the committee on homeland security will come to order as a matter of housekeeping our reporter is in a building where suspicious package has been identi and security will not let anyone out of the building but they are watching us on the house station doing the recording and unless they have to evacuated building rest assu however as indicated will continue with with the hearing that committee is meeting today to receive testimony on beyond reading this an examination of the current status and due to outlook of the national response to pandemic influenza that afternoon i'd like to thank our witnesses for hearing before us today today's hearing will review this nation state of preparedness for an influenza pandemic in april two thousand and nine the centers for disease control and prevention reported two cases a respiratory illness and children caused by a virus these two cases which occur less than four months ago w confirm instances of h one n one flu within the united states by late june u s health officials estimated that there had been more than one million infections in the u s according to the world health organization this virus is traveling the world president it's speed there have been confirmed cases in every continent except antarctica and while this may be troubling there's no need to panic in  face of this pandemic so for the disease has been mild and most people and treatments are available by many scientists and public health officials opic dictum that the virus will research in the fall and it is that resurgence which we must be ready to meet the centers for disease control and prevention estimate that as many as forty percent of the u s population could be infected with h one n one over the next two years the good news is that a vaccine is currently on the development and over the last four years congress has provided approximately eight point six billion for pandemic planning efforts but unfortunately despite this amount of funding according to g a o there are still major gaps in pandemic planning and preparedness efforts among those gaps is a failure to plan for additional bad space and medical supplies additionally g a o determined that leadership roles and responsibilities for an influenza pandemic need to be further clarified that tested and exercise given this country's recent experience with disasters it's hard to believe that there are those who on the estimate the importance of plans and drills our children are taught in school what to do in a fire drill they are not taught to wait until the fire starts yell instruction and hope everybody makes it to the exit we teach them the planning and practice increases their chances of survival that elementary school lesson still applies finally we need to understand that the emergency preparedness and response community and the healthcare community have always shared resources dawn crisis and disasters these formal and informal partnerships may be strained on a pandemic increase drills and exercises relationships decrease uncertainty and improve response and recovery i want to thank our witnesses and look forward to that testimony today the g a o now recognizes the ranking member of the full committee the gentleman from new york m the young children also obviously new departments and this is far as i know is the first health crisis that's a fact of the country since the h s was started by secretary  secretary she is responsible for the operation of our newest federal department and operational coordination of federal nonfederal private sector agencies when the nation is confronted with events that threaten our homeland she was confirmed by the senate in january two thousand and nine and brings to the department over thirty years of military and senior executive experience in the u s government welcome dr luke a second witness is mr william deputy secretary of the department of health and human services as deputy secretary is responsible for the operations of the largest civilian department in the federal government mr carr has extensive management and health care policy experience including work for congress and i welcome him back to the he'll today their witness is miss burney steinhart director of strategic issues at the government accountability office she started a number of different and for being here today without objection the witnesses for the statement will be inserted in the record and now acts each witness to summarize their statement for five minutes beginning with secretary l readily apparent how important the relationship between this committee and the department of homeland security is like all important relationships we won't always get it quite right but mr chairman and ranking member members of the committee i hope you all know that secretary  o and are committed to collaborating with you as we work to make the united states of america safer place we want and need your support your ideas your direction and the american people deserve your oversight well i recognize that this proceeding is focused on h one n one i think it's important to contextualize h one n one within the spectrum of threats that the department of homeland security negotiates and navigates every day secretary napolitano and i often think about our jobs in the context of managing the supply chain of trouble and i'm sure there's a more sophisticated way to express but from new york it is it seems to a vivid representation of the challenges we face trouble it will know it will come as no surprise to this committee comes in many forms whether it's a time bomb or tornado a computer virus created by man a pandemic virus created by mother nature trouble suppliers facilitators purchasers producers distributors and customers these perilous products move through multiple channels before they reach are sure and it is the job of the department of homeland security to understand the supply chain of trouble and identify opportunities along the way to gather information intelligence interdict redirect and stop trouble before it reaches our shores and our communities and to do this in a way that not is all that is not only consistent with but that honors our cherished principles of civil rights decorative and the important walls that guide our privacy and liberty just as threats have multiplied and evolve the department of homeland security's mission to lead the american effort to protect itself must adapt to the new supply chains of trouble that deliver not just bombs and bullets but bottom and now we know pandemic nontraditional threats like h one n one cannot be stopped by magnetometers guns or indeed h one n one as mr chairman as you have noted already here in fact it is ever present around the world and while we lack a complete understanding of what this war will look like we are planning for the worst the outbreak of h one n one this spring offered an unparalleled window into the state of our critical pandemic response capabilities and reading it in some areas we excel in other areas frankly as this com noted we still have work to do as with all aspects of the department's work secretary napolitano has asked me to supervise the staff members responsible for coordinating lessons learned and ensure that the department is ready for whatever the fall may bring and while the secretary pretty principal federal official for domestic incident management she is not the sole federal official the department of health and human services deeply honored to be testifying with my colleague deputy secretary cordless afternoon as a leading role to play in mounting our response to h one n one as does the department of education and others as does congress need congressional leadership on this issue has been of particular importance forty three million forty seven million dollars congress influenza preparedness in fiscal year two thousand and six has already proven its work but that funding we have been able to build the foundation of our pandemic preparedness including stockpiling of personal protective equipment and anti viral drugs for d h as employees and supporting pandemic influenza workshop our role is to coordinate in the federal response we're working with the white house national security staff and our federal interagency partners to finalize the federal strategic implementation plan for the two thousand and nine eight two thousand and one flu and this plan is being revised to reflect the lessons that we learned this spring internally we are finalizing our own operational plans to provide direction to be a judge components to ensure that our mission essential functions are maintained while protecting our workforce in the face of a sustained or worsening outbreak or final touches to formal plans are being made the overall coordination for this incident began months ago the start of the current outbreak of h one n one nash operating center was fully activated to fulfill its role on interagency coordination and we were assisted in this by the office and they were assisted in this by the office of health affairs which coordinate with  help manage requests for information from a variety of stakeholders we have been actively engaged with our federal state and local tribal partners throughout the h one n one outbreak and we are working with others under the direction of president o who hosted an h one n one summit three weeks ago where state and local leaders and stakeholders this summit again focused on lessons learned from the response so far we are helping the private sector to plan for a pandemic began providing extensive guidance to private sector partners several years ago challenges have a risen and we are adapting in view of the experience gained health and safety of our workforce is one of our highest priority and we will continue to ensure that our front line employees receive guidance on personal protection that is based on the best science available we learn from the h one n one flu that we have to have more guidance in place and we worked in that direction there are a number of other efforts throughout the department that i detailed in my statement for the record of the committee it's a pleasure to be here today to give you an update on the activities of the department health and human services it's certainly a pleasure to appear with deputy secretary lew my colleague from the h s and certainly with miss diane hart we have great respect for the work the  does and take it very very seriously secretary sebelius and all of us at the department health and human services deeply appreciate the leadership that the congress has shown in providing the resources in the supplemental appropriations bill to give us the flexibility to begin targeting our resources as we need to for this h one n one outbreak all the headlines in the twenty four hour news updates may have quieted down this virus has not gone away and we cannot let up for one moment in concert with our partners at the homeland security