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BIOTERRORISM: ASSESSING THE THREAT 

HEARING 

BEFORE THE

SUBCOMMITTEE ON EMERGENCY 

PREPAREDNESS, RESPONSE, 

AND COMMUNICATIONS 

OF THE

COMMITTEE ON HOMELAND SECURITY 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

FEBRUARY 11, 2014 

Serial No. 113–51 

Printed for the use of the Committee on Homeland Security 

Available via the World Wide Web: http://www.gpo.gov/fdsys/ 
(II) 

COMMITTEE ON HOMELAND SECURITY 

MICHAEL T. MCCAUL, Texas, Chairman 

LAMAR SMITH, Texas 

PETER T. KING, New York 

MIKE ROGERS, Alabama 

PAUL C. BROUN, Georgia 

CANDICE S. MILLER, Michigan, Vice Chair 

PATRICK MEEHAN, Pennsylvania 

JEFF DUNCAN, South Carolina 

TOM MARINO, Pennsylvania 

JASON CHAFFETZ, Utah 

STEVEN M. PALAZZO, Mississippi 

LOU BARLETTA, Pennsylvania 

RICHARD HUDSON, North Carolina 

STEVE DAINES, Montana 

SUSAN W. BROOKS, Indiana 

SCOTT PERRY, Pennsylvania 

MARK SANFORD, South Carolina 

VACANCY

BENNIE G. THOMPSON, Mississippi 

LORETTA SANCHEZ, California 

SHEILA JACKSON LEE, Texas 

YVETTE D. CLARKE, New York 

BRIAN HIGGINS, New York 

CEDRIC L. RICHMOND, Louisiana 

WILLIAM R. KEATING, Massachusetts 

RON BARBER, Arizona 

DONDALD M. PAYNE, JR., New Jersey 

BETO O’ROURKE, Texas 

TULSI GABBARD, Hawaii 

FILEMON VELA, Texas 

STEVEN A. HORSFORD, Nevada 

ERIC SWALWELL, California 

VACANCY, Staff Director 

MICHAEL GEFFROY, Deputy Staff Director/Chief Counsel 

MICHAEL S. TWINCHEK, Chief Clerk 

I. LANIER AVANT, Minority Staff Director 

SUBCOMMITTEE ON EMERGENCY PREPAREDNESS, RESPONSE, AND 

COMMUNICATIONS 

SUSAN W. BROOKS, Indiana, Chairwoman 

PETER T. KING, New York 

STEVEN M. PALAZZO, Mississippi, Vice Chair 

SCOTT PERRY, Pennsylvania 

MARK SANFORD, South Carolina 

MICHAEL T. MCCAUL, Texas (ex officio) 

DONALD M. PAYNE, JR., New Jersey 

YVETTE D. CLARKE, New York 

BRIAN HIGGINS, New York 

BENNIE G. THOMPSON, Mississippi (ex officio) 

ERIC B. HEIGHBERGER, Subcommittee Staff Director 

DEBORAH JORDAN, Subcommittee Clerk 
(III) 

C O N T E N T S 

Page 

STATEMENTS

The Honorable Susan W. Brooks, a Representative in Congress From the 

State of Indiana, and Chairwoman, Subcommittee on Emergency Preparedness, Response, and Communications ................................................................ 1 

The Honorable Donald M. Payne, Jr., a Representative in Congress From 

the State of New Jersey, and Ranking Member, Subcommittee on Emergency Preparedness, Response, and Communications: 

Oral Statement ..................................................................................................... 3 

Prepared Statement ............................................................................................. 4 

The Honorable Bennie G. Thompson, a Representative in Congress From 

the State of Mississippi, and Ranking Member, Committee on Homeland 

Security: 

Prepared Statement ............................................................................................. 5 

WITNESSES

Dr. Robert P. Kadlec, Former Special Assistant to the President for Biodefense: 

Oral Statement ..................................................................................................... 7 

Prepared Statement ............................................................................................. 8 

Dr. Tom Inglesby, CEO and Director, UPMC Center for Health Security: 

Oral Statement ..................................................................................................... 13 

Prepared Statement ............................................................................................. 15 

Dr. Leonard A. Cole, Director, Terror Medicine and Security, Department 

of Emergency Medicine, Rutgers New Jersey Medical School: 

Oral Statement ..................................................................................................... 19 

Prepared Statement ............................................................................................. 21 

FOR THE RECORD

The Honorable Susan W. Brooks, a Representative in Congress From the 

State of Indiana, and Chairwoman, Subcommittee on Emergency Preparedness, Response, and Communications: 

Bio-Response Report Card ................................................................................... 34 

APPENDIX

Questions From Honorable Steven M. Palazzo for Robert P. Kadlec .................. 41 

Questions From Honorable Steven M. Palazzo for Tom Inglesby ....................... 41 

Questions From Honorable Steven M. Palazzo for Leonard A. Cole ................... 42 

(1) 

BIOTERRORISM: ASSESSING THE THREAT 

Tuesday, February 11, 2014 

U.S. HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON EMERGENCY PREPAREDNESS, 

RESPONSE, AND COMMUNICATIONS, 

COMMITTEE ON HOMELAND SECURITY, 

Washington, DC. 

