S. Hrg. 110–451 

LOCAL CHALLENGES OF GLOBAL PROPORTIONS: 

EVALUATING ROLES, PREPAREDNESS FOR, AND 

SURVEILLANCE OF PANDEMIC INFLUENZA 

HEARINGS 

BEFORE THE

OVERSIGHT OF GOVERNMENT MANAGEMENT, 

THE FEDERAL WORKFORCE, AND THE 

DISTRICT OF COLUMBIA SUBCOMMITTEE 

OF THE

COMMITTEE ON 

HOMELAND SECURITY AND 

GOVERNMENTAL AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED TENTH CONGRESS 

FIRST SESSION 

SEPTEMBER 28, 2007 

THE ROLE OF FEDERAL EXECUTIVE BOARDS IN PANDEMIC 

PREPAREDNESS 

OCTOBER 2, 2007 

PREPARING THE NATIONAL CAPITAL REGION FOR A PANDEMIC 

OCTOBER 4, 2007 

FORESTALLING THE COMING PANDEMIC: INFECTIOUS DISEASE 

SURVEILLANCE OVERSEAS 

Available via http://www.access.gpo.gov/congress/senate 

Printed for the use of the Committee on Homeland Security 

and Governmental Affairs 

( 

LOCAL CHALLENGES OF GLOBAL PROPORTIONS: EVALUATING ROLES, PREPAREDNESS 

FOR, AND SURVEILLANCE OF PANDEMIC INFLUENZA 

U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001

38–846 PDF 2008

S. Hrg. 110–451 

LOCAL CHALLENGES OF GLOBAL PROPORTIONS: 

EVALUATING ROLES, PREPAREDNESS FOR, AND 

SURVEILLANCE OF PANDEMIC INFLUENZA 

HEARINGS 

BEFORE THE

OVERSIGHT OF GOVERNMENT MANAGEMENT, 

THE FEDERAL WORKFORCE, AND THE 

DISTRICT OF COLUMBIA SUBCOMMITTEE 

OF THE

COMMITTEE ON 

HOMELAND SECURITY AND 

GOVERNMENTAL AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED TENTH CONGRESS 

FIRST SESSION 

SEPTEMBER 28, 2007 

THE ROLE OF FEDERAL EXECUTIVE BOARDS IN PANDEMIC 

PREPAREDNESS 

OCTOBER 2, 2007 

PREPARING THE NATIONAL CAPITAL REGION FOR A PANDEMIC 

OCTOBER 4, 2007 

FORESTALLING THE COMING PANDEMIC: INFECTIOUS DISEASE 

SURVEILLANCE OVERSEAS 

Available via http://www.access.gpo.gov/congress/senate 

Printed for the use of the Committee on Homeland Security 

and Governmental Affairs 

( 

(II) 

COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS 

JOSEPH I. LIEBERMAN, Connecticut, Chairman 

CARL LEVIN, Michigan 

DANIEL K. AKAKA, Hawaii 

THOMAS R. CARPER, Delaware 

MARK L. PRYOR, Arkansas 

MARY L. LANDRIEU, Louisiana 

BARACK OBAMA, Illinois 

CLAIRE McCASKILL, Missouri 

JON TESTER, Montana 

SUSAN M. COLLINS, Maine 

TED STEVENS, Alaska 

GEORGE V. VOINOVICH, Ohio 

NORM COLEMAN, Minnesota 

TOM COBURN, Oklahoma 

PETE V. DOMENICI, New Mexico 

JOHN WARNER, Virginia 

JOHN E. SUNUNU, New Hampshire 

MICHAEL L. ALEXANDER, Staff Director 

BRANDON L. MILHORN, Minority Staff Director and Chief Counsel 

TRINA DRIESSNACK TYRER, Chief Clerk 

OVERSIGHT OF GOVERNMENT MANAGEMENT, THE FEDERAL 

WORKFORCE, AND THE DISTRICT OF COLUMBIA SUBCOMMITTEE 

DANIEL K. AKAKA, Hawaii, Chairman 

CARL LEVIN, Michigan 

THOMAS R. CARPER, Delaware 

MARK L. PRYOR, Arkansas 

MARY L. LANDRIEU, Louisiana 

GEORGE V. VOINOVICH, Ohio 

TED STEVENS, Alaska 

TOM COBURN, Oklahoma 

JOHN WARNER, Virginia 

RICHARD J. KESSLER, Staff Director 

LISA POWELL, Chief Investigative Counsel 

JODI LIEBERMAN, Professional Staf Member 

THOMAS RICHARDS, Professional Staff Member 

JENNIFER A. HEMINGWAY, Minority Staff Director 

THERESA MANTHRIPRAGADA, Minority Professional Staff Member 

DAVID COLE, Minority Professional Staff Member 

TARA BAIRD, Minority Professional Staff Member 

THOMAS BISHOP, Minority Legislative Aide 

JESSICA K. NAGASAKO, Chief Clerk 

(III) 

C O N T E N T S 

Opening statements: Page 

Senator Akaka .............................................................................................. 1, 25, 49 

Senator Coburn ................................................................................................. 55 

Prepared statement: 

Senator Lieberman ........................................................................................... 79 

WITNESSES 

FRIDAY, SEPTEMBER 28, 2007 

Bernice Steinhardt, Director, Strategy Issues, U.S. Government Accountability Office (GAO) ............................................................................................. 3 

Kevin E. Mahoney, Associate Director, Human Capital Leadership and Merit 

System Accountability Division, Office of Personnel Management (OPM) ..... 4 

Art Cleaves, Regional Administrator, Region 1, Federal Emergency Management Agency (FEMA) ........................................................................................... 6 

Ray Morris, Executive Director, Federal Executive Board of Minnesota ........... 14 

Kimberly Ainsworth, Executive Director, Greater Boston Federal Executive 

Board ..................................................................................................................... 16 

Michael Goin, Executive Director, Cleveland Federal Executive Board ............. 17 

TUESDAY, OCTOBER 2, 2007 

Kevin Yeskey, M.D., Deputy Assistant Secretary, and Director, Office of Preparedness and Emergency Operations, Office of the Assistant Secretary 

for Preparedness and Response, U.S. Department of Health and Human 

Services ................................................................................................................. 28 

Christopher T. Geldart, Director, Office of National Capital Region Coordination, U.S. Department of Homeland Security .................................................... 30 

Robert P. Mauskapf, Director, Emergency Operations, Logistics, and Planning 

in Emergency Preparedness and Response Program, Virginia Department 

of Health ............................................................................................................... 32 

Darrell L. Darnell, Director, District of Columbia Homeland Security and 

Emergency Management Agency ........................................................................ 34 

THURSDAY, OCTOBER 4, 2007 

David Gootnick, Director, International Affairs and Trade, U.S. Government 

Accountability Office ............................................................................................ 52 

Ray Arthur, Ph.D., Director, Global Disease Detection Operations Center, 

Centers for Disease Control and Prevention, U.S. Department of Health 

and Human Services ............................................................................................ 54 

Kimothy Smith, D.V.M., Ph.D., Acting Director, National Biosurveillance Integration Center, Chief Scientist, Office of Health Affairs, U.S. Department 

of Homeland Security .......................................................................................... 56 

Colonel Ralph L. Erickson, M.D., DrPH., Director, Department of Defense 

Global Emerging Infections Surveillance and Response System (DOD– 

GEIS), U.S. Department of Defense ................................................................... 57 

Kent R. Hill, Ph.D., Assistant Administrator for Global Health, U.S. Agency 

for International Development ............................................................................ 59 

Nathan R. Flesness, Executive Director, International Species Information 

System (ISIS) ........................................................................................................ 70 

Daniel A. Janies, Ph.D., Assistant Professor, Department of Biomedical 

Informatics, Ohio State University Medical Center .......................................... 73 

James M. Wilson V, M.D., Director, Division of Integrated Biodefense, Imaging Science and Information Systems (ISIS) Center, Georgetown University 74 

Page

IV 

ALPHABETICAL LIST OF WITNESSES

Ainsworth, Kimberly: 

Testimony .......................................................................................................... 16 

Prepared statement with attachments ........................................................... 109 

Arthur, Ray, Ph.D.: 

Testimony .......................................................................................................... 54 

Prepared statement .......................................................................................... 203 

Cleaves, Art: 

Testimony .......................................................................................................... 6 

Prepared statement .......................................................................................... 98 

Darnell, Darrell L.: 

Testimony .......................................................................................................... 34 

Prepared statement .......................................................................................... 176 

Erickson, Colonel Ralph L., M.D., DrPH.: 

Testimony .......................................................................................................... 57 

Prepared statement .......................................................................................... 228 

Flesness, Nathan R.: 

Testimony .......................................................................................................... 70 

Prepared statement .......................................................................................... 246 

Geldart, Christopher T.: 

Testimony .......................................................................................................... 30 

Prepared statement .......................................................................................... 160 

Goin, Michael: 

Testimony .......................................................................................................... 17 

Prepared statement with attachments ........................................................... 142 

Gootnick, David: 

Testimony .......................................................................................................... 52 

Prepared statement .......................................................................................... 184 

Hill, Kent R., Ph.D.,: 

Testimony .......................................................................................................... 59 

Prepared statement .......................................................................................... 238 

Janies, Daniel A., Ph.D.: 

Testimony .......................................................................................................... 73 

Prepared statement .......................................................................................... 252 

Mahoney, Kevin E.: 

Testimony .......................................................................................................... 4 

Prepared statement .......................................................................................... 94 

Mauskapf, Robert P.: 

Testimony .......................................................................................................... 32 

Prepared statement .......................................................................................... 166 

Morris, Ray: 

Testimony .......................................................................................................... 14 

Prepared statement .......................................................................................... 105 

Smith, Kimothy, D.V.M., Ph.D.: 

Testimony .......................................................................................................... 56 

Prepared statement .......................................................................................... 220 

Steinhardt, Bernice: 

Testimony .......................................................................................................... 3 

Prepared statement .......................................................................................... 80 

Wilson, James M. V, M.D.: 

Testimony .......................................................................................................... 74 

Prepared statement .......................................................................................... 254 

Yeskey, Kevin, M.D.: 

Testimony .......................................................................................................... 28 

Prepared statement .......................................................................................... 150 

APPENDIX 

Background for September 28, 2007 hearing ........................................................ 261 

Background for Octoober 2, 2007 hearing ............................................................. 267 

Background for October 4, 2007 hearing ............................................................... 274 

Issac Ajit, M.D., M.P.H., Acting Deputy Director of the Office of Preparedness 

and Response, Maryland Department of Health and Mental Hygiene, State 

of Maryland, October 2, 2007, prepared statement ........................................... 282 

Page

V 

Responses to questions submitted for the October 4, 2007 Record from: 

Mr. Gootnick ..................................................................................................... 290 

Mr. Arthur ......................................................................................................... 293 

Mr. Smith .......................................................................................................... 306 

Colonel Erickson ............................................................................................... 316 

Mr. Hill .............................................................................................................. 322 

Mr. Flesness ...................................................................................................... 350 

Dr. Wilson ......................................................................................................... 356 

Charts submitted for the Record for the October 4, 2007 hearing by Ray 

Arthur ................................................................................................................... 359 

Additional Post-Hearing questions submitted for the October 2, 2007 Record 

from Dr. Yeskey ................................................................................................... 363 

GAO Report entitled ‘‘The Federal Workforce, Additional Steps Needed to 

Take Advantage of Federal Executive Boards’ Ability to Contribute to 

Emergency Operation,’’ dated May 2007, GAO–07–515, submitted by Bernice Steinhardt ..................................................................................................... 367 

(1) 

THE ROLE OF FEDERAL EXECUTIVE BOARDS 

IN PANDEMIC PREPAREDNESS 

FRIDAY, SEPTEMBER 28, 2007 

U.S. SENATE, SUBCOMMITTEE ON OVERSIGHT OF GOVERNMENT

MANAGEMENT, THE FEDERAL WORKFORCE, AND THE DISTRICT OF COLUMBIA, OF THE COMMITTEE ON HOMELAND SECURITY

AND GOVERNMENTAL AFFAIRS, Washington, DC. 

The Subcommittee met, pursuant to notice, at 10:03 a.m., in 

Room SD–342, Dirksen Senate Office Building, Hon. Daniel K. 

Akaka, Chairman of the Subcommittee, presiding. 

Present: Senator Akaka. 

OPENING STATEMENT OF SENATOR AKAKA 

Senator AKAKA. This hearing will come to order. 

I would like to thank you all for joining us for this hearing on 

the role of Federal Executive Boards in the preparation and continuity of operations in the event of a pandemic influenza outbreak 

or other emergency. 

Although we spend billions of dollars preparing the National 

Capital Region—the heart of our Federal Government—for emergencies, outbreaks, and potential terrorist attacks, more than 85 

percent of the Federal workforce is employed outside of the Washington, DC area. Next week, we will hear about pandemic preparedness in the NCR and the global surveillance of tracking infectious diseases. 

Today, we begin to look at the preparation of the Federal workforce outside the Nation’s capital and the support that FEBs can 

offer those communities. 

President Kennedy issued a directive in 1961 to create FEBs and 

allow the heads of Federal agencies in 10 regions around the country to come together to address human capital and emergency 

issues in those Federal communities. There are now, can you believe it, 28 boards in 20 States, including Hawaii. 

We invited the Executive Director of the Honolulu-Pacific Federal Executive Board, Ms. Gloria Uyehara, to be present and to 

give her testimony today, but regretfully she was unable to make 

the long trip. 

FEBs are a quasi agency with no institutionalized structure and 

no dedicated source of funding. OPM oversees the FEBs, but the 

staff is usually employed by a local agency detailee. They do not 

receive specific appropriated funds. Some have an executive direcVerDate Aug 31 2005 08:37 Aug 20, 2008 Jkt 038845 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 P:\DOCS\38846.TXT SAFFAIRS PsN: PAT
2 

tor, some have no permanent staff at all. Each one of the 28 FEBs 

seems to have its own funding and operating structure. 

A Government Accountability Office report concluded in the year 

2004 that Federal Executive Boards could play a greater role in the 

coordination of emergency preparedness and response. Their latest 

report released in May of this year reaches the same conclusion 

with a particular focus on pandemic influenza preparedness. 

GAO recommends the development of a strategic plan for FEBs 

to support emergency operations, including dedicated funding and 

performance measurements. I understand that OPM has been 

working on a strategic plan and consulting with the Federal Emergency Management Agency. I look forward to hearing more about 

these efforts. 

Public health experts at the World Health Organization (WHO) 

believe that the world is due for a pandemic influenza outbreak. In 

the past 100 years, pandemic influenza has killed 43 million people 

around the world. Most recently, the Hong Kong flu killed 2 million 

people in 1968. The Centers for Disease Control and Prevention estimate that a flu pandemic could kill between 2 million and 7.4 

million people worldwide. 

Today, the threat of the avian influenza, or the H5N1 virus, continues to rise. WHO reports that there have been 328 cases of infections in humans from South East Asia across the continent into 

Africa and the edges of Europe since 2003. Of those cases, 200 humans have died. While most cases of human infection of avian influenza are through contact with live poultry, in late August a 

group of doctors confirmed for the first time the spread of the 

H5N1 virus from human to human in Indonesia. 

There are treatments available, but there are also distinct challenges to emergency response for pandemic outbreak. Unlike onetime disasters, pandemics can last for an extended period of time, 

come in waves, and infect populations across a broad geographic 

area. They require the coordination of emergency response teams 

with health officials and community groups. Even more difficult, 

they can bring up sensitive issues of social distancing and treatment prioritization. 

I do not think that we will be able to address all of these issues 

at this hearing. I do, however, expect that our witnesses will shed 

light on a few fundamental questions. Should FEBs play a role in 

responding to a single emergency event or pandemic influenza outbreak? And if so, what is their capacity to play a significant role? 

From what I know about this organization, I think that group 

can really make a difference. 

I look forward to hearing from our witnesses on the establishment of emergency response, continuity of operations, and pandemic preparedness and response plans in relation to Federal Executive Boards. 

So I want to say welcome again to our panel and to introduce 

Bernice Steinhardt, Director of Strategic Issues, Government Accountability Office; Kevin Mahoney, Associate Director, Human 

Capital Leadership and Merit System Accountability, Office of Personnel Management; and Art Cleaves, Region 1 Administrator, 

Federal Emergency Management Agency. 

3 

1The prepared statement of Mr. Steinhardt appears in the Appendix on page 80. 

Our Subcommittee rules require that all witnesses testify under 

oath. Therefore, I ask all of our witnesses to stand and raise your 

right hand and take this oath. 

Do you solemnly swear that the testimony you are about to give 

this Subcommittee will be the truth, the whole truth, and nothing 

but the truth, so help you, God? 

Ms. STEINHARDT. I do. 

Mr. MAHONEY. I do. 

Mr. CLEAVES. I do. 

Senator AKAKA. Let it be noted for the record that the witnesses 

answered in the affirmative 

Welcome again, and before we begin, I want all of you to know 

that although your oral statement is limited to 5 minutes, your full 

written statements will be included in the record. So Ms. 

Steinhardt, will you please proceed with your statement? 

TESTIMONY OF BERNICE STEINHARDT,1 DIRECTOR 

STRATEGIC ISSUES, GOVERNMENT ACCOUNTABILITY OFFICE 

Ms. STEINHARDT. Thank you very much, Mr. Chairman. We appreciate the opportunity to be here today to talk about the results 

of our review of Federal Executive Boards (FEBs) and their ability 

to contribute to the Nation’s efforts to prepare for a potential flu 

pandemic. 

The FEBs, as you pointed out, are unique entities in the Federal 

Government. Many of the challenges the country faces, and particularly those having to do with homeland security and emergency 

preparedness, can only be addressed through the collaborative efforts of networks of organizations working horizontally, across 

many Federal agencies, as well as among State and local governments and the private and nonprofit sectors. The FEBs are this 

kind of network. 

They operate in 28 cities and States, and consequently are 

uniquely positioned to improve the coordination of emergency preparedness efforts outside of Washington, DC, which, as you pointed 

out, is where the vast majority of Federal employees work. 

Given the nature of a pandemic flu, this capability could be particularly valuable. Because a pandemic flu is likely to last for 

months and will occur in many parts of the country at the same 

time, the center of gravity of the pandemic response will be in communities. As a result, planning for a pandemic will have to be integrated across all levels of government and the private sector as 

well, and it will have to be sustained over a long time. 

Let me turn now to some of the findings of our study. At the time 

of our review, all 14 Boards in our study were engaged in some 

type of emergency planning. All of them had an emergency communications network, an emergency preparedness council in place, 

and all of them had some degree of involvement with State and 

local officials in their emergency activities. Many of them, were 

also playing an active role in pandemic planning from sponsoring 

briefings to coordinating pandemic exercises involving numerous 

government and nongovernment organizations. 

4 

1The prepared statement of Mr. Mahoney appears in the Appendix on page 94. 

Even looking ahead to a possible response role for them during 

a pandemic, FEBs have the potential to broaden the situational 

awareness of their member agencies and to provide a forum to inform their decisions, much like what they now do during inclement 

weather conditions. 

But the FEBs face a number of challenges in trying to live up 

to this potential. First, the Boards are not included in any national 

emergency plans, which means that their value in emergency support is often overlooked by Federal agencies who are unfamiliar 

with their capabilities. By including the Boards in emergency management plans, the role of the FEBs and their contribution in 

emergencies involving the Federal workforce could be much better 

communicated. 

Second, it will be difficult to provide consistent levels of emergency support services across the country given the variations in 

the capabilities of the FEBs. The Boards, as you pointed out, have 

no Congressional charter, and receive no Congressional appropriation. Instead they rely on voluntary contributions from their member agencies, including staff, which are typically just an executive 

director and an assistant. As a result, funding for the FEBs has 

been inconsistent which, in turn, creates uncertainty for the Boards 

in planning and committing to provide emergency support services. 

In fact, some Federal agencies that have voluntarily funded FEB 

positions in the past have begun to withdraw their funding support. 

Our report outlines several actions to address these challenges. 

First, we recommended that OPM work with FEMA and the Department of Homeland Security to formally define the FEB role in 

emergency planning and response. We also recommended that 

OPM, as part of its strategic planning efforts, develop a proposal 

for an alternative to the current voluntary contribution mechanism 

that would address the uncertainty of funding for the Boards. 

In closing, Mr. Chairman, I want to underscore that the FEBs 

today offer us a potentially—and I want to underline potentially— 

important mechanism to support pandemic planning and the Federal workforce. That potential still remains to be realized in many 

cases where the Boards’ capacity still needs to be developed. 

On the other hand, for an event like a pandemic flu, FEBs are 

tailor-made for working across agency and government lines. As 

one FEMA official told us, if they did not exist, we would have to 

create them. With that, I will conclude my statement and be happy 

to answer any questions. Thank you. 

Senator AKAKA. Thank you very much for your statement. Mr. 

Mahoney. 

TESTIMONY OF KEVIN E. MAHONEY,1 ASSOCIATE DIRECTOR, 

HUMAN CAPITAL LEADERSHIP AND MERIT SYSTEM ACCOUNTABILITY DIVISION, OFFICE OF PERSONNEL MANAGEMENT 

Mr. MAHONEY. Good morning, Mr. Chairman, I am pleased to be 

here on behalf of our Director, Linda Springer, to discuss the role 

of the Federal Executive Boards and how they can assist with panVerDate Aug 31 2005 08:37 Aug 20, 2008 Jkt 038845 PO 00000 Frm 00012 Fmt 6633 Sfmt 6633 P:\DOCS\38846.TXT SAFFAIRS PsN: PAT
5 

demic preparedness and other Federal emergency planning and response efforts. 

We appreciate that this Subcommittee has recognized the value 

of these Bards and we share your commitment to increasing their 

effectiveness. 

As you mentioned, the Presidential Directive established the 

Boards, and the Boards were directed to work on interagency regional cooperation and to establish liaison with State and local governments. The contribution these Boards can make towards emergency preparedness and assistance for Federal employees and their 

families and for all Americans have become more evident as a result of the terrorist attacks of September 11, 2001 and Hurricane 

Katrina in 2005. The National Strategy for Pandemic Influenza, 

issued by President Bush in 2005, also provides opportunities for 

Federal Executive Boards to play a critical role, which I will discuss further in my testimony. 

In close collaboration with the Chairs and the Executive Directors of the Federal Executive Boards, OPM has established two primary lines of business: Emergency preparedness, security and employee safety; and human capital preparedness. In addition to these 

lines of business, the Boards are also expected to focus on establishing communication channels that can help build understanding 

and teamwork among Federal agencies in the field. The experiences of September 11, 2001 and Hurricane Katrina have demonstrated these relationships need to be in place before an emergency occurs. 

While the Federal Government received criticism for its response 

to Hurricane Katrina, there were many successes that have not yet 

received the same level of attention. In particular, I wanted to acknowledge today the key role that was played by the New Orleans 

Federal Executive Board and its Executive Director, Kathy Bar ́re, 

and just underscore some of the things they did. The Board coordinated with OPM and FEMA to collect information, and communicated issues of concern regarding the Federal workforce from 

Federal agencies at the local level. 

The Board also facilitated sharing of Federal workforce information to and from Washington by organizing teleconferences with 

FEMA and OPM and other agencies. 

Finally, the Board helped to identify both the needs and the status of local Federal workers and their families to make sure that 

they were part of FEMA’s response activities. 

Two more recent events have really brought home the importance of these Boards and the relationships and communication 

channels they bring to the table at the Federal/regional level during emergencies. The first is the most recent Minnesota bridge collapse, and you will hear more from Ray Morris later today about 

that event. The second was an event of tuberculosis with a HUD 

employee in New York City. In both of these cases, the Board, 

through its relationships with State, local, and Federal agencies, 

was able to gather information, communicate information, and assure the safety of Federal employees. Quick action, especially in 

New York, alleviated many employee concerns about tuberculosis 

and how tuberculosis can sometimes be spread. 

6 

1The prepared statement of Mr. Cleaves appears in the Appendix on page 98. 

Director Springer and all of us at OPM take very seriously the 

direction that President Bush has assigned to our agency with respect to pandemic preparedness. To help departments and agencies 

mitigate the effects of a pandemic event, OPM has developed 

human resource policies and mechanics to assure safety of the Federal workforce and continuity of Federal operations. We have provided agencies with training, information for their human resources, and emergency preparedness personnel. We have also conducted town hall meetings with the Department of Health and 

Human Services to educate Federal employees on pandemic preparedness. 

Mr. Chairman, the recent report you requested from the Government Accountability Office concerning Federal Executive Boards 

and their emergency operations role acknowledges much of what I 

have described in my statement. The report also makes four recommendations that I would like to address briefly. 

First, GAO recommended that OPM work with FEMA to develop 

a memorandum of understanding that formally defines the role of 

the FEBs in emergency planning and response. My staff has met 

with FEMA and later in October, I will also meet with Dennis 

Schrader, who is the Deputy Administrator at FEMA, to finalize an 

MOU. We have made good progress in that area. 

Second, GAO recommended that OPM initiate discussions with 

Homeland Security and other stakeholders. We have met with the 

White House Homeland Security Council staff and we are integrating the Federal Boards into planning. 

In conclusion, Mr. Chairman, I would like to say that OPM is 

proud of the accomplishments of the Federal Executive Boards, especially with planning and response to emergency situations, where 

lives are at stake and government services are critical. We will continue to work with the Boards and agencies to better prepare the 

Federal workforce at the regional level for a possible pandemic influenza or other emergency event. 

I am happy to answer any of your questions. Thank you. 

Senator AKAKA. Thank you very much, Mr. Mahoney. And now, 

Mr. Cleaves, please proceed with your testimony. 

TESTIMONY OF ART CLEAVES,1 REGIONAL ADMINISTRATOR, 

REGION 1, FEDERAL EMERGENCY MANAGEMENT AGENCY 

Mr. CLEAVES. Mr. Chairman, thank you very much for inviting 

me to appear before your Subcommittee today and highlight our activities with Greater Boston Federal Executive Board and to underscore our strong working relationship. 