and throughout the administration we are doing everything possible to monitor and respond to this virus the department's concentrated and considerable efforts are not about raising alarms they're about being prepared this is a very serious virus capable of causing severe disease and death and it is essential that we have a coordinated and clear strategy to combat it going forward we will work closely with the white house with the department homeland security and all of our federal interagency partners to focus our our health efforts around four areas first is surveillance to learn as much as we can about the virus how it's changing how it's spreading secondly mitigation to encourage people to do what they can do each citizen has things they can do at home in their school rules in their neighborhoods to deal with the potential surge on our medical infrastructure and to provide appropriate medical countermeasures immunization is the third leg which involves laying the groundwork for a potentially large scale campaign to distribute vaccine and last is communication providing clear and accurate information to state local governments and to the public i'd like to mr chairman very quickly try to summarize some of the main activities there are many but i will highlight them and of course then be available for any questions the committee might as k as noted the virus has now reached every state in the united states as of july twenty fourth there were over forty three thousand confirmed cases five thousand hospitalizations and three hundred two deaths going forward c d c will be reporting in a different way reporting on the number of hospitalizations and deaths and a good deal of information about the virus itself how we're tracking it where the flu is occurring and what the impact is on disease and on hospitalisation this virus usually causes a self limited disease that gets better without treatment but it also can cause severe illness and even death infants children and those with underlying health conditions appear to be most vulnerable disease the c d c is working closely with the world health organization and the pan american health organization and ministries of health from around the world to continue characterizing the virus as it spreads today we have  observed rapid early season increases in flu cases in the southern hemisphere evidence of increased burden on the health care system and extended stew school closures in some locations are working aggressively to monitor for evidence of change in the virus and whether it is becoming more virulent and transmittable all of these information will in able us to make decisions as we go forward here in the united states on may twenty second secretary sebelius announced a one point one billion dollars of funds for vaccine development and manufacturing that includes clinical trials that will give us further information about safety in the optimal dose that's needed for the protective immune response that we desire she also has announced eight hundred eighty four million dollars to secure and gradients including the antigens which is a key component of vaccines and agilent so that we will have vaccine available if needed the study is underway the studies are underway now with the vaccine and we anticipate limited quantities of the vaccine in the next several months today a special meeting of the c d c s advisory committee on immunization practices is occurring they will be considering many subjects and one of our many advisory committees that we are relying upon for scientific and public health expertise one of the recommendations will be on the age and risk groups that are recommended for vaccination to help communities prepare for an increase in cases this fall h h s homeland security department of education conducted a summit on july nineteenth valving state local and tribal and federal officials to discuss lessons learned best practices and to discuss preparedness priorities at the summit secretary sebelius announced the availability of three hundred fifty million dollars in supplemental funding will be made available  state local and territorial health departments as well as the hospitals for prepared at the summit we send a strong message to our partners that they must be ready to begin an immunization program this fall when the license vaccine isn't dissipated to be available but the decision to do a vaccination program has not been made yet and will be made in the near future before an emulation campaign begins our scientific and public health experts will learn everything we can about the vaccine its safety and efficacy as well as the status of the spread of the virus as we make decisions we've also purchased antivirals and other needed products we have begun our effort to educate the public congressman king pointed out and i know that all the members of the committee are deeply concerned about so that members of the public have as much information as how they can protect themselves will be providing have provided some school guidance and will be providing extensive guidance to schools about how they should consider their activities as they enter into the school year we're working with federal state and local tribal partners to develop a community by set of interventions and mr chairman if i may say in closing that we will also make every endeavor to keep this committee and other key committees of the congress fully informed about our actions what we know as well as what we do not know thank you mr chairman thank you very much for your testimony and we will get into some of the meat of it as soon as we get the five minutes out of the way and i recognize director steinhart to summarize the statement for five minutes thank you very much mr chairman mr king and other members of the committee we appreciate the opportunity to be here to talk about the work that we've done at your request over the last three years to assess the federal government's planning and preparedness for a pandemic influenza when we started a pandemic was a possibility today it's a reality as it turned out we've been fortunate so far that demick has not been severe the big question that we've course is whether it will stay that way or whether the virus will become more variable and this fall or winter in any case we know we have to be prepared for that so how well prepared are we clearly we're benefiting from groundwork that's been laid over the last few years we have a national pandemic strategy and implementation plan developed by the federal government and all fifty states and the district of columbia as well as many local governments and private companies have their own pandemic plans as well but the work we've done suggests that there is more the federal government can and should do to fill in the gaps in the nation's readiness this afternoon i'd like to focus on the most important of these gaps that are work first the leadership roles in a pandemic the who's in charge question have not been clearly worked out and tested as you pointed out earlier mr chairman under the national plan the secretaries of homeland security health and human services are supposed to share leadership responsibilities along with the system of federal coordinating officials principal federal officials and the female administrator but there has never been a national exercise to test how these roles will work together a point of particular importance now that we have new leaders in these positions in two thousand and seven we recommended that the two departments undertake this kind of exercise but that has not been done second the national plan which was intended to be a three year plan is now over three years old and it needs to be updated particularly in light of the experiences of the last few months but there are no provisions for updating the plan or even reporting on its progress two years ago we recommended that the homeland security council establish a process for updating the plan that would also involve key stakeholders like state and local governments and would incorporate lessons learned from exercises and other sorts that still has not been acted on third the federal government could be doing a better job of sharing its expertise and coordinating its decisions with other levels of government and the private sector there have been a number of mechanisms developed for this purpose but they could be used even more the critical infrastructure coordinating councils for example bring together private sector leaders from the eighteen critical infrastructure sectors with officials from d a and other federal and state agencies to develop plans to protect critical infrastructure in major emergencies including a pandemic flu but at the time of our two thousand and seven review private sector members told us that they were still looking for clarification about the respective roles and responsibilities of the federal and state governments in areas like state border closures and vaccine distribution we recommended then make greater use of the coordinating councils to have these kinds of discussions and to help resolve some of these issues but it's not clear to us that this has been happening and finally there needs to be a greater degree of accountability to ensure that federal workers are protected in the event of a pandemic under the national pandemic plan agencies are supposed to develop operational plans to protect their employees and to maintain essential operations and services but based on our survey of the major agencies progress on these plans appears to be very uneven with several agencies reporting that they were still in the early stages of planning and yet there is no mechanism to monitor agency planning and no provision for agencies to report on their progress as a result we recommended that the homeland security council asked us to take on this monitoring and reporting role h one n one tomorrow do we have enough vaccine on hand now to address it in any real form or are we still s mr chairman we are taking all the necessary steps to develop the vaccine but it will not be available for use for several more months clinical trials at the national institutes of health and among the vaccine manufacturers are now underway we need the results of those trials to understand the level of dosing and the immune response whether we are getting sufficient immune response we also need further information about the vaccine about the virus itself which we're collecting in the southern hemisphere as well as in the states so we expect that we will be in a position to do a vaccination campaign if the decision is made to proceed with one in the september october timeframe thank you dr luke the fact that we don't at this point have enough vaccine ohanian what plans have or h h s that they do this and if so do you have any knowledge as to whether or not they have updated those plans well to our knowledge thank you mr chairman question to our