
did that very thing, brought together in the White House a
group of principals so that when there were issues that arose
in the New York incident, we could resolve them right there at
the table and get them done before they rose to the next level.
Chairman Lieberman. Correct me if I am wrong, but it seems
to me that in response to September 11, I was interested to be
reminded that the immediate consequence management
responsibility was actually in the Department of Justice, not
in FEMA, where I would have guessed it would be. Is that
correct?
Mr. Brown. Well, no.
Chairman Lieberman. No? OK.
Mr. Brown. We have the initial response in terms of the
consequence management. But in terms of the crisis management,
in terms of the crime scene, that is the Department of Justice.
Chairman Lieberman. So is that a clear enough distinction
that Justice is involved in the law enforcement aspect of it
but does not manage the scene where we want most of all to have
rescue and relief occurring?
Mr. Brown. I think it works quite well. I will give you an
example. I think the Attorney General would like to say
something, too.
Chairman Lieberman. Yes.
Mr. Brown. It is clear to me that, for example, in New York
there was a problem with some communications that DOJ, the FBI
needed to resolve immediately. FEMA was able to step in and
resolve that for them. Is that really crisis management or
consequence management? It is really a little bit of both, but
because of them working together, we are able to solve those
problems.
And we know--I think FEMA is smart enough to know that when
it is a crime scene, it is something the FBI needs to take the
lead on. We back off and let them do that and support them to
the greatest extent that we can.
Chairman Lieberman. Ms. Daniels, why do you not respond
about that, and then to the more general question, devil's
advocate though it may be, why should not all these programs of
training and assistance to local responders be in FEMA, for
instance, because it is going to coordinate the response when a
crisis occurs?
Ms. Daniels. Senator, maybe I can back up a little bit and
talk about how we came to be where we are, I suppose. During
the 1990's, there were two Presidential directives that laid
out the hierarchy and the delegation of responsibilities in the
event of a terrorist incident. Those gave the Attorney General
the basic authority to deal with the incident and allowed him
to delegate crisis management to the FBI for the immediacy of
the crisis and crisis management; and delegate the follow-up,
or consequence management, to FEMA at the point where the
crisis aspect has subsided, and we have reached the point where
we can turn that corner.
And I think that the theory was that that gives us the
organizational capability in one official that will enable us
to do that seamlessly. It seemed to work, in fact, very well,
as Mr. Brown has indicated, in New York. I think everyone has
been working wonderfully together.
With regard to the larger issue, your first question, I
think, was who is in charge----
Chairman Lieberman. Right.
Ms. Daniels [continuing]. And I would say that the
President is in charge and Governor Ridge is his spokesman or
his agent. And, frankly, the Department of Justice will do
whatever it is that they determine is the best thing for us to
do.
We do have, and we have developed over many years, a very
close working relationship with law enforcement and that has
helped us in our training exercises. But we also not only work
collaboratively with the other agencies, including FEMA, but
also defer when it is a public health issue, to HHS. We do not
try to do their job for them, and I think everyone has a piece
of this pie and we are all right now seeking the best way to do
that collaboratively.
I liked what Governor Ridge said the day he was sworn in,
which was that the only turf we should be concerned about is
the turf we stand on, and I agree.
Chairman Lieberman. From what you have said, it is clear to
me that you think, and I agree, that we are in a better
organizational structure now that Governor Ridge--that the
Office of Homeland Security has been created and Governor Ridge
is in charge. We may have our discussions and debates about
exactly how much authority he has, but it does seem to me that
he fills a gap that was there before. What would you say to
that and what you have heard, Mr. Hinton?
Mr. Hinton. Mr. Chairman, this report that we issued back
on September 20 dealt right square on with that issue.
Chairman Lieberman. Yes.
Mr. Hinton. And based on all the work that we had done over
the last several years, we saw a lot of fragmentation around
some of the key leadership functions in the government,
overseeing a national threat and risk assessment, setting
priorities for national strategies, coordinating and monitoring
international programs, providing liaison and assistance to
state and local governments. These were spread throughout the
Executive Branch.
We made a recommendation to the President to establish a
focal point within the Executive Office of the President that
would rise above the individual agencies and deal with those
functions and bring them together.
Chairman Lieberman. Right.
Mr. Hinton. To refer to your question about the programs,
whether to put them in Justice or FEMA, there are four programs
right now being run by HHS, Justice, and FEMA, all targeted to
basically the same group in the State and local governments
that are dealing with emergency preparedness. Well, if you can
rise above that and have, like Governor Ridge, that may be one
of the targets of opportunity for him to focus on to try to
make some rational decisions as to how many programs we exactly
need and the resources.
Chairman Lieberman. In other words, we may not need them
all, or maybe they can be consolidated in one or another
department.
Mr. Hinton. Exactly. You asked the question, how much
redundancy might be needed and what is enough? Well, I think
the appointment of Governor Ridge in that position was timely
with respect to that issue. I think there are some long-term
issues that need to be there.
One goes to the definition of homeland security, everything
we would put in it. How can the coordinator achieve real
influence in the budget and resource allocation process, a
question that has come up this morning, is a very important
question that needs to be addressed. Should the coordinator's
role and responsibilities be based on specific statutory
authority? I think that is another question that the Congress
needs to look at over the long term.
Depending on the scope, structure, and organizational
location of this new position, what are the implications for
Congress in its ability to conduct oversight? I think that is
another very important issue--and particularly as GAO's role in
that effort to assist you, the Congress, in its oversight.
Chairman Lieberman. I agree. Thanks. My time is up. Senator
Akaka.
Senator Akaka. Thank you very much, Mr. Chairman.
Attorney General, I am concerned, and this has been alluded
to, that there is a cultural divide between how the law
enforcement and public health communities view bioterrorism.
The difference is demonstrated by how the different groups
answer the following question, and the question is, is a
bioterrorist event a medical crisis with a law enforcement
component or is it a crime scene with a public health aspect?
Now, this question is for you and anyone else who wants to
answer it and to comment on it. So my question is, how would
you answer this?
Ms. Daniels. Senator Akaka, actually, maybe this will be
reassuring to you, coming from the Department of Justice, but I
would say that an incident of biological terrorism is a medical
crisis with a law enforcement component because, as has been
discussed of late with regard to the anthrax situations and
other things that could come up in a biological context, you
are not going to necessarily have a crime scene where there is
an explosion and something happens and you have to clean up
after it. You are going to have people getting sick and they
may be getting sick well after the incident that spurred the
disease. So, frankly, we do think that is a medical crisis and
that is why we want to work very closely with HHS.
Senator Akaka. Thank you. Does anybody wish to comment
otherwise?
Let me ask you my second question. Agriculture terrorism
presents a serious challenge to our legal system's ability to
protect our agricultural industry. Currently, terrorism using a
weapon of mass destruction is a very serious offense. However,
the application of this law to agricultural terrorism is
problematic because the use of biological weapons is defined as
being directed against a person or public property of the
United States. Therefore, a biological attack against
agricultural land or livestock does not qualify as terrorism
using a weapon of mass destruction.
So my question is, do you feel that the threat of
agricultural terrorism warrants amending the U.S. Code to
include private property or agriculture in the definition of
bioterrorism?
Ms. Daniels. Senator, I can answer your question, I think,
only partially, and my partial answer is that I absolutely
think that we should have a serious concern about the safety of
our livestock and it has to do with the safety of our entire
food supply and everything else along the line. So I think it
is very important.
Having said that, I have been in the Federal Government
before but have not been for several years. Now I am back in
and have been in my current position for all of 3 weeks today,
so I have not yet had a chance to examine the current state of
the terrorism law or what the pending bills that came out of
the House and Senate and, I guess, are ready for conference at
this point actually include in the way of legislation that
would protect livestock and the agricultural supply. So with
that, I would be happy to get back to you on that point.
Senator Akaka. You can provide it for our record,
please.\1\ Thank you.
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\1\ Letter from the U.S. Department of Justice responding to
question posed by Senator Akaka to Ms. Daniels, dated June 25, 2002,
appears in the Appendix on page 176.
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Ms. Daniels. Thank you.
Senator Akaka. Mr. Brown.
Mr. Brown. Yes, sir?
Senator Akaka. FEMA uses the Federal Response Plan to
coordinate the government response to disaster or emergency
situations, and we have been alluding now to coordination
between agencies. This plan contains 12 emergency support
functions to mobilize Federal resources and conduct activities
to augment State and local response efforts. My bill would
create an emergency support function for disasters affecting
agricultural production of the food supply, which currently
does not exist.
Could you explain the procedure for creating an emergency
support function? The USDA currently leads the response to
production agriculture disasters. What agencies do you see
filling a support role?
Mr. Brown. Let me answer it this way, Senator. The first
thing we can do is, if there is somebody else that needs to be
a part of the emergency support team during a disaster or a
declaration, we will just add those. I mean, we will rely upon
the willingness of other agencies to come in and help support
our response, which we have seen an overwhelming desire to do
that. So if we see a need that is not being filled that we need
some coordination on, I am certain that the Director can call
any of the secretaries or other directors and say, we need that
support team here on 24/7 and they will be there.