The subcommittee met, pursuant to call, at 10:05 a.m., in Room 

311, Cannon House Office Building, Hon. Susan W. Brooks [Chairwoman of the subcommittee] presiding. 

Present: Representatives Brooks, King, Palazzo, Perry, Sanford, 

Payne, Clarke, Higgins, and Thompson (ex officio). 

Also present: Representative Pascrell. 

Mrs. BROOKS. The Subcommittee on Emergency Preparedness, 

Response, and Communications will come to order. The subcommittee is meeting today to receive testimony on the threat of 

bioterrorism. 

Mr. PAYNE. Madam Chairwoman, I ask unanimous consent that 

the gentleman from New Jersey, Mr. Pascrell, be allowed to sit for 

the purpose of questioning the witnesses at our hearing today. 

Mrs. BROOKS. Without objection, so ordered. 

Today’s hearing is part of the oversight work this subcommittee 

has conducted and will be conducting on bioterrorism and the Department of Homeland Security’s biosurveillance capabilities. As a 

former U.S. Attorney for the Southern District of the Indiana appointed in October 2001, I was involved in the National response 

and alert surrounding the anthrax attacks in 2001. We know that 

while it has been more than a decade, we still need to be reminded 

that these attacks killed 5 people and sickened at least 20 others. 

These attacks showed us both the physical and psychological impacts of a bioterrorism event and they were a reminder that a 

small amount of a biological agent can have a large impact. 

In his 2003 report, ‘‘Catastrophic Bioterrorism, What is to Be 

Done,’’ Richard Danzig noted that the 1 gram of anthrax, which I 

might note is about a sugar-packet size, was sent to Senator Leahy, 

it contained a trillion spores, an amount that if effectively dispersed, could kill thousands of people and could cause great economic damage. I don’t say this to be an alarmist, but we must be 

aware of all of the threats that we face. I fear that over the course 

of time, people have lost sight of the potential impacts of such an 

attack and why we must remain vigilant and prepared, and because of this, I think this hearing is very important to, again, talk 

about this threat and what we are doing about it. 
2 

In addition to this hearing, the subcommittee is also doing several other activities surrounding bioterrorism and biosurveillance. 

At the request of Ranking Member Payne and myself, as well as 

the Chairman and Ranking Member of the full committee, the GAO 

is conducting a review of the National Biosurveillance Integration 

Center to determine whether the NBIC is working to its potential, 

whether it is providing value to the Federal participants and 

whether it continues to be worthy of our vital National security dollars. The subcommittee is also continuing its oversight of the 

BioWatch program, the Office of Health Affairs’ flagship program 

designed to detect aerosolized bioterror agents. 

BioWatch is at a crossroads, and Members may recall that this 

subcommittee requested a GAO review of the program in 112th 

Congress, which was released in September 2012. Among its recommendations was that the Department complete an analysis of alternatives for the Generation III, or Gen–3, system to determine 

whether or not this approach is the right way to go, and the Institute for Defense Analysis completed this analysis and delivered the 

results to the Department late last year. It is my understanding 

that the Department is currently reviewing the AOA and considering options for the future of the program. 

I urge them, and as we will discuss with Secretary Johnson who 

will be before us tomorrow, before the full committee, to thoughtfully consider the results of the AOA to determine the most appropriate path forward for the BioWatch program. I look forward to 

receiving testimony from the Department on this issue in the near 

future. 

As the foundation of this future work, we are meeting today to 

receive an update on the bioterrorism threat, and we know the 

threat is real. In testimony before this subcommittee in the 112th 

Congress, former Senator Jim Talent, vice chair of the WMD Commission reminded us of the Commission’s finding that it was likely 

that there would be an WMD attack somewhere in the world by the 

end of 2013 and that, in their judgment, the attack was more likely 

to be biological. 

Bioweapons can be developed surreptitiously, transported with 

relative ease and deployed insidiously over time. Obviously, as we 

all know, the attack in Syria was just that sort of an attack, with 

respect to an attack that the WMD Commission predicted. 

We have no reason to believe that the threat has changed since 

that testimony. In materials prepared for his appearance before the 

House Intelligence Committee just last week, Director of National 

Intelligence, James Clapper, noted that the intelligence community 

remains focused on the proliferation of chemical and biological warfare-related materials and development of WMD delivery systems. 

In addition to nation-state actors, the intelligence community has 

also judged that groups like al-Qaeda and its affiliates are intent 

on conducting CBRN attacks against the United States. So, I am 

pleased that we will be receiving testimony from such a distinguished panel of witnesses today to put this threat into perspective. 