knowledge they have not updated plan i'm interested in secretary lew comments about a federal implementation plan that is in draft stage we haven't seen that yet and so can't comment on it but i would say that in the past when we've looked at the earlier the current version of the implementation plan a national strategy we noted a number of gaps in what's included there but i would say that the most significant one was the fact that many of the action items in the plan were assigned to state and local governments but there would have been no consultation with state and local governments in the drafting of that plan and when we talk to some of  e some of the state and local governments particularly the local level they weren't even aware that they had responsibility for any of the action items thank you could you provide the committee with  copy of this draft plan and you talk about  n one like symptoms i read that in the paper this morning yes ok but you don't have any knowledge beyond what you read in the paper  people and we have no knowledge of it other than reading it in the paper and i think that's part of the issue that stan hart report goes to is we don't really have a plan of informing people when potential speak mr chairman to the specifics of this situation but i do think it underscores the importance of having operational plans plans at a sufficient level of detail so that when these kinds of situations ar organizations people within the organization know exactly what they need to do to follow up on that situation it's not enough to just have something that's very high level and again it this was brought to m used up my time gentleman from new york for five minutes i was chairman secretary corps you said that right now you're evaluating the virus is it too early to say how very much it might be anyway to make estimates as to will be more severe than spring congressman the experts at c d c have are continuing to watch what happens in this country with regard to the spread and the viru we're watching very closely in south in the southern hemisphere and so far it appears to have a similar pattern in some places the disease has had a serious serious effect on individuals in other places it has been mild as it has in the united states the virus itself does not appear to be mutating which is important information but again we're collecting information we're just reaching the height of the southern hemisphere is flu season so the short answer is there's a great deal of information that we will continue to collect that will inform the decision about whether to do a vaccination campaign here in the united states in the in the meantime there's a great deal that every individual can do one of the most important messages i think that we need to get out to the american people is that every individual every family every business every school has a responsibility to understand what they can do to mitigate the spread of the disease it certainly is an issue for members as many people as you shake hands with and see every day there's some very very basic information that we need in everyone's knowledge base which is wash your hands frequently cover your nose and mouth with your arms out with your hand when you sneeze or cough if you have a fever or flu like symptoms stay home we need to get this message out we're working daily with state and local answer the questions are probably going to have because i'm sure we can expect room is some true some conspiracy theories everything else going to be able to go after them right away and have answers as best we can because we certainly understand it's critical for the public to trust the vaccines in the public health experts who are recommending them we will do everything we can to make sure that there's accurate information available to everyone and secretary corps as far as lessons learned as far as your two departments are  in coordinating all of our activities in integrating our science and public health experts into the decision making process our two secretaries were leaders in terms of talking to the american people about what to expect and we felt like it was a it was an excellent working relationship we need to always build on it we need to incorporate always pointed out our state and local and territorial and tribal partners and we need to incorporate the business community in all of our plans going forward in our attempting to do that to take a look at the c web site it flu dot gov there are extensive guidelines scores of guidelines that are for different provider groups businesses individuals we're trying to provide as much information as rapidly as we can it is evolving as we certainly looking at it from from the outside the coordination seemed to work very well at the outset of the h one n one outbreak but i would point out that at the time secretary sebelius hadn't been confirmed yet in her position just had at the beginning secretary napolitano leading the effort as it were along with obviously others in the two departments the theme and it didn't the pandemic itself it hadn't reached pandemic proportions yet it hadn't it was not yet severe outbreak and so it didn't call on all the resources that might be called on in a more severe pandemic situation and we still haven't tested that kind of scenario and that still remains to be done to make a vaccine and the decision to use it have been separated we're doing everything in our power to get a vaccine ready and in the coming months we will make the decision whether we should have a vaccination campaign  we expect there will be one but that decision hasn't been made and it would be distributed free of charge we hope we hope in the distribution system if there's insurance coverage and jim and me back up and correct myself just a little bit there are still some this is key decisions like the feasibility of having private insurance that already covers vaccines to cover it we're moving very quickly on trying to develop the distribution system since we will be  have a new we will need a mix distribution system some through the private system and some publicly if we have to vaccinate a large number of americans so the feasibility of some aspects of the distribution system still have to be determined accorded us i have found it to be fascinating and i am moved by an indication and perhaps i should ask a question rather than make a statement is it true that united states of america has more cases recorded than any other country is t states and mexico you have the vast majority of confirmed cases but let me just point out to you that the c d c estimates that there maybe a million americans who have been mixed one in one so that the number of confirmed cases is a fraction of what we actually had expected to happen i understand with forty thousand that gives us about forty percent of the known cases and it appears and i would be tempted to ask a question is it true that we have the the most deaths reported my intelligence indicates that we've got two hundred sixty three which appears to be about half of all of the known death is this true the latest c d c numbers are three hundred in two deaths in the united states as of july twenty fourth let me just bring this is dr nicole lurie who is this is secretary for preparedness and response and has some of the individual numbers ok thank you i will get that for you listen let me just say this to you i've been where you are and i've had to to population we don't have more than china we don't have more than india i have more than a lot of other place in the world and when we have forty percent of all of the known cases in the world and half of all of the known deaths in the world that causes me to pause and ask what's happening here in the united states congressman green we also have the finest surveillance system in the world and i think we have a great deal more knowledge about what's happening among our citizens but let me point out to you that in a normal flu season thirty six thousand americans die from seasonal flu including fifty to one hundred children so the regular seasonal flu takes a huge impact on our population and that's the reason we're so concerned about h one n one because it's a novel virus and could potentially do greater harm i would assume that we are also exceedingly concerned because of the possibility of simultaneous infections that will lead to mutations that certainly is the reason we're doing enhanced surveillance in the southern hemisphere what can happen with a virus that as it moves to the southern hemisphere during their flu season is it can mutate and come back to the united states in a more virulent form where we're tracking it as carefully as we can to understand whether that is happening so far it doesn't appear that it is but we won't have a final conclusion until we get farther into the southern hemisphere is flu season and just one final question the the magnitude of this we we don't want to overexaggerate we want to make sure that we try to maintain a level of understanding such that the public won't panic it's important not to panic but by the same token it's important to understand the magnitude of what we may be confronting and i'm i have a little bit of concern when i read the report that i have think we will no have some idea as to whether the current vaccines that we have will be efficacious as opposed to having to deal with a mutation that may create another dynamic that we need not discuss  i i think the and i will correct this for the record if i need to need to i think we will the clinical trials will occur over the next two months but i think in the next two months we will have  about the type vaccine that we would use and within the next two months we will have a great deal more information about the actual virus itself and whether it has mutated as it today when seasonal flu season hits will probably lot more likely than not be a different type of influenza is that correct is correct and so the challenge is to predict what the mutations will i'm i'm not probably in the right in the best position to answer the question about if there's a mutations but we can certainly get that information for you and just hypothetically if it mutates into a strain of the vaccine cannot deal with you know would involve encouraging people not to form in large groups it may involve closing schools the guidance as to when to consider closing schools is being written will be made available  individual practices are so important in those circumstances businesses will have to plan all these things need to happen if we go forward with h one n one and certainly if there's a variation on h one n one as it comes back it would be even more important for those practices to be followed and where where are we right now with the stockpiling of these anti virals i know that the national strategy lies in the states to purchase these and i think  maybe thirty one million courses of