In terms of others that we need, I guess the best analogy
is the working group that has been meeting since September 11.
We have brought in different groups at different times based
upon the particular issue. There is a group today that is going
to meet this afternoon that we are going to bring in the
Department of Energy and EPA where they were not involved
before, but because of some particular issues we need to
address, we are bringing them in.
So I think the way it has been occurring is on an ad hoc
basis. As we need them, they come in, and they do and they
support us.
Mr. Hinton. Senator Akaka, could I jump in there for just a
second with a comment, and it piggybacks on Senator Lieberman's
comment, too, and it deals with threat assessments that we have
been seeing in the government that are ongoing. We have some
agencies doing multiple assessments to look at the impact on
public health. We have the FBI looking at what might be the
more likely attack that we are going to have. And then we have
a few others going on.
We also have some other agencies who have not been involved
in some of the discussions about threat, for example, some of
the transportation, agriculture, and the others that you are
mentioning there, and I think that goes right to your question
there. Unless they are an active player, they may not be
brought in early on in that process and I think that is an
important step that needs to get some consideration in this
environment that we are in.
Mr. Brown. Senator, if I could just add, I just spoke to
one of my experts behind me also who tells me that just last
week, Emergency Support Function 11, which is the food support
function within FEMA, has asked for the Department of
Agriculture and USDA to come in to deal with some issues that
have already arisen that you have alluded to. So we are already
doing that.
Senator Akaka. Now that you have mentioned them, you did
not mention the Department of Transportation on the list that
you just mentioned and I feel that the importance of
transportation restrictions and private industry abiding by
those restrictions cannot be over emphasized.
Mr. Brown. Right, and the Department of Transportation is
already one of our support functions in that group. They
already exist.
Chairman Lieberman. Thanks, sir. Very thoughtful questions,
Senator Akaka.
I just have one additional question for Dr. Johnson-
Winegar. Obviously, the Defense Department has spent a lot of
time and money working on these problems with chemical and
biological components to war fighting, and now we are at a
point where we have got to begin to think about the same
threats here at home. The obvious interest that we have is to
make sure that we do not put civilian agencies into a position
of reinventing the wheel.
I know we are in open session, but I wonder, to the extent
that you can here, Doctor, if you would describe for us some of
the types of technologies and ongoing research that DOD
possesses or is overseeing that would be transferrable or
applicable to the civilian sector, and then what is the process
to make sure now that that happens?
Dr. Johnson-Winegar. Certainly. Thank you for the
opportunity to describe some of our programs.
As Secretary Thompson mentioned this morning, clearly, the
area of medical countermeasures, both prophylactic and
treatment, for biological agents has been one that the
Department of Defense has invested in for a long time. I am
very happy about the collaboration between our two departments
on a new anthrax vaccine, for example. The current vaccine
requires six doses for full immunization and we have pooled our
resources and expertise to look at recombinant technology to
come up with a new product. So that is clearly an example of
one where the Department of Defense and the civilian community
can share in some of the technology that is ongoing.
Beyond the area of specific medical countermeasures, we
could talk about the detector systems, biological and chemical
agent detector systems. And while we have a very well-defined
concept of operations for using those detectors on the
battlefield and can, indeed, when the detectors give an alarm
or an alert, can order our military troops to don their
protective equipment, the protective masks and individual
clothing, certainly, the technologies that we have worked on,
and again, in conjunction with other work that is being done in
the Department of Energy and other organizations, can look at
those technologies for detection and identification of chemical
and biological agents.
The whole area of protection, collective protection for
buildings, individual protection, I think the Department of
Defense has been the leader in developing a number of those
technologies and we are certainly ready and willing to work
with the civilian sector to see which of those can transfer
immediately and which may require some type of modification to
meet the specific needs of the civilian community.
Chairman Lieberman. Is some of the detection equipment you
described in use now as we respond to this anthrax attack or
series of attacks?
Dr. Johnson-Winegar. Well, I would like to differentiate
between detection equipment and identification equipment.
Chairman Lieberman. Yes.
Dr. Johnson-Winegar. And specifically, some of the test
kits that are being used for the identification are, indeed,
those that have been developed by Department of Defense funding
in our research and development programs and those are some of
the little immunoassay tickets, and our laboratories have been
participating with CDC and other labs in identification using
PCR technology and other technologies.
When I was speaking specifically of detectors, I was
referring to those things, for example, which can continuously
collect air samples and then can be periodically analyzed for
the presence of a biological agent.
Chairman Lieberman. At this point, those are not being
distributed throughout the country, but obviously that is one
potential if there began to be concern that there was a
biological threat in some area.
Dr. Johnson-Winegar. Yes.
Chairman Lieberman. Are you confident that the interaction
between the Department of Defense and the civilian agencies is
adequate to guarantee that they have a comprehensive idea of
what capacities you have and, therefore, are more able to use
them to confront the threats here at home now?
Dr. Johnson-Winegar. I certainly think that while I would
not say that we are 100 percent of the way to solving that
communication and information exchange, I think that we are in
pretty good shape and that we have made a number of attempts to
publicize the information about what is available, and as I
said, it is a matter of making those decisions about which is
automatically transferrable and can be used as is, if you will,
and those things which may require some type of adaptation or
modification. And an example of that might be the protective
masks, and I know there was a lot of concern amongst the public
about the need to purchase individual protective masks and we
certainly do not recommend that from a Department of Defense
point of view.
But the technologies and the understanding that we have in
how those work and, for example, we have the specialized
laboratories and expertise where we can do the testing with
real chemical and biological agents where many of our civilian
counterpart agencies do not have those containment laboratories
or do not have the personnel who are trained and qualified to
work with the real pathogens and the chemical agents to do that
testing. And through the interagency board and a number of the
other interdepartmental groups, that is one of the things that
we are bringing to the table, is our ability to do that type of
work.
Chairman Lieberman. Good. Mr. Hinton, did you have a last
word you wanted to offer?
Mr. Hinton. I was just going to say, one of the leadership
functions that we recommended be part of the focal point in
Governor Ridge's office would be the oversight of Federal
research and development activities, also.
Chairman Lieberman. Absolutely. It was a good
recommendation and we included it in our bill.
I want to move on so I can let Mr. McConnell testify and
then return safely and in a timely way to Atlanta.
I want to thank all of you for what you are doing and for
your testimony today, which has been very helpful to the
Committee, and I hope reassuring to the public insofar as they
are watching. Thank you.
The final panel this morning--Senator Akaka, thanks for
hanging in there with me--Dr. Maureen Dempsey, Director,
Missouri Department of Health and Senior Services; Dr. Margaret
Hamburg, Vice President for Biological Programs, Nuclear Threat
Initiative; and Dr. Amy Smithson, Senior Associate of the Henry
L. Stimson Center.
I thank all of you, and with the permission of the other
panelists, or even without it, for that matter, I am going to
call Mr. McConnell to testify first. Mr. McConnell is the
Director of the Georgia Emergency Management Agency and is here
on behalf of the National Emergency Management Agency.
Again, to pose too simplistically the general question that
is before the Committee, in addition to all the expertise all
of you bring to this, we want to know whether the Federal
Government, working together with State and local governments,
is adequately organized to meet the now-real threat of chemical
and biological attack.
Mr. McConnell, thanks for being here.
TESTIMONY OF GARY W. McCONNELL,\1\ DIRECTOR, GEORGIA EMERGENCY
MANAGEMENT AGENCY, ON BEHALF OF THE NATIONAL EMERGENCY
MANAGEMENT ASSOCIATION
Mr. McConnell. Mr. Chairman, I appreciate the opportunity
to be here, and let me tell you a little bit about where I am
coming from. I am more into the yes and no answers, so let me
give myself a little room to get out of this.
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\1\ The prepared statement of Mr. McConnell appears in the Appendix
on page 132.
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Chairman Lieberman. OK.
Mr. McConnell. I have been the Director of Emergency
Management in Georgia for the past 11 years. We have had 16
Presidential disasters. I was also the coordinator for then-
Governor Miller to prepare for and respond to and pull off the
1996 games, and before that, I was a county sheriff for 22
years, so I am more into the yes or no answers, sir, so please
forgive me.
Chairman Lieberman. Yes, Sheriff. All right.
Mr. McConnell. Are we prepared? We are better prepared than
we were 3 years ago. Are we where we should be? Probably not.
There is a lot of Federal agencies doing a lot of good stuff
and the States are very appreciative of that. Most of my
comments today will be from my experience, and you have the
written testimony from NEMA, so please do not hold that against
the other group other than myself.
I certainly hope we do not reinvent the wheel. Justice has
some great programs. FEMA has some good programs. DOD has some
very good programs. But let us not start from ground zero.
Let us understand that when DOD talks about, with all due
respect, to having equipment that can tell you when to put on
your mask, the first responders do not have the equipment or
the mask, in most cases. Usually, with the exception of some
Justice money, normally, the first responders, when they get
sick, they know there is something there.
It is certainly important to understand that the States and
local governments want to plan with the Federal Government, but
we ask you all, please do not plan for us. There are a variety
of issues that are different across this country, from the
simple issues of having ports on the ocean waterfront to the
State of Kansas that does not have much interest in port
authority issues.