Mr. Paulison laid out a vision for a new FEMA that integrates 

and incorporates missions assigned to FEMA by the Post-Katrina 

Emergency Management Reform Act of 2006. An important part of 

that vision is an enhanced role in regional preparedness to include 

the Federal Executive Boards. 

In the new FEMA, preparedness activities will be integrated into 

a regional focus designed to serve the needs for States and local 

communities. FEMA regions will become networking organizations, 

instrumental in the development of a seamless connection with all 

7 

of our partners, Federal, State, tribal, local, homeland security advisors, emergency management directors, and the private sector, as 

well. This is going to result in a full preparedness strategy carrying 

awareness through the State to the individual communities. This 

awareness will become embedded through training and exercising 

from a local level to the Federal level. 

Our approach and preparedness is all hazard approach, including 

terrorist events, other manmade events, natural disasters and, of 

course, including a pandemic. 

The Federal Executive Boards and FEMA share a common role 

as coordinating elements. The Federal Executive Boards are a critical part of preparedness in response, recovery, mitigation, and in 

particular continuity of operations and continuity of government. 

The Greater Boston Federal Executive Board is an integral part 

of our preparedness and our preparedness strategic planning. Their 

proven ability to effectively coordinate with all Federal organizations makes the FEB a key factor in preparing for a potential pandemic. 

Because of New England’s compact geographical size, we maintain a very close working relationship with the States and also the 

Federal organizations. And maintaining this relationship is greatly 

facilitated by the effectiveness of the Executive Director of the 

Greater Boston Federal Executive Board, Kim Ainsworth, and she 

will be testifying on the second panel today. 

FEMA Region 1 is going to be coordinating a regionwide pandemic exercise during the next quarter. This is the first exercise of 

this size, scope or magnitude in New England. The goal is to bring 

Federal/State partners together to review the issues that present 

themselves and to better understand the roles and responsibilities 

of government during any pandemic. The Federal Executive Boards 

play an important role in pandemic preparedness, acting as a coordinating agency for the Federal departments who will have the 

lead in the pandemic outbreak. These departments include Department of Health and Human Services, as well as the Centers for 

Disease Control. Those are key components during this response 

element. But because of the nature of a pandemic and its potential 

to affect large populations, the FEBs’ ability to coordinate with all 

the Federal agencies in a timely manner is essential. 

The FEB and its relationship building capability can be a key resource in the event of a pandemic. Let me underscore just a couple 

very quickly, of coordination elements that they can do. I mentioned the coordination between agencies when social distance is 

required, and that is all agencies in the Federal Government. 

The FEB is also a conduit for resource support during any response operation. And the nature of a pandemic will severely reduce the workforce. The greatest concern of government, and in 

private sector as well, is the numbers of personnel. The FEB is postured to reach all Federal agencies, and give us additional response 

personnel that we might need in the response phase of a pandemic. 

The FEB can and should play a major role in pandemic preparedness and response. By pre-identifying unique capabilities that 

exist within the FEB and by establishing roles and responsibilities 

it will undertake during a pandemic that FEB can engage from the 

8 

outset to enhance response effort and integrate all Federal agencies. 

The FEB has also been engaged in the area of continuity of operations and continuity of government in Region 1 by assisting coordination of training between all member agencies. As I previously 

indicated to you, we are planning a major pandemic influenza exercise in the Region in December. This exercise is going to solicit active participation from all the Federal agencies and the Greater 

Boston Federal Executive Board will again play an integral role in 

part of that coordination. 

This exercise is going to provide an opportunity for all of the 

Federal agencies to gain a more accurate picture of their continuity 

of operations and their continuity of government posture. Overall, 

we can see very quickly that the Federal Executive Boards are an 

integral part of the fabric of the new FEMA. 

In conclusion, I would like to thank you again for the opportunity 

to give you this testimony today and I look forward to any questions. Thank you. 

Senator AKAKA. Thank you very much, Mr. Cleaves. 

I want to thank all of you for your testimony. I must tell you that 

I am delighted to hear what you have said here. 

The GAO report says that FEBs can be a valuable asset because 

of its informal relationships—highlights the importance of informal 

relationships with governmental and nonprofit partners. GAO recommended that FEBs’ role be formalized. So what I am interested 

in, what are your thoughts in the recommendation by the GAO 

that FEBs’ role be formalized? Ms. Steinhardt. 

Ms. STEINHARDT. Well, it is wonderful that the FEBs have these 

relationships with other organizations at other levels of government now and have taken, in some cases, an active role in working 

with them on emergency preparedness activities. But it is not 

enough to do this on an informal basis. Some of the people we 

talked to were not familiar with the fact that they had a role to 

play and so they are an underutilized resource in some instances. 

But beyond that, it is important in an emergency response for everyone to understand what role they are going to play in advance 

of the emergency. Certainly, we learned this lesson in Hurricane 

Katrina and other national disasters. Those roles have to be clearly 

identified beforehand. And so it is important, if FEBs are going to 

play a role in planning and preparedness and response, that they 

be formally identified. 

Senator AKAKA. So your thoughts are that you are on the side 

of formalizing that? 

Ms. STEINHARDT. Absolutely. For that reason we recommended 

that there be some formal agreement between OPM and FEMA to 

formalize that role and to explore the possibility of including the 

FEBs actually in the National Response Plan or other national 

plans. 

Senator AKAKA. Thank you. Mr. Mahoney. 

Mr. MAHONEY. We agree. The role of the FEBs is critical to any 

response to an emergency that might occur and that their role 

should be formalized. As I mentioned earlier, we are and have been 

meeting with FEMA to establish an MOU that would formalize the 

FEBs role and any response to an event. In addition, through the 

9 

creation of our strategic plan with the FEBs, we are moving in a 

direction where the FEBs will focus, hopefully, about 50 percent of 

their time on emergency preparedness. 

We are taking steps through both our own work with the FEBs 

as well as our work with FEMA to formalize a role for the FEB 

in any emergency event. 

Therefore, we do agree with GAO that there should be a process 

in place that identifies the role of the FEB. 

Senator AKAKA. Thank you. Mr. Cleaves. 

Mr. CLEAVES. Mr. Chairman, I could not agree more thoroughly 

with that. 

Mr. Mahoney mentioned that the MOU is now being formulated 

between FEMA and the FEBs, and that will be a critical part both 

in the preparedness area and in a response phase, as well. If all 

organizations understand those roles and responsibilities, we can 

multiply the horsepower and get that much more preparedness 

done and understand roles and response and recovery. It is really 

part of the national response framework, as well. 

So we could not agree more. 

Senator AKAKA. Is there a chance that the informal relationships 

could be threatened by formalizing those relationships? Ms. 

Steinhardt. 

Ms. STEINHARDT. I do not think so. I think the informal relationships, the relationships among people, are vital. That is where the 

relationships occur. But I think it is equally important for those relationships to be understood and formalized so that people are very 

clear about what they are expected to do, both in advance of a national emergency or a local emergency as well as during an emergency. Having clear expectations is critical. 

Senator AKAKA. Mr. Mahoney. 

Mr. MAHONEY. Mr. Chairman, I do not think you can underscore 

enough the importance of the informal relationships that exist at 

the local level. I had a first-hand glimpse of this in August when 

the Minnesota bridge collapsed and Ray Morris, who was in Washington at the time, attending our annual FEB conference, was able 

to communicate with contacts at the State, local, and national levels. I am sure he will talk more about that in his testimony. 

It was an opportunity for me to watch how these informal networks can come together so quickly because people already know 

each other. They do not have to, at the site of an emergency, introduce each other and get to know who does what, it has already 

been established. 

The formalizing process, I think, just makes it easier for everybody in Washington to understand how to communicate with the 

FEBs and what channels to use so that the informal process really 

then begins to take shape at the site level. 

I agree with Ms. Steinhardt, I do not see any danger in formalizing this. 

Senator AKAKA. Mr. Cleaves. 

Mr. CLEAVES. I also agree with that. I think formalizing it, again, 

will multiply the efforts. 

So many times in an informal relationship there is a crossover, 

there is a duplication of effort. When you formalize it then, in fact, 

10 

you will get more effort accomplished in the end, a much better 

way to do it. 

Senator AKAKA. Mr. Cleaves, are there similar organizations to 

FEBs in the State, local, or private sector that play a formal or informal role in responding to an emergency or pandemic outbreak? 

Mr. CLEAVES. Yes, Mr. Chairman. The first one that comes to 

mind is the volunteer organizations active during disasters, all volunteer groups that come forward. So there are many organizations 

that respond during that phase. 

One of the things that I captured in my notes here is that training and exercise and then, in fact, I could tell you, in our case, the 

Federal Executive Board in the Greater Boston area is an integral 

part of what we do. It is an organization that can reach all of the 

Federal agencies, not just the major responders, but all organizations. So it is a critical piece of what we do. But there are many 

organizations that we try to have memorandums of understanding 

with so again it is not a duplication of effort but a better, broader 

preparedness effort. 

Senator AKAKA. Ms. Steinhardt, a pandemic outbreak could last 

a long time. 

Ms. STEINHARDT. Right. 

Senator AKAKA. Come in waves, as I said, and happen over a 

broad geographic region, which would make continuity of operations planning especially challenging. What strengths do FEBs 

have for dealing with emergency response for an event unfolding 

over an extended time and over a geographic area? 

Ms. STEINHARDT. That is an excellent question. One of the 

strengths of the FEBs is that they have an established network of 

Federal officials in their location. Because a pandemic, as I said in 

my statement, will last for a long time and occur all over the country, unlike other kinds of disasters where the Federal Government 

can mobilize a lot of resources to a single location, communities are 

going to have to deal with a pandemic flu largely on their own. 

They are going to have to do—as you say, they are going to do it 

over an extended period of time. So it is going to involve a sustained level of leadership. 

And because FEBs are in those communities, because they have 

established relationships, because they represent the largest Federal agencies, they can bring that kind of sustained leadership over 

an extended period of time. 

Senator AKAKA. OPM is in the process of developing a national 

strategic plan for FEBs with input from FEMA. For some FEBs the 

guidance will be welcome direction, and for others it could read 

outside the scope of their capacity. Given the differences among 

FEBs around the country, how are you ensuring that strategic 

plans reflect the capacity of each FEB? Mr. Mahoney. 

Mr. MAHONEY. Mr. Chairman, in OPM’s review of the FEBs one 

of the things we are looking at is the question of whether FEBs are 

staffed appropriately by the size of the population they serve, 

which I think gets to the heart of your question. We have not 

reached any firm conclusions yet. Most FEBs operate on a model 

with an Executive Director and an Assistant. We are not sure if 

that model holds for an area like Los Angeles, which has a large 

population. 

11 

We are in the process of evaluating what level of staffing is appropriate. 

As you know, the Board itself comprises the most senior persons 

in agencies located within the FEB’s geographical area, and therefore Board size varies. But, the support of the Board is critical, and 

I think as we move further into emergency preparedness, roles having the FEB properly staffed to carry out those functions is going 

to be an important issue on which OPM should work. 

Senator AKAKA. Mr. Cleaves. 

Mr. CLEAVES. We are involving the Greater Boston Federal Executive Board in our strategic planning starting this year. And I do 

not think in the past we have done it as thoroughly and deeply as 

we are attending to this year. We have already a very strong working relationship. But we are going to involve them early in the preparedness portions, the planning portions, and then intricately in 

the exercises. 

As I mentioned, for those Federal organizations that do not normally respond to a major event, there are all the other agencies 

that will need that coordination. That is a big role for the Federal 

Executive Board to take on. 

We have also made working space in our Boston office for Ms. 

Ainsworth so she can become a closer part of knowing what we do 

on a day-to-day basis. So that is going to be a more integral working relationship than there has been before. 

Ms. STEINHARDT. Mr. Chairman, if I can add to Mr. Mahoney’s 

comments particularly, one of the issues we touched on in our report dealing with capability of the FEBs and their varied capability 

had to do with performance expectations for the executive directors. 

Currently, they are employees of a host agency in each of the regions. In some instances their performances expectations and their 

performance is assessed by that host agency. In some cases, it is 

by the chair of the Federal Executive Board. In some cases, OPM 

plays a part in fact, and in some cases it does not. 

And so one of our recommendations was for OPM to develop a 

more consistent set of performance expectations for the executive 

directors. We think that will help a lot. 

Senator AKAKA. This question will be for OPM. When can we expect to see the strategic plan? And how are you incorporating 

GAO’s recommendation? 

Mr. MAHONEY. Well, to add to Ms. Steinhardt’s comments, we 

very much agreed that there should be a common set of performance metrics for the FEBs. Earlier in your comments, you mentioned the funding issue. We think it is important, as we ask agencies to fund the FEBs, to be able to demonstrate what the FEBs 

will accomplish. Therefore, part of our review in the strategic plan 

is to work with the Executive directors and the Board chairs to develop a set of performance metrics on which we can all agree. 

We think, with relationship to the strategic plan, we should have 

something finalized this coming winter. We have been working on 

it. As you know, there are 28 separate locations and communication and coordination take a little time. We think by this winter 

we should have a finalized strategic plan. 

Senator AKAKA. Mr. Mahoney, it is my understanding that in the 

event of a pandemic outbreak local health departments may not 

12 

have the capacity to treat the critical personnel at Federal agencies 

that must be at work. Some Federal agencies are already identifying critical personnel and stockpiling medication. Have you begun 

to look at how agencies are handling this issue in the field? And 

how can FEBs help in this effort? 

Mr. MAHONEY. Mr. Chairman, in a number of cities the FEBs are 

working with State and local authorities to identify the appropriate 

distribution of vaccines in the event of an emergency and I guess 

the appropriate order in which vaccines should be delivered. Some 

of this work is still in the early stages, but we are encouraging all 

of the FEBs to get more involved in this particular process because 

we see it as key not only for the Federal population, but also for 

the people locally in those areas. We are working toward a program 

with respect to vaccine distribution. 

Senator AKAKA. Mr. Cleaves, the testimony presented today 

shows some of the ways that FEBs can support the overall response efforts in the event of a pandemic and other emergency. 

What do you see as the realistic responsibilities that should be 

given to FEBs in the event of an emergency or pandemic? 

Mr. CLEAVES. I think the two areas that I mentioned earlier is 

the coordination that they provide. We have got a proven track 

record in the Greater Boston area of Ms. Ainsworth being able to 

coordinate with all of the Federal agencies very effectively during 

a pandemic. There is going to be a very reduced workforce so it is 

going to be critical for that. 

The second one I mentioned in the testimony is the ability for the 

FEB to identify additional workers in that response phase. We 

have a very deliberate and defined action that we take, whether it 

is a hurricane coming into the region or whether it is a pandemic, 

that we move our response coordination center out in Maynard, 

Massachusetts. The FEB can communicate with all Federal agencies what our strategy will be and then also what their response 

objectives can be during a pandemic. 

Senator AKAKA. Mr. Mahoney and Ms. Steinhardt, FEBs do not 

conduct performance reviews, provide pay adjustments, or provide 

bonuses to participants. Their employing agencies do that. This 

presents challenges for establishing performance measures. When 

talking about establishing performance standards for FEBs, how do 

you recommend establishing them? And who should be responsible 

for evaluating them? And whose performance should be measured? 

Ms. Steinhardt. 

Ms. STEINHARDT. An excellent question and one that is, I think, 

very important. We recommended that this be part of the strategic 

planning effort that is now underway, OPM working with the Federal Executive Boards. To the extent that OPM is setting expectations for the FEBs for human capital, in the area of human capital 

management and in emergency preparedness, then OPM needs to 

be involved in setting those standards so that there is some consistency across the country. 

At the same time though, it is important to recognize that one 

of the strengths of the FEBs is the fact that they are local, that 

they are responsive to their local conditions, to their regional perspective. So there needs to be some collaborative effort, I think, beVerDate Aug 31 2005 08:37 Aug 20, 2008 Jkt 038845 PO 00000 Frm 00020 Fmt 6633 Sfmt 6633 P:\DOCS\38846.TXT SAFFAIRS PsN: PAT
13 

tween OPM and the FEBs and the members of the FEB on what 

those standards should be. 

Senator AKAKA. Mr. Mahoney. 

Mr. MAHONEY. As I said earlier, we are in the process of working 

on a common set of performance measures. It is problematic that 

the FEB directors report to a variety of different agencies. But I 

think the common denominator is that all of those agencies are interested in employee security and human capital readiness. 

As we go about looking at how to develop agreed-upon standards, 

I think we will work very closely with the agencies that support 

the FEBs and get their buy-in on a set of plans that both support 

the FEBs and support their own agency needs with respect to employee security and human capital readiness. 

Senator AKAKA. As I mentioned here, I was asking your thoughts 

on any recommendations on how to establish this and also who 

should be evaluating. Of course, OPM being the personnel, could 

be. The other question was who should you measure? But this is 

something that we need to really think about. 

Mr. Mahoney, OPM has oversight of the operations of FEB. But 

most FEB operations are directed by the FEB chairman and the 

executive director. All participation by agency heads is voluntary. 

That is the setup. If we place greater emphasis on FEBs in participating in emergency response plans, who ultimately would be accountable for their efforts? 

Mr. MAHONEY. Mr. Chairman, we do have oversight over the 

FEBs and we have established, as I mentioned, these two lines of 

businesses because we feel that they are most important in the ongoing collaboration and coordination in Federal agencies outside of 

Washington, DC. We take very seriously our role in overseeing how 

this is accomplished. 

As we have discussed here this morning, this is a very localized 

organization which has a national responsibility. We have to continue to work with the local agencies as well as setting standards 

we think the agencies need to live up to. Ultimately, each agency 

has to evaluate how their FEBs are performing. OPM plans to have 

a significant role in that discussion. 

Senator AKAKA. I want to thank you all for your responses. It is 

very evident that coordination, collaboration, working together, trying to keep it as a formalized organization informally. And so this 

is a challenge. I am glad that you are thinking about this and we 

look forward to us continuing to work on this because finally the 

mission is to deliver in emergencies. And unless, as you mentioned, 

we plan beforehand we will not do as well. 

I would tell you after 20 hearings on Hurricane Katrina we have 

learned a lot and so much has to be done. I tell you one of the problems with Hurricane Katrina that many people, I think, miss what 

I caught in the 20 hearings was personnel, and that there were positions that were vacant. So therefore, it could not be carried forward. 

So all of these need to be part of the strategic planning for the 

future. 

I appreciate your thoughts on this and was glad, as I said at the 

beginning, to what you have said about bringing it together and 

the importance of working from the regional level all the way up 

14 

1The prepared statement of Mr. Morris appears in the Appendix on page 105. 

through the agencies. But we have to communicate and take all advantage of communicating. And also, the other part to that as we 

are working here is that we need to make good use of our information technology. That technology is building fast and we need to 

use it well. 

So again, thank you so much for your responses and I really appreciate it. 

Let me call panel two forward. The witnesses are Ray Morris, 

Executive Director of the Federal Executive Board of Minnesota; 

Kimberly Ainsworth, Executive Director of the Greater Boston Federal Executive Board; and Michael Goin, Executive Director of the 

Cleveland Federal Executive Board. 

Our Subcommittee rules, as I mentioned earlier, require that all 

witnesses testify under oath. Therefore, I ask all of the witnesses 

to please rise and raise your right hand. 

Do you solemnly swear that the testimony you are about to give 

this Subcommittee is the truth, the whole truth, and nothing but 

the truth, so help you, God? 

Mr. MORRIS. I do. 

Ms. AINSWORTH. I do. 

Mr. GOIN. I do. 

Senator AKAKA. Let it be noted for the record that the witnesses 

answered in the affirmative 

Again, I want to welcome you to this Subcommittee. As a reminder, your oral statements are limited to 5 minutes but your full 

written statements will be included in the record. So Mr. Morris, 

will you please proceed with your statement. 

TESTIMONY OF RAY MORRIS,1 EXECUTIVE DIRECTOR, 

FEDERAL EXECUTIVE BOARD OF MINNESOTA 

Mr. MORRIS. Good morning, Mr. Chairman. I am Ray Morris, Executive Director of the Minnesota Federal Executive Board. 

As a FEB director, I am responsible for the coordination of over 

120 Federal Government agencies within Minnesota and intergovernmental relations with State and local government. 

There is a great need among FEB directors to have our current 

work and function reflected in Federal emergency planning documents like the National Response Framework. This action will enhance our effectiveness and credibility for the work that we are 

doing with Federal, State and local government agencies. We fill a 

niche that the FBI, FEMA, and the military do not focus on, the 

Federal workforce in field areas. 

Established in 1961, FEBs had our roots in the cold wars, ensuring the continuity of government in the field, a duty that is perhaps more important in today’s threat environment. 

An example of our work in communicating crisis information is 

as recent as last month. August brought Minnesota two federally 

declared disasters, one natural and one manmade. The intergovernmental response to the sudden collapse of the eight lane I–35 W 

bridge in Minneapolis showed the Nation the excellent level of preparedness that exists within our State. Although 13 lives were lost, 

15 

over 108 people survived the over 60 foot fall to the river due to 

the heroic efforts of all levels of government personnel. 

Another disaster struck Minnesota 17 days later as up to 20 

inches of rain fell across seven counties in Southeast Minnesota 

causing massive flooding resulting in seven fatalities and $67 million in damage. 

During both of these events, our FEB acted swiftly, passing critical information from local and State government sources to all 

Federal agencies on the recovery operations, road detours, and 

other potential workforce impacts. 

The response to these disasters by all levels of government in the 

State was exemplary and was due to one vital element: Trust 

through previous friendships. No business cards were exchanged 

during any of these disasters among the responders. FEB Minnesota has worked hard over the past 10 years, serving as a catalyst in the Federal sector, to establish and maintain these relationships with State and local government who are our first responders. 

We have helped many of our State and local partners through 

our educational activities. Since 2001 our Federal Executive Board 

has sponsored five tabletop exercises that are open to all levels of 

government. In the past year we held two of these. Pan Flu II, that 

had close assistance from the Minnesota Department of Health and 

the Minnesota Division of Homeland Security and Emergency Management. 

The most recent that we held was Going to Red, that explored 

the national threat of nuclear terrorism, culminating with a 10 kiloton improvised nuclear device detonated outside the capital city of 

Saint Paul. 

During the past 6 years, we presented 20 half or full day seminars with expert speakers on the hot topics of the day. And since 

2005 we have worked very extensively with officials at the State 

Department of Health on a program to cover Federal workers, critical Federal workers in the event of a pandemic or a bioterrorism 

release so that they could continue their crucial duties without 

interruption. 

Three elements come together to make our FEB strong and effective. The first is an active executive committee, comprised of 33 

senior Federal officials. The second is a great intern program with 

over a dozen colleges and universities. And the final part of the 

equation in making our FEB strong and effective as financial and 

administrative support by a key Federal agency, the Department of 

the Interior, through the National Business Center in the Office of 

the Secretary. 

In summary, including FEB roles and documents, in documents 

like the National Response Framework will minimize the duplication of Federal resources, especially in the areas of crisis communications and training programs within Federal field areas. Defining FEBs’ existing functions in these planning documents would 

foster a clear understanding of our roles by the State and local governments that we partner with on our training programs and preparedness activities. Thank you again, Mr. Chairman, and I look 

forward to your questions. 

16 

1The prepared statement of Ms. Ainsworth with attachments appears in the Appendix on 

page 109. 

Senator AKAKA. Thank you very much, Mr. Morris. Ms. Ainsworth, please proceed with your statement. 

TESTIMONY OF KIMBERLY AINSWORTH,1 EXECUTIVE 

DIRECTOR, GREATER BOSTON FEDERAL EXECUTIVE BOARD 

Ms. AINSWORTH. Good morning, Mr. Chairman, and thank you 

for this opportunity to appear before you today to discuss the role 

of Federal Executive Boards in pandemic preparedness. My name 

is Kimberly Ainsworth and I am an employee of the EPA New England Region and have been assigned to a long-term detail as Executive Director of the Greater Boston Federal Executive Board. I am 

here today in that capacity. 

In this role I have primary responsibility for the coordination and 

implementation of our programs and activities under our lines of 

business. Federal Executive Boards have played a meaningful role 

in emergency planning and response in many ways since created 

in 1961. The U.S. Government is the Nation’s largest employer and 

among the top five in many areas across our country, including 

Massachusetts. During emergencies it is our responsibility to act 

uniformly to ensure the safety of our employees and customers. 

To that end, Federal Executive Boards play a vital role from a 

workforce planning perspective. Although we are not first responders, emergency managers, or law enforcement professionals we can 

and do play an important role in public safety. Federal Executive 

Boards are positioned to provide crucial communication links 

among Federal agencies and State and local officials alike. 

More than 180 Federal agencies maintain a presence in Massachusetts and approximately 90,000 citizens in our State are employed civilian, military, and postal positions. Although each Federal agency is responsible for the safety of its employees and the 

continuity of operations, collaboration is extremely important. 

Our experiences in Boston prior to 2001 focused primarily on 

weather-related events. However, in the post-September 11 environment local agencies have greater needs and expectations of us. 

In 2002, Boston unveiled a comprehensive emergency decision and 

notification plan outlining an all hazards approach to emergency 

preparedness, response, and recovery from a workforce perspective 

including during a pandemic. 

We collected 24/7 contact information for our local agency decisionmakers. A variety of communication strategies were implemented and designed to ensure that we could disseminate accurate, 

up-to-date, and consistent information around the clock. 

Our experiences have taught us that there is a significant role 

that we serve during what I call perceived emergencies. For example, the first national political convention, since the 2001 terrorist 

attacks, took place in Boston in 2004 and was designated as a National Special Security Event. The Federal Executive Board represented the Federal workforce during the year-long security planning and also during the event itself. 

Although it experienced no disruptions, there were several instances where rumor threatened public safety. The Federal ExecuVerDate Aug 31 2005 08:37 Aug 20, 2008 Jkt 038845 PO 00000 Frm 00024 Fmt 6633 Sfmt 6633 P:\DOCS\38846.TXT SAFFAIRS PsN: PAT
17 

1The prepared statement of Mr. Goin with attachments appears in the Appendix on page 142. 

tive Board stepped in several times to coordinate the collection and 

dissemination of real-time information from subject matter experts 

within our Federal law enforcement community. We were able to 

quickly provide local agency leaders with accurate, consistent, and 

up-to-date information to make informed decisions to ensure the 

safety of the Federal workplace. 