treatment the states have not purchased or not yet have they my understanding is that we have roughly thirty five million courses of treatment which is a full course  among the states now and an additional the total is somewhere between seventy five and a hundred million complete total courses available through the federal government and the state government do you feel that we have an adequate supply then stockpiled to deal with this if the vaccine is not successful our public health experts believe that for the virus as it is we now projected that we have sufficient anti viral s we have have the manufacturers working full speed on antivirals and we purchased the capacity to develop the vaccine so we have moved ahead to make contracts to be sure that we have the manufacturing capacity committed to us to make the necessary medicines in vaccines and in the last question when you look at mutation i'm not an expert in the surgery and all that but you are as you look at mutations it is acceptable to look at say wh america as they're dealing with their different change of seasons from ours and then and then it moves up north to let's across the entire southern hemisphere in south america we're looking in south africa we're also looking at australia as a great deal of information basically it's the it's the the flu season in the southern part of the world is where we're looking because that's you know the virus moves to the colder climate and then it turns colder here it's back in the united states and so it star when we have the fall we have increased cases of h one n one we expect that we will and we expect it will also have seasonal flu circulating at the same time and what we've seen happen in terms of the colder climates though this is not mr chairman i had a quick question i guess it goes back to the planning aspect also how are you employing the universities for the regional bio labs that exist or are you for this virus congressman the supplemental funds that we received as i mentioned a moment statement a portion of those three hundred fifty million have been granted to state and local government as well as to hospitals for preparedness planning c how would the homeland security agency the different agencies address areas that are in tremendous need like like new orleans may i just say  terms of the distribution of a vaccine if we were to conduct a vaccination campaign one of the reasons for a mix the distribution system is to provide public health sites so that individuals who don't have a regular provider or if there's an inadequate number of medical providers there's a place where all individuals would be able to go to get vaccinated thank you very much very much gentleman from new mexico for five minutes most of the want thank you very much mr chairman and mr chairman far beyond my questions in regards to the committee markup of h r eight hundred eighty one the transportation security workforce announced an act of two thousand and i ask unanimous consent that the record for the markup reflect that i would have voted on the question of adoption had i been present here no objection sauda thank you very much mr chairman again for this very important hearing  d mr court did i hear correctly that as we're preparing for this that the only one of the things that's been looked at on how will deliver some of  the medication necessary anti viral to be distributed to people if their health insurance allows for it to be paid for the question involved the vaccine distribution system the if we were a vaccination campaign that covers hundreds of millions of americans which is one possibility the question is how we do that in a timely fashion the expectation is that we would want to distribute it to providers but also through public site so that we can be sure first that the priority groups that need the vaccine first receive it and secondly so that we make sure that we actually reach the americans that we need to one of the issues we will have to deal with the as we have the funds to pay for that vaccine but to the extent that it private insurance covers it decision would have to be made about whether to try to have the insurance companies cover that particular shot the first and most important aspect of this is to get people vaccinated under these circumstances if people go without vaccination they may be exposed to h one n one and become sick and infect others so it's first and most important that we have a successful vaccination campaign and those decisions will be made in that context so in that situation as your course sounds like the more people we have covered the better up will be there was some attention brought to the fact that los alamos national laboratory at sandia national laboratory have in place a national infrastructure simulation analysis center i know that some work was done in order to collaborate with  for modeling perspective and preparation for what we could have dissipated before this pandemic what's the department doing to work with our laboratories and utilizing nice sac and other resources to and in regards to preparation getting the word out coming from a border state i hope that we're preparing and multiple languages including spanish and the district that i represent represents many native  nations as does the rest of the country and so i hope that something is being considered as we prepare for it in that regard and speaking to that specifically with our tribal nations what's being done to specifically cornett with them and how can that be and i think that's important that we keep our eye on the ball thank you very much agree with the gentleman from new jersey for five minutes mr chairman managed by simply saying i think that our committee should yeah i'm asking if you gentleman from new jersey forgive me for that i did answer that one i greatly appreciate that thank you all for coming today i have a question for both the secretary lew secretary corps about this time last year in september my region was hit by hurricane ike which devastated much of the region and had a particular impact on some of the health care aspects particularly the university of texas galveston's medical branch it basically was lost they opened up their level three trauma center just this past week they had that a level was before and were in the cities to get august and september are historically the big months where the strong hurricanes come through if we had the misfortune of having a low category three four or five hurricanes come hit our country hit the texas gulf coast while we're in the middle of some sort of pandemic h one n one do you have the planning have you done the planning to have the resources to make sure you can respond to both those and so the pandemic doesn't run out of control congressman you raise a very very important question which we have asked ourselves and the what the department has done is go through our hurricane preparedness planning in every aspect and ask ourselves the question if we're in the middle of an h one n one outbreak how does it change what we need to do how do we move patients how do we where do we put individuals the one thing you don't want to do in an h one n one outbreak is collect lots of people in a small room but that may be the only thing we can do to move people out of the way of the hurricane all aspects of that are being gone through thoroughly we need regularly with our state preparedness and emergency manager coordinators  so we will be we will be working closely with them we will be discussing this very situation and we'll provide extensive guidance before we get to before the we get to flu season here again the administration of a new vaccine so the health care workers are provided the coverage that will participate in the vaccination programs and won't be worried about the liability my understanding is the current law protects them i think that we should ask both departments who i am a great deal of respect for that they respond to all of the concerns or recommendations laid before us today within the next three months stafford act disaster assistance is applicable here will the department will the deployment retain the fema disaster assistance policy an influen which was issued in two thousand core can you tell me the replenishing of the eleven million antivirals in the strategic national stockpile was that a one time act or do you view it a standard operating procedure as the federal government moves forward in facing the threat of h one n one in the coming months and we have two minutes before we go i have to maintaining a current effective stockpile is essential and that's an ongoing process so this is going to be a regular practice certainly the purpose of the stockpile is to have it ready and available in the event that maybe the verb is but we i want to hear from you that this is going to be regular procedure and that this is not simply a one shot deal that's my concern the department of human services certainly values the strategic national stockpile and hope that it will stay full my final question is what do you tell mothers and fathers about what they should be telling their kids about this particular virus that we're talking about that should make getting the vaccination if it happens something that the children view as i've got children i'm not quite sure you make it fun to do but you've got to impress upon them the importance of it in that where it's  certainly not only because i think they're going to hear about it in school they're going to hear about the things they need to do things on their age so i think we need to have a broad public discussion about this if we're going to succeed in our efforts very much committed to a recess to take three votes should be about twenty minutes going to stand in rece we'd like to reconvene our recessed meeting we've been told that we have about an hour before the next series of questions while she get a read or a comment came to mind for the panel relative to the the vaccine that we talked about a little earlier and the question continues to be when we have reached a critical number that the department is comparable with  will the department look at some distribution process that would allow the immunization to occur or is your is that it's important to separate the decision to make a vaccine from the decision to use that we have made the decision because we have to in order to have them and the vaccine manufactured as quickly as possible to go forward with method manufacturing but the decision to start a vaccination campaign we will benefit from the additional information we can collect if you ask us do we expect there'll be a vaccination campaign i think the answer is  yes but the decision needs to await additional information that will collect in the southern hemisphere and in the united states and the decision will be made thank you very much i hope  if at all possible for you to fully implement the recommendations