How can we do it better? I think I have heard a lot of
questions this morning about who is in charge, and we heard
that a lot in 1996 with the Olympics and I have a different
view of that. Who is responsible? Everybody is in charge.
Everybody wants to be in charge when it is going real well. But
who has to stand there and tell those parents or tell the
families that their fire fighters or EMS folks or law
enforcement did not come out of the Twin Towers or did not come
out of Centennial Park? That is when you decide who is
responsible, Mr. Chairman.
We think that State and local governments are responsible.
I know if it happens in Atlanta, Georgia, this afternoon, I
know who Governor Barnes is going to hold responsible for it. I
do not have a problem with that. But I do have a problem with
everybody being in charge and nobody being responsible.
The assistance coming from the Federal Government is great.
I have been doing this now for about 30-odd years and some of
these issues we have been talking about for quite some time.
Terrorism is certainly different. It is on the front burner
today. But a lot of the responses, just as the gentleman from
the Budget Office mentioned, are also applicable to a number of
disasters and emergencies--communications, command and control,
unified command. The last thing we need is 46 or 50 or whatever
number you want to use of State and Federal agencies showing up
and having to decide in the parking lot who is responsible for
what, and that actually happens, sir.
Chairman Lieberman. You have seen that happen?
Mr. McConnell. I saw a fistfight in downtown Atlanta,
Georgia, in 1996 when we had the Olympic park bombing, between
two Federal agencies deciding who was in charge----
Chairman Lieberman. Right.
Mr. McConnell [continuing]. And we decided that I was
because I outweighed both of them. [Laughter.]
That is to the point that we need to get on with it, sir. I
am sure that the new Office of Homeland Security or Homeland
Defense is certainly a step in the right direction, but let me
encourage you to think about three or four things as we move
forward.
Chairman Lieberman. Please.
Mr. McConnell. Please do not stovepipe all the Federal
resources. Right now, for example, the Department of Energy,
Federal Emergency Management, DOD, and two or three others deal
with hazardous materials and biological chemicals. Now we get
money from the Federal Government to do certain things with
that, but we are not allowed to use DOE money, for example, to
train people not on the DOE transportation routes. Even though
it is the same training it would need somewhere else.
Please understand that a simple thing like a background
check to have clearance to find out what is going on from five
different Federal agencies requires five different background
checks for me. It looks to me like DOD, FEMA, the Department of
Energy, and whoever else should do one background check or at
least share that information, not only the cost savings to the
Federal Government but also getting the information to the
folks that need to know.
There is an information void. I am not sure whether the
information is available or we may not be on a need-to-know
list or how to arrive at--information sharing is a two-way
street, Mr. Chairman. A lot of times, the local responders or
the State may know more about what is going on in that local
jurisdiction than the Federal authorities, so we certainly need
to have a clear path of how to pass that information on and to
who. There also needs to be a clear understanding of how the
information is coming back to us.
So very honestly, as an old country sheriff, most all
politics is local and most all disasters and most all terrorism
is local. The Federal Government has a great response
capability and it is going to be there in about 3 days, with no
disrespect.
Chairman Lieberman. Understood.
Mr. McConnell. Your local fire, EMS, and your State folks
are going to be there for 2 to 3 days before you get Federal
assistance, and I am not trying to be ugly to the Federal
counterparts, please understand.
One of the things that I did not hear this morning when we
were talking about monitoring disease from Secretary Thompson
is looking at the possibility of monitoring 911 calls as they
come in as a faster way of knowing what is going on with
diseases. Certainly it is more accurate to get it from a
medical professional, but if you have a tremendous increase in
calls for 911 service in Georgia and Ohio, there might be some
connection for that. So as we gather that information on
biological and chemical weapons and certainly a variety of
diseases, let us look at the possibility of gathering that from
the 911 system.
Chairman Lieberman. That is a good idea.
Mr. McConnell. Also, it is interesting to hear the comments
about agriculture. One of the major concerns, I think, is the
spread of chemical and biological on our agricultural products
across this country. As it stands right now, if there is an
agricultural emergency, the communities could not even recover
under the Stafford Act because agriculture is not seen as part
of the Federal infrastructure. So the communities, if they had
a foot-and-mouth or hoof-and-mouth disease outbreak right now
would not be able to recover any money through the Stafford Act
through the FEMA process that is normally taking place. I
encourage you to look at that.
And I guess in closing, Mr. Chairman, there is a lot of
resources out here. We need to make better use of those. Some
of the things that are working very good is the National Guard-
DOD response teams, what used to be the raid teams, now the
civil support teams, are outstanding. We have one in Atlanta.
In the last 2 weeks, we have used it on an average of once
every 8 or 10 hours.
But we have also got to understand that they are spread
very thin. Our particular team in Georgia has eight Southern
States. If I am using it every ten hours, that means Florida
and a lot of other States do not have access to it. We need to
enhance that capability. We certainly need to move forward with
the medical packs and a variety of those things.
But another thing that has not been mentioned that we used
both in New York and several natural disasters is mutual aid.
Each State has a specific or has a lot of capability. We
certainly need to look at how to federally fund that once it is
sent from Georgia to New York or New York to California, to
better use the State resources that are out there.
I think we have made tremendous strides in the last 10
years, but we have got a long way to go, sir. And with that, I
will conclude and try to answer any questions you might have,
sir.
Chairman Lieberman. Thanks, Mr. McConnell. That was
excellent.
Maybe I will ask you a question or two and then ask my
colleagues if they have any, and I apologize to the other panel
members, and let you go and run and catch the plane.
But I thought what you said about the response organization
was critical. We had heard the testimony before that there is a
Federal Response Plan and that, presumably, FEMA is in charge.
But my concern is, and you have illustrated it here, is that
when there is a crisis, it really is not clear who is in
charge. So if you had a crisis of the kind we are talking about
now in Georgia, would it be clear to you who was in charge?
Mr. McConnell. Without a doubt, Senator.
Chairman Lieberman. Who would that be?
Mr. McConnell. It would be my governor and myself.
Chairman Lieberman. Amen. But not----
Mr. McConnell. We look at the Federal response as support
to us.
Chairman Lieberman. Right. They would be, in a sense,
working at your direction. Do they see it that way?
Mr. McConnell. Normally, yes, sir.
Chairman Lieberman. They do?
Mr. McConnell. Not always when it first starts. We have a
way of delivering that message, sir.
Chairman Lieberman. Yes.
Mr. McConnell. But in all seriousness, it has got to be a
partnership. They have certain expertise. They bring a lot of
resources to the table. But you have also got to remember that
they are going to get on--locals feel the same way about the
State, that once it is over, they are going to be gone and we
are still left there to explain why we did certain things, why
it occurred that why and why it did not occur that way, and the
same thing will happen in New York eventually, just the same as
with any other natural disaster. It has got to be well
coordinated between the State, the local, the Feds certainly
play a major role. But I think the ultimate decision on how to
respond to it in a State has got to lie in the governor's
office, sir.
Chairman Lieberman. I do not want you to name names or
agencies, but just going back to that argument or fistfight
that you described in 1996, was that between people at the
Federal level or was it Federal and State arguing about who was
in charge?
Mr. McConnell. Two Federal agencies.
Chairman Lieberman. That is what I was concerned that you
were saying.
A final question, which I think you answered, but I want to
make sure I understand. As I said to the last panel, it struck
me that we have got three or four different Federal agencies
with programs to train and equip local responders, who as we
all agree, are where it is going to happen. These attacks are
going to be local and the response is going to be local.
Is that not a problem for you in terms of even applying for
grant money? I mean, would it not be better if it was
concentrated in one place, because it feels as if you have got
to shop around now.
Mr. McConnell. It would be better from one aspect if you
could have a broader base to use the funds for. We do not mind
chasing the funds in different agencies, but we do have a
problem, for example, if you have Department of Energy money to
train first responders on moving hazardous materials from the
Savannah River plant to New Mexico and Arizona for storage, but
you also have a need off of that corridor to train the first
responders in the same thing and you have the expertise and the
people on board to do that with and you are not allowed the
flexibility to do that.
If you do not move the money to one place, please try to
encourage the flexibility that we can use those resources, if
they are sitting there not busy doing their major response, to
do DOE, for example, that we have the flexibility to use them
somewhere else if we determine it is necessary, sir.
Chairman Lieberman. Well said. Do either of my colleagues
have any questions specifically for Mr. McConnell?
Senator Akaka. Yes.
Chairman Lieberman. Senator Akaka.
Senator Akaka. I like your straightforward comments----
Mr. McConnell. Thank you.
Senator Akaka [continuing]. About being in charge and who
is responsible. I see you recommend that all Federal programs
and funding should go to the governor's designated single point
of contact.
Mr. McConnell. Yes, sir.
Senator Akaka. You have been in emergency management for a
while and therefore are very experienced. My question is, how
can we assure--I am thinking of communities--how can we assure
smaller communities that all the Federal funding will not be
sent to one or two large urban areas?