I will note for the Members that we are planning to follow up this 

hearing with a Classified briefing on the threat later this month, 

and with that, I look forward to the testimony and our discussion 

here this morning. 
3 

The Chairwoman now recognizes the gentleman from New Jersey, our Ranking Member, Mr. Payne, for any opening statement 

he may have. 

Mr. PAYNE. Good morning. First, I would like to thank Chairwoman Brooks for holding the hearing today on the threats posed 

by bioterrorism. I would also like to thank Chairwoman Brooks for 

allowing my friend and my colleague, my mentor from the Garden 

State, Congressman Bill Pascrell, to participate in today’s important hearing. As a former Member of the committee and a leader 

on bioterrorism issues, I know we will benefit from his expertise. 

I commend Mr.—I commend both Mr. Pascrell and Mr. King, the 

lead sponsors on the WMD Prevention and Preparedness Act, for 

their efforts to comprehensively address the threats that are posed 

by weapons of mass destruction, particularly biological weapons. I 

admire their bipartisan effort and their persistence in championing 

this legislation that will implement many of the recommendations 

of the bipartisan WMD Commission. I look forward to doing my 

part to help advance the bill. 

As a freshman Member, I appreciate this opportunity to explore 

threats posed by weapons, weaponized pathogens, and what we can 

do as legislators to address them. During my preparation for this 

hearing, two things stuck out to me. First, without a special assistant to the President for biodefense, there does not appear to be a 

unified coordinated effort for addressing these threats posed by biological weapons. 

Second, we are not where we need to be with respect to caring 

for children in the event of a biological attack. 

To my first point, it seems that the Federal effort to address bioterrorism ebbs and flows. In December 2009, President Obama 

signed an Executive Order that outlined a process for the Federal 

Government to deliver medical countermeasures. Shortly after the 

administration created a Federal working group tasked with designating this high-risk Tier 1 biological select agents and toxins, the 

release in July 2012 of National strategy on biosurveillance—biosurveillance that emphasized the need to coordinate among Federal, State, and local governments, the private sector was a really 

positive step. 

However, since that time, specifics on how to carry out the strategy have not been forthcoming. As a result, efforts continue to be 

disjointed. I am not alone in reaching this conclusion. GAO stated 

in its testimony before this subcommittee in 2012 that the National 

biosurveillance efforts continue to be without a system to determine current resources, ask assessed risk, and prioritize investment. This mission is too critical to be without a coordinated and 

consistent Federal framework. 

To my second point, I am concerned, as a Nation, we have not 

done enough to ensure in the event of a biological attack, children 

get the care that they need. It is well-understood that as a population, children may experience biological reactions to weaponized 

pathogens more quickly than adults. There is a very healthy and 

active debate about the development and provision of countermeasures to children. 

Last April, the GAO reported that 40 percent of countermeasures 

in the strategic National stockpile were not approved for the use 
4 

on children. I understand that last—I understand that last year, 

the President’s Commission for the study on biological—bioethical 

issues released a report entitled, ‘‘Safeguarding Children, Pediatric 

Countermeasures Research’’ to make recommendations about carrying out research for medical countermeasures for children. 

Aside from the question of developing and stockpiling countermeasures for children, there is the matter of treating children in 

such a disaster. I am concerned that in recent years, the advent of 

the Federal support for public health such as a termination of 

funding for the Metropolitan Medical Response System and its vital 

programs, local public health personnel do not have the training 

necessary to treat the unique needs of children who have been exposed to weaponized pathogens. I look forward to learning more 

about these issues from our witnesses. 

I want to thank the witnesses for being here today, and I look 

forward to their testimony, and I yield back. But Madam Chairwoman, before I yield back—that was in the script, but before I 

yield back, you know, I had a situation when I was president of the 

Newark Municipal Council that an envelope was mailed to my 

home and mailed to several other council members during our tenure, and one of my children’s jobs is to get the mail. Luckily, this 

day, my wife picked the mail up and a powdery substance had been 

mailed to my home and several other council members. The other 

council members, it was mailed to City Hall, but this one was 

mailed to my home. 

So, you know, I have an experience with what this could potentially be and mean to citizens that we are here to protect and 

serve, so I just wanted to add that, that this is very, very important work we are doing and the witnesses and very personal to me 

and what it means to children. Thank you. 

[The statement of Ranking Member Payne follows:] 

STATEMENT OF RANKING MEMBER DONALD M. PAYNE, JR. 

FEBRUARY 11, 2014 

As a former Member of the Committee, and a leader on bioterrorism issues, I 

know we will all benefit from his expertise. I commend both Mr. Pascrell and Mr. 

King—the lead sponsors of ‘‘the WMD Prevention and Preparedness Act’’—for their 

efforts to comprehensively address the threats posed by Weapons of Mass Destruction—particularly biological weapons. I admire their bipartisan effort—and persistence—in championing legislation that will implement many of the recommendations 

of the bipartisan WMD Commission. I look forward to doing my part to help advance the bill. 