if not the expectations is you would indicate back to the committee which ones you are unable to to accomplish later from new york for five minutes thank you very much mr chairman thank you ranking member this examination of the current status of h one n one is so very important right now where we are still hearing  f occurrences not only in our nation but around the world and so it's a very timely that we address this now particularly before we go into our recess and come back towards the fall my question  or as well as c b p are doing to address account of it vaccines for h one and on as well as counterfeit anti virals and other medication that make substantiated claims to treat h one n one influenza illness  we recognize that there are certain incentives for groups to profit from what we expect to be a major national incident come the fall and we're very vigilant on that and working together with our colleagues throughout the system to be sure that we have complete as complete as possible surveillance and detection and interdiction and disruption and proper law enforcement accountability should should that circumstance ar and we just want to make sure that our our population is well protected so we look forward to any findings that you may have about any developments any cooperation that you getting from any of our partners across the border about any instances that they may have incidents that they may have encountered as they are beginning to deal with the flu even in in their respective areas my next question is about science and technology challenges the committee is always on the lookout for new technologies that will help us address the threats facing the nation but i'm kind of disappointed to see that we have not made further progress in getting beyond the use of egg based technologies for vaccine production still depending on that technology for the h one n one virus vaccine this time around however i am heart congresswoman as you point out the resources of the department are advanced research resources have focused on developing new methods of making vaccines and other products i can't speak to you off the top of my head about that particular methodology we will get that information for you but rest assured that we recognize that using technology is not as efficient and as productive as we need and as we move forward with this it's a very important aspect of our advance development program to find other development technologies that will produce more vaccine and at lower prices only congresswoman that we work very closely with h h s and science and technology along with personnel and partnership forms the backbone department of homeland security's response to all risks and hazards that the country faces  farley new york city's health commissioner stated the majority of individuals who died new york city from influenza all over the age of sixty five as you may know my district in florida is home to a significant elderly population and the h one n one strain of influenza is particularly vigilant how are you how are your departments working with the state and local governments to provide outreach and information to elderly and other special needs populations and what recommendations are you making to state and local governments as they work to prepare these populations and who should be vaccinated and that's a question for available planning templates and planning training as well conference i would just add that the one of the challenges this flu season is going to be that we expect seasonal flu to be circulating at the same time that h one n one is from the elderly person or senior citizens perspective h one n one at least so far appears to be more severe among younger people among children  among younger people that have other can do underline conditions it doesn't seem to have to be as severe in senior citizens it may be because of some partial immunity develops from i just want to nine hundred seventy six or  flus that they were exposed to this just points up the incredible importance of communicating clearly to the public through our work with the state and local and and tribal in territorial health department says secretary lew was saying so that people understand how important it is to get their seasonal flu shot and to get their h one n one shot so we will be endeavoring to make sure the public understand what they need to patterns of previous pandemics there have been at least twenty two desks in my state of individuals who had each when and one virus i'm especially concerned that the number of cases in florida will skyrocket when school begin in the fall since this virus is disproportionate share lately if you said affected school children what a way each of you please comment on the following questions what recommendations should we provide parents  school age children in my district about how to protect their children from the from this virus and should children with this virus stay home from school and should school administrators close schools in which schools have become infected with it with this virus and their uniform reckoned it recommendations about how long schools should remain closed under such circumstances if you could address those one more of what federal department or agency is the lead authority when it comes to such guidelines thank you very much steps they can take that will protect them and it's the same instructions really for all of us which is that you if you're coughing or sneezing you cough into your arm if you're sick that you stay home  wash your hands frequently do not touch your eyes nose or mouth those basic steps can make a huge difference in the transmission of the virus having said that the guidance that secretary lew talked about  d work with the school systems are very important for them to understand what steps they should take as the exposure to the virus spreads gentleman's time is expired  exist in the state of our national preparedness to deal with this we have learned a lot i would like to underscore mr chairman about this and how we should respond to with the state of readiness in the federal government at the state and well let me ask let me put it with are they sufficiently qualified to determine who my display symptoms of a particular number one and number two is what protection are we giving to those men and women at the  for their valuable testimony in the members for their questions before being dismissed mind our first panel witnesses that the members of the committee may have additional questions for you and we actually do respond expeditiously in writing we've been told that we have another series of votes but i'm going to try to get through the witness statements for east and they would come back to the question always go right into the questions i'd like to welcome our second panel of witnesses our first absolutely essential thank you again for the opportunity thank you very much for your testimony we now recognize must move for five minutes good afternoon chairman thompson ranking member king and members of this committee before being appointed to my current position i served in the baltimore county fire department for over thirty years including fifteen years as the county's emergency manager i thought that was important to say because i come here today representing both the state government but also much experience at the local level is an honor to be invited here today to discuss maryland's current preparedness and response activities for the h one n one and a critical way shoes that remain a challenge for the future a pandemic flu response presents a set of challenges that are different from other emergencies since the last severe pandemic in united states happened about ninety years ago we don't have any hands on experience dealing with one and unlike most emergencies especially does a declared disaster have a well defined beginning and ending does not have geographic limitations and potentially lasts much longer with experience a relatively mild spring operate but experts tell us the fall flu season will be much worse merlin is committed to using all available resources and personnel to address the situation this committee's majority staff reported in a fight for major categories of action items to strengthen established effective management addressing bt medical requirements evaluate and update plans and improve early warning and detection here are some of marilyn's accomplishments in these areas our plans in our areas that we're still working on first governor martin o'malley instructed the maryland department of health and mental hygiene in my agency to lead an h one n one leadership task force to a dress some of these issues determine who is in charge integrate the response into incident command system and improve communications among various state and local agencies and with the public next the gov mandated state agencies continuity of operations plans to be updated and completed by october first along with updated pandemic flu operational plans and our t j national stockpile plan just two days ago we hosted the h one n one summit to insure open dialogue between public health  officials emergency medical providers and local emergency managers while we are working diligently to prepare for a possible pandemic at schools return to session next month and as a traditional blues season hits later in the fall we have identified several issues that must be addressed at the federal level either by congress or the administration first leadership in coordination issues must be resolved at the federal level which will give the states more confidence in the guidance we receive from the department of health and human services the department of homeland security and other federal partners but there may have been legitimate political and logistical reasons for having h h s and v h s as a federal voices of h one n one but that may have confused the public and while the leadership issue may have been resolved at the federal level that resolution needs to be communicated to the states i had the opportunity to speak to some of my peers across the country and they all had the same concerns that we had so this communication certainly needs to be worked on it is vital that all agencies use the incident command system failure to use this consistent common language and commands can delay the coordination of resources and may endanger both responders and the general public and it is important at the public receive timely credible and definitive guidance from the centers for disease control for example the radical change in school closing guidance several days into the spring pandemic clearly colored the public perception of government decisions second as  shown with both the inaugural activities last chance in the spring h one n one outbreak it may be time for a legislative review of the stafford act to help make sure it is appropriate to deal with today's events