We employed similar procedures when, on July 7, 2005, Americans awoke to reports of terrorist attacks on London’s public transportation system. At 9:38 a.m. in Boston on that same day two subway trains were involved in a minor collision underground. Although officials quickly determined that there was no link to the 

London incidents, an intense flow of misinformation circulated rapidly and the Federal Executive Board was called in to action. 

There are so many examples nationwide. From massive crowds 

descending on government sites for civic rallies to extreme weather 

events, Federal Executive Boards have consistently been there to 

meet the information needs of our member agencies. 

Most recently on January 31, 2007, Boston made national headlines when a marketing scheme went wrong. Thirty-eight electronic 

devices resembling Lite-Brite toys were placed in public locations 

to promote a movie. The suspicious devices sent public safety officials scrambling for many hours. Once again, agency leaders called 

upon the Federal Executive Board to provide accurate, up-to-date, 

and consistent information as the situation unfolded. 

I believe that this information sharing and communication role 

will be increasingly important during a pandemic, particularly 

given the likelihood of its extended timeframe and anticipated 

widespread national impact. 

Federal Executive Boards continue to be effective in this regard 

while overcoming recurring challenges. Many were captured in the 

May 2007 GAO report and are currently being addressed. The first 

step was the development of a business plan which includes two 

lines of business. These have, in short, helped Federal Executive 

Boards gain the attention of policymakers and increased credibility 

in our communities. 

Thank you, Mr. Chairman, for this opportunity and I look forward to your questions. 

Senator AKAKA. Thank you. Thank you very much, Ms. Ainsworth. Mr. Goin, please proceed with your statement. 

TESTIMONY OF MICHAEL GOIN,1 EXECUTIVE DIRECTOR, 

CLEVELAND FEDERAL EXECUTIVE BOARD 

Mr. GOIN. Good morning, Chairman. And thank you for the opportunity to appear before you today to discuss the role of Federal 

Executive Boards in pandemic preparedness. 

Again, my name is Michael Goin and I am an employee of NASA. 

Currently, I serve as the Executive Director of the Cleveland Federal Executive Board, a position I have held since 2004. 

Like my counterparts, I see my responsibilities as that of ensuring the organization and delivery of programs and projects to support the two distinct lines of business, all while promoting communications, cooperation, and collaborations across agency lines. 

18 

FEBs have attributed to the emergency response capability of the 

Federal community, as many reports have stated. My comments 

today will focus on the Cleveland FEB and what it has done in the 

areas of emergency preparedness. It is my belief that we serve a 

unique and vital coordinating role for our community. 

Our organization covers 94 agencies in more than 17 counties. 

However, I should admit that we also include into that the Northern half of Ohio, where many of our agencies have responsibility. 

The activities, projects, and programs of the Cleveland FEB are coordinated utilizing special committees that focus on activities, one 

of those being emergency preparedness. 

As stated, FEBs are not first responders. However, we feel that 

we enhance the response capability through our lines of business, 

enhancing the readiness of our responders as well as our employees. 

Following September 11, 2001, we developed an all hazards plan 

and an emergency contingencies procedures and guidelines handbook to assist employees prior to, during, and immediately following emergencies or a disruptive event to include a pandemic. 

Through the efforts of the 28 FEBs, we are delivering and adopting 

best practices and setting measurable goals and adding credibility 

to the FEB as a source for emergency preparedness and human 

capital needs. 

Much has been accomplished, but I must say that more needs to 

be done to ensure uniformity across the FEB network. Our FEB 

has been very active in supporting our lines of business, as well as 

developing partnerships with our State and local agencies. We 

partnered with the Cuyahoga County Board of Health to conduct 

a series of pandemic briefings designed to educate employees and 

managers on the plans and procedures that will help mitigate the 

effects of a pandemic outbreak. 

We assisted FEMA with the distribution of emergency preparedness cards for all civilian and contract employees in our areas. We 

also enhanced our 24/7 notification system. Our member agencies 

are now part of a national emergency notification system, more 

commonly referred to as USP3. The web-based system can issue 

notifications in multiple formats: E-mail, text, text to voice, over 

5,000 e-mail and text messages, and up to 10,000 outbound calls 

in a matter of minutes. Prior to that, sir, I would say that we were 

using a calling tree that was very inefficient. 

In response to the recent floodings that many Ohio counties experienced, we will be adding a National Weather Service alert to 

that warning system. In addition to the notification capability, the 

system also provides members with a daily global snapshot of 

world events. Many of those snapshots include information relevant 

to pandemic concerns. 

In a recent survey of our member agencies regarding their challenges associated with the pandemic planning, many identified 

issues related to telework programs. They are seeking our assistance in clarifying telework, emergency policies, hiring, and leave 

flexibilities. Much of that will be accomplished with the help and 

assistance of the Office of Personnel Management. 

Many agencies point to the need for periodic security and emergency preparedness training, credible information on new developVerDate Aug 31 2005 08:37 Aug 20, 2008 Jkt 038845 PO 00000 Frm 00026 Fmt 6633 Sfmt 6633 P:\DOCS\38846.TXT SAFFAIRS PsN: PAT
19 

ments, timely updates from reliable sources. I believe our close 

working relationship with FEMA will help us in the training needs. 

However, resource limitations may impact our ability to deliver all 

that is needed and all that is expected. 

As the GAO report stated, there are inconsistencies across the 

FEB network in regards to different staffing levels, different funding models, different resources and different reporting structures. 

However, each Federal Executive Board faces the same degree of 

responsibility and the same degree of complexity in carrying out 

their duties. If FEBs are to be effective in these areas, our positions will need to be properly designated as having an emergency 

role? It should be written down. 

It is also my hope that the final version of the National Response 

Framework will appropriately identify FEBs as having that emergency and supporting role. 

In closing, I would like to share with you a comment, made by 

one of our agencies. It states: ‘‘The FEB is the only venue for agencies to interact with each other, thereby offering a means of communication that would otherwise not exist.’’ 

Thank you, Mr. Chairman, and I stand ready for your questions. 

Senator AKAKA. Thank you. Thank you very much to the panelists for your statement and your testimony. 

I have a question for all of you. This hearing is to discuss whether or not FEBs should have a formal responsibility in emergency 

response planning and implementation. You have heard from our 

first panelists. Do you agree with GAO’s recommendations? Mr. 

Morris. 

Mr. MORRIS. I absolutely agree. I think that will make our efforts 

and our job a lot easier, especially when we network with our State 

and local counterparts, and also some of the other Federal agencies 

because they will know that we really do have an official seat at 

the table. 

Senator AKAKA. Ms. Ainsworth. 

Ms. AINSWORTH. I, too, agree and I agree with what the previous 

panel said. I think that having it formally in writing somewhere 

provides us with the credibility hat we need. Right now there is 

lots of transition at the highest levels of government. The regional 

directors and the heads of the agencies transition sometimes every 

2 years. The FEB is not yet necessarily part of the transition package. So I think if we have something in writing it provides us with 

the credibility that we need. 

Senator AKAKA. Mr. Goin. 

Mr. GOIN. I would also agree with the panelists regarding that 

and also remind you of the statement that we do believe that we 

are the only entity that is capable of performing that in our field. 

And our agencies have stepped forward and stated they will be engaged and they will support the mission of the FEB. So I think 

that is the right thing to do. 

Senator AKAKA. Mr. Morris, your FEB has led the way in coordinating pandemic training programs and exercises. I would like to 

commend you for your efforts. 

Mr. MORRIS. Thank you, Mr. Chairman. 

20 

Senator AKAKA. Aside from the issue of funding, what has been 

the greatest challenge in integrating the FEB in the emergency response planning? 

Mr. MORRIS. The greatest challenge is really being able to formulate those relationships, especially those critical relationships with 

State and local government. Because for field Federal agencies, we 

are really dependent upon them because they are our first responders in any major disaster, whether it be a biological disaster with 

a pandemic or a weather-related—which Minnesota is rather famous for—or also a terrorist related event. 

Obviously, if we had some additional resources, additional staffing even, that would be a greater help. But in light of that, having 

the authority of being in the Federal response plan would be a big 

help. 

Senator AKAKA. Thank you. 

This one is for the panel. Funding for FEBs has been a large 

topic of the conversation today. How do you generate revenues and 

establish an operating budget, if you have one? Let me ask Ms. 

Ainsworth first. 

Ms. AINSWORTH. In short, we are very entrepreneurial at the 

Federal Executive Boards. In Boston, I am blessed to have a wonderful network of agencies who are really there to support me. So 

I know that I can ask for any level of resource, whether it be a case 

of copy paper, something as simple as that, or whether it be a person to help me with a particular event, a body. I have agencies that 

are willing to contribute. 

That said, I feel like it is a hat in hand approach where I am 

continually going back to the trough and asking for these things 

and some of that might dry up sooner or later. So a more consistent 

funding stream would be beneficial to me and to others. 

Senator AKAKA. Mr. Goin, how do you generate revenue? 

Mr. GOIN. Very much in the same manner. It is very dependent 

upon our agencies in the collaboration and the efforts as agencies 

step forward as we identify the needs. We will tell them what the 

program is, what the program requires, and then ask their assistance in delivering that. 

But I should also state that I am very fortunate to be an employee of NASA in our area, who have been very diligent about ensuring that we have all of the resources that we need and that are 

necessary for carrying our mission forward. 

Senator AKAKA. Mr. Morris. 

Mr. MORRIS. I am one of the fortunate ones. I happen to be a 

Washington employee of the Department of the Interior in the Office of the Secretary. They fund two positions in Minnesota very 

adequately and a modest budget for our office expenses and regular 

needs. 

However, we have some great local support, too, especially from 

the Transportation Security Administration. They do a lot of heavy 

lifting for us when we need some—the National Weather Service 

and a number of different agencies—and really, the whole Federal 

community at large will support us if we ask. 

But again, our base funding is a fairly stable thing. And I am 

the exception, rather than the rule. 

21 

Senator AKAKA. Since you have experience in this system, let me 

ask the panel again, outside of the direct appropriated funds is 

there a logical funding source that could support your efforts? Mr. 

Morris. 

Mr. MORRIS. I think some of the issues that OPM is working on 

in developing a national funding strategy at the chief human capital officers level really deserves a lot of merit and really would enable many Federal Executive Boards to really do a lot more than 

be concerned about whether or not they are going to have operating 

funds for the next 6 months. 

One of the great assets that we have is that stable funding. It 

is one of the primary reasons why we are able to perform to such 

an extent in emergency management because we have that base 

covered. 

But I think what OPM has been doing in working with the chief 

human capital officers, in getting really a consistent funding 

scheme for the whole network, is a solution, an important solution. 

Senator AKAKA. Mr. Goin. 

Mr. GOIN. I think that OPM’s approach is appropriate and I do 

believe that the answer is a national model and that way it takes 

a lot of pressure off of the local to step forward in that matter. We 

should be established in a manner where we have uniformity 

across the entire FEB network. Everyone should be operating from 

the same perspective, knowing what resources are available at the 

beginning of each fiscal year and not trying to establish it along 

the way. 

So I think the answer is a national model and OPM is on the 

right track and we will certainly—as FEBs in the field—assist 

them in helping them understand what the local contribution 

would be from that. 

Senator AKAKA. Ms. Ainsworth. 

Ms. AINSWORTH. I agree with what both of my colleagues have 

said. Over many years I looked at many of the funding models and 

considered how FEBs could operate. I often liken a strategy to 

something like what GSA does with joint use space. A lot of us are 

in GSA buildings and our office space is joint-use space and GSA 

builds it into their rent schemes. 

A similar funding agreement to something like the Federal Protective Service has on the national level, where all agencies contribute because the Federal Protective Service is an agency that 

impacts everybody. 

So I believe that OPM is on the right track in pursuing the national model that they are looking at now. 

Senator AKAKA. Thank you. 

Ms. Ainsworth, you mentioned in your testimony that earlier this 

year the marketing scheme for a cartoon show created havoc in the 

Boston area and agencies looked to the FEB to collect and disseminate information. Being able to communicate is, of course, essential 

in the event of an emergency. 

What communications exercising have you done to be sure that 

you will be able to communicate with the necessary people in the 

event of an emergency? 

Ms. AINSWORTH. Mr. Chairman, it changes every day with technology. In that particular case, it happened to be during the day, 

22 

in the daylight hours. So we were able to utilize our e-mail 

schemes and get people when they were at their desks and they 

have blackberries and whatnot. So we, in that particular case, did 

focus primarily on electronic communications. 

We do have now, we are part of the USP3 network, where we 

will be able to use telecommunication systems which will be a voice 

message and also text messaging to complement the e-mail. So 

there will be three ways that we can communicate 24 hours a day 

with our members. 

Senator AKAKA. If you were to look at highlights, what strengths 

and weaknesses have these exercises highlighted? 

Ms. AINSWORTH. I think our strengths are our ability to quickly 

get information and, as you heard me say several times, accurate, 

consistent, and up to date information out there. I talked a little 

bit about our experiences with perceived emergencies. And a lot of 

perceived emergencies are generated due to blogs and people getting online and talking about things or media picking up on a story 

and just sensationalizing a lot of it. 

So our ability to be able to, for lack of a better word, fact check 

some of the information that is surfacing in these forums has really 

provided us with credibility. 

We find that we are a greater resource to the non-law-enforcement and military agencies, the agencies that I call the administrative types, Social Security, IRS. We all work in the same buildings 

and rumor spreads very quickly, particularly when folks are on the 

Internet or watching television during the day. 

Senator AKAKA. Mr. Morris, next year the Republican National 

Committee will hold its national convention in the Twin Cities. 

This could create a range of challenges in the event of a pandemic 

outbreak or other emergency. What role are you playing in preparing for this large national event? Are you working with the Boston and New York FEBs, which hosted national party conventions 

in the year 2004? What are you doing here? 

Mr. MORRIS. Last winter we asked for both Boston and New 

York’s after action reports from both the DNC and the RNC conventions in their respective cities. And then, in the early spring we 

had the U.S. Secret Service Special Agent in Charge come into our 

executive committee and give a briefing for all of us on all of the 

aspects on the National Special Security Event. 

For this fiscal year we also had him come on our executive committee. We have also been working with both local and State government. Again, in Minnesota, we really know everybody on a first 

name basis, all of the major players in law enforcement and emergency management. And we are anticipating in the spring and 

probably early summer putting on a major, probably a daylong 

seminar on the ramifications of the Republican National Convention from September 1–4, 2008. 

Senator AKAKA. Ms. Ainsworth, GAO recommends that performance standards be established for FEBs. Would this be a helpful 

tool or a hindrance to your preparedness work? 

Ms. AINSWORTH. I personally applaud it. I think it is a great 

mechanism and I think they should exist. I think it will help us 

a lot. 

Senator AKAKA. Mr. Goin. 

23 

Mr. GOIN. I believe it will give us a clear direction and something 

to work towards throughout the year. We can set our strategic position to go in that direction to ensure we are meeting those. 

Senator AKAKA. Mr. Morris. 

Mr. MORRIS. I agree with my colleagues on that point. 

Senator AKAKA. I want to thank all of our witnesses for your 

thoughtful testimony and answers to the questions. There is clearly 

a lot more that needs to be done to prepare for a pandemic outbreak, and including FEBs in that planning. 

In addition, we need to look beyond the Federal emergency response professionals and look to the preparation of the larger Federal employee population. 

Senator Voinovich and I have asked the Government Accountability Office to examine how well prepared the Federal workforce 

is in the event of a pandemic influenza outbreak and I am sure we 

will hold a hearing when that report is released. And so we look 

forward to continuing to hear from you and to improve the system 

so that we can deal and respond whenever it is necessary. 

With that, again, I want to thank all of you for being here. 

This hearing is adjourned. 

[Whereupon, 11:23 a.m., the Subcommittee was adjourned.] 

(25) 

PREPARING THE NATIONAL CAPITAL REGION 

FOR A PANDEMIC 

TUESDAY, OCTOBER 2, 2007 

U.S. SENATE, SUBCOMMITTEE ON OVERSIGHT OF GOVERNMENT

MANAGEMENT, THE FEDERAL WORKFORCE

AND THE DISTRICT OF COLUMBIA, OF THE COMMITTEE ON HOMELAND SECURITY

AND GOVERNMENTAL AFFAIRS, Washington, DC. 

The Subcommittee met, pursuant to notice, at 10:03 a.m., in 

Room SD–342, Dirksen Senate Office Building, Hon. Daniel K. 

Akaka, Chairman of the Subcommittee, presiding. 

Present: Senator Akaka. 

OPENING STATEMENT OF CHAIRMAN AKAKA 

Senator AKAKA. This hearing will come to order. Good morning 

and welcome to our panel and to all of you in this room. 

I would like to thank all of you for joining us at this hearing to 

discuss the status of pandemic preparedness in the National Capital Region (NCR). This is the second in a series of three hearings 

that our Subcommittee is holding related to pandemic influenza. 

Last week, we heard about the role of the Federal Executive 

Boards in responding to an outbreak, and on Thursday afternoon, 

we will discuss global surveillance of emerging infectious disease. 

Public health experts believe that the world is overdue for a pandemic influenza outbreak. The Spanish flu pandemic of 1918 and 

1919 killed approximately 40 million people around the world. Beyond this tremendous death rate, an estimated 20 to 40 percent of 

the population fell ill. The Centers for Disease Control and Prevention estimate that a flu pandemic could kill between 2 to 7.4 million people worldwide. In the United States, an estimated 200,000 

people could die and another 2 million people could become ill. In 

short, we must prepare our communities to protect lives. 

The effect of pandemic in our Nation’s Capital, the heart of the 

Federal Government, would be dramatic. Comprised of 11 local jurisdictions, the District of Columbia, and parts of Maryland and 

Virginia, the NCR is home to over 5 million people, 340,000 Federal employees, 40 colleges and universities, and 27 hospitals. The 

NCR has the second-largest rail system in the country and hosts 

nearly 20 million tourists each year. 

To help coordinate planning and response with the State, local, 

and regional authorities in the NCR, Congress established the Office of National Capital Region Coordination in the Homeland SeVerDate Aug 31 2005 08:37 Aug 20, 2008 Jkt 038845 PO 00000 Frm 00033 Fmt 6601 Sfmt 6601 P:\DOCS\38846.TXT SAFFAIRS PsN: PAT
26 

curity Act of 2002. In the past 5 years, we have spent millions of 

dollars through DHS and HHS grants to prepare the NCR for natural disasters, public health emergencies, pandemics, and potential 

terrorist attack. 

According to the World Health Organization, since 1997, 328 people from South East Asia to Africa and Europe have been killed as 

a result of the bird flu or the H5N1 virus strain. In response to the 

growing threat, the CDC and HHS have granted Maryland, Virginia, and the District of Columbia a total of nearly $90 million in 

fiscal years 2006 and 2007 for pandemic preparedness. Congress 

has appropriated more than $7.5 billion since 2004 for pandemic 

flu-related activities, including $6.1 billion to HHS in fiscal year 

2006 to work with the States on stockpiling antiviral drugs and 

vaccines. 

In 2005, the CDC required all States to develop strategic plans 

for pandemic influenza, and in 2006, the CDC required the States 

to exercise them. In May 2006, the White House released a National Strategy for Pandemic Influenza. In addition, the local jurisdictions and NCR have their own strategic plans for pandemic influenza. However, while the NCR as a whole has a strategic plan 

for security in the event of a terrorist attack or a disaster, there 

is no regional strategic plan specifically for pandemic influenza. I 

think this will be a useful tool to develop, and so this hearing is 

part of planning for that. 

Strategic plans are just the first step. These plans must be tested 

through repeated training and exercising. Weaknesses can be found 

and improvements can be made. This is the only way that the National Capital Region can become adequately prepared to face the 

pressing issue of a pandemic influenza outbreak. I am pleased to 

hear that DC will host an exercise with nonprofits on pandemic 

preparedness later this month. 

Like the NCR, my home State of Hawaii faces unique challenges 

in pandemic flu preparation with its large tourist population and 

location between Asia and the contiguous States. The Hawaii Department of Health has been working hard to address pandemic 

preparedness, and earlier this year Hawaii held a massive exercise 

simulating a plane crash of a flight from Indonesia heading to Mexico City. The exercise scenario included passengers infected with 

avian influenza. It required Federal, State, local, and military responders to treat injuries related to the crash and possible exposure to avian flu. Participants walked away from the exercise understanding the importance of interoperable communication and 

the need for medical surge capacity. 

In our Subcommittee hearings last year, we discussed the importance of interoperable communication in the NCR and the challenges to achieve interoperability with so many jurisdictions in the 

region. I believe you all have made great strides in this area and 

I want to congratulate you on these efforts, but there are other 

problems that need to be addressed. 

Pandemic flu will be a shock to the entire medical system. Most 

hospitals function at capacity and leave little room for surge. Twenty-five percent of the population could be infected by the pandemic 

strain over a period of months or even years. Patients’ needs could 

far outstrip available hospital beds, health professionals, and venVerDate Aug 31 2005 08:37 Aug 20, 2008 Jkt 038845 PO 00000 Frm 00034 Fmt 6601 Sfmt 6601 P:\DOCS\38846.TXT SAFFAIRS PsN: PAT
27 

tilators, and I understand that DC, Maryland, and Virginia have 

made improvements for medical surge capacity, but more needs to 

be done to look at alternate sites for care and altered standards of 

care during a pandemic emergency. 

Medical surge capacity is only one of the challenges related to 

treatment and public health response. Keeping our government’s 

services running and caring for other sick patients are also distinct 

challenges in the event of a pandemic disease outbreak. I know 

that you all have put a lot of thought and energy into developing 

plans and working together to prepare for a pandemic. I am interested in hearing about the good work that I know is being done by 

the various jurisdictions in the region, how HHS and DHS are 

helping in that process, and areas where efforts can be improved. 

I want to welcome our panel this morning and introduce Dr. 

Kevin Yeskey, Director of the Office of Preparedness and Emergency Operations and the Deputy Assistant Secretary in the Office 

of Preparedness and Response at the Department of Health and 

Human Services. 

We have Christopher Geldart, Director of the Office of National 

Capital Region Coordination at the Department of Homeland Security. 

We have Robert Mauskapf, Director of Emergency Operations, 

Logistics, and Planning in Emergency Preparedness and Response 

for the Virginia Department of Health. 

And we have Darrell Darnell, Director of the Homeland Security 

and Emergency Management Agency for the District of Columbia 

and a Member of the Senior Policy Group in the National Capital 

Region. 

I would like to note at this time that we also invited a representative from the State of Maryland to participate in the panel discussion this morning, but they were unable to provide a witness. I do, 

however, look forward to viewing their testimony to find out what 

their efforts have been on behalf of preparing the National Capital 

Region for pandemic influenza. 

Our Subcommittee rules require that all witnesses testify under 

oath. Therefore, I ask all of our witnesses to please stand and raise 

your right hand. 

Do you solemnly swear that the testimony you are about to give 

to this Subcommittee will be the truth, the whole truth, and nothing but the truth, so help you, God? 

Dr. YESKEY. I do. 

Mr. GELDART. I do. 

Mr. MAUSKAPF. I do. 

Mr. DARNELL. I do. 

Senator AKAKA. Thank you. Let it be noted for the record that 

the witnesses answered in the affirmative 

All witnesses will have 5 minutes to summarize their testimony, 

and without objection, your full written statements will be included 

in the record. 

So we will begin with Dr. Yeskey. Dr. Yeskey, will you please 

proceed with your statement? 

28 

1The prepared statement of Dr. Yeskey appears in the Appendix on page 150. 

TESTIMONY OF KEVIN YESKEY, M.D.,1 DEPUTY ASSISTANT 

SECRETARY, AND DIRECTOR, OFFICE OF PREPAREDNESS 

AND EMERGENCY OPERATIONS, OFFICE OF THE ASSISTANT 

SECRETARY FOR PREPAREDNESS AND RESPONSE, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Dr. YESKEY. Good morning, Chairman Akaka. Thank you for the 

opportunity to present the progress HHS has made in preparedness 

for pandemic influenza in the National Capital Region. 

The ASPR mission is to lead the Nation in preventing, preparing 

for, and responding to the adverse health effects of public health 

emergencies and disasters and the vision we have is a Nation prepared. Like our response counterparts in other agencies, ASPR has 

taken an all-hazards approach to public health preparedness planning. The gains we make in increased preparedness and response 

capability for pandemic influenza will help us in preparing for 

other emergencies and disasters. 

My oral testimony will focus on the Federal preparations for the 

National Capital Region and how HHS is supporting Maryland, 

Virginia, and the District of Columbia in their pandemic influenza 

preparations. 

In November 2005, the President released the National Strategy 

for Pandemic Influenza, followed by a detailed implementation plan 

from the Homeland Security Council in May 2006. HHS also released its pandemic implementation plan and developed an operational plan, or as we call it, the ‘‘Pandemic Influenza Playbook,’’ 

which details how HHS will coordinate the deployment and utilization of Federal medical resources. Our goal for the next year is to 

work with States to develop regional playbooks that will continue 

to promote integrated planning across tiers of government. 

HHS also published multiple documents to assist State and local 

public health officials in their preparations for pandemic influenza. 

Two documents of note are the ‘‘Interim Pre-Pandemic Planning 

Guidance: Community Strategy for Pandemic Influenza Mitigation 

in the United States.’’ This publication provides detailed strategies 

for the use of non-pharmaceutical interventions, such as social 

distancing. 

The second publication, called the ‘‘Community Planning Guide 

on Mass Medical Care with Scarce Resources,’’ provides guidance 

to health care professionals, permitting them to provide the highest 

possible standards of care in situations where resources are scarce. 

Included in this guide is a pandemic influenza case study. 