As a Freshman Member, I appreciate this opportunity to explore the threats posed 

by weaponized pathogens and what we can do, as legislators, to address them. During my preparation for this hearing, two things stuck out to me. First, without a 

special assistant to the President for biodefense, there does not appear to be a unified, coordinated effort for addressing the threats posed by biological weapons. Second, we are not where we need to be with respect to caring for children in the event 

of a biological attack. 

To my first point, it seems that the Federal effort to address bio-terrorism ebbs 

and flows. In December 2009, President Obama signed an Executive Order that outlined a process for the Federal Government to deliver medical countermeasures. 

Shortly thereafter, the administration created a Federal working group tasked with 

designating the highest risk or ‘‘Tier 1’’ biological select agents and toxins. 

The release, in July 2012, of a National Strategy on Biosurveillance that emphasized the need to coordinate among Federal, State, and local governments and the 

private sector was a positive step. However, since that time, specifics on how to 
5 

carry out the Strategy have not been forthcoming. As a result, efforts continue to 

be disjointed. 

I am not alone in reaching this conclusion, GAO stated in its testimony before this 

subcommittee in 2012 that National biosurveillance efforts continue to be without 

a system to determine current resources, assess risk, and prioritize investments. 

This mission is too critical to be without a coordinated and consistent Federal 

framework. 

To my second point, I am concerned that, as a Nation, we have not done enough 

to ensure that, in the event of a biological attack, children get the care they need. 

It is well-understood that, as a population, children may experience biological reactions to weaponized pathogens more quickly than adults. 

There is a very healthy and active debate about the development and provision 

of countermeasures to children. Last April, the GAO reported that 40 percent of the 

countermeasures in the Strategic National Stockpile were not approved for use on 

children. I understand that, last year, the President’s Commission for the Study of 

Bioethical Issues released a report entitled Safeguarding Children: Pediatric Countermeasure Research, to make recommendations about carrying out research for 

medical countermeasures for children. Aside from the questions of developing and 

stockpiling countermeasures for children, there is the matter of treating children in 

such a disaster. 

I am concerned that, in recent years, the advent of less Federal support for public 

health—such as the termination of funding for the Metropolitan Medical Response 

System and other vital programs—local public health personnel do not have the 

training necessary to treat the unique needs of children who have been exposed to 

weaponized pathogens. I look forward to learning more about these issues from our 

witnesses. 

Mrs. BROOKS. Thank you, Congressman Payne, and thanks for 

reminding me that we also had an incident when I was U.S. Attorney a couple—I think on more than one occasion where letters 

were mailed to our office as Federal employees and with powder 

and the office had to go through the emergency procedures and 

HAZMAT teams were called to test it and so forth, and so—and 

you know, we just saw very recently what happened in Sochi, or 

I am sorry, at the Super Bowl, rather, with hotels, with powder 

being sent to various hotels, and so, I think you reminded us of the 

psychological impact and the fear that doing something as simple 

as going and getting the mail can have on your family, so thank 

you for sharing that. 

Members are reminded that additional statements may be submitted for the record. 

[The statement of Ranking Member Thompson follows:] 

STATEMENT OF RANKING MEMBER BENNIE G. THOMPSON

FEBRUARY 11, 2014 

I understand that Congressman Pascrell and Congressman King plan to reintroduce the WMD Prevention and Preparedness Act today. I commend both of them 

on their efforts to improve WMD preparedness, response, and recovery in a bipartisan manner. 

Their bill has been approved by the full committee twice. With any luck, maybe 

the third time will be the charm, and this critical legislation will finally get due consideration by the full House. Enactment of this measure will strengthen our Nation’s homeland security posture in very meaningful ways—particularly in the area 

of bio-defense. 

Over the past 10 years, we have invested over $60 billion in bio-security programs. Nevertheless, most of the assessments I have seen indicate that the United 

States is not where it needs to be with respect to preventing and responding to a 

large-scale biological attack. The legislation authored by Mr. Pascrell and Mr. King 

would begin the effort of building a robust biodefense enterprise. 

In addition, it would ensure that first responders have the committed and collaborative Federal partner needed to address the unique issues of a potential WMD attack. 
6 

Importantly, the bill reauthorizes the Metropolitan Medical Response System 

(MMRS). This critical grant program has not been funded since 2011, and its authorization has lapsed. The MMRS reauthorization language included in this bill 

would provide grants to metropolitan areas to bolster medical surge capacity, 

strengthen capabilities, and improve biological response and decontamination activities. 

State and local public health departments have been hit hard by budget cuts, and 

they need MMRS. I am committed to seeing the WMD bill become law, but I know 

there are obstacles in its path. As we work to resolve those issues, I hope that the 

legislation can be the springboard for discussion, and that it will keep the issue of 

biodefense and WMD on the front burner. I thank the witnesses for being here, and 

I look forward to their testimony. 