and their potential enormous costs the stafford act was designed to deal with disasters like tornadoes and hurricanes but does not work so well with emergencies that don't have a definitive ending date or may have a lot several months between activities such as we're seeing now with the pandemic we need federal guidance about what types of disaster systems might be available for responding to a pandemic and what thresholds are required for a disaster declaration in this economic climate states cannot afford to guess at what may or may not qualify for assistance third state and local governments need greater flexibility to use various federal grants to help with h one n one prevention and response protection for first responders and workers in the medical field need to be one of the top priorities and i'm asking that congress and the administration develop a new funding source so that these front want line workers can be supplied with appropriate personal protective equipment it is also vital that these grants allow states the flexibility is to manage their own need one size does not always fit all finally we must have consistency between public health emergency management planning guidance so that the various agencies can work together seamlessly not only is the current guidance inconsistent with the status emergency management guidance it does not allow for the needs likes ability and scale ability for each state or situation this spring outbreak for example while it was fast spreading novel virus did not seem to have the high mortality rate of previous pandemics however much of the planning guidance was based on the high mortality pandemics in nineteen eighteen in one nine hundred ninety in addition i would like to mention one other area concern i sit on the subcommittee of the national children's and disasters and one area they have is that the children not be forgotten in all areas including planning and any type of inoculation so i thank you for giving me the opportunity to discuss these porton issues today thank you very much we'll have some time for for the explanation on the question we have ten minutes left on this vote and we have two five minute witnesses date going forward and what of our major challenges as i begin though i wanted to make a couple and reiterate points that have been made about this virus first of all it's a novel virus and we don't have a vaccine this means that there are a huge number of susceptible individuals still in our population we can fully expect a lot of six people through the summer and into the fall a lot of hospitalizations and yes a lot of deaths i think we can fully expect that secondly this and this virus is acting very differently than seasonal  flu the fact that we're seeing still growing activity in many states right now today we talk about a resurgence but the fact of the matter is with us right now and it's affecting different populations and it's mutable which means we have to maintain full capacity  our epidemiology and laboratories in order to adequately monitor this and give us the information to make to make the correct public health decisions what worked well i want to i want to congratulate the centers for disease control in taking the lead in ensuring that there was good vertical coordinate collaboration and communication connecting the state health offices with the local health officers throughout the first wave of the of the of this pandemic some of manifestations of that where for example  within days of the first identification of the first cases in southern california there were teams of epidemiologists on the ground that included c d c epidemiologists state epidemiologists and local epidemiologists to quit to ask the right questions to help us better characterize the the seriousness of the old this is what's causing and the transmissibility secondly laboratory capacity certainly in california the coordination between the twenty four local laboratories state laboratory and the california laboratories allowed us to test fully fourteen thousand specimens within a period of six to eight weeks unprecedented capacity so it was good working together similarly with the strategic national stockpile each state received twenty five percent of its allotment of antiviral in fact of our antiviral medications and masks we were able to receive those and redistribute those to twelve fifty one just a local  california within a matter of days we think this is a huge success and speaks to the to the excellent planning and resources that have been provided to us for putting things together what are the lessons that we've learned first of all as as i  congratulate the epidemiologic on laboratory capacity i should also state that they were stretched to the limit we no way could we have sustained the effort that we put forward in the first weeks of this campaign i am very concerned about our ability to continue to monitor this  pandemic adequately as we move through the summer into the fall into the regular season secondly i think previous mention was made about the supply chain for critical materials we detected some serious vulnerabilities their laboratories in the state of california were telling me that we were within hours of having to stop testing for influenza because we didn't have proper love laboratory reagents similar problems were currying about the availability of antiviral medications and masks we need to rethink and reconfirm the consistency of the manufacturers the distributing systems to ensure that we can continue to supply those materials to local and state health departments that need them thirdly we have inadequate data systems now in the epidemiology area i think we have good systems in place to gather epidemiological information at the local state and federal level to be able to correlate that data and tell us what's going on we don't have similar effective data systems in the health care system at the local level local health officers and emergency medical technicians can tell you what's available emergency what's happening in their emergency rooms and in their hospitals but we have no way consistently to cole eight that information regionally and at the state level so that i a state health officer have a heck of a time telling my governor what's happening broadly in the state and the health care system throughout throughout california what are our challenges moving forward i think there are three big ones i think once i'll reiterate maintaining epidemiological and laboratory capacity at the state local and federal level to be able to give us the information we need on an ongoing basis to make the right public health decisions is of vital importance and it's a major challenge for us mass vaccination it's been mentioned before but what i want to emphasize in my comments is i think we have the capacity if we decide to do this to do you get the vaccine delivered from the federal government to the state to the locals the real challenge is administer that's going to be left up to the locals the state and the federal government and agencies need to be prepared to to support local agencies that are going to be responsible for actually administering that vaccine and then one final comment is on surge capacity there's no question in my mind that our health care system is going to be stretched to the limit if not overwhelmed we need to take major steps forward to assist the healthcare system in preparing for for this for this overwhelming increase in sick people that we're likely to areas like new york city based unique challenges when combating highly contagious viruses such as influenza the city has a population of over eight million and the population growth nearly twelve million on weekdays more than one million students attend about fifteen hundred public schools in the city these are ideal conditions for easy transmission of influenza we know that we will not be able to prevent pandemic influenza from entering new york city once it emerges anywhere in the world and that once it arrives we can try to slow it transmission but will not be able to halt it when h one n one arrived in new york city in late april and we knew little about how easily the virus would be transmitted the severity of the onus it might cause and who among the new york city population was most at risk for infection or severe illness through c d c we quickly acquired the technology necessary to begin performing confirmatory tests for the new h one n one in our laboratory besley improving our ability to obtain timely information about the virus  development and distribution of such a test in such a short period of time is a remarkable feat and we appreciate the support we've received from our partners at the c d c from reports of severe illness it appears that h one n one community transmission in new york city was more widespread than elsewhere in the united states we estimate that at least several hundred thousand and perhaps as many as one million people in the city became ill with h one n one with forty seven recorded that's an h one from h one n one the case fatality ratio is approximately one per ten thousand cases roughly the same as or lower than the case a tallit ratio for seasonal influenza during the outbreak the health department recommended closing fifty seven schools for five days to protect those at highest risk of complications school closures were not expected to interrupt the spread of influenza in the city as a whole our plans for the expected return of h one n one in the fall or winter are focused on assessment of current resources addressing gaps in implementing enhanced since this process will be greatly aided by the supplemental funding that congress recently approved we would like to express our thanks for that support the best tool we have to prevent influenza infection and severe disease is vaccination are hopeful that a vaccine against h one n one will be available before the virus returns if ample supplies are available we will provide it to people in ways to protect those most at risk for severe infection however because we do not yet know how much vaccine will be available we must prepare for a range of options these include vaccination by private medical providers next a nation of public clinics mass vaccination in schools and vaccination using point of distribution or pod sites if an h one n one vaccine is not available in ample supplies before the virus returns we will have to rely more on antiviral medications to protect persons at risk for severe disease we are developing contingency plans for use of antivirals that rely on distribution to hospitals and community centers a significant challenge for public health departments will be responding to an h one n one outbreak while we are also promoting vaccination against seasonal influenza the overlap of these activities will further strain private providers health care facilities long term care facilities and the health