HHS recognizes the lead role of the Department of Homeland Security during disasters of national scale. We support DHS by providing public health and medical expertise in all disasters and will 

do so in a pandemic. With regard to pandemic influenza, HHS has 

identified six senior health officials to support the DHS pre-designated pandemic principal Federal officials. Our six senior health 

officials have been working hand-in-hand with the DHS PFOs at 

the regional, State, and local levels and have participated in exercises, roundtable discussions, and other preparedness activities. 

HHS has provided preparedness funding to States and local governments through two mechanisms, cooperative agreements and 

29 

emergency supplemental funding. HHS has two cooperative agreements that aid in all-hazards preparedness, including pandemic influenza. The Hospital Preparedness Program is managed by ASPR 

and provides funds to States for surge capacity, development of alternative care facilities for health care during disasters, regional 

coordination among hospitals, and exercises. The Public Health 

Emergency Preparedness Cooperative Agreement managed by CDC 

funds public health activities such as surveillance, lab support, and 

exercises. 

This year, $25 million was made available for a competitive 

award program that addressed surge capacity in hospital emergency care. Five health care facilities were awarded $5 million each 

under this program and one of the awardees was the Washington 

Hospital Center here in the District of Columbia. 

Emergency supplemental funding has been designated specifically for pandemic influenza. By the end of this year, the Department will have awarded over $600 million in emergency supplemental funding through the CDC and ASPR to States, the District 

of Columbia, and other jurisdictions to upgrade State and local capacity with regards to pandemic preparedness. 

The funding has occurred in three general phases. Phase one was 

used to assess gaps in pandemic planning and guide preparedness 

investments. Additionally, each State conducted summits between 

senior HHS officials and State officials and these summits were intended to facilitate community-wide planning and to promote 

shared responsibility for pandemic preparedness. 

Phase two funds were used to develop an operational work plan 

to address identified gaps from phase one and to develop an 

antiviral drug distribution plan. Awardees also developed a pandemic exercise schedule. 

Phase three funds will be used to address any outstanding gaps 

identified in phases one and two, such as stockpiling of ventilators, 

personal protective equipment, alternate care sites, mass fatality 

planning, and medical surge exercises, and these will be awarded 

as supplements to jurisdictions that currently receive awards 

through HHS cooperative agreements. 

Also in 2007, ASPR placed a Regional Emergency Coordinator 

within the DHS Office of National Capital Regional Coordination 

to enhance the HHS contribution to this very important office. It 

is our objective to provide a full-time resource to the director of this 

office who can provide public health expertise, enhanced coordination and preparedness planning, and improved communications between the director and HHS. 

The responsibility for pandemic preparedness is shared at the 

local, State, and Federal levels and includes private as well as public partners. HHS has provided funding and guidance to our State 

partners and we have actively engaged in workshops and exercises 

with our State and local partners to advance pandemic preparations. In the NCR, we have enhanced our partnership with the Office of National Capital Region Coordination by providing a fulltime Emergency Coordinator to assist with public health and medical preparedness. 

Thank you for the opportunity to present progress HHS has 

made in preparedness for pandemic influenza. With your leaderVerDate Aug 31 2005 08:37 Aug 20, 2008 Jkt 038845 PO 00000 Frm 00037 Fmt 6601 Sfmt 6601 P:\DOCS\38846.TXT SAFFAIRS PsN: PAT
30 

ship and support, we have made substantial progress. The threat 

remains real. We have much left to do to ensure that we meet our 

mission of a Nation prepared for a potential influenza pandemic. 

This concludes my testimony and I will be happy to answer any 

questions. Thank you. 

Senator AKAKA. Thank you very much, Dr. Yeskey. Now we will 

hear from Mr. Geldart. 

TESTIMONY OF CHRISTOPHER T. GELDART, DIRECTOR, OFFICE OF NATIONAL CAPITAL REGION COORDINATION, U.S. 

DEPARTMENT OF HOMELAND SECURITY 

Mr. GELDART. Thank you, sir. Good morning, Chairman Akaka. 

Senator AKAKA. Good morning. 

Mr. GELDART. Thank you for the opportunity to appear before the 

Subcommittee today to discuss the role of the Office of National 

Capital Region Coordination within the Department of Homeland 

Security’s Federal Emergency Management Agency. 

I will describe how we work with our Homeland Security partners to enhance preparedness within the National Capital Region, 

and more specifically, our role in ongoing pandemic influenza initiatives as part of our core mission in the region. 

The Chairman gave a very accurate summary of the National 

Capital Region, of what is at stake here in this region and also of 

the office that was created to help address that from the Federal 

perspective. The major role of the office is to oversee and coordinate Federal programs for and relationships with State, local, and 

regional authorities. The office originally was within the Office of 

the Secretary at DHS. However, with the passage of the PostKatrina Emergency Management Reform Act of 2006, the Office of 

National Capital Region Coordination became a component of 

FEMA. We directly report to the FEMA Administrator. 

The office coordinates daily with local, State, regional, Federal, 

private sector, and nonprofit entities. Some of those entities include 

the Joint Federal Committee, the Metropolitan Washington Council 

of Governments, Regional Emergency Preparedness Council, the 

National Capital Region Senior Policy Group, and FEMA Region 

III. 

Since joining the office 5 months ago and looking at the overarching priorities of the office, three major areas came to the top. 

The first one is to enhance regionally coordinated catastrophic 

planning. We helped to initiate and we participate on the NCR 

Evacuation and Sheltering Plan Working Group led by the District 

of Columbia’s Homeland Security Emergency Management Agency. 

We work with our partners at all levels of government in the region to coordinate activities of this Working Group with Federal 

continuity programs. There is an opportunity to take a substantial 

leap in the NCR in catastrophic planning as we are now in the 

Federal Emergency Management Agency, and looking at that agency’s vision as it moves forward. 

Our second area that we looked at is enhanced Federal coordination in the NCR. The National Capital Region Coordination Office 

is working on strengthening the Federal coordination with our 

State and local partners. We do this through our Joint Federal 

Committee. We do this through the several regional emergency 

31 

support functions, which I am sure my colleague, Darrell Darnell, 

will address when he gives his testimony. Operationally, the NCRC 

in its standing Federal coordination role ensures the coordination 

of Federal protective measures in advance of and immediately following an event. 

The last area that we focus on is the Comprehensive Regional 

Risk Assessments. The region is committed to doing Regional Risk 

Assessments to focus its limited resources on the top key issues for 

the area. We have conducted several and we are refining the process. Within these priorities, pandemic flu is a major consideration. 

To meet the challenge of pandemic influenza, there are many entities that have a role in preparedness in the National Capital Region. 

The Department of Homeland Security’s role as described in the 

implementation plan for the National Strategy for Pandemic Influenza is to coordinate the overall Federal response during an influenza pandemic. The Federal Emergency Management Agency’s role 

during a pandemic influenza outbreak is to coordinate the identification, mobilization, and deployment of Federal resources to support the life-saving and life-sustaining needs of the States and 

their populations. 

In March of this year, the Federal Emergency Management 

Agency published a Disaster Assistance Policy establishing the 

types of emergency protective measures eligible for reimbursement 

to States and local governments during a Federal response to a 

pandemic influenza, among other things. 

The role of the National Capital Region Coordination Office does 

not lead efforts to create pandemic influenza contingency plans. 

However, we coordinate and synchronize Federal interagency planning efforts with the National Capital Region jurisdictions. Our coordination efforts ensure complementary multi-jurisdictional planning for preparedness, response, and recovery actions in the region. 

A pandemic influenza differs from any other—most other events 

that may happen in this region. It will last much longer. It will 

come in waves. The numbers of health care workers and first responders available can be expected to be reduced. Resources in 

many locations will be limited, depending on severity and spread 

of a pandemic influenza. 

Given this, let me tell you how the National Capital Region Coordination Office is working towards its three priorities with its 

partners in addressing pandemic influenza. 

The NCRC works in close coordination, as Dr. Yeskey has just 

mentioned, now with an HHS person on board to coordinate the activities and the grant streams that HHS has ongoing. We also work 

with HHS and the Department of Homeland Security in bringing 

a public health officer into our office, as well, to help coordinate 

planning between State, Federal, regional, and local authorities. 

To enhance our Federal coordination within the region, FEMA, 

the National Continuity Programs disseminated their pandemic influenza guidance to more than 70 Federal departments and agencies in the NCR. We have coordinated with the General Service Administration to use the Federal Virtual Workplace in the event of 

a pandemic influenza, and the U.S. Postal Service regarding potential role in distributing prophylaxis. There are several exercises 

32 

1The prepared statement of Mr. Mauskapf appears in the Appendix on page 166. 

that either recently have been conducted or that are planned, and 

I will be glad to cover any of those that the Chairman would want 

me to go over. 

And the last is in our regional risk assessment area. Of course, 

pandemic influenza is a major piece in that. 

In conclusion, I would like to say that the NCRC is at an exciting 

crossroads as it continues its central preparedness and coordination 

missions as part of the Federal Emergency Management Agency. 

Building upon the foundation that has already been constructed, 

the NCRC will continue to take proactive steps with our Homeland 

Security partners to protect, prepare for, respond, and recover from 

the public health threat posed by pandemic influenza. 

Thank you, Chairman Akaka and Members of the Subcommittee, 

for the opportunity to discuss the role of FEMA’s Office of National 

Capital Region Coordination. I will be glad to answer any questions 

that you have, sir. 

Senator AKAKA. Thank you. Thank you very much, Mr. Geldart. 

Now we will hear from Mr. Mauskapf. Please proceed with your 

statement. 

TESTIMONY OF ROBERT P. MAUSKAPF,1 DIRECTOR, EMERGENCY OPERATIONS, LOGISTICS, AND PLANNING IN EMERGENCY PREPAREDNESS AND RESPONSE PROGRAM, VIRGINIA DEPARTMENT OF HEALTH 

Mr. MAUSKAPF. Thank you, Chairman Akaka, for this opportunity to address the Subcommittee on this very important issue. 

I am Bob Mauskapf from the Virginia Department of Health and 

I want to discuss the activities in Virginia in combatting the potential for a pandemic. 

Three points that I would like to emphasize are that Virginia has 

undertaken extensive planning efforts for a possible pandemic. Additionally, the three jurisdictions within the National Capital Region work closely together on all aspects of emergency planning 

and response. And there needs to be closer collaboration and communication on NCR emergency planning between the three jurisdictions and the Federal Government. 

Monthly activity reports from throughout Virginia provide the 

governor anecdotal descriptions of local, regional, and State preparations. Pandemic influenza plans are coordinated across the NCR 

at State and local levels. School systems, private sector, critical infrastructure partners, all are collaborators in this effort. 

One important gap in our planning is the coordination with key 

Federal agencies. NCR jurisdictions must be integrated into Federal continuity of operations and continuity of government planning. Federal employees live in our neighborhoods and are dependent on our services. If there are any preferential expectations to assist in the continuity of Federal operations, they have not been 

shared with us. 

Under continuity of operations, governor Kaine has issued an Executive Order directing the State and all State agencies to create 

and update continuity of operations plans. Among the issues that 

are addressed in these plans are workforce reduction, staffing supVerDate Aug 31 2005 08:37 Aug 20, 2008 Jkt 038845 PO 00000 Frm 00040 Fmt 6601 Sfmt 6601 P:\DOCS\38846.TXT SAFFAIRS PsN: PAT
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port coordination, identification of key personnel skills, leadership 

succession, systems readiness, and prioritization of agency functions. 

Communications efforts focus on pre-scripted public service and 

public health announcements, keeping the media engaged, developing public education opportunities and materials, and developing 

message maps and establishing a public inquiry center. 

All treatment planning has been collaborative with the health 

care community and specifically with the Commonwealth’s 90 acute 

care hospitals. Mass vaccination plans have been developed and exercised at both the State and local levels. Virginia has focused 

much effort in the refinement of its antiviral distribution plan. 

Governor Kaine has authorized the purchase of over 770,000 

courses of antivirals, now on hand within the Commonwealth. It is 

hoped that the Federal Drug Administration will approve shelf life 

extension programs for the States, thereby protecting this significant investment and extending the longevity of these medications. 

In preparing for a possible pandemic event, the Commonwealth 

will distribute to target populations through a regional delivery 

network, to private sector pharmacies, military TRICARE clinics, 

community health centers, dispensing physicians, health care facilities, and local health departments. The plan is designed to provide 

antivirals to treat up to 25 percent of the State’s population. This 

percentage is based on worst-case modeling from the 1918 pandemic. Participating pharmacies will receive and dispense the 

medications at no charge. A tracking system will assure that each 

individual receives only one course. 

On the medical surge, approximately 3,600 staff beds are available State-wide for the influx of surge patients within 4 hours of 

notification. The immediate bed surge capacity within this 4 hours 

for the Virginia portion of the NCR is 780 beds. Surge capacity 

within 24 hours amounts to 5,600 patient surge beds among normal staff beds within the Commonwealth. 

Virginia continues to identify additional potential alternate care 

sites to enhance the treatment of patients. Additionally, the use of 

mobile medical assets is a valuable option for providing medical 

stabilization and treatment outside of hospitals. Stabilization and 

treatment-in-place units are now in place for four of our six hospital regions. A vendor-managed inventory surge plan now under 

consideration proposes to provide medical surge materials from two 

locations to all of our sites within Virginia. 

In August 2006, Virginia hosted a State-wide pandemic influenza 

tabletop exercise and followed it up in October of that year with a 

full functional exercise. All 35 local health districts participated 

and they operated 77 mass vaccination clinics and vaccinated over 

10,800 citizens with annual flu vaccine provided by the State. Last 

month, Governor Kaine led a cabinet-level pandemic flu tabletop 

exercise. State and regional caches of antiviral treatment courses 

are in place to provide treatment to over 37,000 hospital staff. That 

is approximately 30 percent of the Commonwealth’s hospital employees. 

In summary, Virginia has planned extensively for a possible pandemic. Collaboration among Virginia, Maryland, and the District is 

34 

1The prepared statement of Mr. Darnell appears in the Appendix on page 176. 

extensive and productive. Increased direct involvement of Federal 

agencies in the planning process is required. 

Thank you for this opportunity to address the Subcommittee and 

I will be glad to take your questions. 

Senator AKAKA. Thank you very much, Mr. Mauskapf. 

Now, Mr. Darnell, will you please proceed with your statement. 

TESTIMONY OF DARRELL L. DARNELL,1 DIRECTOR, DISTRICT 

OF COLUMBIA HOMELAND SECURITY AND EMERGENCY 

MANAGEMENT AGENCY 

Mr. DARNELL. Good morning and thank you, Chairman Akaka, 

for the opportunity to appear today to discuss pandemic preparedness in Washington, DC and the National Capital Region (NCR). 

A pandemic is likely to cause both widespread and sustained effects and is thus likely to stress the resources of every State nearly 

simultaneously. This anticipated resource drain will make it difficult for States to assist each other, thereby reinforcing the need 

to develop a plan that reflects a substantial degree of self-reliance. 

The District’s response to a pandemic will include significant governmental coordination, communication to the public, increased 

medical surge capacity, and first responder protection. The District’s Pandemic Influenza Preparedness Plan provides a framework to prepare for and respond to a pandemic. The plan is based 

upon the pandemic phases determined by the Centers for Disease 

Control and Prevention, in collaboration with the World Health Organization. These phases help identify the estimated impact of a 

pandemic on the government, residents, and visitors. These defined 

phases help ensure a consistent and coordinated response by the 

District of Columbia Government in the event of a pandemic. 

To facilitate homeland security collaboration at the regional 

level, the NCR leadership established a Health and Medical Regional Programmatic Working Group which addresses mass vaccination and mass dispensing issues, as well as the Surge Subcommittee which addresses mass fatality planning throughout the 

NCR. These groups provide forums for regional planning and cooperation related to pandemic preparation, and to encourage local 

coordination, the District has developed partnerships with the business community and the city’s hospitality industry in order to enhance preparation and response efforts. 

In addition to forming partnerships, we have worked to be certain that before, during, and after an emergency, we are in a position to provide timely, accurate, and easily understood information 

and instructions to the public. The District has made information 

about pandemic influenza planning and preparedness widely available through websites as well as fact sheets and preparedness 

checklists for the media, schools, businesses, and public safety officials. 

And to help ensure the efficacy of our planning and training efforts, the District has conducted a number of pandemic influenzarelated exercises that have focused on managing Strategic National 

Stockpile assets in response to a pandemic flu outbreak in schools 

and the hospitality industry. Further, on October 17, we will parVerDate Aug 31 2005 08:37 Aug 20, 2008 Jkt 038845 PO 00000 Frm 00042 Fmt 6601 Sfmt 6601 P:\DOCS\38846.TXT SAFFAIRS PsN: PAT
35 

ticipate in an exercise with nonprofit organizations to test their 

continuity of operations plans using a pandemic flu scenario. These 

exercises have familiarized District personnel and the public with 

pandemic response plans and they have demonstrated the ability 

of DC agencies to coordinate the response effectively. 

But, of course, a crucial aspect of pandemic response is early 

identification. District hospitals report diagnosed cases of influenza 

on a daily basis, which are compiled and compared against normal 

seasonal patterns. This monitoring will reveal an unusual or sudden spike in flu-like symptoms being reported at multiple hospitals 

and will notify public health officials of it early on. 

Turning to medical surge capacity, in the event of a pandemic influenza outbreak, the number of patients seeking treatment at hospitals in the region would soar. The District and the NCR have invested in increasing hospital surge capacity in previous years to expand hospitals’ ability to accept a larger than normal volume of 

payments. Throughout the NCR, the number of additional surge 

beds that were created was 2,367, and approximately one-third of 

those are located in hospitals here in the District of Columbia. 

In order to effectively treat the large number of affected individuals who will need medical treatment during a flu outbreak, it is 

critical that hospitals, public health, and emergency medical service providers have adequate protection so that they themselves do 

not become infected. The District of Columbia and the NCR have 

purchased protective equipment for health personnel in order to 

maintain their safety while treating the public during a pandemic. 

In conclusion, the District is continually preparing for response 

to a pandemic through the following activities: Identifying public 

and private sector partners needed for effective planning and response; planning for key components of pandemic influenza preparedness, including surveillance, vaccine, and antiviral distribution and communications; integrating pandemic influenza planning 

with other activities conducted under the Centers for Disease Control and Protection and the Health Resources Services Administration’s Bioterrorism Preparedness Cooperative Agreements with the 

States; coordinating local plans and providing resources to assist in 

the planning process; exercising our plans; and continually coordinating with adjoining jurisdictions. 

Thank you again for the opportunity to testify before you today, 

and I welcome any questions you may have. 

Senator AKAKA. Thank you very much, Mr. Darnell. 

Dr. Yeskey, according to CDC, among the three flu strains it is 

preparing for in the 2007 and 2008 season, one of them is a type 

AH3N2. This strain is linked to the 1968 Hong Kong pandemic flu, 

the deadliest flu in the past 30 years, which killed two million people worldwide. What is the outlook for this upcoming flu season 

and are we prepared for this type of influenza? 

Dr. YESKEY. I would say that the preparedness activities that we 

are undergoing for pandemic influenza put us in a position to be 

able to respond better to any influenza, seasonal influenza that we 

might see this year. I can’t comment specifically on the vaccines associated with that. I just don’t have that material available. I 

would be happy to provide that answer to you. But I think because 

we have preparations in place for pandemic influenza, we have 

36 

done some exercises, we have done planning, we have done a number of different activities related to pandemic influenza, this puts 

us in a better position to respond to seasonal influenza, as well. 

Senator AKAKA. You just mentioned that there has been an improvement in preparedness. Can you mention something about just 

one part of the preparedness that you have been working on? 

Dr. YESKEY. Sure. I think a number of things. One, with regards 

to our exercises that we have done, a number of States have used 

seasonal flu clinics as a model for pandemic influenza mass vaccination, so we have looked at that, so that is an area where State 

and local authorities have practiced their seasonal influenza clinics 

and gaining efficiencies in those areas. In fact, Admiral 

Vanderwagen, the Assistant Secretary in our office participated in 

a drive-through seasonal flu vaccination clinic in his home county 

in Maryland last year. 

We have exercised distribution plans for antivirals. We have hospitals that have looked at surge capacity and how to enhance their 

ability to respond to a peak in influenza patients. So I think those 

are areas where we have seen improvements in our preparedness 

for pandemic influenza that should carry over into seasonal influenza. 

Senator AKAKA. Mr. Darnell, the first human-to-human transfer 

of H5N1 Avian influenza occurred in Indonesia last year and this 

is alarming. The first question everyone has in mind is, if NCR 

were hit with a pandemic influenza this season, are we ready? 

Mr. DARNELL. Well, Mr. Chairman, I think we have taken all the 

steps that we possibly can to be ready. We have developed plans. 

We have exercised those plans. We have coordinated those plans 

with our partners within the NCR as well as with the Federal Government. We have also reached out to the hospitality industry, as 

well, because a major part of our economy is tourism. A number 

of people come through this area, and if I understand your question, the gist of it, it could spread really rapidly. 

In fact, we recently held an exercise this past September 10 with 

the hotel and hospital industry in the NCR about an airborne disease that could affect people who were attending a convention here 

and who then traveled up and down the Eastern Seaboard. So we 

have stockpiled antivirals that we would need here and we also 

have the surveillance tracking system, and then working with the 

hospitality industry and their folks, as well, on how we could track 

people who are here for conventions, who are here visiting the Nation’s Capital, and then follow up with those people in the event 

that they were infected or potentially could become infected. 

Senator AKAKA. Mr. Mauskapf. 

Mr. MAUSKAPF. I believe we are ready. With the stockpiling of 

over 770,000 courses of antivirals already on hand, the enlisting of 

over 600 pharmacies to aid us in dispensing, the development of a 

distribution network with private distributors backed by UPS and 

our State resources, exercising both mass vaccinations once vaccine 

becomes available every year for the past 3 years, exercising points 

of dispensing at the drive-through clinics and other asymmetric 

types of forms of dispensing, with the governor’s executive-level decisionmaking exercise that he conducted with his entire cabinet 

earlier last month, and with our participation regionally in the upVerDate Aug 31 2005 08:37 Aug 20, 2008 Jkt 038845 PO 00000 Frm 00044 Fmt 6601 Sfmt 6601 P:\DOCS\38846.TXT SAFFAIRS PsN: PAT
37 

coming National Governors Association Region 3 exercise, which 

will go on November 8 and 9 here in the National Capital Region, 

I believe that we have made great strides toward preparedness. 

Senator AKAKA. Thank you. Mr. Geldart, along the lines of strategic planning for such an event, I know that it took all the jurisdictions working together with ONCR a number of years to develop 

the NCR security strategic plan. The regions have individual strategic plans for pandemic influenza, but it seems like a cohesive 

plan for the NCR would be a useful tool. Has this come up in your 

meetings within the NCR and could you work as a facilitator to develop such a plan? 

Mr. GELDART. Mr. Chairman, I would say that we do have a National Capital Region strategic plan. Within that strategic plan, we 

have a focus area that covers many of the aspects, if not all of the 

aspects, that go into mass care, medical surge, mass prophylaxis 

areas, which are the key pieces that go into a pandemic influenza 

plan. 

To create a regional plan for pandemic influenza would definitely 

be a discussion that myself, Mr. Darnell, and the other folks that 

make up the Senior Policy Group in the National Capital Region 

would have to discuss to ensure that each State and entity that 

would take part in that would find usefulness in creating a regional plan, or is there a way that with the exercises that we do 

and the strategic plan that we have for the region, do they believe—do we all believe that covers us, how we need to for pandemic influenza planning. If they were willing, sir, I would be willing to facilitate, yes, sir. 

Senator AKAKA. Thank you. We look upon you and the Department of Homeland Security to be a kind of facilitator to bring these 

groups together. 

Doctors and pharmacists across the country are already offering 

flu shots. With the flu season upon us, there is a real opportunity 

for the NCR to test strategic plans that you all have been working 

on. What exercises are scheduled for NCR to use this flu season to 

test current plans for a pandemic flu outbreak? Mr. Mauskapf. 

Mr. MAUSKAPF. Our mass vaccination with using annual flu vaccine was so successful last year that we have purchased an additional 12,000 doses of annual flu vaccine and have actually taken 

delivery of pre-loaded syringes and needles, and we have provided 

that to 19 of our 35 health districts, and they will be conducting 

mass vaccination exercises during October and November. 

Some of the settings, for example, within the National Capital 

Region, in Loudoun County, we will actually be in a high school 

and do mass vaccinations during a class session, one hour, and we 

will test and use performance metrics to determine how long it 

takes to put each individual through the line to receive a vaccination. We will repeat this in several other areas. 

Some of the themes, for example, on Veterans’ Day in our Southwest Region, we will be giving flu vaccine to veterans. We have 

other thematic types of exercises that will be going on, as I said, 

19 in all, and we will be taking complete advantage of the annual 

flu season being here for mass vaccination. 

Senator AKAKA. Thank you. Mr. Darnell. 

38 

Mr. DARNELL. In addition to the October 17 exercise that we will 

be participating in with the nonprofits where we test their continuity of operation planning, we will also be participating in the 

Region 3 exercise that Mr. Mauskapf mentioned, as well, I believe 

on November 8 and 9. And then we are also going to be opening 

up two sites that we will use as sort of a test of how we would offer 

vaccines to the larger public and we will be vaccinating our Department of Health, our Metropolitan Police Department, and our Fire 

Department as a test for that. 

Senator AKAKA. Thank you. HHS and DHS are the Federal leaders in pandemic emergency response. But a recent GAO report 

found that their respective roles haven’t been clarified. Have HHS 

and DHS communicated to the 14 jurisdictions of NCR the roles 

and the responsibilities of each agency? Dr. Yeskey. 

Dr. YESKEY. We at HHS support the role of DHS as the lead in 

the overall response to any event in disasters, any disaster, including pandemic influenza, and we have established our senior health 

official structure to mirror what DHS has set up in establishing 

principal Federal officials for pandemic influenza. We have that 

structure set up and our senior health officials, along with the DHS 

principal Federal officials, have been going out, meeting with State 

officials, meeting with local officials, and, among other things, talking about the structure and how we provide support with the public health and medical expertise to the overall structure of DHS. So 

we have communicated the message to our State and local counterparts of how we will structure our HHS support to DHS, in their 

capacity as overall lead in the event. 