Mrs. BROOKS. We are pleased this morning to have a very distinguished panel before us on this important topic. Dr. Robert Kadlec 

served 26 years as an officer and physician in the United States 

Air Force where he held senior positions in the Executive and Legislative branches. Until January 2009, Dr. Kadlec served as the 

special assistant to the President and senior director for biodefense 

policy on the Homeland Security Council. While on the Homeland 

Security Council, Dr. Kadlec drafted the National Biodefense Policy 

for the 21st Century, which became Homeland Security Presidential Policy Directive 10. He was also the staff director of the 

Senate Committee on Health, Education, Labor, and Pension’s Subcommittee for Bioterrorism and Public Health Preparedness. 

Next is Dr. Tom Inglesby, who is the director of the UPMC Center for Health Security. He serves as a co-chair of the National 

Health Security Preparedness Index Initiative and has also been a 

chair or a member of a number of National Academy of Sciences 

committees. He is coeditor-in-chief of the journal Biosecurity and 

Bioterrorism: Biodefense Strategy, Practice and Science and is an 

associate professor of medicine and public health at the University 

of Pittsburgh Schools of Medicine and Public Health. I now yield 

to the Ranking Member to introduce our next witness. 

Mr. PAYNE. Thank you, Madam Chairwoman. I am pleased to introduce Dr. Leonard Cole, an expert on bioterrorism and on terror 

medicine. Dr. Cole is an adjunct professor at the University of Medicine and Dentistry of New Jersey, where he is the director on the 

program of terror medicine and security, which is part of the University’s centers for biodefense. Dr. Cole serves on the advisory 

board of the International Institute of Counterterrorism and is a 

trustee of the Washington Institute for Near East Policy. 

He has written numerous articles for professional journals as 

well as general publications, including The New York Times, Washington Post, Scientific American, and the Sciences. 

Let’s see. Dr. Cole received a BA with the highest honors from 

University of California at Berkley. He holds a master’s degree and 

Ph.D. in political science from Columbia University and a doctorate 

from the University of Pennsylvania School of Dental Medicine, 

which in 2008 awarded him its alumni award of merit. We are 

happy to have him testify before us, the committee today. 

Mrs. BROOKS. Thank you. Just to remind you as witnesses before 

us, it is a green, yellow, red light, and the green will go on when 

you begin testifying and the yellow light comes on when you have 

a minute left in your testimony, and so if you could do your best 

to wrap up in that last minute, that would be terrific so we can 

hear from all of you. 
7 

So the full written statements will appear in the record, and we 

appreciate the time and effort that went into preparing those full 

written statements, and the Chairwoman now recognizes Dr. 

Kadlec for 5 minutes. 

STATEMENT OF ROBERT P. KADLEC, FORMER SPECIAL 

ASSISTANT TO THE PRESIDENT FOR BIODEFENSE 

Dr. KADLEC. Thank you, Madam Chairwoman Brooks and Ranking Member Payne. It is a privilege to appear before you today, and 

Members of the subcommittee, to talk about this serious National 

security issue. It doesn’t receive the kind of attention or consideration that it deserves. I would like to commend the committee for 

taking the time and effort to raise awareness and inform the public 

about it. 

Congress plays a vital leadership role through hearings like this 

authorizing important programs and appropriating sufficient funds 

to ensure the means to protect America and Americans from this 

threat. The risk of BW’s attacks is not an easy problem to talk 

about. Frankly, it scares people. The deliberate use of biological 

agents or toxins is as distinct from natural diseases and highlights 

a fundamental principle not found in nature, the efforts of a thinking enemy to inflict death, incapacitation, or economic loss by confounding diagnosis and frustrating treatment. 

Adversaries who use BW are intent on creating conditions that 

are not found in nature, aerosolizing overwhelming doses to infect 

large numbers of people with agents that are more virulent than 

natural strains and resistant to common forms of treatment. 

Conflating deliberate and natural infectious diseases implies that 

by addressing the more common natural problem, the solution will 

be sufficient to address the BW threat. It is not. To confront this 

threat effectively requires an understanding of its fundamental 

principle, and I am afraid we have not done so yet. It is a threat 

that could result in a significant loss of life, severe economic losses, 

and cause social instability and forever change our way of life. Simply stated, BW can kill as many people or more than the nuclear 

weapon. The technological barriers to achieve this potential are significantly less for nuclear weapons. Graham Allison, the founding 

dean of Harvard’s John F. Kennedy School of Government and a 

leader and an expert on nuclear proliferation said, ‘‘Nuclear terrorism is a preventable catastrophe, and the reason it is preventable is because the material to make a nuclear bomb can’t be made 

by terrorists. Can I prevent terrorists from getting it into their 

hands anthrax or other pathogens? No. Even our best efforts can’t 

do that. The fact that it has not yet happened may be luck that 

is undoubtedly assisted by the efforts of the U.S. military intelligence community disrupting terrorist groups.’’ 