department during the peak of the pandemic this past spring some hospital emergency departments were severely strained some hospitals created additional space by setting up tents outside of their emergency departments or used outpatient clinic space to quickly separate insulins of patients from others to avoid this overcrowding this coming season we are working to develop better ways to guide people decision making about when it is necessary to seek medical assistance assistance publicize up today guidance on our website and disseminate it through community and faith based organizations as well as schools to provide alternatives to hospital emergency departments the health department is working with community health centers to expand their operations we will also encourage hospitals to develop specialized influenza clinics were alternate emergency departments so that they can handle the patient load and reduce exposure to influenza to other emergency room patients our current thinking regarding school closure policy is that if the virus does not increase in severity we unlikely to recommend widespread or prolonged school closures because the disease has been mild in nearly all children such closures would not stop the spread of the virus and the economic and social disruption caused by school closures is substantial we will recommend the children of staff with symptoms stay home and the children or staff at risk of severe disease who come in contact with oprah bill persons consult with their medical provider about taking anti viral medications on the other hand if there is evidence to suggest that the virus is more severe or the disease incidence increases significantly school closures and other measures to reduce contact among large numbers of persons may be considered to date the cost of the h one n one response for the health department activities alone has been approximately four million dollars citywide costs are estimated to exceed twelve million while the funding has been very much appreciated the funding that will be needed for more severe response to more severe return of this virus would be substantially more like a thank again the committee for  opportunity to testify and i'll be happy to answer any questions you have i think will the witnesses that their testimony and i remind members that he or she will have five minutes to question the panel i want to recognize my south i want to thank all of the witnesses for taking the time to come and share your experiences in managing this outbreak as the only member of this committee from new york city i specially want to welcome commissioner farley and thank him for  managing this crisis in the city new york was hit hard with h one n one with the highest death count sixty three total of any state three deaths in new york city confirmed cases in new york total twenty seven hundred thirty eight to date and the fourth highest commission of folly also testified that it of july first nine hundred nine people diagnosed with h one n one have been hospitalized in new york city alone that the farley tell us about the lessons learned by new york city during the h one n one outbreak have you been able to rectify the lack of guidance coming out guarding school closures  was a little different from what we had expected it was a very widespread infection caused many many cases but it was milder than what we had prepared for so we had to adapt our pandemic preparedness plan that caused changes in policy about issues such as school closures one of the lessons i think learned from this is that it is important to have the ability to closely track the arrival and the severity of the virus such as this and to be able  with the guidance from centers for disease control so one of the lessons learned is that at the national level plans need to be flexible for differences between different areas and for differences in how severe the infectious virus may be let me center is just one example for for instance at the federal level and we know there's been an outbreak at rikers island jail can you tell about how the city handled the outbreak as well as the concerns  employees we did have infections occurring in people who were at bikers island jail this is a jail many people are arrested frequently so there's a lot of communication between the general city population and the jail  we took very aggressive action to try to limit the spread of the infection within the jail and when necessary provide prophylactic medication to people who were at risk and came in contact with those that infection we were able to contain the transmission in the jail but it did point out to us the fact that there are populations who can't follow general guidance they don't have an opportunity to not come in when they're sick they are forced to stay in that institution and so we do need to have guidance for congregants settings like that but i think we did show that taking proper precautions were able to control the spread of an infection in that institution aside from the recently issued c d c guidance guidance have you given these facilities regarding the operations protecting both employees and detainee and guys from the centers for disease control was trying to censor contain it and it was clearly passed containment so there were settings where for example we were not recommending a ninety five masks because we felt that the virus was similar to seasonal influenza and the drop the precautions were adequate and the virus was around and the c d c was still recommending in the five and ninety five masks so our ability to adapt to the situation we thought was important and we still believe it was successful thank you very much i now recognize the ranking member of the full committee the gentleman from new york with the king for his questions at this time thank you ms clarke and let me thank the witnesses for their patience and forbearance and putting up with us on our question dr following but also opened up to a direct movement dr horton i know that congresswoman crocker mentioned the fatalities in new york we have a high number compared to the rest of the country i dove right outside the city and many of my constituents you know commuter lines into the city but still for the most part this was treated in the papers after the first few days in the media as not being a big deal as being somewhat under control and yet this twenty percent increase in the emergency rooms now if this were a more requirements were strained by a large numbers of people coming there some of those were the worried well some were people who had symptoms of disease and that was with symptoms that were not that bad i mean the fact is that this was a very mild strain the vast majority people got over this fine and so with not a very severe strain nonetheless there were large numbers of people coming to emergency departments our way of trying to handle that going forward is to purse communicate to people about the fact that if they're well they don't need to come to the emergency department or even if there have mild symptoms they don't necessarily need to come to any medical provider they might be able to that have a telephone to also provide alternate alternate sites where they can get medical care such as community health centers and then also to work with hospitals to handle those people who will nonetheless have to come there again having potentially separate specialized flu clinics or flu emergency departments i think with that the hospitals can handle this i think it will be strained but i do think that they can handle that but all of those pieces need to be put into place as a separate issue if we have a more severe strain of a surge needed for people with very severe disease and the new york city health department has done a lot to try to increase the number of ventilators so that patients who has here enough disease that they need to be on a ventilator could be handled  place well before that hits we still see thirty five to forty five thousand deaths and hundreds of thousands of hospitalizations now in this case where there's a novel virus was virtually nobody is immune to the virus and there is not a vaccine in place early i think we can anticipate problems a couple other comments that i would just compliment with dr farley said a couple of other steps i think we really need i think there's some evidence i could say as a doctor myself that that physicians and high nurses working in hospitals are not consistently complying with recommendations about infection control and personal protection and i think we need to get everybody up to snuff and operating to a new ensure that the hospitals and health facilities themselves to be not become a night of infection in communities and that we're doing everything that we can to protect health care workers so that they can stay onboard so i think that's extremely important and also individual hospitals each one of them should have a surge plan which means when they activate it they can  charge patients that are ready to be sent home early and they can restrict the admission of new elective admission to the hospital to ensure they maximize hospital capacity so there's a couple of additional steps i i think they can take to help the health system absorb some of this additional activity director mark congressman i spent as a state early about thirty years at the local level writing medic units everything and i would say our system strained every day especially the education effort i think we need to do a push to educate the public at all levels across the country with the same message which i think is critical and to follow what dr wharton said that if they're not you know let him know they're not ill then they don't necessarily need to go to a transit in new york city people new york city rely on mass transit and a feeling was that we could not shut down the mass transit system because people couldn't go to work including health care workers and other essential personnel there are things one can do to reduce the number of people on mass transit  s richardson and and her line of questioning and i thank you for allowing me to question as well and i'm glad that she acknowledged that individual to hear from v h s and from  health and human services ma'am chair i was delayed for the earlier panel because i was in back to back meetings on negotiating health care reform and one meeting dealing specifically with the global issue of what we were dealing addressing in a second one that was texas based so i'm going to make some comments and ask some questions that sort of generate back to the first panel but i do want to place on the that i had in along with the state commissioners and i'm very glad that deputy secretary lew to and corps have indicated that they will now have a regional strategy i hope they call them regional teams obviously that doesn't go directly to federal employees  ms kelly let me ask you this