Mr. McConnell. I think there are two or three ways to do
that. One is the Department of Justice now has what is called
Byrne Grant money that has a formula that a certain percentage,
and I am sorry, I do not remember the percentage off the top of
my head, cannot be used for jurisdictions over 30,000
population. It breaks down how the funding has to be passed on.
The reason I think it ought to go to the governor's office,
Mr. Chairman, is that way you will have some central point to
know where the resources are in case you do have an emergency
or an event, that now, unless you happen to ask the right
person, you may not know that a particular community in your
State has got a Federal grant to do something with unless you
just heard about it by the grapevine.
But there is already a process in place, I known with the
Byrne Grant money for law enforcement, that breaks it out into
populations where you have to put a certain percentage of the
money in certain jurisdictions, or not to certain
jurisdictions, but certain sized jurisdictions, sir.
Senator Akaka. Thank you, Mr. Chairman.
Chairman Lieberman. Thanks very much.
Mr. McConnell, good luck in catching your plane. Thanks for
the job you do in Georgia and thanks for your testimony today.
Mr. McConnell. Thank you.
Chairman Lieberman. Thanks to the three remaining
panelists. It is too bad, in some ways, that we cannot do this
on another day, because you are each superb witnesses, but we
are here and so is C-SPAN, so there are people who are going to
be watching and listening and being affected by it.
Dr. Dempsey, you were previously quite well introduced by
Senator Carnahan, so it is nice to have you and I look forward
to your testimony now.
TESTIMONY OF MAUREEN E. DEMPSEY, M.D., F.A.A.P.,\1\ DIRECTOR,
MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES
Dr. Dempsey. Thank you, Mr. Chairman, and good afternoon. I
would like to thank my Missouri Senator, Jean Carnahan, for
initiating discussions about my opportunity to testify here
today. It is an honor to be here and I am happy to talk about
preparedness.
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\1\ The prepared statement of Dr. Dempsey appears in the Appendix
on page 143.
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I would briefly like to discuss the foundation that we have
established in Missouri with the Department of Health and
Senior Services with regard to bioterrorism preparedness and
then use that as a basis for several issues that I would like
to put forth for consideration.
We have been consistently planning over the last decade in
Missouri with regard to strengthening the public health
infrastructure, which is now the topic of the day. We wish it
could have started 10 years ago in better times and would have
addressed, I believe, our under-preparedness to a great degree.
We have utilized that planning to think strategically about
our workforce, about how we carry out our roles and
responsibilities, and how we plan for the future while taking
care of our day-to-day business. As an outgrowth of that
planning, we began to think about bioterrorism preparedness
several years ago as a component of that planning and began to
move our workforce around internally.
Despite that, we felt that we were not able to achieve an
adequate focus on bioterrorism preparedness, so in May 2000, we
created a bioterrorism preparedness unit within my office and
have staffed it with a medical epidemiologist and an emergency
coordinator. Because it is placed in my office, they therefore
have the entire resources of the Department at their disposal,
which includes our State epidemiologists and our CDC EIS
officer and a host of other individuals who are responsible for
communicable disease preparedness.
They have been tasked with the oversight of 12 work groups
to look at many of the areas that were highlighted in Denver's
TOPOFF exercise and our own State preparedness planning for a
pandemic, influenza training that we had several years ago. We
looked at areas such as mass prophylaxis, mass casualties,
information systems, training of the media, building those
partnerships and identifying the steps that needed to be put in
place in order to effectively deal with an event should one
occur.
We have also participated in the active development of the
HAN Network, the Health Alert Network, and do have a capability
to communicate rapidly with all of our 114 local public health
agencies, either via E-mail or fax, and are currently working
on other modes of communication should they fail, as they did
on September 11.
In addition, since September 11, we have had in place--
begun to put in place an active surveillance system so that we
can more rapidly detect unusual events, clusters of diseases,
or aberrant trends in diseases. This is in addition to our
usual disease surveillance systems that have been in place,
like many other States have at their disposal.
We have instituted it currently with over 1,100 providers
across the State, including sentinel hospitals, physicians,
federally-qualified health centers, day care centers, schools,
and a host of other sites.
Chairman Lieberman. How does it work?
Dr. Dempsey. Currently, we are utilizing a syndromic list
of signs and symptoms that we are tabulating on a three times a
week basis with those sites, active phone calls going from our
staff that we have reassigned to those sentinel locations to
tally on a regular basis what they are actually seeing at those
locations so that we have an ability to have an early warning
of any unusual trend.
If we would see an unusual trend as evaluated by our
epidemiologist and analyst, we would then initiate an
epidemiologic investigation to determine whether or not it is a
manmade event or something unusual.
Chairman Lieberman. Please go ahead.
Dr. Dempsey. In addition, we have had conversations with
the Missouri Hospital Association and with our hospitals across
the State to tap into the emergency rooms and the urgent care
centers and some of our primary care providers across the
State, as well, in order to achieve the same type of data
surveillance on an active basis. We are looking at ways of
doing that rapidly. Currently, there are resource constraints
and personnel constraints in those hospitals that are somewhat
making that a difficulty to rapidly implement, although we are
looking at other mechanisms to gather that data on a very rapid
basis and believe within the next several weeks we can begin to
have that data available, as well.
Having said that, I will say that I think there are several
areas within that public health infrastructure that we still
need to support. We have heard a lot about State
epidemiologists today and the ability to have CDC-trained
individuals available to all States. We have that luxury in
Missouri, and yet I do not believe that capacity will be
adequate to meet our needs, or probably any other State's
needs. We need additional individuals who can do the outbreak
investigation. Currently, our folks who are doing the
investigations are the same folks who are refining our plans
and doing a host of other activities within the State.
In the flurry of the anthrax threats that have been
occurring in Missouri, as they have elsewhere, those resources
are strained and we need additional individuals who are highly
trained, ready to go in at a moment's notice to ask specific
questions, detailed questions, establish case identification,
and then move on to establishing are other people affected and
to what extent.
We also have a concern about that rapid response, and
Chairman Akaka had a good question about who is in charge when
you have an unusual event and is it a law enforcement or a
public health lead agency at the time of that event, and I
would argue that it is both, and that is true for us in
Missouri, as we found out this last weekend.
There are two issues. One, as long as it is anthrax, I
could say very easily, public health could handle that. But we
do not know at the time the event is unfolding if, indeed, it
is anthrax, and there are several considerations that need to
be put in place. If it is a bioterrorism event, it would
require a criminal investigation to be opened.
We currently, since October 1999, have had a relationship
with the FBI and had a protocol in place in Missouri and have
tested specimens for them during that 2-year period under that
protocol. It has worked very effectively. They establish
whether or not there is a credible threat. We do the testing
for them after they have assured us that there is no chemical
or radiological event that is unfolding, or if it is a package,
that it is not an explosive device. All of those activities
must occur before those specimens can be sent to the State
public health lab, so it must be a dual responsibility at the
outset of the event until the substance or agent or device, if
you will, is properly identified.
As we found out this last weekend, when those resources are
strained, we had to modify our protocol and are now utilizing a
similar protocol for our local law enforcement agencies and are
asking them to conduct an initial investigation in concert with
public health, both local and State individuals. We feel that
this is critical in order to protect the folks who are
responding as first responders, as well as to preserve evidence
and to assure that any public health threat outside of anthrax
would properly be identified.
In addition to our workforce, equipment, and information
systems, we believe that our Federal partners need to be
adequately trained with adequate resources. They are our
backup. They are the individuals we call when we need
additional field investigation or technical assistance,
additional expertise and knowledge that may not be available at
the State level.
With regard to the training of emergency personnel, first
responders, I would also like to echo other comments from today
that those training dollars need to be coordinated across
multiple agencies within the State, and I would often argue
that the State agency or the State entities involved in that
State responsibility, which may differ from State to State,
should be involved in some capacity in the planning for those
educational dollars.
For example, independent agencies who do not have knowledge
of governmental roles and responsibilities with regard to
public health cannot adequately train our medical providers on
what that response system is unless they understand the
response system and where the authority lies within the State
to call up additional State or Federal resources.
The same is true for our law enforcement individuals. Those
dollars often are coming down. I am not aware of them. We are
not involved in that training. And our exercises of this past
weekend and the last few days have shown us that I cannot give
certain advice to law enforcement agencies, and when we train
only within disciplines, I am missing critical information
about how I help them respond appropriately during an event
that I may take as lead and how they can assist me so that I
can do my job more effectively as a public health individual.
A lot more cross-training from the State, Federal, and
local level really needs to occur. Those critical roles and
responsibilities are very difficult to establish in times of
confusion and high energy and high concern. One of the things
that having the protocol with the FBI in advance allowed us to
fix our situation in Missouri very rapidly because our roles
and responsibilities had been clearly defined.
We also believe that we need responsive teams available 24
hours a day, 7 days a week. We have a system available to do
that. Many States do not. Many of our local public health
agencies do not. But those teams need to be broad-based and
supported.
We have inadequate resources for mass casualties in our
State. Most of our hospitals have an inventory that is ``just
in time.'' They can barely meet their daily needs and will not
be able to gear up for a large influx of ill or injured
individuals.