Senator AKAKA. Mr. Geldart. 

Mr. GELDART. Yes, sir. I think building off of what Dr. Yeskey 

just commented on, the fact that DHS being the responsible party 

for response in a pandemic influenza and developing the plans, 

overarching planning, strategic planning framework for that. I 

think that has been communicated. I think it is very clear that the 

Department of Health and Human Services has a large role in developing the processes and procedures that are most important and 

that most people need to know from the health perspective. In that, 

the Federal departments are receiving guidance from the Department of Health and Human Services on what they do for their employees, their critical mission assignments, and how they protect 

those folks for continuity within each Federal entity. 

So I think in that respect it is very clear for folks, and on top 

of that, looking at the NCR in particular right here, bringing in 

that person directly working for Dr. Yeskey into the Office of National Capital Region Coordination and embedding that person in 

all of the regional emergency support function meetings, the planning meetings, the development meetings that the region does, and 

having that direct continuity link from local jurisdictions, State jurisdiction, to the Federal folks, to HHS is a huge help for my office, 

I know, in coordinating between the Federal side and the State and 

local side, as well as for the State and locals to have somebody to 

turn to directly for answers for that. 

Senator AKAKA. Dr. Yeskey, public health professionals all cite 

the need for alternative standards of care during pandemic outVerDate Aug 31 2005 08:37 Aug 20, 2008 Jkt 038845 PO 00000 Frm 00046 Fmt 6601 Sfmt 6601 P:\DOCS\38846.TXT SAFFAIRS PsN: PAT
39 

breaks. Can you explain to us what would happen for those requiring medical care for non-pandemic flu reasons during an outbreak? 

Dr. YESKEY. Part of the public health and medical strategy is to, 

first, if you look at the epidemic curve of how a pandemic would 

look, part of our strategy is to reduce that overall impact, kind of 

drop the peak of that curve down a little bit so we don’t have as 

many patients and reduce the overall load on hospitals. The second 

part is to disrupt transmission so we don’t get an immediate burden on our hospitals but we spread that out over time as the pandemic moves through the country. So the intent is to reduce the 

overall number of patients who seek hospital care and to spread 

the burden out over a period of time so hospitals aren’t as overburdened so they can work on taking care of the non-pandemic patients that show up at their hospitals, as well. 

So our plan is really to try and keep those people who don’t— 

who are infected with the pandemic virus—keep them out of the 

hospitals as much as possible and only the people who really need 

to be treated in hospitals, get them in there, and that enables the 

hospitals to reduce that surge need and to provide staffing for the 

non-pandemic patients, as well. Plus, the development and production of vaccines and the acquisition of antivirals, help keep that 

burden off hospitals. 

We have published a document, as I said earlier, on allocation of 

scarce resources and it walks through the various aspects of how 

health care facilities can determine how they are going to allocate 

those resources when they are faced with those situations. So those 

are several of the strategies that we have employed in making sure 

that we try and meet the surge demand that will occur during a 

pandemic. We recognize that this is a tough issue. This is probably 

one of the tougher issues in pandemic flu preparations, is medical 

surge capacity with staff, with equipment and supplies as well as 

hospital services. 

Senator AKAKA. In reducing impact and disrupting transmission, 

you would be working with these jurisdictions. You mentioned that 

you would try to keep people out of the hospitals as you do this. 

In case people would need hospital care, and knowing that today 

many of the hospitals around the country or in different communities are unable to deal with any surge for hospital care, are there 

any plans to deal with that? 

Dr. YESKEY. Well, I think States and local communities and 

health care systems and hospitals are working on how to provide 

surge capacity. And one of the key components of our hospital preparedness program over the past 5 years is providing funding to 

States so they can address surge capacity, they can address interoperable communications, hospital incident command, and also address some of the equipment and supply needs that hospitals might 

face during a pandemic. So those are the strategies employed and 

then we work with the States and the local health care facilities 

to develop their surge capacity planning. 

Senator AKAKA. Thank you. Mr. Mauskapf, Dr. Yeskey just mentioned medical surge capacity is going to be a huge challenge during a pandemic outbreak. According to your testimony, Northern 

Virginia, the most populous part of the State, has a short-term 

surge capacity of 1,100 beds with a benchmark of 1,162 beds. HowVerDate Aug 31 2005 08:37 Aug 20, 2008 Jkt 038845 PO 00000 Frm 00047 Fmt 6601 Sfmt 6601 P:\DOCS\38846.TXT SAFFAIRS PsN: PAT
40 

ever, this shortfall doesn’t take into account long-term surge requirements. How will Northern Virginia address a long-term medical surge? 

Mr. MAUSKAPF. One of our methodologies obviously is going to be 

reaching out to the rest of the State, and we have plans that we 

can incorporate bed capacity throughout the State. Obviously, in a 

pandemic, if everybody is being affected simultaneously, that will 

be difficult. 

We have developed four stabilization and treatment-in-place facilities throughout the State which are triage sites. That will enhance our capability. They are canvas facilities. They can be deployed quickly and they can be consolidated and used together. So 

those are our mobile resources. 

We have also been identifying alternate care centers and we have 

established 26 Medical Reserve Corps around the commonwealth 

with a very significant number—I think the number is in my testimony—of medical professionals that would assist in staffing these 

alternate care sites and mobile care sites that I mentioned. 

Additionally, with our exercises, we are prepared to request Federal assistance and DOD assistance. Indeed, we have Memoranda 

of Understandings with all of our military bases, and there is a significant amount of those that we do cooperative training and exercising with on a regular basis. So we go through the same process 

working with the Department of Homeland Security for our State 

Emergency Operations Center requesting Federal assistance. So 

those would be the methodologies that we use to enhance our surge 

capacity. 

Senator AKAKA. Mr. Darnell, similarly, with the closing of DC 

General Hospital a few years ago, DC’s reduced hospital infrastructure raises questions on its ability to meet medical surge capacity 

needs. While DC managed to increase bed capacity by 300 beds last 

year, that doesn’t seem to be able to meet the potential need during 

a pandemic. My question to you is what is DC doing to address 

short-term and long-term medical surge capacity needs during a 

pandemic? 

Mr. DARNELL. Well, I think the increase in the 300 beds that you 

referred to, Mr. Chairman, really is a normal steady State, if you 

will. We have already identified, as I testified earlier, the creation 

of about 2,300 or so beds in a surge capacity that we could bring 

to bear if we had this type of outbreak. Similar to what Mr. 

Mauskapf had indicated, we also have Memoranda of Understanding with our regional partners where we can identify available beds if we need to use them. We have also purchased medical 

field units that we can deploy if we need to have people hospitalized. We are also working with the DC National Guard to provide 

DOD support in the event that we have to do that, as well. And 

then, finally, we are identifying primary care facilities, outpatient 

primary care facilities that we could use as inpatient if we need to 

do that. So those are some of the steps that we are taking, and 

again, as Mr. Mauskapf said, we would also reach out to the Federal Government for more Federal assistance if we needed it. 

Senator AKAKA. Thank you. Mr. Darnell, as you know, children 

could easily transmit the flu in concentrated places such as schools, 

and I know as a former teacher they can become a central source 

41 

for the disease. In a large outbreak, it might be necessary even to 

close schools. I wonder if you have taken this into consideration in 

your planning in DC. If so, how long would the schools be closed 

and have you begun planning with the school departments on alternative ways to provide education during a pandemic? 

Mr. DARNELL. Yes, we have discussed what our response would 

be, and quite frankly, Mr. Chairman, I couldn’t tell you how long 

the schools would be closed. In fact, I think the decision to close 

schools would be one that we would make with great care and 

great caution. My understanding of pandemic influenza is that unlike normal, if you will, influenza that is seasonal that generally 

runs from October to February or March, this particular strain, the 

H5N1, has tremendous peaks and valleys and there are possible 

times where it could be extremely high, where it could be extremely low, where it could transmit at varying rates that, quite 

frankly, again, as I understand it, we can’t accurately predict. 

So I think, first of all, we would take great care in making a decision to close schools. I would respectfully submit that one of the 

things we have to do is really communicate and educate the school 

system—educators, parents, and kids—in the things that they can 

do to protect themselves and protective actions that they can take, 

signs and symptoms of the disease, of the influenza, if they have 

it, where they can seek treatment immediately, as Dr. Yeskey said 

earlier in his response to one of your questions, so that we can sort 

of clamp down on the spread of it so we don’t have to make that 

type of decision. 

Senator AKAKA. In your March pandemic flu exercise, you mentioned that there were gaps in communication with the K through 

12 schools. I am glad to hear you say that you have worked with 

parents, as well, on this. Were there any other ways that you have 

addressed the communication gaps in schools? 

Mr. DARNELL. Yes. One of the things we have done, as I testified 

earlier, we have the websites, we have the checklist, the outreach 

directly to educators and parents and kids, and we just recently 

implemented what we call a Commander Ready Program that is a 

part of a Federal program for K through 12. Right now, we are concentrating on K through the age of 13, and it is an overall emergency preparedness training curriculum for kids that pandemic influenza is just one facet of that process. 

We also have some informational material that we are going to 

be sending out to all of the District residents. Our goal is to send 

this information out to 100,000 households within the District of 

Columbia, again, that not only focuses on pandemic influenza, but 

emergency preparedness in general with that just being one facet 

of emergency preparedness. 

Senator AKAKA. Dr. Yeskey, HHS has responsibility for overseeing and administering the Strategic National Stockpile of 

antiviral drugs and vaccines. Congress appropriated $6.1 billion 

over 3 years for HHS to work with States on building a stockpile 

of Tamiflu, Relenza, and available vaccines. Can you give us a status, an update on this? 

Dr. YESKEY. Sure. A couple things about the medical countermeasures. We have established several goals that I think are in my 

written testimony, but one is to maintain a pre-pandemic vaccine 

42 

for about 20 million people. The second goal is to provide pandemic 

vaccine to all citizens within 6 months of pandemic declaration. 

Our third countermeasure goal is to provide influenza antiviral 

drug stockpiles for treatment of pandemic illness for about 25 percent of the population. And then the last one is to provide an influenza antiviral drug stockpile for strategic limited containment, so 

called ‘‘quenching.’’ If an isolated case breaks out, we can use that 

treatment to prevent or delay the spread. 

We have a couple of strategies for our countermeasures, the medical countermeasures for pandemic influenza. One is the advanced 

development piece of that, and that is to look at alternate ways to 

be less dependent on egg-based vaccination cultures, and we are 

looking at developing cell-based production of vaccine that gives us 

more vaccine production capability. We have also looked at antigensparing vaccine with the use of adjuvants. Adjuvants are materials 

added to vaccines that improve their efficiency, thus requiring a 

lesser dose for the vaccination. That would give us a bit more vaccine in our stockpiles. We are also looking at new antivirals. We 

currently have two in our stockpile. We are looking at production 

of other new antivirals. 

We are also looking at Federal Stockpile acquisitions. That is the 

second part of our strategy. As I mentioned, we were looking at 

about 81 million treatment courses for the antivirals. Currently, we 

have about 37.5 million in the stockpile, with an appropriations request for another 12.5 million. States have also been given the responsibility of stockpiling about 30 million doses, and I think the 

last numbers that I saw, they have purchased about 15 million 

treatment courses. Money has been made available so States get a 

subsidy on the purchases and they are also able to purchase at the 

Federal price. 

The third piece that we have developed, or the third strategy 

that we have looked at, is infrastructure building, trying to look at 

how we can increase the domestic infrastructure for vaccine production. We have invested money in the retrofitting of existing vaccine production facilities to specifically address some of the new 

cell-based technologies. So that, in a nutshell, is a summary of our 

progress with countermeasures. 

Senator AKAKA. Thank you. Dr. Yeskey, CDC has the authority 

from the FDA under the Shelf Life Extension Program to store 

antiviral drugs and vaccines for a longer period of time than States 

or local governments. It must be a tremendous additional cost for 

States to replenish their purchases every few years. How do you 

decide when pandemic-related antiviral drugs and vaccines are 

stored by the State and when they are stored by the CDC? 

Dr. YESKEY. A little bit about the Shelf Life Extension Program. 

That is an interagency agreement between the Department of Defense and the Food and Drug Administration, and the arrangement 

is that when drugs are stored appropriately—for the agencies that 

participate in this—when the drugs approach their shelf life termination, the FDA tests them to see how potent they remain in that 

period of time and then will grant, if they meet the standards established by CDC—and again, this is a superficial explanation of 

this process—but nevertheless, the FDA tests it and then assigns 

an additional 2 years or so shelf life extension for products that 

43 

meet their requirements—stored appropriately, maintained appropriately, and maintain their potency during testing. The agreement 

is that any material that does not meet those requirements when 

it is tested gets destroyed. 

The process is fee-for-service and currently the VA, Health and 

Human Services—through the Stockpile—and DOD participate in 

this process. So that is the process that occurs, and it is all done 

through the Defense Medical Standardization Board. 

For States to participate in this program would require a significant increase in the demand on FDA resources and on the Department of Defense to administer this. At the direction of the HSC, 

an interagency panel met to look at whether we could offer this 

program to the States. For the present time, the recommendation 

out of the panel was that they would not be able to accommodate 

States in the Shelf Life Extension Program, but they have not absolutely ruled that out, to the best of my understanding. So they 

are going to continue to look at this to see if there is a mechanism 

by which States can participate in a Shelf Life Extension Program. 

But for now, in the DOD-FDA Shelf Life Extension Program, they 

do not. 

Senator AKAKA. Thank you. Mr. Mauskapf and Mr. Darnell, you 

have heard Dr. Yeskey mention about stockpile. Can you provide 

us with a stockpile update for Virginia and for DC? Mr. Mauskapf. 

Mr. MAUSKAPF. Virginia has received the highest rating from 

CDC, a green rating, for the last 3 years running. We will have our 

State review later on in October for our fourth year and we anticipate a like situation. 

We have developed what I think is a pretty imaginative set of 

partnerships with private sector. A national transportation company has undertaken a ground contract for all State agencies within the Commonwealth and that includes—the RFP that went out 

included that to get that contract, they must also deliver our stockpile, and, in fact, they were signed on to that and that is now part 

of their contract. 

We have a network of five Receive Stage and Store sites around 

the Commonwealth to receive the stockpile. We are working with 

Wal-Mart at their distribution center in Harrisonburg as a potential new site. We have identified over 300 Points of Dispensing 

(PODs), around the Commonwealth. We have enlisted the assistance of 26 Medical Reserve Corps in helping to dispense our stockpile. We also have tested in every single one of the 35 health districts twice a year either a mass vaccination or a mass dispensing 

exercise. 

Under the Cities’ Readiness Initiative in the three regions that 

are CRI areas, the National Capital Region, Metropolitan Richmond, and Hampton Roads, we have done asymmetric dispensing 

exercises, which include drive-through exercises, school bus delivery of meds, bookmobiles. We are working now with major newspapers in the three regions to develop our printed material and we 

have agreements with them to develop the printed material that is 

attendant to dispensing within 20 hours of request. So I think we 

are in pretty good shape for the stockpile. 

Senator AKAKA. Thank you. Mr. Darnell, will you update us on 

your stockpile for DC? 

44 

Mr. DARNELL. Yes, sir. We have about 45,000 treatment regimens that we have stockpiled. We have the green rating from the 

CDC, as well, green minus for the receipt and distribution of the 

Strategic National Stockpile, and similar to my neighbors in Virginia, we have also exercised how we would distribute the stockpile, identified the sites where we would do that. As I indicated 

earlier, we will have a test of that in November as we do that with 

some of our public safety personnel on how we would carry that 

out. And so we continually take a look at that. As Chris Geldart 

indicated earlier, as a part of our shelter and evacuation plan of 

identifying sites and distribution shelters and those different types 

of things, that is a part of that process, as well, for the District, 

let alone for what we are doing for the larger NCR. 

Senator AKAKA. Thank you. Mr. Darnell and Mr. Mauskapf, as 

I mentioned in my opening statement, there are 20 million tourists 

who visit the NCR every year. There are also 130,000 students in 

the region who may not be permanent residents. Are you taking 

non-resident populations into account, Mr. Mauskapf? 

Mr. MAUSKAPF. Absolutely. We don’t ask to see a State-specific 

identification card. With our border States, we have entered into 

agreements. If we open our PODs and they are closer for some of 

their citizens, there is no problem for them coming across the border. We have done, as recently as last October, a joint exercise with 

the District and with Maryland. We have received the stockpile 

and we have worked together in the management of the stockpile 

and the distribution to the PODs throughout the National Capital 

Region. There is full understanding that we will be mutually supporting in the event of such a requirement. 

Certainly in Virginia Beach and Williamsburg and areas where 

we have huge populations of visitors during the tourist season; all 

our colleges and universities have been integral to our planning 

and exercising and certainly they are all considered and will be 

part of the distribution and dispensing. 

Senator AKAKA. Thank you. Mr. Darnell? 

Mr. DARNELL. Yes. I would just echo Mr. Mauskapf’s comments, 

as well. The exercises that he referred to, we will have participated 

in that. We all have Memoranda of Understanding that we would 

support each other in the event of this type of outbreak. 

With regard to the colleges and universities that are located 

within the District of Columbia, we have what we call a College 

and University Consortium where we meet with them on a monthly 

basis to discuss emergency preparedness issues in general, and 

again, this is one facet of it. So we certainly would include students 

in that equation if they needed to receive treatment. 

Again, we have a close working relationship with the DC Greater 

Board of Trade as well as the DC Chamber of Commerce and the 

hotel and hospitality industry, so again, as I stated earlier, if there 

was an outbreak, we would be able to utilize their resources to 

track individuals who come in and out of the city and as they leave 

so that we can contact them in case they were infected or had the 

potential to become infected. 

Senator AKAKA. Mr. Mauskapf, according to CDC guidance, the 

States may elect to request assistance from the Postal Service to 

aid in the direct delivery of antiviral medications to residences. 

45 

Would this work for something as big as pandemic flu, or have you 

exercised this or dealt with the Postal Service on this? 

Mr. MAUSKAPF. We have done joint planning with the Postal 

Service in the National Capital Region under the Cities’ Readiness 

Initiative Program. It is the most efficient and effective means to 

get medications out to the citizens. The issue with delivering 

through the Postal Service is security. A requirement from the 

Postal Service’s unions is that they have an armed guard riding 

along with them if they are, in fact, delivering meds. 

During a pandemic or during any major event, you can imagine 

the requirements that are going to be levied upon law enforcement 

entities, so it is difficult to assure the Postal Service that we will 

be able to have an armed guard with each one of their mailmen 

and delivery vehicles. We have looked at mobilizing the Guard in 

the Commonwealth. We have looked at mobilizing the Department 

of Corrections. And we have worked with local law enforcement 

agencies. We agree that is a viable methodology. The issue is going 

to be whether or not we will be able to provide the law enforcement 

to support the union requirement. 

Senator AKAKA. Mr. Mauskapf, are there plans to provide the letter carriers—and you mentioned the guards—but do you have 

plans to provide letter carriers with police protection? 

Mr. MAUSKAPF. That is what I am saying, that is the issue, 

whether or not there is sufficient law enforcement or Guard or Department of Corrections armed guards to provide—the requirement 

is 1,100 when we modeled this. It is a requirement for 1,100 for 

the Virginia portion of the National Capital Region to handle all 

the routes, if they are doing two routes a day. They have to cease 

all mail delivery, do two routes a day of nothing but medications. 

So that is a requirement of 1,100 personnel that would be able to 

do that. Given the other requirements upon law enforcement at 

that time, that is going to be a tough nut to crack. 

So we are continuing to look at that, and one of the initiatives 

that we have studied is going to the Federal Government for the 

National Capital Region and requesting the assistance of Federal 

law enforcement agencies to support us in the event of doing this. 

That has not been developed any further than the idea level right 

now. 

Senator AKAKA. Thank you. The Federal Government is a huge 

partner in the NCR. I would like to hear from all of you on how 

OPM and local Federal Government agencies have been working 

with you on coordinating their pandemic response plans. Dr. 

Yeskey. 

Dr. YESKEY. At HHS, we have been working on our continuity of 

business, continuity of operations plans by trying to work through 

identifying our essential functions that we will need to carry out 

during a pandemic with a reduced workforce. We are also looking 

at identifying those critical personnel and those personnel who can 

work from home and then looking at the mechanisms by which we 

can enable them to work from home and carry out those functions. 

I can’t comment on the interactions with OPM since this continuity of business is handled outside of my office, but I can get 

that information for you for the record. 

Senator AKAKA. Thank you. Mr. Geldart. 

46 

Mr. GELDART. Yes, sir. As I mentioned earlier, and to lead off of 

what Dr. Yeskey just said, to tail onto that, the Federal employees 

that work within all of these departments and agencies are residents within this region, residents within the States somewhere 

within this region. So from that perspective as each of the States 

are doing their planning and localities are doing their planning, 

within that are the people that come to work here. However, the 

higher level of planning that needs to happen, and this is where 

Dr. Yeskey was going towards, is those critical mission areas, those 

things that the Federal Government must continue to do to function. 

From the Federal Reserve Board perspective, to give an example, 

the Federal Reserve pays us all and they also pay many State employees. That is part of their mission. That would need to continue. 

So as Dr. Yeskey says, each agency is looking in to see what are 

those employees that consist and make up that critical mission 

area, and then what is that continuity of business plan that we 

have as an agency to ensure that those folks are being addressed 

so that we can maintain those critical mission areas. 

As the individual departments and agencies come up with those 

plans, that is going to be needed to take a look at are they doing 

prophylaxis? Are they looking at doing the Tamiflu things that 

were mentioned before, and are those contracted or are those 

stored? Those kind of things obviously are going to be needed to be 

coordinated throughout the region. 

Senator AKAKA. Mr. Mauskapf. 

Mr. MAUSKAPF. We have done extensive work with the Federal 

Reserve Bank in Richmond, and as recently as 2 months ago the 

three of us met with the Federal Reserve Bank and the Board of 

Governors here in DC to discuss this very issue. We have got 

Memoranda of Understanding with each of our military bases, and 

when I talked about our antiviral distribution, I mentioned that we 

do it through the TRICARE clinics and military clinics assigned to 

them. 

As Mr. Geldart said, the Federal employees are residents of our 

communities and certainly we have planned for their coverage. The 

issue comes when we talk about continuity of government, continuity of operations planning and whether or not there are expectations for early delivery of medications, be they prophylaxis, 

antivirals, or flu vaccine when it becomes available. How is that 

going to be happening and what is the requirement? Identification 

of key personnel and the synergizing, if you will, of the Federal 

plans with our distribution and dispensing plan is key, and that 

has yet to happen with most of the agencies. 

Senator AKAKA. Thank you. Mr. Darnell. 

Mr. DARNELL. I would echo those comments and I think I would 

also add that we probably need, or not probably, in my opinion, we 

need more transparency in terms of OPM and what their plans are, 

under what conditions those plans will be implemented, and how 

we interact with that. Quite frankly, it would probably be nice just 

to get them to let us know when they are going to let people leave 

work early, as we are concerned, in the District of Columbia. 

So in this case, in particular, what telework plans do they have 

if they are going to allow people to work regular hours? Again, as 

47 

Mr. Geldart indicated, what are their mission-critical agencies or 

personnel that are going to continue to work, non-essential personnel who won’t be working? Those are shifting patterns that affect our transportation systems, that affect our businesses, all 

those different types of things. So we just need more transparency 

with the Federal Government on those types of things. 

Fortunately, I think we are headed in that right direction. As 

Mr. Mauskapf said, we met 2 months ago with the Federal Reserve 

Board Governors. We are actually, as the District of Columbia Government, we are going to be meeting with my counterparts at OPM 

and on Capitol Hill in the Legislative Branch to discuss some other 

issues and this will be one topic that we bring up, as well. 

Senator AKAKA. Thank you. Dr. Yeskey, the cost of treating patients infected with pandemic flu over time is going to be considerable, especially in light of the fact that 46.6 million Americans are 

without health insurance. Have you given any thought to the costs 

of care for those who do not have health insurance? 

Dr. YESKEY. Our overall strategy, again, is to try and keep people out of hospitals by preventing the transmission of disease. So 

part of our strategy is to minimize the number of people who are 

infected. 

With regard to the health care costs associated with the surge in 

patients who might seek hospital care, that is an area that is not 

covered within my office. But again, I would have to go back and 

talk to our CMS folks and try and provide you with an answer to 

that. 

Senator AKAKA. Well, thank you. Thank you very much, all of 

you. You have been helpful to the Subcommittee in dealing with 

the pandemic flu. I am impressed by the work that our witnesses 

have done, but it is clear that we need to do more to prepare for 

a potential pandemic flu outbreak in the National Capital Region. 

I look forward to continuing this discussion on preparedness and 

staying informed about what additional progress is being made. 

I want to thank you again for your responses. I appreciate you 

being with us today. The record will remain open for 1 week for 

any statements or additional questions Members may have. 

With that, this hearing is now adjourned. 

[Whereupon, at 11:30 a.m., the Subcommittee was adjourned.] 

(49) 

FORESTALLING THE COMING PANDEMIC: 

INFECTIOUS DISEASE SURVEILLANCE 

OVERSEAS 

THURSDAY, OCTOBER 4, 2007 

U.S. SENATE,

SUBCOMMITTEE ON OVERSIGHT OF GOVERNMENT

MANAGEMENT, THE FEDERAL WORKFORCE

AND THE DISTRICT OF COLUMBIA,

OF THE COMMITTEE ON HOMELAND SECURITY

AND GOVERNMENTAL AFFAIRS, 

Washington, DC. 

The Subcommittee met, pursuant to notice, at 2:32 p.m., in Room 

SD–342, Dirksen Senate Office Building, Hon. Daniel K. Akaka, 

Chairman of the Subcommittee, presiding. 

Present: Senators Akaka and Coburn. 