Madam Chairwoman, I think you noted the testimony by national—Director of National Intelligence, James Clapper, that 

starkly conveyed the reality that we find ourselves in. The global 

trends emerging for the risk of BW are alarming, and in addition 

to those that he outlined in terms of the dual-use nature of this 

technology diffusing globally, complicating this picture is the discipline of synthetic biology. The World Health Organization has assessed that advances in synthetic biology now permits adversaries 
8 

to recreate pathogens no longer found in nature such as smallpox. 

General Clapper also noted that elements of serious BW program 

might have progressed beyond research and development, and 

might have achieved limited agent production. In an environment 

where a variety of radical Islamic groups, some aligned with alQaeda, the risk that 1 or 2 kilograms of anthrax could fall into the 

hands of terrorists should motivate us significantly to improve our 

preparedness. 

During my tenure as a special assistant to the President, we 

evaluated and modeled the human and economic impact that a couple of grams, kilograms of anthrax could have on a major metropolitan area. Such an attack could threaten millions, kill several 

hundred thousand, and result in a direct economic impact of greater than $1 trillion. 

As good as our intelligence is, it can never be perfect. The 2005 

Commission on the Intelligence Capabilities of the United States 

regarding WMD characterized the biological threat has the greatest 

intelligence challenge. According to a senior CIA official interviewed for that report, we don’t know more about the BW threat 

than we did 5 years ago, and 5 years from now, we will know even 

less. 

Our intelligence was less than perfect in identifying the al-Qaeda 

clandestine BW weapons laboratory in Afghanistan prior to the invasion of the United States in the 2002. The possibility and probability that al-Qaeda may still harbor the strategic intent and may 

still pursue BW capabilities to attack the United States should be 

sufficient impetus. The risk of surprise is great and more preparedness, not less, is our greatest insurance policy. It requires a champion in Congress and in the White House and continued support 

of programs like BioWatch, the biothreat risk assessment, National 

Biodefense Analysis and Countermeasures Center, as well as programs at HHS for biosurveillance, BARDA, BioShield, and Strategic National Stockpile. 

Finally, it also requires promoting vaccinations of first responders against the most likely biological threats and means for home 

medical kids to protect first responders and their families. The risk 

of bioattacks in the United States is an uncertain yet imminent reality. It requires a credible and rapid means to detect, mitigate 

such attacks, and equally credible means to attribute and hold 

those accountable. I thank you for this opportunity and look forward to your questions. 

[The prepared statement of Dr. Kadlec follows:] 

PREPARED STATEMENT OF ROBERT P. KADLEC

FEBRUARY 11, 2014 

Madame Chairwoman Brooks and Ranking Member Payne it is a privilege and 

honor to appear before you and Members of this subcommittee to talk about a very 

important National security issue: Bioterrorism and biological warfare. It is a subject that has not received the kind of attention or consideration that it deserves and 

I would like to commend the committee for taking the time and effort to raise 

awareness and inform the public about it. Congress plays a vital role in confronting 

this threat through hearings like this, authorizing important programs, and appropriating the necessary funds to ensure we have the means and medical countermeasures to deter and if necessary protect America and Americans from this threat. 

Talking about the threat I am always reminded of the sage words of Dr. Joshua 

Lederberg, Nobel Prize-winning microbiologist who said ‘‘I am very worried about 
9 

this (bioterrorism) but hardly dare to mention it for fear of putting an evil idea in 

someone’s head.’’ His words resonant constantly with me and serve as a practical 

warning. But, the practical reality argues that in a democracy we must talk about 

these otherwise unspeakable threats in a responsible way to inform, not to incite. 

If no one talks about the risks of biowarfare (BW) or bioterrorism (BT); few in Government will think about it, much less act to do the necessary things to protect 

America and Americans. 

The risk of deliberate biological attacks is not an easy problem to talk about. 

Frankly, it scares people. In today’s public discourse, we usually hear the risk embedded in the phrase natural, accidental, and deliberate disease threats. 

Somehow if we cloak it with other infectious disease threats that emerge from 

Mother Nature it is easier to contemplate or accept. We do ourselves, however, a 

great disservice by doing so. 

The deliberate use of biological agents or toxins to achieve strategic military and 

political objectives invokes a fundamental principle not found in nature—the efforts 

of a thinking enemy to use biological agents to inflict death, incapacitation, or economic loss by using biological agents to confound diagnosis and frustrate treatment. 

The military or terrorist intent is to create conditions that are not found in nature 

or with natural disease epidemiology: Aerosolizing overwhelming doses of infectious 

agents to infect large numbers of people simultaneously with agents that are not 

naturally endemic and are likely to have been engineered to be more virulent than 

natural strains and resistant to common forms of treatment. 