Mental health capacity and funding for dealing with the
immediate and long-term consequences of a catastrophic or
terroristic event are currently unknown and untapped, I
believe.
Our laboratories need to be increased in capacity. We need
highly-trained individuals and they need to be staffed. We say
at the public health level, I do not have reserves to call up.
I do not have a Public Health Guard. We do not have time to
train highly-skilled individuals in a very short time and need
to assure that we are prepared in advance and adequately
staffed.
With regard to dealing with the public, we would like to be
able to speak with one voice and assure that we have adequate
educational campaigns to address the public. They need to be
comfortable with our credibility and know that our information
is accurate and timely. If there were an event that we would
need to assure there was no secondary transmission or
quarantine and evacuate, we would need them to trust us and to
listen to us immediately and respond. We believe that needs to
be established in advance.
I have one final area that I would like to address that
goes well beyond the vaccine for smallpox and anthrax and I
think that we have a national tragedy in that we can currently
not protect our population against many usual diseases that are
not of terroristic origin. Influenza is a prime example. We
currently also have a shortage of tetanus vaccine. Most of our
current supply in Missouri was sent to New York and we have not
been routinely administering the boosters to adolescents for
several months, not only in Missouri, but across the country.
We have recently been notified there may be shortages of
childhood vaccines.
It is impossible to adequately protect our populations
currently, and our vaccine supply and distribution system
really needs to be examined and perhaps overhauled. We would
request that we could have a rational national vaccine policy
to help us deal with this issue and protect our population so
they are not vulnerable to manmade or natural threats. Thank
you.
Chairman Lieberman. Thank you, Dr. Dempsey. Excellent
testimony. Your State is lucky to have you. I would guess that
some of the programs you described do not exist in many other
States, certainly the preparedness for bioterrorism. Am I
correct in that?
Dr. Dempsey. I do not know the extent of that preparedness.
I know that the degree of preparedness is fairly high in
Missouri and many other States are enacting very similar types
of activities and units.
Chairman Lieberman. Excellent. Thanks.
Dr. Hamburg, thanks for being here. It is good to see you
again.
TESTIMONY OF MARGARET A. HAMBURG,\1\ M.D., VICE PRESIDENT FOR
BIOLOGICAL PROGRAMS, NUCLEAR THREAT INITIATIVE
Dr. Hamburg. Thank you very much for your leadership on
this important issue. It could not come at a more important
time. I think today we are all painfully aware of our Nation's
vulnerability to terrorism, including bioterrorism, and whether
it is an unsophisticated delivery system with a limited number
of exposures, as we have been seeing in recent days with the
anthrax situation, or the potential of a more high-tech mass
casualty attack, the prospects are certainly frightening, and
today, no one is complacent any longer about this biological
threat.
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\1\ The prepared statement of Dr. Hamburg appears in the Appendix
on page 152.
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While there are many challenges, we do know a great deal
about what needs to be done and how to do it. Improving the
national response to bioterrorism must involve a comprehensive
and coordinated plan. From a public health and medical
perspective, several key elements must be strongly present, and
you just heard a good recitation.
But perhaps first and foremost is prevention, efforts to
reduce the likelihood that dangerous pathogens will be acquired
or used by those who want to do harm.
Second, strengthening the public health infrastructure, our
ability to rapidly detect, investigate, and respond to
outbreaks of disease, enhancing medical care capacity to be
able to surge in response to a large-scale event.
The National Pharmaceutical Stockpile that Secretary
Thompson talked about this morning is essential to ensure that
necessary drugs or vaccines can rapidly get where they are
needed.
And we also need research, perhaps right now most urgently
to improve detectors and diagnostics, along with better
vaccines and new medications, and we also need to make sure
that we bring to bear all available scientific knowledge and
technology on the problems before us, that we translate what we
know into action, and whether it is the development of the
second generation anthrax vaccine or the implementation of new
standards for ventilation systems, we still have opportunities
to actually put in place a number of things that we know.
There are programs across the domains I just talked about
that have been initiated in recent years. The bioterrorism
preparedness activities are not just in Missouri. CDC has
sponsored programs across the 50 States, but many of those
programs need to be strengthened, need to be extended, and
there are still many programs and policies that need to be
developed and implemented.
And really, until recently, the importance of these kinds
of programs in our overall efforts to protect national security
and prepare against the threat of terrorism have been under-
appreciated and under-funded and I think we really have an
important opportunity at this moment to change that situation
in positive ways.
So how big is the gap between the threat and our ability to
respond? I was asked by your staff to briefly discuss the Dark
Winter exercise, a recent bioterrorism war game involving the
intentional release of smallpox. Although a simulation of a
worst-case scenario, it powerfully conveyed the distinctive and
sobering features of a potential bioterrorist attack and
helped, I think, to spotlight vulnerabilities that we must
urgently address.
Chairman Lieberman. For the record, why do you not indicate
under whose auspices Dark Winter occurred.
Dr. Hamburg. OK. It was created by the Johns Hopkins Center
for Civilian Bio Defense, along with the Answer Institute for
Homeland Security and CSIS, the Center for Strategic and
International Studies. It was played out at Andrews Air Force
Base in late June of this year and it involved a simulation of
a series of National Security Council meetings and the
participants were all individuals who had served in government,
many in cabinet or sub-cabinet roles, and I played the
Secretary of Health and Human Services.
Over a 24-hour period, this game went forward, but it
actually represented a 3-week simulation of a bioterrorist
event. In the opening minutes of the exercise, we learned that
cases of smallpox had just been diagnosed by the Federal
Centers for Disease Control. Given the propensity of this
disease to spread person-to-person, its 30 percent fatality
rate, and the limited supply of smallpox vaccine, it was not
surprising that we were soon dealing with an epidemic of
devastating, if not catastrophic potential.
Smallpox has an incubation period of 7 to 21 days, and as
the exercise began, we did not know when the attack had
occurred or where. We had no way to understand the full scope
of the crisis we were facing. How many cases were there? How
many more cases could we expect? When and where did the first
infections take place? Who released it? Did we have enough
vaccine and could we obtain more?
We did not know it at the time, but there actually were
three simultaneous attacks that had taken place 9 days earlier.
Terrorists had silently released smallpox in three shopping
malls at the start of the Christmas shopping season, and
although the releases were variably effective, some 3,000
people turned out to have been infected by these initial
exposures.
To contain a smallpox epidemic, there are two primary
tools: Isolation of cases and protective vaccination of those
exposed. Most of the available vaccine was distributed early on
in an effort to protect key health care workers and other
critical responders, to protect a fraction of our military, and
most importantly, to try and put a ring of immunity around the
smallpox cases that were being reported, and as you heard this
morning, we only, as a Nation, have enough smallpox vaccine for
about 1 in 23 Americans.
But from the beginning, the strategy for smallpox control
was limited because of the large numbers of people initially
infected, the contagiousness of smallpox, and our limitations
on vaccine supplies. Accelerated production of new vaccine was
ordered by the President, and the Secretary of State was asked
to try to find surplus stocks from other countries, but this
was doubtful in the face of a smallpox epidemic that was likely
to quickly become global in nature.
Over the course of days, vaccine started to run out and we
had to contemplate measures considered draconian by modern
standards, including enforced isolation of contact and
restrictions on travel. We also had to address logistical
concerns, such as getting food and other essential supplies to
affected areas in the face of these restrictions. And these
problems were exacerbated by the fact that, by this point, we
could no longer provide vaccine to essential providers.
As the exercise progressed, we started to see what appeared
to be secondary infections, although we could not be 100
percent certain that we were simply seeing secondary cases or
if we were seeing a subsequent attack. Because of the person-
to-person spread, epidemiologic models predicted that without
effective intervention, every 2 to 3 weeks, the number of cases
would increase roughly 10-fold. So we were looking at three
million cases in 2 months if we did not stop the waves of
follow-on infections.
At the conclusion of the exercise, the epidemic had spread
to 25 States and 10 foreign countries. Civil disorder was
erupting sporadically around the Nation. Interstate commerce
had ceased in large areas of the country. Financial markets had
suspended trading. We were out of vaccine and we were using
isolation as the primary means of disease control.
So you can see, for the participants, this exercise was
filled with many difficult dilemmas and unpleasant insights. I
want to stress again that this is, of course, a worst case
scenario and it was really designed to help surface some of the
critical issues in terms of how we think about a bioterrorist
threat, how we organize systems to respond, and what are some
of the critical gaps that we need as a Nation to address.
So some of the key lessons learned included, first, that we
really need to focus more attention, concern, and resources on
the specific threat of bioterrorism, understanding that it is
different from the other threats we face, that it will unfold
as a disease epidemic over time, potentially with waves of
infection and disease as opposed to the kind of attack we saw
on September 11, where, while devastating, it was confined in
both time and geography.
Critically, we need to recognize the central role of public
health and medicine in this effort and engage them fully as
true partners. We must act on the understanding that public
health is an important pillar of our national security
framework.