OPENING STATEMENT OF SENATOR AKAKA 

Senator AKAKA. I call this hearing to order. This is a hearing of 

the Subcommittee on Oversight of Government Management, the 

Federal Workforce, and the District of Columbia, and I call it to 

order. I want to welcome our guests and thank you very much for 

being here. 

This is the third in a series of hearings that my Subcommittee 

is holding to ensure that we are as well prepared as possible to 

handle the possible pandemic flu. Last week, we examined the role 

of the Federal Executive Boards in assisting in pandemic flu preparation, and earlier this week we examined National Capital Region 

efforts to prepare for such a public health emergency. 

Today’s hearing focuses on efforts to project our defenses beyond 

our borders. The Government Accountability Office will also be releasing a report today entitled ‘‘Global Health: U.S. Agencies Support Several Programs to Build Overseas Capacity for Infectious 

Disease Surveillance.’’ That report reviews several of the programs 

we will hear about during this hearing. 

The consensus among public health specialists is not if there will 

be another pandemic influenza outbreak in the United States, but 

when and if we will be prepared when it happens. A pandemic of 

avian influenza, the disease being most closely monitored by the 

public health community, as you know, could kill hundreds of millions of people throughout the world and alter the balance of power 

within and between nations. That is how huge it is. 

As we will hear from Colonel Erickson shortly, a 2001 National 

Intelligence Estimate concluded that emerging infectious diseases 

50 

are a global security issue, destabilizing countries and institutions, 

impacting economic growth, and obstructing trade. 

Experts agree that the way to reduce the impact of a pandemic 

disease is to identify, isolate, and treat it at the place it emerges. 

Similar to our efforts to turn back the threat of terrorism, it is better to defeat this enemy in its homeland and not in ours. 

The topic of our hearing today, global disease surveillance, seeks 

to do just that. By identifying and isolating diseases early and 

where they first appear, we can minimize the potential impact on 

the United States by preventing the spread beyond its original borders. If they do spread, the early information provided by surveillance systems allows us to be better positioned to take early steps 

to protect Americans. 

The last major flu pandemic to hit the United States was the 

1968–69 Hong Kong flu outbreak, which caused approximately 

34,000 deaths. Since then, we have become more vulnerable to dangerous diseases that move among countries. Increased international travel coupled with the impact of climate change, economic development, land use, and in some cases the breakdown of 

public health are all factors in the emergence of new and novel 

strains of disease that impact many countries. 

The rapid spread of severe acute respiratory syndrome in 2003 

demonstrated how a disease outbreak can pose a threat beyond the 

border of the country in which it originates. The impact of another 

severe pandemic flu outbreak could devastate the United States 

and, in particular, the U.S. economy. 

In a March 2007 report, the Trust for America’s Health estimated that a severe pandemic flu outbreak would cause a drop in 

the U.S. gross domestic product of roughly 4.25 percent to 6 percent. The Trust defines a ‘‘severe outbreak’’ as one that would 

make approximately 90 million Americans ill and cause roughly 

2.25 million deaths. An outbreak of this severity could almost certainly lead to a major economic recession. According to the Congressional Budget Office, a contraction of this size could cause the 

second worst recession in the United States since World War II. 

Hawaii has taken a lead in ensuring its residents and visitors 

are protected and prepared to respond swiftly to any pandemic disease outbreak. For example, Hawaii became the first State to 

screen incoming airline passengers on a voluntary basis. Health officials have stockpiled enough antiviral drugs to treat a minimum 

of 25 percent of the resident and visitor population. The Hawaii 

Department of health is developing a lab with the capability to test 

for avian flu and other flu strains. Hawaii has also established a 

Medical Reserve Corps to recruit volunteers to assist in a public 

health emergency. 

In March, the Hawaii Department of Health launched a public 

awareness campaign called ‘‘Share Aloha, Not Germs’’ to raise public awareness of pandemic threats and the steps everyone could 

take to minimize them. And this past July, Hawaii conducted the 

most ambitious pandemic flu exercise of its kind. The exercise, 

called ‘‘Operation Lightning Rescue,’’ involved a fictional commercial airplane carrying a number of suspected avian flu victims 

which crashed on Midway atoll while traveling from Jakarta to 

51 

Mexico City. The exercise trained local, State, and Federal officials 

in limiting the impact of a flu outbreak. 

It is widely accepted that the key to control of any pandemic outbreak is early identification and rapid response. The earlier a dangerous disease is identified and steps are taken to respond, the 

higher the probability that such interventions, including development of vaccinations can be successful. The global disease surveillance activities we will examine in this hearing can help forestall 

a potential pandemic by identifying those threats where they first 

emerge in other countries. 

While international travel and other factors have changed the 

way emerging disease spreads among nations, the nature of emerging disease itself has also changed. Now, more than ever, the majority of diseases capable of creating a pandemic have come from 

animals and spread to humans. We need only look at some of the 

most recent global health threats to find evidence of this trend. 

West Nile, HIV, SARS, and most recently, avian influenza, or bird 

flu, are all diseases that have originated in animals and then 

spread to humans to create global health emergencies. This means 

that we must not only monitor new human diseases, but also those 

that arise in all types of animals. 

Emergence of the West Nile virus in 1999 in New York City is 

a clear example of the value of bringing the human health and animal health communities together. At first, the public health community was focused on reports of elderly people coming down with 

similar symptoms, but when flamingos and black crows began 

dying at the Bronx Zoo around the same time, a veterinary pathologist there, Dr. Tracey McNamara, made the connection between 

the sick birds and the sick people. Her analysis provided the breakthrough in diagnosing West Nile virus, a disease that had never before been seen in the Western hemisphere. 

Having just observed National Preparedness Month, I can think 

of no more important issue than situational awareness, an essential element of homeland security. Situational awareness must include being aware of emerging infectious diseases before they devastate our communities. 

So I look forward to hearing from all of our witnesses about their 

work in contributing to our awareness of those potential threats to 

our homeland. Again, I want to thank our witnesses for being here 

today to discuss this important issue. And I want to welcome the 

witnesses to this Subcommittee today: Dr. Ray Arthur, Director of 

the Global Disease Detection Operations Center at the Centers for 

Disease Control and Prevention at HHS; Dr. Kimothy Smith, Director of the National Biosurveillance Integration Center at the Department of Homeland Security; Colonel Ralph Erickson, Director 

of the Department of Defense Global Emerging Infections System 

at Walter Reed Army Institute of Research; Dr. Kent Hill, Administrator for Health at the U.S. Agency for International Development; and David Gootnick, International Affairs and Trade, U.S. 

Government Accountability Office. 

I want our witnesses to know that it is the custom of the Subcommittee is to swear all witnesses, and I would like to ask all of 

you to stand and raise your right hand. Do you solemnly swear 

that the testimony you are about to give this Subcommittee is the 

52 

1The prepared statement of Mr. Gootnick appears in the Appendix on page 184. 

truth, the whole truth, and nothing but the truth, so help you, 

God? 

Mr. GOOTNICK. I do. 

Mr. ARTHUR. I do. 

Mr. SMITH. I do. 

Colonel ERICKSON. I do. 

Mr. HILL. I do. 

Senator AKAKA. Thank you. Let it be noted for the record that 

the witnesses answered in the affirmative 

Before we start, I want you to know that your full written statements will be part of the record. I also would like to remind you 

to keep your remarks brief, given the number of people testifying 

this afternoon. 

So, again, we appreciate your being here. Thank you for being 

here, and I will ask Mr. Gootnick to begin. 

TESTIMONY OF DAVID GOOTNICK,1 DIRECTOR, INTERNATIONAL AFFAIRS AND TRADE, U.S. GOVERNMENT ACCOUNTABILITY OFFICE 

Mr. GOOTNICK. Thank you very much, Mr. Chairman. 

Mr. Chairman, I am pleased to discuss GAO’s recent review of 

U.S. programs to build overseas capacity for infectious disease surveillance. As you have well stated, Mr. Chairman, H5N1 influenza 

in birds has the potential to evolve to a disease transmitted from 

person to person, setting the stage for a human flu pandemic. 

As you said earlier, SARS in Asia demonstrated, amongst other 

things, that international response to an outbreak is dependent on 

cooperation from affected countries, and West Nile virus highlighted the need for improved links between human and animal 

surveillance. 

In this environment, the United States has a key interest in 

building capacity within developing nations to identify and respond 

to outbreaks of infectious diseases. Building and sustaining this capacity poses considerable challenges, including shortages of trained 

personnel, limited lab capability, and weak or deteriorating infrastructure, including facilities, roads, and communications, in the 

overseas environment. 

In this context, you asked GAO to report on: One, the key U.S. 

programs that build capacity for infectious disease surveillance 

within developing nations; and, two, agencies’ efforts to monitor the 

progress of these programs. 

We identified a set of activities generally embedded in larger programs that also conduct research, support outbreak investigations, 

link with larger networks, and, in the case of DOD, enhance readiness and force protection. In addition, even these programs which 

we have reviewed exist in a larger context that includes diseasespecific surveillance, such as vertical systems for HIV, polio, and, 

increasingly, avian influenza. 

From 2004 to 2006, CDC, USAID, and DOD obligated about $84 

million to capacity-building efforts. CDC’s GDD Initiative is establishing centers of excellence overseas that, amongst other things, 

strengthen labs, develop active surveillance systems, and train 

53 

local health workers. CDC and AID together support 2-year field 

epidemiology training programs in 24 countries. These programs 

have trained over 350 epidemiologists and lab professionals. For 

example, CDC’s Central American program reports that it has 

trained, placed, and supported 58 master’s level epidemiologists 

and provided field-based training to a larger cadre of health workers at local levels. AID and CDC also provide technical assistance 

and training to African nations to integrate disease-specific surveillance systems and prepare to meet the broadened national requirements of recognition and response as established by the revised 

international health regulations. 

DOD, through its GEIS program, has funded more than 60 

small-scale projects for surveillance and capacity building, again, 

within their larger mission of readiness and force protection. For 

example, in parts of Southeast Asia, GEIS has disseminated a 

syndromic surveillance system designed for resource-poor settings. 

Finally, AID independently funds a number of activities to, for 

example, build capacity and develop tools for monitoring and evaluation. 

Regarding coordination, we found that CDC and AID through cooperative agreements, joint funding, and staff details frequently 

work in partnership. DOD and CDC report that collocation of major 

operational centers, for example, in Kenya and Egypt, facilitates 

communication. 

In a study released this week, the Institute of Medicine observed 

that collaboration between CDC and DOD is critical to ensure the 

most effective use of resources targeting avian influenza. The IOM 

recommended, amongst other things, that DOD further strengthen 

this critical linkage for emerging infectious diseases. 

Individual programs monitor activities, such as the number of 

trained individuals and the number of outbreak investigations conducted by their trainees. They recently began efforts to evaluate 

the larger impact of these programs, but have yet to report results. 

Evaluating these programs will be challenging for a number of reasons. 

First, capacity efforts are generally collaborations within a host 

country health ministry, making impact of a program difficult to 

isolate. 

Second, data quality and competing priorities may complicate efforts to evaluate programs. 

And, finally, demonstrating program impact is very difficult in 

the complex and changing environment in which these programs 

operate. 

In closing, Mr. Chairman, a number of activities are underway. 

However, outside of the vertically oriented disease-specific systems, 

support for broadly targeted assistance to build capacity for infectious disease surveillance has been limited. Numerous studies and 

experts have noted that investment in these programs is small 

compared to the risks of emerging infectious diseases and the challenges associated with sustained preparation and effective response. 

Mr. Chairman, this concludes my statement. I am happy to answer your questions. 

Senator AKAKA. Thank you very much, Mr. Gootnick. 

54 

1The prepared statement of Mr. Arthur with attachments appears in the Appendix on page 

203. 

Now we will hear from Dr. Arthur. 

TESTIMONY OF RAY ARTHUR, PH.D.,1 DIRECTOR, GLOBAL DISEASE DETECTION OPERATIONS CENTER, CENTERS FOR DISEASE CONTROL AND PREVENTION, U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES 

Mr. ARTHUR. Good afternoon, Chairman Akaka. My name is Dr. 

Ray Arthur, Director of CDC’s Global Disease Detection Operations 

Center. I have 15 years of specialized experience in detecting and 

responding to global disease outbreaks, including 6 years at the 

World Health Organization and 5 years at the DOD Medical Research Unit in Cairo, Egypt. I am pleased to discuss CDC’s global 

health investments that build capacity for disease detection and response. 

CDC has approximately 200 staff assigned to 50 countries 

throughout the world and supports an additional 1,200 locally employed staff in these countries. As you have indicated, SARS demonstrated that a highly infectious disease can quickly spread 

around the world. In 2004, recognizing this, the U.S. Congress provided funding for CDC to establish the Global Disease Detection 

Program. The GDD program built on CDC’s health strengths and 

brought together three established programs: The Field Epidemiology Training Program that was just mentioned, which provides 

training on the investigation and control of outbreaks; the International Emerging Infections Program, which integrates disease 

surveillance, research, and prevention and control activities; and, 

third, influenza activities, including the development of surveillance capacity. 

In addition, the GDD Program coordinates with other global 

health programs at CDC, such as HIV/AIDS, polio, and measles, to 

leverage resources that contribute to outbreak detection and response. As an example of this capacity, one of the first places to 

identify the SARS coronavirus was a global polio network laboratory in China. 

Earlier this year, staff from the CDC Global AIDS Program in 

Nigeria, played a critical role in the diagnosis of the first human 

case of avian influenza in Sub-Saharan Africa. The GDD Program 

then utilized its regional resources to deploy staff and continue the 

response activities. 

The central focus of the GDD Program is the establishment and 

expansion of the GDD Centers mentioned by Mr. Gootnick. Strategically positioned around the world, these centers focus on five activities in key areas: Outbreak response, surveillance, training— 

both epidemiology and laboratory—research, and networking. CDC 

currently operates five centers—two mature centers in Thailand 

and Kenya, and three developing centers in Guatemala, China, and 

Egypt. 

The GDD Operations Center serves as CDC’s central coordination point for international outbreak information. Information is 

collected from many sources, including GDD centers, other CDC 

programs, WHO, DOD, USDA, USAID, Homeland Security, the 

55 

State Department, and Georgetown University’s Project Argus, 

among others. CDC scientists analyze the information, determine 

the public health threat, and guide the appropriate level of response. 

For example, CDC and other international partners are currently 

responding to an outbreak of Ebola in the Democratic Republic of 

Congo, DRC. In Collaboration with Argus, CDC began tracking reports of unexplained illness in DRC in late August and alerted 

WHO and other partners once this was determined to be a significant health threat. CDC has deployed a physician to provide an assessment of the situation and, with support from the CDC Global 

AIDS Program in Kinshasa, to guide a larger response. Shortly 

thereafter, on September 10, a CDC lab confirmed Ebola. CDC then 

deployed a response team comprised of nine scientists, and we continue to work closely with the Ministry of Health, WHO, and other 

partners to stop this outbreak. 

During 2006, the GDD centers collectively responded to more 

than 144 disease outbreaks, including avian influenza, hemorrhagic 

fevers, meningitis, cholera, plague, and unexplained sudden death. 

CDC currently considers influenza to be the most urgent threat to 

human health. Bilaterally, and globally through WHO, CDC is providing support to over 40 countries to advance the capacity to detect influenza viruses with pandemic potential. CDC is one of four 

WHO collaborating centers for influenza. As such, CDC serves as 

a global resource and reference center for the WHO Influenza Surveillance Network. Between 2003 and 2007, CDC received 1,445 

suspect avian influenza specimens through this system, of which 

508 were positive, and also received nearly 20,000 non-avian influenza viruses through this network. 

In addition, CDC has conducted numerous training programs to 

prepare rapid response teams in Africa, Asia, and Latin America. 

Since 2003, CDC has responded in two and helped contain many 

outbreaks of avian influenza globally, and all responses were initiated within the target goal of 48 hours. 

CDC looks forward to continued collaboration with our partners 

to implement additional activities that will further enhance capacity. 

This concludes my testimony, and I would be pleased to answer 

any questions you may have. 

Senator AKAKA. Thank you very much, Dr. Arthur. 

At this time, before I call on Dr. Smith, we are glad to have Senator Coburn here. 

OPENING STATEMENT OF SENATOR COBURN 

Senator COBURN. Thank you, Mr. Chairman. 

Senator AKAKA. Do you have a statement you would like to 

make? 

Senator COBURN. No. I may put a statement in the record. Thank 

you, sir. 

Senator AKAKA. Thank you, Senator. 

Dr. Smith, will you please proceed with your testimony? 

56 

1The prepared statement of Mr. Smith appears in the Appendix on page 220. 

TESTIMONY OF KIMOTHY SMITH, D.V.M., PH.D.,1 ACTING DIRECTOR, NATIONAL BIOSURVEILLANCE INTEGRATION CENTER, CHIEF SCIENTIST, OFFICE OF HEALTH AFFAIRS U.S. 

DEPARTMENT OF HOMELAND SECURITY 

Mr. SMITH. Certainly. Thank you, sir. Mr. Chairman, Members 

of the Subcommittee, I am Dr. Kimothy Smith, Acting Director of 

the National Biosurveillance Integration Center for the Department of Homeland Security. I appreciate this opportunity to discuss with you today the advances in the program and particularly 

the incorporation of global biosurveillance data and wild animal information into our biosurveillance products. 

Our mission to leverage and integrate existing biosurveillance capabilities to provide early recognition of biological events of potential national significance was mandated initially by Homeland Security Presidential Directives 9 and 10. Additionally, the newly 

signed Public Law 110–53 further codifies our cross-domain, integrative biosurveillance mission and gives us clear guidance for our 

efforts. 

Today I will provide a continuing vision for the NBIC, highlight 

for you the advances we have made, and provide you with the current status of the program. Additionally, I will address our integration and interface with sources of global biosurveillance and wild 

animal biosurveillance information. Last, I will mention the challenges that remain before us in this effort and my view for onward 

movement towards meeting the mandates the country has lain before us. 

It is essential that I convey to you that NBIC is more than an 

information technology solution to the Nation’s integrated biosurveillance challenge and is unique in both mission and breadth. 

The heart of the NBIC, though, is relationships between people and 

the agencies and organizations they represent. These are relationships vital to obtain access to the valuable, often sensitive, and 

sometimes classified information collected and used by the NBIC 

partners. NBIC does have and will continue to pursue relationships 

with personnel from a wide variety of Federal agencies and other 

relevant entities. We are developing relationships with various 

State intelligence fusion centers and with entities such as Georgetown University’s Argus Project, which will be represented here 

today. 

As for where we stand today, it should be noted that our center 

is operational today. Though not at its full operational capabilities, 

we have had a 24-hour-a-day, 7-days-a-week national biosurveillance watch desk up and working since December 2005, responding 

to real-world events. Facilities have been acquired and personnel 

requirements have been finalized, with two-thirds of our personnel 

requirements filled to date. Six significant Federal partners have 

already signed memorandums of understanding for mission support 

and integration with five others in an effort to best determine their 

abilities to contribute. 

Interagency agreements and memorandums of agreement have 

also been developed for the integration of subject matter experts 

from both the Center for Disease Control and Prevention and the 

57 

1The prepared statement of Colonel Erickson appears in the Appendix on page 228. 

Armed Forces Medical Intelligence Center. These are just some of 

the significant advances I would like to highlight for you that our 

program has. 

Currently, the acquisition process for our biosurveillance program is based on monitoring sources for significant information to 

be used in product development for dissemination to decisionmakers and key stakeholders, and includes information that is 

global in scope. Key sources in use include government agency reports and open-source information, such as Argus, the Office International des Epizooties, or OIE; the Centers for Disease Control 

and Poverty Global Disease Detection Program—Ray Arthur sitting 

next to me; the World Health Organization; and the Department of 

Defense GEIS program, whom you will hear from in a moment, 

among others. 

Another important function of NBIC is the integration of wildlife 

biosurveillance information as a potential key early indicator of bioevents. Government organizations like the Department of Interior, 

the Department of Agriculture, and the U.S. Geological Survey, 

along with such information networks such as the Global Avian Influenza Network for Surveillance (GAINS), that receives support 

from my colleagues here from USAID as well as CDC, as well as 

the International Species Information System/Zoological Information Management System (ISIS/ZIMS), all play a key role in monitoring and reporting what could be very early indicators of a significant bioevent by way of our wildlife. 

To this end, we have clear interest in and intend on supporting, 

where possible, the ISIS/ZIMS efforts, as well as deepening our relationship with our GAINS colleagues for enhanced information 

sharing beneficial to the broader biosurveillance community. 

Mr. Chairman and Members of the Subcommittee, as with any 

maturing program there are challenges. While continuing to move 

forward to meeting our goals, we are cognizant to keep a heads-up 

posture and maintain a broad vision with realistic assessment of 

the biosurveillance mission to assure success. We can achieve success in this critical mission with your support and that of our interagency partners and the members of the biosurveillance community, such as those testifying here today. 

Thank you for your time, and I look forward to your questions. 

Senator AKAKA. Thank you very much, Dr. Smith. 

And now we will hear from Colonel Erickson. Will you please 

proceed? 

TESTIMONY OF COLONEL RALPH L. ERICKSON, M.D., DrPH.,1

DIRECTOR, DEPARTMENT OF DEFENSE GLOBAL EMERGING 

INFECTIONS SURVEILLANCE AND RESPONSE SYSTEM (DODGEIS), U.S. DEPARTMENT OF DEFENSE 

Colonel ERICKSON. Mr. Chairman. Senator Coburn, Members of 

the Subcommittee, thank you for inviting me to speak with you 

today. I am Colonel Ralph Erickson, Director of the DOD Global 

Emerging Infections Surveillance and Response System, a program 

which is abbreviated DOD-GEIS. 

58 

The DOD-GEIS was created in 1996 by a Presidential Decision 

Directive that expanded the role of the DOD to address threats to 

our Nation and others posed by emerging and re-emerging infectious diseases. 

DOD-GEIS has four goals, of which the first, surveillance and detection, is the primary area of concentration. Anchored by five robust overseas laboratories in Thailand, Indonesia, Kenya, Egypt, 

and Peru, the DOD-GEIS team operated in 77 different countries 

worldwide in fiscal year 2006 and fiscal year 2007. 

Our efforts to improve outbreak detection including electronic 

surveillance systems which apply computer and information technology in places with very few resources. These systems are currently operational in Indonesia, Laos, and Peru. Other recent accomplishments of DOD-GEIS are these: 

Our Rift Valley Fever risk prediction project provided us warning 

of the Rift Valley Fever epidemic in East Africa in September 2006, 

2 months before the outbreak began. The Navy’s lab in Cairo, 

Egypt, responded to influenza outbreaks in Iraq and Afghanistan. 

Not surprisingly, this same lab has become the WHO influenza regional reference laboratory for the Eastern Mediterranean region 

and is working in many countries in the Middle East and Central 

Asia. In all, DOD-GEIS partners are currently collecting influenza 

isolates at 273 distinct sites in 56 different countries. DOD-GEIS 

works closely with other U.S. Federal agencies who are also engaged in the surveillance of infectious diseases. Of note is the 

CDC–DOD Working Group. 

To further enhance our integration of DOD-GEIS surveillance efforts globally, we have a military medical officer assigned to the 

World Health Organization in Geneva, Switzerland. Our DODGEIS network is replete with talented physicians, veterinarians, 

entomologists, and laboratory professionals drawn from all of the 

Uniformed Services where the culture of One-Health/One-Medicine 

is already well established. 

As an example of this, since 2003, the Navy’s lab in Cairo, Egypt, 

and the Army’s lab in Nairobi, Kenya, have worked with the Centers for Disease Control and Prevention and host Nation regional 

partners to collect wild bird surveillance samples to detect circulating strains of avian influenza virus. Incidentally, our Navy lab 

in Egypt was the first to detect, diagnose, and confirm highly pathogenic avian influence, H5N1, in poultry in Afghanistan, Djibouti, 

Egypt, Iraq, Jordan, and Kazakhstan. 

In conclusion, the Institute of Medicine, in a review of DODGEIS, described it as ‘‘a critical and unique resource of the United 

States in the context of global affairs.’’ It is the only U.S. entity 

that is devoted to infectious diseases globally and that has broadbased laboratory capacities in overseas settings. 

Again, Chairman Akaka, Senator Coburn, Members of the Subcommittee, thank you for this opportunity to present to you today. 

Thank you particularly for taking this issue of emerging infectious 

diseases so seriously. 

I would be happy to answer any questions which you might have 

at this time. Thank you. 

Senator AKAKA. Thank you very much, Colonel. Now we will 

hear from Dr. Hill. 

59 

1The prepared statement of Mr. Hill appears in the Appendix on page 238. 

TESTIMONY OF KENT R. HILL, PH.D.,1 ASSISTANT ADMINISTRATOR FOR GLOBAL HEALTH, U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT 

Mr. HILL. Senator Akaka, Senator Coburn, thank you so much 

for convening this important hearing and inviting us to participate, 

and it is a privilege to be here with my colleagues from the other 

agencies with whom we work so closely on many of these issues. 

My comments will focus on the work and vision of USAID, and 

I would first like to note that our programs strengthen surveillance 

systems by building developing country capacity to detect newly 

emerging diseases. Second, our programs focus on fully implementing both arms of the surveillance loop, that is, early detection 

and rapid and effective response. Third, recognizing the increased 

threat of diseases of animal origin, our programs are fostering critical links between human and veterinary public health. And, finally, interagency collaboration is absolutely vital to our work and 

the work of the USG to deal with these issues. 

Diseases are not only significant public health threats, as has 

been noted; they jeopardize international commerce, development, 

and security. The estimates of the cost of SARS to the global economy is between $30 and $100 billion. As has been mentioned, the 

potential impact of an influenza pandemic similar to that of 1918 

could take the lives of 50 to 100 million people and devastate the 

global economy for years. 

Such outbreaks are capable of destabilizing governments. They 

increase the threat of international terrorism. In short, anything 

we do abroad to affect this affects the national security of this 

country. 