Conflating deliberate and natural disease threats somehow implies that by addressing the more common Mother Nature problem, the solution will be sufficient 

to address the deliberate biological threat. It is not. To understand this threat and 

confront it effectively is to understand this fundamental principle. I am afraid, we 

as a Nation and Government do not fully comprehend the kind of threat we are 

talking about today. 

Fortunately, unlike cyber attacks which occur with some frequency and have received media notoriety, deliberate biological attacks have been very few and far between. It is, however, a threat that could result in enormous loss of life, severe economic losses, cause social instability, and forever change our way of life. Simply 

stated, biological weapons have the power to kill as many or more people as a nuclear weapon. The technological barriers to achieve this potential are significantly 

less than for nuclear weapons. The fact it has not happened yet may be more a matter of luck and the superb efforts of the U.S. military and intelligence community 

than restraint or unwillingness on the part of terrorists. 

The trends emerging around the potential threat of deliberate use of biological 

agents are alarming. The dual-use means to cultivate, grow, and produce biological 

agents in quantities sufficient for nefarious use has grown smaller and more efficient, harder to locate, and diffused globally. This technology and know-how are increasingly becoming available to wider group of potential adversaries. In the past, 

BW was a capability reserved for nations, now it is a potential weapon for terrorist 

groups and disaffected individuals. Complicating this picture is the discipline of synthetic biology. The World Health Organization has assessed that advances in synthetic biology now permits adversaries to recreate pathogens no longer found in nature such as smallpox. It is conceivable in the not-too-distant future that someone 

could design and produce a new pathogen never seen before. 

One way to consider the seriousness of the threat is to observe what Congress has 

said and done. Congress has mandated commissions, enacted laws, and appropriated funds going back to the late 1990’s highlighting the risks from deliberate 

use of biological agents. In 1999, Senators Gary Hart and Warren Rudman highlighted the risk in their report entitled ‘‘A New World Coming: American Security 

in the 21st Century.’’ It noted that the increase in information technology and biotechnology will cause new vulnerabilities for the United States and that the proliferation of chemical, biological, and potentially nuclear weapons that will empower 

and embolden both state and not-state actors to threaten or act against the United 

States. 

In 2004, Congress passed the Project BioShield Act (Pub. L. No. 108–276) that 

appropriated $5.6 billion to create a guaranteed market for the acquisition of medical countermeasures against chemical, biological, radiological, and nuclear threats. 

An essential provision of that law was directed the Department of Homeland Security (DHS) to determine which biological threats pose a priority threat in order to 

prioritize medical countermeasure development and acquisition. DHS uses the Integrated Terrorism Risk Assessment findings to determine which CBRN agents 

present a greater risk based on the relative risk ranking against the U.S. population 

sufficient to affect National security. Specifically, for the highest-ranked agents, 

DHS evaluates the intelligence and threat information and develops and models a 
10 

highly-plausible consequence scenario taking into account acquisition, production, 

dissemination efficacy, source strength, and meteorological conditions. This model is 

used to derive an estimate of the number of potentially exposed individuals at various levels of exposure, which becomes part of the Material Threat Assessment. The 

estimates are provided to the Department of Health and Human Services (HHS), 

which conducts its Public Health Consequence Modeling to determine the public 

health impacts. 

DHS has issued about a dozen Material Threat Assessments for biological threat 

agents that have served as the basis for advanced development and acquisition of 

medical countermeasures by HHS. As mandated by law, the United States is currently researching, developing, producing, and stockpiling medical countermeasures 

against a variety of biological agents such as anthrax, botulinum toxin, smallpox, 

and other agents viewed as a credible BW or BT threat. Project BioShield funding 

acquires the medical countermeasures that create a powerful deterrent against this 

threat. 

The 2008 Weapons of Mass Destruction Commission chaired by Senators Bob Graham and Jim Talent further highlighted growing trends in the spread of enabling 

technology and led to their principle finding that the risk of a WMD attack was rising and that the terrorist use of biological weapons was greater than the likelihood 

of terrorists building or obtaining a nuclear device. Their Commission recommended 

greater efforts to both prevent and respond to this threat. Their periodic report 

cards indicate that we have achieved much but still have far to go in our preparedness efforts. 

The intelligence community annually reports to Congress on the threats confronting the Nation. I note that Director of National Intelligence James Clapper and 

other senior intelligence officials testified before the House and Senate Intelligence 

Committees in January of this year. Their annual assessment identifies the greatest 

National security threats. General Clapper stated: 

‘‘Nation-state efforts to develop or acquire weapons of mass destruction (WMD) and 

their delivery systems constitute a major threat to the security of the United States, 

deployed troops, and allies. We are focused on the threat and destabilizing effects 

of nuclear proliferation, proliferation of chemical and biological warfare (CBW)-related materials, and development of WMD delivery systems. The time when only a 

few states had access to the most dangerous technologies is past. Biological and 

chemical materials and technologies, almost always dual-use, move easily in the 

globalized economy, as do personnel with scientific expertise to design and use 

them. The latest discoveries in the life sciences also diffuse globally and rapidly.’’ 