Public health takes place, of course, at the local, State,
and national level, and we have to recognize that and support
capacity at all those levels, as well as integration. We need
to increase the core capacities of our Public Health System to
detect, track, and contain epidemics by providing resources for
effective surveillance systems, including the kind of real-time
data collection and analysis strategies that were mentioned by
Dr. Dempsey and by Mr. McConnell.
We need diagnostic laboratory facilities to support these
efforts and effective communication links to other elements of
the response. This must include a reexamination and
modernization of the legal framework for epidemic control
measures, and we must recognize the need to fully bring in and
work with new partners, both within health, veterinary
medicine, and agriculture, as we heard earlier, and also the
importance of law enforcement in this kind of a context.
We also need to develop plans for a surge of patients in
the Nation's hospitals. This will require careful advance
planning, since most hospitals are operating at or near
capacity now.
Mr. McConnell mentioned the Stafford Act as it related to
agriculture, and I also think that if you are looking into
that, some of those same uncertainties about reimbursement
exist for voluntary and private hospitals in the event of
response to a national disaster.
Related to this is the National Pharmaceutical Stockpile,
which should be built to capacity, including extra production
capability for drugs and vaccines with heightened security at
the various storage and dispersal sites. It will also be
necessary to increase funding for biomedical research to
develop new vaccines, new therapeutic drugs, and new rapid
diagnostic tests for bioweapon agents.
In a broader sense, we need to identify and put into
practice the mechanisms by which all levels of government and
all relevant agencies in government will interact and work
together. These responses, as just mentioned, are cross-
disciplinary and must cross agency lines. We must understand
our differing roles, responsibilities, capabilities, and
authorities and continue to plan and practice how to work
together before an act of terrorism occurs.
We should also build on systems that are used routinely to
the greatest degree possible so that we are not trying things
out for the first time in the event of a crisis, whether it is
HAZMAT teams that will be relevant in case of a chemical attack
or disease surveillance and public health systems for a
bioterrorism attack.
Similarly, there should be a clear plan for providing the
news media with timely and accurate information to help save
lives and prevent panic, and I think we have seen the
importance of that in recent days.
Finally, measures that will deter or prevent bioterrorism
will be the most beneficial means to counter these threats to
public health and social order. We need to prevent the
proliferation of biological weapons, in part by strengthening
intelligence gathering about such threats, but also by
providing peaceful research options to former bioweapons
scientists in the former Soviet Union and securing their
biologic materials. In addition, we need to encourage the
scientific community to confront the potential misapplication
of modern biological research and help them devise systems and
practices that ensure secure access to dangerous pathogens for
legitimate use only.
So in conclusion, let me reemphasize that a sound strategy
for addressing bioterrorism will need to be quite different
from those that target other terrorist acts. While a larger-
scale event likely remains a low probability, the high
consequence implications of bioterrorism place it in a special
category that requires immediate and comprehensive action.
Yet as we move forward to address this disturbing new
threat, it is heartening to recognize that the investments we
make to strengthen the public health infrastructure, to develop
new drugs and vaccines and assure their availability, to
improve medical consequence management, and to support
fundamental and applied research will also benefit our efforts
to protect the health and safety of the public from naturally
occurring disease, be it flu or food poisoning.
So again, I appreciate your efforts on these important
topics and would be happy to answer any questions you may have.
Chairman Lieberman. Thanks. That is a very good point at
the end, also, about the connection to more traditional public
health threats.
Dr. Smithson, nice to see you here in person. I have seen
you a few times on television in recent weeks.
Ms. Smithson. That is not my normal shtick, I assure you.
Chairman Lieberman. Well, you do it well.
Ms. Smithson. Thank you, sir.
Chairman Lieberman. We will hear your testimony now.
TESTIMONY OF AMY E. SMITHSON,\1\ PH.D., DIRECTOR, CHEMICAL AND
BIOLOGICAL WEAPONS NONPROLIFERATION PROJECT, THE HENRY L.
STIMSON CENTER
Ms. Smithson. On September 11, this Nation suffered an
unthinkable tragedy, particularly the family and friends of
those who perished. In the aftermath of that horrific attack, a
series of incidents involving anthrax have unfolded, including
here on Capitol Hill. One American has died from anthrax, three
have the disease, and several dozen others have been exposed to
the agent. Over 280 million Americans are physically unharmed
by these isolated anthrax incidents, but a great many of them
are fearful of what might come next.
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\1\ The prepared statement of Ms. Smithson appears in the Appendix
on page 164.
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No matter where one comes out in the debate about whether
terrorists can pull off a biological attack or a chemical
attack that causes massive casualties, the debate itself is
moot. One need only consult public health journals to
understand that it is only a matter of time before a strain of
influenza as virulent as the one that swept this country in
1918 resurfaces. You can also examine issues regarding emerging
infectious diseases and the rise in the number of diseases
resistant to antibiotic treatment to know that Mother Nature
herself is a very formidable opponent.
The fact that we now live in large population centers and
travel with great frequency, not just in this country but
internationally, will complicate the ability of public health
authorities to address epidemics.
As for the prospects of a large-scale chemical disaster,
one needs to keep in mind what America's first responders and
health care workers have to deal with on a routine basis.
According to the U.S. Chemical Health and Safety Investigation
Board, between 1987 and 1996, a hazardous chemical incident of
some severity took place in over 95 percent of this Nation's
counties. Every year, over 60,500 accidents and incidents with
these chemicals occur at fixed facilities or in transit.
Thus, there is a need for this Nation's front-line
responders, from fire fighters, police, and paramedics to
doctors, nurses, laboratory workers, and public health
officials, to be prepared to cope with chemical and biological
disasters, regardless of whether or not terrorists turn to
these agents in the future in an attempt to cause mass
casualties.
The appointment of Governor Tom Ridge as the Director of
the new Office of Homeland Security would certainly seem to be
a constructive step that could put improved coordination and
streamlining of the Federal response bureaucracy on a fast
track. To aid Governor Ridge in his efforts, Congress should
grant him czar-like budgetary authority. I will not kid you.
Everybody that works inside the beltway knows that the real
clout comes with control of the budgets.
Alone, Governor Ridge will have difficulty taming the
Federal bureaucracy, however. When I try to tally the number of
Congressional oversight committees on Capitol Hill, I not only
run out of fingers, I run out of toes. A consolidation of
Congressional oversight committees is sorely needed.
Also in order is a reassessment of the true value of
politically popular placebo programs, like the National Guard's
Civil Support Teams, and my remarks in this regard will differ
from what you have heard from Mr. McConnell. I assure you I
have no disrespect or intend no disrespect for the National
Guard as an institution or for the fine men and women who serve
our country in the National Guard.
But I urge you to consider the evaluation of these teams
offered by public safety and public health officials, including
members of the National Guard, that I interviewed in 33 cities
in 25 States. Their views are presented fully in ``Ataxia,'' a
report that I co-authored with Leslie-Anne Levy and released
last October. This report can be found on the World Wide Web at
www.stimson.org.cwc.
Briefly, the message from the front line about these Civil
Support Teams is unified and clear. They have a minuscule, if
not negative, utility in a chemical or a biological disaster, a
point that I would be pleased to elaborate on during Q and A.
To those accustomed to overseeing billion-dollar budgets,
the National Guard program in this area might not seem so ill
advised, but please consider how this program's budget could be
put to uses that could make a real preparedness difference on
the front lines. For example, to begin fixing the glaring lack
of decontamination capacity in U.S. hospitals that results in
recurrent hospital closures even after small HAZMAT incidents.
In most of the cities that I surveyed for ``Ataxia,'' the
central game plan for hospitals in the event of a major
chemical catastrophe was to lock down. That means to shut their
doors to incoming patients.
Chairman Lieberman. Why was that?
Ms. Smithson. Simply because in order to protect the safety
of the patients that are already in their facility, as well as
the safety of the workers there, physicians, nurses, etc., if
they allow someone that is contaminated inside the premises,
they have to close that area of the hospital down.
For the cost of standing up one National Guard Civil
Support Team, 2,333 hospitals or fire stations could be
outfitted with decontamination capabilities. With the total
1999 budget for this program, 49,800 local rescue and health
care facilities could have been armed for decontamination.
Civil Support Team funds, in other words, could be used to make
a genuine preparedness difference were they applied to
overcoming the decontamination bottleneck at U.S. hospitals.
I am aware that proposals are now circulating for each
State to have its own Civil Support Team. I would encourage you
to reconsider those proposals. By all means, leave the
resources in the States, but this is something, again, I would
encourage you to reconsider.
If there is no other message that you take away from my
testimony today, let it be an understanding that the key to
domestic preparedness lies not in bigger Federal bureaucracy
but in getting taxpayers' dollars channeled to readiness at the
local level, and I would like to spend a few minutes, with your
indulgence----
Chairman Lieberman. Please.
Ms. Smithson [continuing]. Explaining a couple of concepts
that I believe will be key to readiness at the local level.
The first of these refers to something that Dr. Hamburg
just discussed and that is how can hospitals handle a great
surge of patients either in a chemical or a biological
disaster? The key here appears to be a need for regional
hospital planning. This is something that used to occur in a
lot of our cities but no longer does because of the way that
our health care system currently works.