USAID is in a critical position to help countries develop these capacities and has taken on this challenge through several of our programs targeting health system surveillance capacity. The GAO report released today captures some of the central efforts, such as 

our support for Field Epidemiology Training Programs and WHO’s 

Integrated Disease Surveillance and Response (IDSR). 

But in addition, I would like to mention that important contributions are also being made by our disease-specific programs. For example, since the mid-1980s, about $290 million has been expended 

by USAID on polio surveillance in approximately 40 countries, and 

as mentioned here already, some of those labs work on other diseases besides polio. They have impact elsewhere. One hundred and 

forty-eight national and regional polio laboratories and hundreds of 

medical surveillance officers have been trained. 

But we also do work in tuberculosis and in HIV/AIDS and malaria. Although these are disease-specific initiatives, anytime you 

improve surveillance for specific diseases, you improve the capacity 

to detect and respond to other diseases. We have programmed $345 

million to limit the spread of avian influenza and to prepare for a 

possible pandemic, and this is very important. 

USAID and HHS and CDC are working together to support the 

African Field Epidemiology Network. USAID and CDC are also 

jointly developing a Field Epidemiology and Laboratory training 

Program in Nigeria that will be the first in Africa to integrate vetVerDate Aug 31 2005 08:37 Aug 20, 2008 Jkt 038845 PO 00000 Frm 00067 Fmt 6601 Sfmt 6601 P:\DOCS\38846.TXT SAFFAIRS PsN: PAT
60 

erinary, laboratory, and field epidemiology training. We work with 

the military, obviously, on NAMRU in a variety of places. In fact, 

it is an excellent example of interagency coordination, with the surveillance work represented by the people before you today. 

We work with important NGOs, such as the Wildlife Conservation Society, through whom we have helped to establish the Wild 

Bird Global Avian Influenza Network for Surveillance, which is 

also called GAINS and is tracking influenza in wild birds worldwide. 

One of the most important lessons in human health of the last 

30 years is the fact that the human population is facing an increasing risk from infectious diseases of animal origin. Of all the pathogens that infect humans, about two-thirds originated in animals— 

a sure sign that this has to be a focus of our work. 

Several recent outbreaks of zoonotic diseases demonstrate that 

our investments really make sense. It was mentioned already this 

afternoon that in Eastern Africa, specifically, Tanzania, the response to a Rift Valley Fever outbreak this year could not have 

happened apart from work that was done on other topics, such as 

on avian influenza, which brought the Ministry of Health together 

with other ministries—the Ministry of Agriculture—in a way that 

they had not coordinated before. It helped them to early diagnose 

and respond to the outbreak. 

Finally, let me just note that in the future what we need to do 

more of is study how we can scale up and more effectively work together. We have commissioned the Institute of Medicine at the National Academy of Sciences to convene an expert consensus committee to consider the challenge of achieving sustainable global capacity for surveillance and response to emerging zoonotic diseases. 

A full report will be released in 2008, and I anticipate the finding 

will guide programming for zoonotic diseases and enable us to be 

better prepared to make a difference in the future. 

Thank you very much, Mr. Chairman. 

Senator AKAKA. Thank you very much, Dr. Hill, for your testimony. 

Dr. Arthur, despite our efforts to control emerging threats at the 

source, I understand that vaccine production can lead to the creation of even more dangerous forms of these diseases. China has 

an active vaccine research program for bird flu. They also vaccinated their chickens. 

Is there any indication that China’s vaccination research and 

vaccination of poultry contributes to continued mutations of the 

bird flu virus? 

Mr. ARTHUR. Thank you for your question, Mr. Chairman. The 

use of animal vaccines is a little bit out of my scope of expertise. 

I would consult with some of the many veterinarians and the influenza specialists that we have in Atlanta and be glad to provide 

that additional information for the record. 

Senator AKAKA. Well, thank you for that, Dr. Arthur. 

The global disease surveillance and capacity-building programs 

we are discussing today have been around for several years. I am 

concerned that you are just beginning to evaluate the impact of 

these surveillance programs. Why has this taken so long? Dr. Hill. 

61 

Mr. HILL. Some of the programs that the GAO report noted are 

new and have not yet been evaluated. Some of the other programs, 

however, are much older, the polio programs, and our work in 

other diseases, which have been operating long enough that we 

have been able to do empirical studies to see if we have had an impact. 

For example, the evidence on the number of polio cases is pretty 

startling. There were hundreds of thousands of cases in the late 

1980s, compared to less than two thousand in 2006. So we know 

that the surveillance and the response to polio is working. 

Even influenza is an interesting case. It is also very new. But we 

can tell that in places like Vietnam and other places in the region 

that what we are doing is making a difference. But we acknowledge 

that the fuller-scale evaluation is simply going to take a little time. 

The United States is very disciplined about its reporting to Congress. We need to be able to promote results to make a difference. 

Senator Coburn has been a fierce fighter for being able to show 

results in malaria. If you compare what we were doing a few years 

ago on malaria prevention and surveillance with now, the results 

are very encouraging. So when we put our minds to it, we can do 

a good job. 

Senator AKAKA. Dr. Arthur. 

Mr. ARTHUR. You are correct, some of the programs have been 

in existence for several years. The GDD Program attempts to bring 

these together so that the sum of the program itself is more than 

the individual parts, and to develop a long-term strategy to enhance the capabilities of all the programs. 

Also, by having the GDD Program and these three programs already mentioned as a part of those, it increases our accountability, 

and we are able to develop monitoring and evaluation systems to 

assess the progress of these programs. As was mentioned by Mr. 

Gootnick, the evaluation was done for 2006. We now have that 

baseline. We will be starting our evaluation of 2007 activities in 

December, and we will be glad to share the findings of those with 

you early in 2008. 

Senator AKAKA. Thank you. 

Colonel Erickson, what has DOD done to evaluate the impact of 

GEIS for host countries? 

Colonel ERICKSON. Mr. Chairman, we have learned a lot from our 

colleagues, especially some of those that are at the table, as to the 

proper ways to evaluate surveillance systems. In fact, there is one 

particular reference which we hold to which was published in 1988 

and then republished in 2001, which actually sets forth the standards for evaluating a surveillance system, and I can get that for 

you. But it has some very practical advice in it. Is the system actually doing what it is called to do? Are the expectations being met? 

Is it sufficiently sensitive? Is it timely to be able to report back, 

etc.? Is it well accepted? In the case of our work, well acceptance 

would not be just the military but the host country, the community, 

the location at which the surveillance is going on. 

In practice, the way we evaluate our programs, we have regular 

reporting requirements from our GEIS partners, which is something that we look at very closely, monthly reporting, quarterly, 

and annual reporting. In addition, we make field sites. I can tell 

62 

you that in my first year as the Director of GEIS, I visited all five 

overseas labs to conduct personally that very type of investigation 

and inspection. 

In addition, we have outside external reviews which go on. In 

2001, the Institute of Medicine published a book which you may be 

familiar with, which evaluated all of GEIS, and as Mr. Gootnick in 

his opening comments made mention to, the Institute of Medicine 

has just finished a new evaluation of our influenza surveillance 

programs. The pre-publication meeting for that was just this last 

week, and we are expecting that to hit publication in the next 

month, and I would be more than happy to make sure that you get 

copies of that. 

Senator AKAKA. Thank you very much. At this time I would like 

to call on Senator Coburn for his questions. 

Senator COBURN. Thank you, Mr. Chairman. 

I have read the GAO report. How often do you all drill together— 

in other words, create a scenario that is not true but respond to 

it in a coordinated fashion? Anybody want to answer that? 

Mr. HILL. I would mention that we are in the process of putting 

together a tabletop simulation—and tomorrow, in fact, I have a 

meeting with the group that is designing the simulation. We will 

be working with the same folks who put together for CDC, in Atlanta, a series of tabletop exercises on avian influenza. We are 

going to do it within the next few weeks here in Washington at the 

Assistant Secretary of State and Assistant Administrator of USAID 

level. And we are putting the final touches on that to work specifically on the avian influenza. That is the most recent one I know 

of related to this sort of activity. 

Senator COBURN. And that will include all the rest of the gentlemen at this table? 

Mr. HILL. Yes, I think it will include all the agencies and departments represented at the table. 

Senator COBURN. OK. But we have not done that yet, right? We 

have not said, ‘‘here is a scenario, a false scenario, we have generated some type of practice, so that if we see another SARS or we 

see H5N1, do we know what we are doing and that it is going to 

coordinate?’’ 

Mr. HILL. We actually are modeling this in part on what CDC 

has done several times already related to avian influenza, but we 

are bringing it to Washington to work on the agencies that are 

here. 

Senator COBURN. OK. Do your IT systems communicate between 

the different agencies—DHS, CDC, USAID, Department of Army? 

Do you all have effective communication of your data links? 

Mr. SMITH. Sir, I find that an excellent question. I really do. And 

I am going to be the first one up to the plate here to say that, looking toward the future, I think that they absolutely must. I find that 

Health and Human Services and the Centers for Disease Control 

are taking the lead with the Office of National Coordination and 

with the National Center for Public Health Informatics, and setting 

a standard for a Federal health architecture, setting a standard for 

the National Health Information Exchange. We, at the Department 

of Homeland Security, are involved in those activities and making 

sure and certain that our IT systems that are involved, particularly 

63 

with biosurveillance, are compliant and will be able to exchange information. 

Senator COBURN. So, in other words, the answer to the question 

is the biosurveillance data now are not compatible from agency to 

agency. 

Mr. SMITH. Sir, I would not say that is true across the board. 

Senator COBURN. Well, but it is not totally compatible so that the 

data you have and the analysis you have are available to all the 

other groups that we are depending on for biosurveillance. 

Mr. SMITH. I would have to say that across the board that is correct, sir. 

Senator COBURN. DHS is really at the center of this. Do you all 

have a program that coordinates right now the integration of data? 

Or is that what you were speaking to, you are developing that and 

planning on having that, but you do not have a coordinated, integrated program right now so that everything could feed to DHS? 

Mr. SMITH. Sir, that is correct. That is what we are in the process of developing now. 

Mr. HILL. But, Senator, I should probably mention that the 

agreement between CDC, HHS, USAID, and others has been to facilitate WHO as the center for collecting much of this information 

with respect to our international programs. And so there has been 

a lot of work that has been put into making sure that systems are 

in place, that we will flow through WHO a lot of this information. 

So there is an attempt—— 

Senator COBURN. OK. Well, that is great. So we do have one 

place. Do you all have access to all the data that flow into WHO? 

Mr. HILL. As far as I know, the information we share, the whole 

point of that is information—— 

Senator COBURN. To get a coordinated response. 

Mr. HILL. Right. 

Senator COBURN. But does every other group on this panel have 

access to that information, that we have shared in total? 

Mr. HILL. The international health regulations, which WHO has 

been working on and we are trying to get as many countries involved in as possible, the whole requirement of that is that people 

get the information or countries get the information to WHO. The 

expectation or the requirement is that WHO get it back to the rest 

of the globe in the appropriate way so that the information is useful. Whether all the countries are—— 

Senator COBURN. Well, I am not really concerned about the rest 

of the countries. I am concerned about what we are doing and what 

we are collecting and what we are trying to create in terms of surveillance capability outside of this country. Do we have the IT capability to know what that is if we put it in and—I know we are 

building that at DHS, but what we give up and goes to a centralized collection point, does everybody have access to that now? 

For example, if your computers cannot talk to DHS but you both 

can talk to WHO, can Dr. Smith get the information that you have 

computed to WHO and bring it back to DHS? 

Mr. HILL. I would need to get an authoritative answer on that, 

but I believe the answer would be yes. I think anything that we 

could communicate to WHO we would certainly be able to communicate to each other. 

64 

Senator COBURN. Should we have had WHO representatives here 

today, especially our delegates to WHO? And could we maybe ask 

them some questions on the basis of what we are finding here 

today and get their input, because that would have been probably 

helpful to see what their input is since they know what that is. 

Colonel ERICKSON. Senator Coburn. 

Senator COBURN. Yes, sir. 

Colonel ERICKSON. If I could just weigh in, in terms of more perhaps pedestrian IMIT capabilities, we use computers and e-mail 

and push data, use VTCs, telephones, etc. DOD has a very close 

working relationship with CDC to the point where we are sharing 

reports, we are sharing isolates. We, in fact, use them as sort of 

our Supreme Court where we send those isolates for further confirmation and for selection of isolates for, for instance, vaccine development. 

Within the WHO, as I mentioned in my earlier comment, we 

have a military medical officer who is assigned there full time who 

provides that link to much of that information. In addition, we are 

a member of the Global Outbreak Alert Response Network 

(GOARN), which also provides a forum for getting that information 

out to the different agencies, many of those represented here. 

And so there are good systems in place. We can do better, certainly, that you are alluding to, but I would not want to leave you 

with the impression that we are not—— 

Senator COBURN. I know you have the capability to communicate, 

but the problem we have across the government is we have 

stovepiped IT programs that very much limit the capability of accessing people who need to know and can utilize the information 

that is easy. 

Colonel ERICKSON. Sure. 

Senator COBURN. And that is one of the goals. We spend $65 billion a year in this country on new IT programs, of which $20 billion gets wasted every year. And so this is an important area. If 

we are going to allow you to be more efficient and functioning better, what we have to do is make sure that everybody’s goal is to 

eventually get to where we can talk to one another through our 

computers, analyzing data, so we do not have to buy new programs 

so that one computer can talk to another computer. That was the 

purpose for the question. 

The GAO identified several weaknesses within DHS. One was 

there has not been consistent leadership at DHS for this program, 

and that is probably a legitimate criticism, and that is no reflection 

on you whatsoever. 

Does DHS have a plan with metrics and milestones for addressing the weaknesses that GAO identified in their report? 

Mr. SMITH. Yes, sir, we do. 

Senator COBURN. And is that plan available to this Subcommittee? 

Mr. SMITH. Certainly it will be. 

Senator COBURN. OK. Well, I would very much appreciate a copy 

of that. 

I just have one other comment, Mr. Chairman, and then I have 

to go to the floor to offer some of my dreaded earmark amendments 

65 

so that we can get money to run the government instead of run the 

politicians. 

I think back to the SARS outbreak. We did not get a handle on 

that until we stopped commerce. Under the threat of the stop of 

commerce did we get compliance. And our goal has to be to get 

where we do not have to go to that level. And I know that is what 

the goal is in terms of trying to build surveillance teams and everything else. 

Would any of you care to comment on how we could have done 

that better and not wasted the time where we finally had WHO 

issue a travel ban to get compliance out of a foreign country who 

at first was denying that there was an epidemic—in other words, 

what it did is more people died because of the denial that there 

was a problem. What can we do as America—we cannot imfringe 

on the sovereignty of other countries, but can we work better and 

can we bring to bear forces sooner so that we get the proper reaction? And I am talking all types of leverage—suspension of aid, all 

these other things—to get people, when they have the resources 

and know how to do it, to actually report it. Any comments? Yes, 

sir, Dr. Arthur. 

Mr. ARTHUR. That is exactly the intent of the International 

Health Regulations, which came into force for the United States in 

July of this year. There had been a 10-year process to revise those 

regulations and move away from a list of three diseases to a concept of identifying a particular health threat so that it would account for new entities such as SARS or the next unknown disease 

that may occur. 

Senator COBURN. And in your position at CDC, do you feel pretty 

comfortable that we are going to see—because of the new regulations, we are going to see much greater coordination because of 

those? 

Mr. ARTHUR. I think the international political pressure will increase dramatically since under the new International Health Regulations, WHO could have gone to China in December when I was 

in Geneva and first knew about these reports several months before it became publicly known—this was in 2002—go to China 

under the new International Health Regulations and say, look, another member state has reported that they see this event, you are 

required under the International Health Regulations to respond in 

24 hours and provide that information. If China then does not do 

so, then WHO would use other political pressures, other countries 

and so forth, which now have signed—all 193 countries in WHO 

have agreed to accept the International Health Regulations—then 

would be in a position to leverage tremendous international pressure on China to do the right thing. China, as a signatory to the 

IHR, they would be required to respond to that. 

Senator COBURN. And so what are the actual teeth of that response? If they fail to respond, what are the teeth? They have 

signed an agreement. They are not complying with the agreement. 

Mr. ARTHUR. The IHR unfortunately does not have any punitive 

or penalty assigned to it, so WHO is not in a position—— 

Senator COBURN. So, therefore, it is going to require courage on 

the part of the people leading WHO to do a travel ban early, to 

threaten those things. 

66 

Mr. ARTHUR. Right. But the information also will be disseminated internationally to all the other countries saying that we have 

this situation in China, we have asked for information, we do not 

know what is going on. The WHO Director General, if she determines the event to be a public health emergency of international 

concern, has already a pre-rostered committee that would advise 

her on the recommended measures that she needs to take, and it 

could include travel bans, it could include travel restrictions, whatever. But this would be the international community that would be 

dealing with the problem. 

Senator COBURN. But you would agree the thing that got action 

was the travel ban on that? When that was issued, they started cooperating. Is that correct? I mean full-fledged cooperation. When 

there was a travel ban issued by the WHO, what happened? All of 

a sudden we had admission there is a problem and help. Right? 

Mr. ARTHUR. They were very closely timed with each other, yes. 

Senator COBURN. Yes, all right. 

Thank you, Mr. Chairman. Thanks for holding this hearing. 

Senator AKAKA. Senator Coburn, just to answer your question 

about WHO, it is not that we have not thought of them, but we received the message that, for whatever reason, they would not testify before Congress. 

Senator COBURN. Actually, I was wanting our members that 

come from our country to WHO to testify, not WHO. In other 

words, our delegates, because they represent us there, and I am 

certain that we can ask them questions—I would hope. It is not 

surprising that a lot of international agencies are not very transparent and responsive to some of the demands of Congress, even 

though we contribute about 25 percent of all their funding. 

Thank you. 

Senator AKAKA. Thank you very much, Senator Coburn. 

My question is to Dr. Hill, Dr. Erickson, and Dr. Arthur. The 

programs you have summarized in your statements describe surveillance of known diseases. But what about diseases we have not 

seen before? It took many weeks for human and animal health experts to figure out that it was West Nile virus, a disease not previously seen in the Western hemisphere, that was killing the birds 

and people in 1999 in New York City. 

Can you give us assurance that your surveillance systems can 

help to identify and monitor new or emerging diseases that have 

not been seen before in this country? Dr. Hill. 

Mr. HILL. I think the first thing I would say is it would probably 

be a question almost like a puzzle—the process of elimination. If 

you have the right labs set up globally and you know you have got 

a problem, there is an outbreak of something that is killing people 

with high fevers, etc., the most obvious thing, of course, to do 

would be to test for the known likely possibilities. 

If all those tests come up negative, in the sense it is clearly not 

what it is, it is obviously something else. Will that tell you what 

it is necessarily? No. But it will at least tell you that you have got 

a problem that you better address pretty quickly. 

As I understand it on HIV, one of the big problems was we did 

not pick up years, maybe even decades, before that something was 

going on, that had we known or had our surveillance systems been 

67 

more sensitive, we might have responded much quicker and perhaps have stemmed the tide. But we did not even realize or pick 

it up. 

But you cannot do anything if you do not have the labs in place 

to test for the known possible problems. If you have that, then you 

have at least a chance to know that you are dealing with something new. 

Senator AKAKA. Dr. Erickson. 

Colonel ERICKSON. Mr. Chairman, your question is an excellent 

one, and it is one that we frequently will discuss among ourselves. 

We have different aspects to our surveillance efforts. The 

syndromic surveillance, which we do in a number of areas, is not 

dependent upon a lab test. It is not dependent upon having actual 

diagnostic tests to know what something is. We can use case definitions, syndrome constellation of symptoms to determine that there 

is something going on, there is something new. It might look like 

diarrhea, it might look like a respiratory disease, it may have a 

high fever, etc. And that is the first indication of what we can do. 

If I can add to Dr. Hill’s comments, the response can start at 

that point. For instance, in the case of SARS, the response was 

started in advance of there being diagnostic capability to realize 

that it was a coronavirus. And so my encouragement is that we 

continue to focus on an approach which builds broad-based laboratory capability, which enables us to have a sufficient number of 

public health practitioners, epidemiologists, etc., build this human 

capacity so that we can respond with the bread and butter, tried 

and true public health responses that will be somewhat generic for 

many of these new types of threats, realizing that we need the lab 

capability, we will need to finally know through molecular microscopy, through genetic sequencing, etc., that it is something new, 

that we are now going to call it virus X. But the response can start 

before that, and so I think building the broad public health infrastructure at this point is key, because we will not necessarily 

know—I cannot tell you, sir, that we are absolutely ready to be 

able to diagnose something that is new because we will not necessarily know. We will have to be responding before we know. 

Senator AKAKA. Thank you. Dr. Arthur. 

Mr. ARTHUR. I would like to add one additional aspect. I think 

one of the key elements and one of the things that we are very sensitive to and invest a considerable amount of effort at CDC, particularly in the Global Disease Detection Operations Center, is to 

look for those events which are unexplained, unexpected, unusual, 

and to use—instead of conventional surveillance systems with reporting systems, particularly in international settings where those 

types of infrastructure do not—that infrastructure both for reporting and laboratory diagnosis do not exist, using media reporting 

and mining of news reports. And you will hear later this afternoon 

about a project, Project Argus, from Dr. Wilson at Georgetown University. 

These reports, while they are very non-specific and often require 

verification, are incredibly important as a first alert for something 

unusual happening, something that needs further investigation, 

and then it can be followed up with the appropriate laboratory 

studies, etc. 

68 

But it turns out that in resource-poor countries in many parts of 

the world, the press report or the reporter is one of our best surveillance officers. They are highly motivated to provide this information, and it gets disseminated very broadly, and we focus on 

picking up those early signals. 

Senator AKAKA. Thank you. As you know, because the Chinese 

Government was not forthcoming in reporting cases of SARS and 

avian influenza, these diseases spread more widely and more 

quickly. 

Are you considering incentives to encourage countries to report 

these diseases before they become pandemics? Mr. Gootnick. 

Mr. GOOTNICK. Well, I would refer back to the earlier conversation on the International Health Regulations, which, amongst other 

things, is a politically binding document, creates an international 

norm, and is intended to facilitate an international response. It is 

important to recognize that the International Health Regulations, 

while they were adopted by the World Health Assembly in 2005, 

have really just now entered into force in 2007, and there is a 

phase-in period that really takes us out to 2012 before there is 

really a full implementation and binding set of agreements and expectations that the ability to intervene on the part of the international community is implemented. 

And then, even at that, the resources for countries who are motivated to take the steps dictated by the International Health Regulations are, at the beginning at least, the obligation of those sovereign nations. 

Senator AKAKA. Thank you. Dr. Arthur. 

Mr. ARTHUR. I think one of the incentives that we can provide 

to countries is building the capacity for them to be transparent and 

feel comfortable in doing so about an event. If something bad is 

happening in their country, frequently countries do not report because it is associated with some economic impact—loss of trade, 

tourism, whatever. By providing countries with risk communication 

skills so that they feel comfortable talking to their populace about 

a particular problem, knowing how to say, yes, we have a problem 

in the country, knowing that we have someone standing beside us, 

whether it be WHO or another country that is providing assistance, 

it is not good news, but we are doing something about it and we 

are attempting to do something about, having resources available 

to support epidemiologic investigations and laboratory investigations and appropriate interventions from the international partners 

also gives the country some confidence then that they are more 

willing to go forward with the information because they are actively doing something in the eyes of the global community to contain the event; and, more importantly, they are helping their own 

populace and their country. 

Senator AKAKA. Dr. Smith. 

Mr. SMITH. Yes, sir. Certainly, we are considering incentives that 

we might offer, and the Department of Homeland Security might 

have a little bit different take than the other agencies represented 

here at the table. The exchange of information or information sharing that might not otherwise happen from the integration of biosurveillance information, perhaps not at the WHO level but at a 

different collection level, the sharing of best practices, and some of 

69 

these will branch out into non-traditional means. Certainly, as Dr. 

Arthur has mentioned, there are not necessarily health care workers or the public health infrastructure to report up, examination of 

non-traditional sources of information. DHS is involved in the trilateral talks and negotiations for counterterrorism and presenting 

the integration of law enforcement and public health and agriculture and how that exchange of information can actually facilitate reporting and awareness in rural areas or outside of metropolitan areas. 

Senator AKAKA. Colonel Erickson. 

Colonel ERICKSON. Mr. Chairman, I just would want to say that 

I wholly agree with my colleagues here in other comments already 

made. My sense is this issue of getting to transparency involves a 

cultural change, and though we can look for incentives in the near 

term, I think we are looking at a generational effect. And that is 

the reason why I think many of our programs have training components in them, where, in fact, we are training the next generations 

of laboratorians, epidemiologists, public health officials to step into 

a culture where reporting will not be punished, where bad news 

will not be received and bad things will happen to you because you 

are the one that is reporting. 

But that is, in my mind, a cultural change that we need to effect 

through these many efforts that you are hearing about today. 

Senator AKAKA. Thank you. Dr. Hill. 

Mr. HILL. Just to summarize, I think there are four ways to 

incentivize the kind of reporting you want. I will start with the 

most negative first. Most countries want to be a respected member 

of the international community, but I think that should not be our 

first line of defense. Negative publicity does have an impact sometimes. 

Also, second, if we make it very clear that when countries do the 

right thing they will be welcomed into the international community, that is a big deal, frankly. And if you think what happened 

last year at the major Beijing conference where China was the 

international host for a big international conference to raise funds 

for avian influenza, at which was discussed how do you avoid the 

kind of thing that happened with SARS, I think it was very significant that China was willing to take the lead in hosting such a conference. So they clearly want to be a part of something that works 

better than what happened during SARS. 

And then, third, it has been mentioned, but I think it needs to 

be mentioned again: the promise that if you share information you 

are going to receive information is a powerful incentive to be up 

front. 

And, finally, if there is some sense that if you report a problem 

you are going to be helped, the international community will help 

you deal with it, is significant. 