do you think an ounce of prevention is worth a pound of cure and i think especially when it comes to front line employees who are facing very real threats you know running into travelers who may be carrying any kind of virus that they have the right to make that choice on their own and i remember the debate of t s a in particular the a soul's asking for mass and i remember the confusion of not being able to get an feel that there is a great a stakeholder position right now we don't know how it's going to turn out but we do know that you have a stakeholder position is that important it's very important and i believe the language is very clear that i have that right and of course implementation will be the real test will work with you on that do you also think and i really respect scientists because they are dispassionate they look at things as one two three but isn't it important to do you feel it's important because most of us are laymen and not scientists that we have the right amount of passion and concern and also quick quick acting so that there brings a sense of calmness whether it's a federal employee or the broader community absolutely the more information the better  that employees can understand not in scientific language your medical language which often causes even more confusion so the clearer the more direct the better let me i'm asked to to commissioners thank you very much from both california and new york and certainly maryland texas unique not represented here on the panel but a lot of different counties and it's normally diverse as some of your states are as well  concern was that the c d c and others who are engaged did act dispassionately as scientists i think that's very important but do you believe it's important for there to be quick acting communication with state agencies and do you believe that these regional sites which may be over a certain number of states would also be important to come to large cities like new york the large cities like los angeles large cities like baltimore large cities like houston that there is an on site team in these larger cities and from the commission from new york the our communication in this outbreak was mainly through the centers for disease control and health issues there are there are larger issues there and if this  more severe and if it impacted on critical infrastructure we would need to have discussions with agencies outside of health agencies and having a regional coordination a regional presence would be valuable you wouldn't object however if you had also localized coordination meaning some of these officials on site in in new york city that that would be valuable in new york city all right gentleman from california i'm sorry i certainly agree i think that  that representation would would be of helpful i think that in the case seemed so far there was very good like i said vertical integration of of messaging but recognizing the fact that both across the united states and within states there's a lot of regional differences to the extent that there can that the whole process of communication can be regionalized at me bring additional helpful information to look for example myself as a state health officer to know what's happening and differences between different regions within the state and perhaps within the country and a particular team that might be dispatched to an l a or san francisco or since i'm not from that you're speaking yeah i would also be helpful to a team dispatched to a large city would also be helpful as like ordinated epidemiology team about epidemiologists or that kind of team yes i think for example once again at the very beginning of the outbreak in southern california as i mentioned in my comments that the centers for disease control provided epidemiologists on site that were matched with epidemiologists from from the state and that worked locally in southern california to assess that's that's it was a very effective way of  be some focusing on school districts and i would ask for a team such as the ones the commission mentioned to not only be on the cities but that they should be teamed up with school districts because that's where our impact was that's where parents were panicking and that's where we had no answers i know it well having a number of those schools in my congressional district and i thank the don't lady for yielding i thank the the second panel and i look forward to meeting with hiv tests and v h s on this another round of questions and i'm very mindful of everyone's time at this stage but there were a couple of outstanding issues that i wanted to just have on the record and there has to do with drug reasons the drug resistance issue and i want to raise this for both quarter and dr farley by january of two thousand nine our committee found that the pharmaceutical interventions demick influenza would be limited this turned out to be the case with novel h one n one there was there was and is no readily available vaccine and this particular strain of h one n one was already resistant to two of the four anti viral ordinarily and anti virals order ordinarily useful in combat and when so how are you overcoming this problem to deal with the h one n one now and how do you think this problem needs to be addressed in the future and what  need from congress to make this happen be the first to speak from california first of all the information i have is that currently the information we have about the h one  one virus is it is almost universally sensitive to the two most commonly used and stockpiled antiviral medications that are available to us the stockpile that was set up on the direction of the federal government and most states bought their purchases  f tamiflu and relenza and to mine to my knowledge to date there have been really only been a handful of cases of h one n one that have been resistant to those drugs so i think we're very encouraged at these at this point to my knowledge the information we have so far from the southern hemisphere is that the genetic composition and the the phenotypic expression of the virus has not changed such that it is still so i'm feeling that despite the fact that there is some resistance to other  virus can develop the ability to become resistant to the enrolls we're using now in which case then we didn't have a vaccine we would have no tools so i do think it is there is value to developing additional antivirals to keep one step ahead of influenza virus and i would agree with that health directors would comment on the uniqueness of schools and school districts as it relates to health intelligence getting to you as state leaders and then it transmitting to the consumer and i hate to call a student a consumer of h one n one that is not the interpretation i want given but the impact that individual and it seems in our state certainly children where the most schools were an immediate source and i would also want to put on the record that we've noted that a few summer camps have also been in essence victimized by h one n one mass start here please  this particular strain of influenza h one n one particular favored younger people and there was transmission of young among younger people may very well have been transmission within schools that make some important sites for us to consider how to prevent infection with the next epidemic wave i've understood that today there are recommendations that children are a high party group for vaccination when the vaccine becomes available the important is to vaccinate children to try to prevent infection in the fall  think how i'd like to address your question and concern is just just is to point out that what you're really what it would was really is needed is cross sectoral collaboration a much stronger level i think but what we experienced early this spring when  c came up with recommendations which we got school closures was a few hiccups to say the least i'd like to think that the vertical integration allowed us to respond to that and c d c modified it in a very timely fashion but nonetheless i think what we need the public health needs to be more aware of the implications of public health recommendations like school closures i mean how is education going to continue our nutrition programs going to continue what is going to be the impact on the parents and their work places  if we have if we send kids home from school all those factors we need the science the public health but the science forward in terms of the effectiveness of closing a school but we also have to factor in the social impacts of that and ensure that there good that everybody's on the same page that we have communicated effectively with the school authorities to ensure that we all agree that this is the right step we're aware of its implications and that we have to have a we have a consistent communication to the parents and the children and i think that's what was missing  mister yes ma'am and i'm from the emergency management field not the medical field but i would like to say that getting back to the whole topic of communications within maryland we certainly a problem with the national capital region and that it's very very likely that we will have a person living in maryland possibly dropping a child off in d c for school and either living or working in virginia so because of that tri state or the two states in d c it's really critical that we're all issuing the same guidance and direction and that that certainly was a stumbling block for us in the in the spring a band it also was because the c d c and i not blaming putting thought on them but constantly changing the guidance for closing schools also creating confusion in news areas so i think we have a ways to go to assure that communication is is across the board to go back to your idea of regional teams gets a great idea and i think part of that should be the whole an occasion package to go along with that but we certainly don't want communication to be missing and we don't want to dumb down the communication in essence to suggest that people should not be concerned no actually i mean i think i think the facts should come out as the facts or as my last question is kelli i just want to end on this note federal employees are everywhere and many times dealing with the public do you think it is crucial that there immediate beyond the m o you that you have but there may be immediate contact communication without federal employees when there is a and there leadership when there is a sign of a pandemic of the kind that h one n one could have been  i thank you very much for your back i thank the witnesses would be a valuable testimony and the members for their question is before concluding i'd like to remind our second panel of witnesses that the members of the committee may have additional questions for you and we will ask you to respond expeditiously in writing to those questions here you know for the business the committee stands adjour