If the Federal Government provides grants to regions so
that hospitals can get together and have a pre-agreed game plan
about how to share burdens in these circumstances, who is going
to remain open for what, for traumas, for maternity, for heart
care, which hospitals would convert to care of infectious
disease patients, these types of arrangements, including plans
about how to prophylax a large population, how to secure
emergency supplies, how to bring in, in the near term, before
Federal help can arrive, reservoirs of health care personnel
that might be nearby. All of these factors are all essential to
the ability of hospitals to withstand the flood of patients
they are likely to see, such that the local health care system
does not collapse in such an event.
Chairman Lieberman. As far as you know, none of this is
happening now?
Ms. Smithson. In the survey that I conducted, there were
only a couple of cities across the country--and I was not
everywhere, but 33 is pretty large--that were even beginning to
attempt this type of planning.
Chairman Lieberman. And the Federal Government is not
requiring it, as far as you can tell?
Ms. Smithson. This is not a requirement of the Federal
programs as I currently understand them.
Chairman Lieberman. OK.
Dr. Hamburg. I think it is part of the MMRS program that
Secretary Thompson talked about. They are trying to get cities
receiving monies to do planning. It is not quite as required or
comprehensive as what Amy is suggesting, though.
Chairman Lieberman. Right.
Ms. Smithson. She is correct. With the MMRS program, the
difficulty has been, and also with the Domestic Preparedness
Program, getting hospital administrators and physicians into
the planning process because they simply do not have the
ability to charge their time anywhere and their time is needed
for other duties.
Another concept that I would like to discuss with you is
that of early warning syndrome surveillance. Disease reporting
usually comes from two sources, physicians who are alert and
pick up signs and symptoms, as well as laboratories that do
detailed analyses of cultures.
Well, if we really want to get a head start on an outbreak,
there are several places across the country that are attempting
to institute disease syndrome surveillance. The utility of this
is that it takes data that is already available and creates a
historical database. This is a computing and data analysis
challenge, and monitoring things like 911 calls and other
leading-edge indicators would allow public health and emergency
officials to understand that something is going wrong in the
health of their communities.
They might not know what, but this kind of a technique
would allow them to notify hospitals and laboratories to look
hard and look fast to get more specific about what might be
going wrong. It may make the difference in the ability to get
that early notice of a disease outbreak in time to take
lifesaving intervention. The most advanced system in that
regard that I am aware of is in New York City. They have done
path-breaking work.
And with that, I think I will wait for your questions.
Chairman Lieberman. Thank you.
Ms. Smithson. Thank you.
Chairman Lieberman. No, thank you. It was very helpful.
Talk just a moment about what the purpose of the Civil
Support Teams of the National Guard was supposed to be.
Ms. Smithson. I think I should actually let the National
Guard speak to their purpose because they run the program, but
if one understands the dynamics of a chemical disaster
response, this peaks very quickly. If you look at the situation
that occurred in Tokyo, the victims in that particular instance
were at the hospital within a matter of a couple of hours.
Chairman Lieberman. Right.
Ms. Smithson. Now, the National Guard is saying that these
teams will go ``wheels up'' in 4 hours. In New York City, I
believe that they arrived at the World Trade Towers within 12
hours, perhaps that was 11 hours, and in that particular
situation, they began to monitor for chemical and biological
agents. Well, quite frankly, the New York City officials had
begun to do that hours before, as had the Environmental
Protection Agency.
There are a number of exercises and incidents that have
been related to me from my interviews with regard to how well
these teams have been able to perform, and simply, they have
been put in between a rock and a hard place. They are very well
trained, but unless you have been in the heat of battle, so to
speak, it is very difficult to apply a lot of the skills that
they have been asked to master.
In a biological disaster response, for example, the medical
component on these teams is four people, and in terms of how
much medical manpower would be needed, that is pretty much a
drop in the bucket.
Chairman Lieberman. Right.
Ms. Smithson. So, again, these are things we can discuss in
more detail----
Chairman Lieberman. It is well stated and that is a
question we will throw back at those in charge of those
programs.
You made a point which has interested me for a while as I
have focused on the current wave of terrorist attacks and
concern about chemical and biological, which is the extent to
which changes that have occurred in our health care system in
recent years, decades, have put us more on a kind of a ``just
in time'' inventory basis. I am making a manufacturing
comparison, but you talked about it in terms of hospital rooms
available.
I want to ask you, Dr. Hamburg, to comment on that from
your background in public health generally. It strikes me that
if we want to be really ready to respond medically to an
attack, it does take government intervention, because it is not
going to normally happen in the health care system as it is
operating out there today. Am I right?
Dr. Hamburg. You are exactly right. The current pressures
in the health care environment have led to an enormous amount
of downsizing, fewer hospital beds, ``just in time'' purchase
of pharmaceuticals and supplies, and minimal staffing patterns,
and that is fine if you want to save money, but it is not what
you need in the event of a large-scale, potentially
catastrophic event with many casualties.
Clearly, we do not want to encourage our health care system
to add on unnecessary, unutilized beds or services in the event
that a catastrophic attack will occur or a major natural
disaster, but I think that what Amy was saying about regional
planning is absolutely the key. We need today to have
localities assess what their assets and capabilities are, not
just in terms of the existing health care system but also
ancillary facilities and staffing possibilities that could be
brought to bear in a crisis. Then you need to look at what are
the State programs and assets and the Federal programs that can
be brought to bear to add to the local capabilities in a staged
kind of way, recognizing that, as has already been emphasized,
that the initial response is going to be truly local and it has
to build on local capabilities.
It is absolutely key that as monies go out to States and
localities to build new programs of preparedness in this
context, I think that we put a requirement on them to do this
kind of planning and specify the kinds of elements that they
need to address in their plans, because again, this is the kind
of thing where you have to develop a plan, you have to bring
all the partners together, you have to understand the
components of that activity, and then you have to practice it.
Chairman Lieberman. Good idea. Going back to your report on
the exercise, the simulation of Dark Winter, are you beginning
to see responses from the government to some of the lessons
learned from Dark Winter?
Dr. Hamburg. Well, I think it is a combination of Dark
Winter and real world experience, I think has put some of these
issues on the public consciousness in a way that it has never
been before and in the halls of Congress, as well. Frankly,
when I used to talk about public health infrastructure needs
and the surveillance, et cetera, people's eyes would glaze over
and they would find an excuse to leave the room. Now, people
that I would never imagine to be interested and supportive of
these issues suddenly are at the front line in terms of calling
for greater investments in these areas.
From the public health perspective, I think it is very
exciting and I think it really is truly the case that these are
very sensible investments for the American people because, as
Amy eloquently described in her testimony, Mother Nature
herself is a very powerful adversary and we know that we are
vulnerable to a whole array of infectious disease threats. And
as I think about the problem of bioterrorism, it is part of a
continuum of infectious disease threats, but at the farmost
extreme end. We have allowed our Public Health System to be
under-funded and inadequately supported and this is the
critical time to turn that situation around.
Chairman Lieberman. I agree. The investments we make now in
reaction to this terrorist crisis will, if we do them right,
have the effect of strengthening our Public Health System for
the kinds of challenges that just face us in a more natural
setting than enemy attack, including the flu epidemic that you
referred to.
Dr. Dempsey, if you were taken up to the Federal level and
asked how best to organize the Federal programs that we have
talked about today for preparing for responding to chemical and
biological attacks, what would be the overview of what you
would do?
Dr. Dempsey. With organizing the Federal level?
Chairman Lieberman. Yes.
Dr. Dempsey. To assist the States or just for the Federal
response?
Chairman Lieberman. Generally, and to assist the States,
yes.
Dr. Dempsey. Well, I believe that, first, I would have to
understand their primary roles and responsibilities and assure
that the interconnections and the collaborative efforts that
needed to be established between them were put into place and
actually operationalized.
And what we have found on the State level, we have similar
issues about how do we organize these activities at the State
level, is that we are always long on theory and short on
application and it is really hard to operationalize how it
finally works until you try to do it, and I think that takes a
different level of planning, a very deep understanding of the
primary roles and responsibilities and how they relate to the
roles and responsibilities.
If you look at the way we are organized now, both
federally, at least the way I view the Federal perspective, is
that everybody has their roles and responsibilities but they
are within their discipline and within their authority, and
that plays out in parallel and not in concert. So you get a lot
of response, but it is not coordinated and perhaps not as
effective as it could be.
I think a focus on the outcomes of what we are trying to
achieve, if you are going to reorganize or reallocate
resources, what are the outcomes you are trying to achieve and
set your programs up or your organizations up to achieve those
outcomes and then assign back roles and responsibilities. That
approach, generally, I think, would be far more effective than
starting from a role and responsibility and trying to figure
out how to make the collaboration work later.
Chairman Lieberman. Thanks. We have just completed our
fifth hour in this room, or yours, anyway, and I do not want to
keep you much longer, but I want to ask you a last question
just to bring it back to what is happening here now, because
obviously we left to go to the meeting with all of the
Senators, and there are well over 20, maybe approaching 30 or
just over 30 cases now around Senator Daschle's office in which
people have been determined to have been exposed to the
anthrax. And, of course, we have had the other episodes.