And one last point that relates to the last question. Sometimes 

we get in the habit of thinking everything has a technical silver 

bullet, and I was the one that talked about the importance of labs, 

and I believe in the importance of labs. But even if the lab is 

present, the best labs in the world may not be able to identify a 

new problem. We still do not have a solution to HIV. We do not 

70 

1The prepared statement of Mr. Flesness with an attachment appears in the Appendix on 

page 246. 

have an HIV vaccine. But we know how to prevent it. We know 

how to contain it. 

If on the front lines globally out in the rural areas we do a much 

better job of communication so that people know what they should 

look for, what they should report immediately, and those people 

take the right action, you can quarantine immediately. You can 

quarantine several square kilometers and avoid a problem. That 

does not require a technological bullet solution. 

So there is an awful lot that can be done short of the solutions 

we hope are down the road that will control a lot of this much better than in the past. 

Senator AKAKA. Well, I want to thank you very much. That is a 

good summary, I think, of this panel. I want to thank all of you 

for your valuable testimony. I look forward to working with each 

of you to ensure that we are aware of potential emerging diseases 

and the threats that could impact the United States. And I would 

ask that our second panel of witnesses then come forward, but we 

may have questions from other Members of this Subcommittee that 

we will submit to you for your responses. 

So thank you very much for your testimonies and your responses. 

We welcome the second panel to our Subcommittee hearing: Dr. 

Nathan Flesness, Executive Director, International Species Information System; Dr. Daniel Janies, Assistant Professor, Department 

of Biomedical Informatics, Ohio State University Medical Center; 

and Dr. James Wilson, Director, Division of Integrated Biodefense, 

Imaging Science and Information Systems Center, Georgetown 

University. 

Again, it is the custom of this Subcommittee to swear in all witnesses, and so I will ask you to rise and raise your right hand. Do 

you solemnly swear that the testimony you are about to give this 

Subcommittee is the truth, the whole truth, and nothing but the 

truth, so help you, God? 

Mr. FLESNESS. I do. 

Dr. JANIES. I do. 

Dr. WILSON. I do. 

Senator AKAKA. Thank you. Let it be noted in the record that the 

witnesses answered in the affirmative. 

Mr. Flesness, will you please proceed with your statement? 

TESTIMONY OF NATHAN R. FLESNESS,1 EXECUTIVE DIRECTOR, INTERNATIONAL SPECIES INFORMATION SYSTEM 

(ISIS) 

Mr. FLESNESS. Thank you, Chairman Akaka, and thank you for 

this opportunity to testify on the infectious disease surveillance 

role our unprecedented new Zoological Information Management 

System (ZIMS), can play for the United States and other countries. 

It is an honor to be asked to appear and valuable to learn from 

other members of both panels. 

The International Species Information System (ISIS), is a 34- 

year-old, U.S.-based nonprofit of international scope. ISIS has 

spent three decades building a worldwide network of 700 zoos and 

71 

aquariums which pool detailed animal data on 2 million specimens 

of 10,000 species. Maps and lists of our members are attached to 

my written testimony. 

We currently cover facilities in 73 countries on all six occupied 

continents. This includes 263 ISIS member zoos and aquariums in 

47 States of the U.S. ISIS is by far the world’s largest membership 

organization of zoos and aquariums and continues to grow. 

For example, the Indian Government has just announced they 

will sponsor 59 Indian zoos to join ISIS next year. 

Honolulu Zoo Director Ken Redman sends his regards to you, 

Chairman Akaka, and would welcome the opportunity to show you 

how his zoo will use our new ZIMS system to connect to other zoos 

worldwide. 

After several years of fundraising and software development, we 

are now testing this profound transformation in our capabilities. 

Our new Web-based, real-time software, ZIMS, will replace our 

older systems, be online sharing information among our members, 

and keeping watch for zoonotic infectious diseases. 

Avian flu is, of course, the current concern, and ZIMS will include powerful worldwide monitoring for the different strains of 

avian influenza. But ZIMS will be equally powerful for detecting 

the next disease threat and the ones that will come after that. This 

is a long-term permanent effort to develop both situational awareness and an early-warning system for all zoonotic diseases. 

In fact, if you were going to imagine an ideal zoonotic disease 

biosurveillance system which could help stand watch in countries 

around the world, in my mind it would monitor thousands of species of animals, daily or hourly, to be sure to include vulnerable 

hosts for any threatening disease. It would use already trained and 

paid veterinary wildlife professionals for this monitoring. It would 

monitor animals in hundreds of urban centers worldwide where, in 

fact, most humans are. It would have already established broad 

international data-sharing cooperation and a culture of trust. It 

would have all data on the Web in real time. It would have enormous detail, such as vaccination history of each specimen stored 

serum samples, and so on. And it would be primarily privately supported. 

Of course, the system I am talking about is the one we are finishing called ZIMS. After 3 years of design and development, it is 

now in testing and will roll out worldwide starting July 2008. 

You have already noted, Chairman, that the zoo community has 

demonstrated its considerable power to spot new and emerging diseases with the story about West Nile virus. With ZIMS, they will 

be able to do so even more rapidly in real time. 

When the next human pandemic outbreak happens, it will come 

from and affect animals. It may be a disease we have already worried about, or it may be one we have never noticed before. ZIMS 

will give countries around the world valuable additional power to 

spot the next threat early, whether it is an old or a new disease. 

To make this real, consider the following hypothetical scenario. 

On a Thursday morning, an animal keeper named Susie Chi, working at a Southeast Asian zoo, makes her morning rounds and observes with concern that the leopards in two different exhibits look 

ill. She radios the veterinarian, Dr. Paulo, and stops by her desk 

72 

to enter these observations into ZIMS. Receiving the call, Dr. Paulo 

checks ZIMS for the best anesthesia drugs and doses and then does 

a hands-on physical. He draws blood samples and orders the animals moved to the hospital. His assistant enters the data into 

ZIMS while Dr. Paulo does some preliminary blood work. He sees 

anomalies he does not recognize and sends the sample by courier 

to the local university lab. 

Dr. Paulo then searches in ZIMS to see what problems other 

ISIS members have with leopards recently. He notes one very recent and troubling case of a similar problem of unknown cause reported a few days earlier. Over the next few hours, Dr. Paulo sees 

in ZIMS that a nearby zoo is now reporting similarly ill leopards 

and, more alarmingly, problems with other big cats. 

By the close of this first day, the ISIS–ZIMS epidemiological 

scanning program automatically detects an unusual pattern of animals becoming ill within a short time in the same geographical 

area. An ISIS staff veterinary epidemiologist is automatically alerted. She calls Dr. Paulo and confirms there are grounds for concern 

and learns the disturbing fact that both of the animal keepers involved have just called in sick. She advises Dr. Paulo on local useful governmental, CDC, OIE, and WHO contacts and triggers an 

alert to ISIS partner agencies. Less than 24 hours have passed 

since that first animal was noted sick on the other side of the 

world. 

To develop ZIMS, ISIS had meetings with the World Organization for Animal Health, the new European Union CDC in Stockholm, CDC Atlanta, Homeland Security, and other agencies. They 

have helped us see just how unique and powerful ZIMS will be. No 

one has ever built an internationally adopted, computerized, lifetime medical records system for humans or animals before. To our 

surprise (to be honest), ISIS–ZIMS seems to be the first. 

We have built ZIMS mostly with private funds, primarily from 

our member institutions. Currently, we are working with NBIC officials to design a framework for sharing ZIMS data and are cooperating on standards and compatibility. We look forward to 

NBIC’s support for ZIMS training and rapid rollout to 25 major 

U.S. metro areas in key sites abroad. We are also hoping for 

NBIC’s support to hire staff to watch for and interpret data patterns, and we hope to borrow the disease detection algorithms. 

While ISIS currently has robust global coverage, we are also 

seeking an additional $2 million a year to cover far more institutions and cities in Latin America, Asia, and Africa, and be online 

standing watch in those regions. 

A couple of points to leave you with in closing. As you have already noted, it is experts in our network who are finding diseases 

such as West Nile virus early. It takes decades to build the broad 

cooperation we already have. ZIMS is mostly privately funded and 

represents a $25 million investment. ZIMS offers the Federal Government an enormous opportunity to leverage private sector capability with a modest Federal investment and add an additional, effective, global zoonotic disease surveillance system to our pandemic 

defenses quickly. Thank you very much. 

Senator AKAKA. Thank you very much, Mr. Flesness. Now we 

will hear from Dr. Janies. 

73 

TESTIMONY OF DANIEL A. JANIES, PH.D., ASSISTANT PROFESSOR, DEPARTMENT OF BIOMEDICAL INFORMATICS, 

OHIO STATE UNIVERSITY MEDICAL CENTER 

Dr. JANIES. Thank you, Chairman Akaka. I am an Assistant Professor in the Department of Biomedical Informatics at the Ohio 

State University. My current research concerns the global spread 

of emergent infectious diseases. This work involves the use of 

large-scale computations on genetic and geographic data derived 

from viruses and their hosts, both animal and human. I received 

a Bachelor of Sciences degree in biology from the University of 

Michigan and a Ph.D. in zoology from the University of Florida. I 

worked as a postdoctoral fellow and a principal investigator at the 

American Museum of Natural History in New York City where, 

with funding from NASA and the city, we built one of the largest 

computers used in biological research. 

At Ohio State and the museum, we are using public databases 

of genetic sequences from viruses isolated from human and animal 

hosts. Just as deciphering an enemy code can provide warning of 

an attack, we are decoding the genetic sequences of emergent viruses in order to protect our citizens and food supplies. 

We are interested in genetic codes such as mutations that confer 

drug resistance among viruses and permit viruses that were once 

restricted to animal hosts to infect humans. With funding from 

DARPA, we have created a computational system to rapidly compare genetic sequences and return a global map depicting the 

spread of viruses carrying key mutations over hosts, time, and geography. 

As demonstrated by the success in stopping SARS, the rapid collection and dissemination of sequence data throughout the research 

community are key components in the fight in emergent diseases. 

Decision makers and the research community must work together 

to translate raw data into actionable knowledge. We have developed the information technology to track the stepwise movement of 

diverse strains of viruses over different countries and among various hosts. We monitor the spread of dangerous strains of viruses 

that are resistant to drugs or are able to infect human and animal 

populations. Regional threats are forecast based on the distribution 

of these dangerous strains with respect to population centers, 

farms, and areas of military deployment. 

As we scale our computational infrastructure and staff, we are 

able to rapidly add new data on a variety of agents of infectious 

disease and generate knowledge on which preemptive measures are 

important. Our maps, as depicted in this graphic here, are useful 

for understanding the complex mixture of processes that spread 

disease in various regions. For example, in Indonesia it is clear 

that chickens are responsible for spreading avian influenza—in this 

map, chicken-hosted viruses are depicted in blue lines—whereas in 

other areas, such as Central China, migratory birds are important. 

In this graphic, strains of avian influenza that are hosted by ducks 

and other migratory birds are depicted in red lines. 

However, illegal trade is also a concern. There was an interesting 

case in 2004, where an eagle infected with avian influenza was 

smuggled from Thailand to Belgium. While this infected eagle was 

quickly confined and the virus did not spread at that point, that 

74 

1The prepared statement of Dr. Wilson appears in the Appendix on page 254. 

case appears as a clear anomaly in our map, betraying an instance 

where illegal trade allowed avian influenza to make a huge geographic leap. I would like to turn your attention to the large green 

line showing the strain of avian influenza infecting the smuggled 

eagle is actually related very closely to Thai strains, and the geographic reach of that line is anomalous with respect to the other 

lines. Anomalies such as this provide means to detect illegal trade 

processes carrying avian influenza. 

Furthermore, using methods we have developed, we can detect 

and visualize gaps in the available data that represent undersurveyed regions or underreporting. Even though we have made tremendous analytical advances, a significant portion of the data on 

avian influenza remains in private hands. Among the reasons for 

the lack of data sharing include the career aspirations of scientists 

who want first crack at the data and the interests of nations to assure that their citizens will have access to vaccines. 

In light of the severity of the health and economic issues surrounding influenza, we have tried to change the model for data 

sharing via collaboration and co-authorship with international colleagues who work in the field and are providers of key viral strains 

for sequencing. These efforts have been exemplified by the Influenza and Coronavirus Genome Sequencing Projects, who are funded by the NIAID under a mandate to share data within 45 days 

of collection. 

I realize that data-sharing issues are complex and that a balance 

of competition and collaboration is natural, both in science and 

international relations. We will use the data security concepts that 

have been developed to protect the privacy of patients while allowing clinical research to move forward in the context of data sharing 

on emergent diseases. 

For example, cancer research is currently being accelerated by a 

data-sharing and analysis initiative of the NCI called the Biomedical Informatics Grid. We will apply the same underlying software for analysis and mapping of infectious diseases. 

Mr. Chairman, I am pleased to have had a chance to discuss 

these issues with you today and I welcome questions. 

Senator AKAKA. Thank you very much, Dr. Janies. Dr. Wilson. 

TESTIMONY OF JAMES M. WILSON V, M.D.,1 DIRECTOR, DIVISION OF INTEGRATED BIODEFENSE, IMAGING SCIENCE AND 

INFORMATION SYSTEMS (ISIS) CENTER, GEORGETOWN UNIVERSITY 

Dr. WILSON. Good afternoon, Mr. Chairman. I appreciate the opportunity to testify about Project Argus, the biosurveillance 

priming system developed and implemented at Georgetown University’s ISIS Center. Argus is designed to detect and track early indications and warnings of foreign biological events that may represent threats to global health and national security. Argus serves 

a ‘‘tipping function’’ designed to alert its users to events that may 

require action, but it does not determine whether or what types of 

actions should be taken. 

75 

In the summer of 2004, the Intelligence Technology Innovation 

Center (ITIC), and the Department of Homeland Security funded 

our research and development of a foreign biological event detection and tracking capability called Argus. Argus is based on monitoring social disruption. Local societies are highly sensitive to perceived emergence of biological threats, and the resulting conditions 

and responses are readily identifiable through a granular review of 

local sources of information. 

Argus specifically focuses on three types of indications and warnings: Environmental conditions conducive to outbreak triggering; 

reports of disease outbreaks in humans or animals; and markers of 

social disruption such as school closings or infrastructure overloads. 

The system is built on advanced operational social disruption 

and event evolution theory; unique disease event staging and warning; a defined doctrine of biosurveillance; real-time, high-performance Internet technologies; advanced modeling and linguistics capabilities; visualization and modeling capabilities; and disease 

propagation modeling. 

Argus analysts focused on identifying trends in disease and on 

social behaviors associated with such events and are accessing over 

a million pieces of information daily worldwide. They produce, on 

average, 200 reports per day. Using a disease event warning system modeled after NOAA’s National Weather Service, we issue on 

average 15 advisories, 5 watches, and 2 warnings at any given 

time, with 2,200 individual case files of socially disruptive biological events maintained and monitored daily in over 170 countries involving 130 diseases affecting animals or humans. 

To facilitate operational validation, we initiated an unofficial Biological Indication and Warning Analysis Community (BIWAC), 

which reviews our reporting requirements quarterly to ensure 

proper product alignment with the user. The BIWAC now includes 

CDC’s Global Disease Detection team, whom you have heard from 

today; USDA’s Centers for Epidemiology and Animal Health; DHS’ 

National Biosurveillance Integration Center; the Armed Forces 

Medical Intelligence Center; other Intelligence Community organizations; the Defense Threat Reduction Agency; and the U.S. Strategic Command Center for Combating Weapons of Mass Destruction. 

To enhance this process, we activated a new Internet portal, 

Project Wildfire, where Argus-derived warnings and watches are 

posted to facilitate unclassified dialogue among the BIWAC partners. Wildfire, although experimental, has attracted a substantial 

amount of Federal use. The Argus Watchboard has an audience 

from 100 organizations, including State of Colorado officials and 

the DC Department of Health. 

There is a significant degree of uncertainty surrounding biological event indications until ground verification has been obtained. 

Time is critical, and developing an approach to integrated, federally 

facilitated ground verification is important. 

As examples, Argus has served as the lead tactical global event 

detection team for H5N1 avian influenza; provided daily situational 

awareness reports to tsunami-related humanitarian responders; notified the U.S. Government of undiagnosed vesicular disease in catVerDate Aug 31 2005 08:37 Aug 20, 2008 Jkt 038845 PO 00000 Frm 00083 Fmt 6601 Sfmt 6601 P:\DOCS\38846.TXT SAFFAIRS PsN: PAT
76 

tle in the United Kingdom, later diagnosed as hoof-and-mouth disease; and reported indications of the current Ebola epidemic in the 

Congo. 

Eight months ago, the Argus team identified hundreds of reports 

of an H3N2 influenza virus that has possibly drifted away from the 

current vaccine strain and collaboratively worked with CDC to 

track this important finding. The value of this information was 

validated when the WHO and its partners recommended a change 

in the Southern hemisphere influenza vaccine to include an updated H3N2 strain. 

Argus reached full operational capability in July 2007, but there 

are challenges ahead. Funding for Argus is currently secure only 

through July 2008. We hope that you will agree that Argus should 

be maintained well beyond that date. 

This global biosurveillance resource needs to be operational within the United States. Because of our funding source, we are prohibited from monitoring domestically. DHS recently issued a solesource request for a proposal to initiate work on Project Hyperion, 

but it has not yet been funded. That needs to happen. 

There remains an important need for continued enhancements of 

Argus. The methodology can be made sensitive to nuclear, radiological, chemical, terrorist, and natural events. Also, the current 

Argus network does not fully incorporate wildlife disease outbreaks; therefore, we have approached the Wildlife Conservation 

Society. 

Finally, decisions need to be made about dissemination of Argusgenerated information. 

Thank you again for this opportunity to testify. I stand ready to 

answer any questions you may have. 

Senator AKAKA. Thank you very much, Dr. Wilson. 

What steps do you think should be taken to better integrate 

human and animal emerging disease surveillance? Mr. Flesness. 

Mr. FLESNESS. Thank you, sir. I think, sir, that meetings like 

this that happen informally behind this podium, where the people 

with various parts of the solution could work together and be encouraged to combine those efforts would be extremely productive. 

Senator AKAKA. Thank you. Dr. Janies. 

Dr. JANIES. I concur with Mr. Flesness. I think the common 

framework we have developed in using genetic data is actually very 

important, because the viruses do not care if they are infecting humans or animals, they are just DNA ORRNA hitching a ride across 

different organisms. Thus a genetic approach provides commonality. Similarly we are using an open-source solution for sharing data. Much like HTML is interoperable on all Web browsers, 

we are using KML, a language for sharing geospatial data, which 

is interoperable throughout all geospatial browsers such as used by 

Argus. 

Senator AKAKA. Dr. Wilson. 

Dr. WILSON. Sir, I am in vigorous agreement with the prior answers that have been given here. Networking is critical. Collaboration is critical. We cannot function in a vacuum at Argus. As powerful as this capability is, it is useless without collaboration. And 

I hope that you will see, too, that even with the panel here today, 

everyone has a unique competency, a unique skill set that is being 

77 

brought to the table. The world of biosurveillance is beginning to 

speciate, if you will. There are a lot of unique expertise and disciplines and competencies evolving that all have to work together, 

a lot of different parts to a well-tuned engine, so to speak. 

So we have to work together and we have to drop any kind of 

stovepiping mentality, in the interest of the mission. 

Senator AKAKA. Thank you, Dr. Wilson. 

Mr. Flesness, how can ZIMS be useful to NBIC? And how do you 

believe DHS can use ZIMS data to identify and dissipate the emergence of new diseases that are transferred from animals to humans? 

Mr. FLESNESS. Thank you, Mr. Chairman. I believe that ISIS’ 

new ZIMS system can help NBIC by providing, as it were, an extra 

layer of information focusing on incredibly intensively watched animals located primarily in urban centers with a little bit of diffusion 

because of the interests and projects of the veterinarians that work 

with the zoo animals that are often involved in wild animal 

projects outside the city. That gives us sort of a fuzzy dot in 700 

cities around the world, and I think detecting both syndromics 

early on—because we have a very rapid response system since it 

is real-time—and, second, as the cases develop and there is more 

and hard information available, and the fact that we have a culture 

of sharing already established, we think we have quite a resource 

and quite a unique international resource to help NBIC and hopefully its equivalents in other countries around the world make 

sense of and confirm patterns of data provided to them. 

Senator AKAKA. Thank you. 

Dr. Wilson, you mentioned some of the governmental consumers 

of data collected by Argus. It seems that the information you collect 

and analyze would be valuable to a broader spectrum of users, including those at the State and local levels and the public health 

community. 

Are there any plans to expand access to Argus information and, 

in particular, the similar reports of your product and of what you 

produce? 

Dr. WILSON. Yes, sir. That is the key question, Mr. Chairman. 

Our team believes that this technology is going to change the way 

that we do business in biosurveillance, at least in the foreign 

arena. However, it has to be done in partnership with people, so 

we strongly value our partnerships with the Federal Government, 

as we have mentioned in our testimony, and we value their input 

and guidance for how best to extend the information to State and 

local authorities as well as other countries and NGOs. 

I am not a fan of rolling out disruptive technology like this before 

it is ready. This program needs a lot of human time. It needs basically for me to sit down with, say, city officials in San Francisco 

and say, Folks, how do you do business? How might this information help you? When is it too much information? What are your reporting priorities? What are your concerns? How many people do 

you have to do this? Do you have the bandwidth to handle receiving this information? 

At the end of the day—and it may take us years to get there— 

this information has to get all the way down to the individual 

health care provider regardless of what organization they belong to, 

78 

and that includes veterinarians as well as agriculturalists. To get 

there from here, though, again, this is going to require a lot of culture change, a lot of dialogue, a lot of socialization of the technology, and that is just something that you really just cannot rush. 

The problem, of course, that we have is that Mother Nature may 

not wait for that, so we are kind of in a race against time, if you 

will, to figure out the best solution possible. And this is why we do 

this with our partners, and we do not operate in a vacuum. 

Senator AKAKA. Thank you. 

Dr. Flesness, human disease surveillance in developing countries 

is traditionally weak. This is why programs such as those implemented by AID, CDC, and DOD are so important. However, one 

could imagine that animal disease surveillance in developing countries is even more weak. 

What are your thoughts about bringing ZIMS to developing countries and in helping these countries develop better disease surveillance? 

Mr. FLESNESS. Thank you, Mr. Chairman. ISIS has been expanding its membership network for the 34 years it has existed, and we 

attend national and regional conferences of the zoos in Latin America, Asia, Africa, and so on. So we have gotten to know many of 

the people in the institutions who would like to become members 

of this global network. So we know that there is interest and will 

and even friendships. 

The two obstacles that remain are essentially financial: One is 

access to technology and technology transfer. That is both IT and 

lab and veterinary. And the other is our annual membership dues, 

which average about $4,000 per year per institution. In the developing world, that is a problem. There are about 500 institutions 

that we do not yet have to add to our 700. We estimate there are 

1,200 quality zoos and aquariums in the world. We would like to 

bring them in. That would require a couple of million dollars a year 

subsidy. 

Senator AKAKA. Yes. Well, I want to thank all of our witnesses. 

It is my hope that the work each of your organizations is doing will 

help our country and the U.S. public health officials ensure that 

any potential health threat to Americans is caught early and dealt 

with effectively. As with all programs, there is always room for improvement. I hope that the discussion of these activities today has 

helped identify some of those places where more work can be done. 

Situational awareness is central to our efforts to secure the homeland. Global disease surveillance is very much a part of these efforts. We must ensure that these activities are effective and also 

that they yield results, particularly over the long term. And your 

contribution to this hearing will certainly be helpful in our work 

in bringing this about. 

I want to thank you all. There may be questions from other 

Members who will submit them for your responses. I want to thank 

you for being part of this hearing and contributing as you have. 

The hearing record will be open for 1 week for these Members to 

ask questions. 

The hearing is adjourned. 

[Whereupon, at 4:16 p.m., the Subcommittee was adjourned.] 

(79) 

A P P E N D I X 

PREPARED STATEMENT OF SENATOR LIEBERMAN 

October 4, 2007 

Thank you, Mr. Chairman. 

And thank you for holding this important hearing on the United States’ preparedness and efforts to combat infectious disease. As stated by Dr. Margaret Chan, director of the World Health Organization, ‘‘International public health security is 

both a collective aspiration and a mutual responsibility.’’ 

A growing world population combined with the ease of global travel and a warming planet has lowered the barriers to the spread of infectious disease and now more 

than ever the United States must work cooperatively to identify and effectively respond to emerging threats. As our panel of witnesses illustrates a number of agencies are working on securing the United States by building capacity for the surveillance and detection of emerging infectious diseases overseas. The GAO report released in conjunction with this hearing says that the U.S. has invested approximately $84 million in this effort over the last two years. However, thee is still work 

to be done. 

Not only are diseases emerging at an unprecedented rate, but an overwhelming 

proportion of these diseases are zoonotic. Avian influenza, West Nile, SARs, and 

HIV/AIDS are recent and devastating examples of the impact animal born diseases 

can have when they transition to humans. 

The appearance of zoonotic diseases in humans is prevalent in developing countries, where trade in wild animals is concentrated. Therefore, ti is important for the 

U.S. to have a strong presence in these countries to allow for the training of individuals and the sharing of data. USAID and CDC have been successfully collaborating 

with the Wildlife conservation Society through the Global Avian Influenza Network 

for Surveillance (GAINS) in 28 countries detecting disease in wild bird populations. 

While this disease specific program has proven successful it is just the tip of the 

iceberg—a key to preventing a pandemic is early detection. Surveillance of an array 

of wildlife populations will increase our ability to fight the next emerging disease 

as we will have a better understanding of our enemy. For this reason, my colleagues, Senators Akaka and Brownback, and I have introduced legislation to expand the collaboration of USAID and CDC with the Wildlife Conservation society 

to address the need for a global wildlife disease surveillance system. 

We must prevent the outbreak and spread of new zoonotic diseases that have no 

treatments or cures to save the next generation from suffering the pain millions 

have faced from HIV/AIDS and avian influenza. 

Thank you, Mr. Chairman. 

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