I got a note, and I should not be repeating hearsay, but
that there was now a finding of anthrax in Governor Pataki's
New York City office.
I wanted to ask you, you are experts, you are
administrators, you have been involved in this, you have
thought about it, just give me for a couple of minutes each,
what are your reactions to what is happening now, and if you
have any particular counsel here in terms of the Capitol or
generally, I would be happy to hear it.
Dr. Dempsey. Actually, I have thought about it a lot
because we have been dealing with it, and I think part of the
difficulty that we are having with resolving the situation is
the panic that ensues.
Chairman Lieberman. That is right.
Dr. Dempsey. Even the word ``exposure'' and the unknown
quantity for these agents that are being unleashed and what
that means for individuals, you cannot see them, you cannot
predict when they will be out there. And we are seeing a lot of
individuals who are jumping at shadows, very concerned,
beginning antibiotic therapy. We have deep concerns that if we
do not manage this public message from a State, Federal, and
local level with a united voice, that we will have more
antibiotic resistance in the future, perhaps against agents
that we only have one drug that may be effective against it
now. That is a huge consideration and that is part of the
management of the public.
I think the unified approach really is to assure that we do
establish protocols and procedures for both testing, diagnosis,
and treatment, and begin to educate people adequately on what
those protocols are and then adhere to them.
Part of the difficulty we have had with overloading the
system is that we have no way to manage that. Everybody wants
everything evaluated within 24 hours. Everybody wants to be on
drugs and everyone wants someone to come and investigate.
Without a way to truly manage that, to manage the public
response and the official response in a coordinated, concerted,
unified effort, I think that we may miss something that is
going on while we are exhausting our resources on something
that we do not need to exhaust them on and that we create undue
panic in the public because we have not given them credible
information on how to protect themselves.
We have given them good information on what not to do. Do
not buy masks. Do not stockpile. But we have not said, here is
something you can do, and I think they are hungry for that.
That is why they are buying the masks.
So I would say that good, credible information, timely
coordination, and a unified approach.
Chairman Lieberman. Dr. Hamburg, I would ask you to
respond, and maybe I will focus it a bit because I know you
have spent some time thinking and working in this area. What
conclusions do you draw, and I understand you are dealing with
public information here, about the finding that the anthrax
sent to Senator Daschle's office was of a more pure variety,
and I presume, and again, I am going beyond my expertise, the
fact that so many more people in his office have been exposed
suggests that this anthrax was moving more widely in the air.
Dr. Hamburg. Well, I clearly do not know all the facts
about the investigation or the nature of the material
identified, but I think it underscores the importance of really
addressing the problem of access to dangerous pathogens. The
fact that it has been described as of a higher grade and
apparently prepared in a way that would suggest an intent to
make it more harmful reminds us that whoever is doing this is
intending to do harm and has been able to get access to
materials that will make the harm done more severe.
And so I think that this is the time to really look at the
systems that we have in place to assure that only those who
have a legitimate use for this organism and other dangerous
pathogens have them, that we know more about who is using them
and why. And it underscores our need to really improve
intelligence in the biological area and I think that public
health and the scientific community actually has an opportunity
and an obligation to work more closely with intelligence
authorities in those collection efforts because I think we have
expertise that can be very helpful in data collection and
analysis.
Chairman Lieberman. That is very interesting. I appreciate
that, because it is not that this stuff is easy to get, but I
have learned over the last couple of days even that there is
more of it around than I would have guessed, so that--and I
presume there is not much intelligence work being done in this
area, so you are right. Without compromising anybody's
independence and etc., the ability to share information between
the research scientific communities and intelligence agencies
or law enforcement now will be critically important. Thank you.
Dr. Smithson, finally.
Ms. Smithson. Well, I think that the scars from September
11 are running deep, but the scars that are being created by
the events that are unfolding now may be even deeper and more
difficult to address. I echo Dr. Dempsey's concerns in that
regard and----
Chairman Lieberman. Unduly, I take it you mean, in other
words, that it is beyond----
Ms. Smithson. Yes. A lot of what the American public heard
in the initial media cycles, I think, blew some of this out of
proportion, so it is very difficult now when they hear messages
about these are isolated incidents, that there are lots and
lots of hoaxes interspersed with these things. What can they do
to protect themselves? How can we move forward? I am perhaps
here suggesting a public service information campaign so that
the messages get repeated often about how to put this threat
into context.
In my initial statements about this, I talked about how
someone was more likely to be the victim of a lightning
strike--your odds there are one in 600,000--than you are to be
the victim of a chemical or biological terrorist attack. I have
used the reference of how we learned to buckle our seat belts
when we get into the car to reduce the chances that we might be
injured in a car wreck, but we still drive our cars and we
still need to open our mail. So we are going to have to learn
to take some new precautions with our mail. What are those
precautions? Some of these messages are getting out, but they
are getting interspersed with a lot of other stuff that, I
think, is confusing for the American public as well as for
policy makers.
Another thing that these incidents illustrate again and
again is that all emergencies are local. I guess what I would
advise you to consider is that there are some roles that the
Federal Government must fulfill, for example, those related to
research, development, and production of emergency medical
supplies and the provision of emergency medical manpower, the
provision of mid- to long-term recovery assistance in the
aftermath of a disaster. Some of these--a lot of these
capabilities and resources are already in place.
But there are some roles that are not appropriate for the
Federal Government to undertake. Allow me to illustrate that by
pointing to how training is currently being conducted. The
Federal Government is hiring contractors, and according to the
GAO statistics here, training is getting to responders that
serve only 22 percent of our Nation's population.
Chairman Lieberman. That is right.
Ms. Smithson. So we can either go about this the smart way
or we can continue on a costly and inefficient track. The goal
here is to get the entire country prepared in an even and
systematic way, hopefully. It will be tough.
But, for example, on the training front, the solution there
is very clear. Institutionalize the training in fire academies,
in police academies. All paramedics ought to have training with
regard to this. This needs to be in our medical schools, in our
nursing schools. Our microbiologists need to have certain
training in this regard, as do our public health officials. Get
the Federal Government out of the way there, and that way, I
think we will get the entire country better prepared.
There are several common sense solutions, and if you need
anyone out of my Rolodex from 33 cities to convey these
messages personally and with much more authority, you are
welcome to them.
Chairman Lieberman. Thank you. That is a generous offer.
You have been very helpful and you have got great
expertise. You have shared it with us. And I think to the
extent that you have given statements that are quite balanced
and proportionate. It is very important to do that.
Now, obviously there is great anxiety here, as I said long
ago at the beginning of the hearing, and part of it is because
we are in a territory that we have not been before within the
United States. I mean, there have been health epidemics, and in
some ways, people have been fearful when that has happened. I
watched it on a relatively small scale about West Nile virus.
And, of course, earlier in our history, terrible losses
associated with influenza. I lost my paternal grandmother, who
I never got to know, in the influenza epidemic of 1918.
But it seems far away from life as we have known it in
recent times and that is part of the anxiety, and I do think we
have to put it in proportion, compare it to other risks that we
have, and then share information and then, and this comes back
to the purpose of the hearing, make sure that the government is
organized as effectively as possible to both prepare for crises
of this kind and then respond to them, and if we are, then we
will give the public even greater reason for confidence.
Anyway, you have helped measurably. This has been a long
hearing and it has taken at least one unexpected twist, but I
think it has been valuable, certainly to me and the Committee
in assisting us in fulfilling our responsibilities to the
public. So I thank you very much.
Before we recess, I would like to enter into the record a
statement from Senator Bunning.
[The prepared statement of Senator Bunning follows:]
PREPARED STATEMENT OF SENATOR BUNNING
Thank you, Mr. Chairman.
The threat of a biological attack has unfortunately been brought
home to us during the past couple of weeks.
Understandably, Americans are nervous.
Companies and offices are taking extreme measures when opening
mail, hundreds of employees have been tested for anthrax exposure and
many Americans have contacted their doctors about getting prescription
drugs.
During this time of confusion and anxiety, the American people are
turning to us for answers.
We have known for some time that we need to be better prepared to
respond to a biological or chemical attack. We have taken some steps in
the past to address these concerns and better prepare our state and
local governments.
However, as some of our witnesses will testify today, we have a
long way to go in being able to adequately handle a large-scale
biological attack.
This includes making sure our hospital personnel and others on the
front line have the training and equipment they need to make the
fastest diagnosis possible, making sure that we have enough medicine
stockpiled to treat those infected, and making sure that our state and
local governments can coordinate and communicate with the appropriate
Federal personnel during and after an attack.
The United States has entered a new era. With the events of
September 11 and the anthrax cases throughout the country, we must
become more proactive in addressing all types of terrorist threats.
I want to thank our witnesses for being here today, and taking time
out of their busy schedules to share with us their expertise on this
issue.
Thank you, Mr. Chairman.
Chairman Lieberman. The record of the hearing will remain
open for another week for those who may wish to submit
statements. At this point, I will recess the hearing.
[Whereupon, at 2:40 p.m., the Committee was adjourned.]
A P P E N D I X
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