He also noted note that elements of Syria’s biological weapons program might 

have progressed beyond research and development and might have achieved limited 

agent production. In an environment where a variety of radical Islamic groups are 

fighting the Syrian government, the risk that 1 or 2 kilograms of anthrax could fall 

into the hands of terrorists should make us pay serious attention. During my tenure 

as the special assistant to the President for biodefense policy in the Bush administration, we evaluated and modeled the human and economic impact that a couple 

of kilograms of anthrax could have on a major metropolitan area. 
11 

In addition to Congress and the intelligence community’s perspectives, I would 

like to offer you a more personal evaluation of the threat as it has evolved during 

my professional career. I come to you as an accidental tourist as it pertains to the 

subject of bioterrorism and biological warfare. My introduction came some 24 years 

ago when I was a young officer and physician assigned to the Joint Special Operations Command at Fort Bragg on the eve of the Iraqi invasion of Kuwait. I was 

pressed to serve as an advisor on these issues to then Major General Wayne A. 

Downing. 

At that time, the U.S. military was marginally prepared to confront a regional 

power that possessed chemical and biological weapons. The military lacked the necessary protective equipment, detectors, and medical countermeasures including vaccines and antibiotics against the immediate threats posed by Iraq. Congress played 

a vital role in rectifying those shortfalls and our military is better prepared. 

While the United States was victorious in 1991, the scale and scope of Iraq’s biological weapons program remained elusive despite the most intrusive inspection and 

monitoring regime ever conceived and implemented by the United Nations Special 

Commission (UNSCOM). I experienced this first-hand, as I served as a UNSCOM 

biological arms inspector in 1994, 1996, and 1998. It was only after the defection 

of Saddam Hussein’s son, Hussein Kamel, did UNSCOM and the world learn of the 

extent of Iraq’s biological weapons. Even so, UNSCOM was never able to fully account for or verify the destruction or elimination of the biological weapons Iraq possessed or the precursors (seed stock) that were used as part of the program. 

The events in Iraq and the coincident dissolution of the Former Soviet Union signified an important milestone in historical trend of biological warfare. Previous to 

the 1990’s, biological weapons were capabilities limited to advanced nations and indeed superpowers. The defections of high-level officials from the Soviet BW program 

illuminated the size and sophistication of a program that involved an estimated 

30,000 scientists and workers and 2 dozen large-scale facilities. The Soviets manufactured metric tons of anthrax and smallpox to be used in war with the United 

States. Despite the enormous scale and scope of the Soviet program, the disturbing 

fact is the U.S. intelligence community knew little of its existence. Once again Congress played a vital role in efforts to prevent the risk of proliferation of nuclear and 

biological weapons with Soviet Threat Reduction Act of 1991. 

From Fort Bragg I was assigned to the Pentagon Office of the Secretary of Defense for Counter-proliferation Policy that was established after the first Gulf War. 

There, I witnessed the efforts to ascertain the truth behind the former Soviet 

Union’s BW effort. The Trilateral Process between the United States, United Kingdom, and Russia stalled and the government of Russia never provided a full accounting of its BW program. The fate of these agents and associated weapons was 

never satisfactorily resolved. The enigma of the Russian program is only magnified 

when President Putin recently called for exploiting new and emerging technologies 
12 

to rearm Russia and mentioned the development of genetic weapons as means ‘‘for 

achieving political and strategic goals.’’ 

The revelations from the Former Soviet Union and Iraq all occurred as the advances in biotechnology and molecular biology marched on in the background. The 

dual-use means (both the enabling technology and the know-how) continue to increase and diffuse around the globe. The means are available for any nation with 

modest pharmaceutical manufacturing capacity to achieve a capability with lethal 

equivalence to nuclear weapons. 

The concern that non-state actors could divert legitimate biological process and 

equipment was realized when the Japanese cult Aum Shinrikyo surprised the Japanese government and the world by perpetrating a chemical nerve agent (sarin) attack in the Tokyo subway system in 1995. While the manifestation of the Aum’s intentions was a nerve agent attack, Japanese law enforcement investigations uncovered Aum’s efforts to develop, produce, and disseminate botulinum toxin and anthrax. The cult tried several times, fortunately unsuccessfully, to disseminate botulinum toxin and anthrax. One attempted anthrax attack targeted the U.S. naval installation at Yokohama. Probably, the greatest limitation to their effort was obtaining a virulent strain of anthrax to affect their plan. In the end they were the cult 

that ‘‘could not spray straight.’’ Their incompetence was fortunate for us, but the 

story is not reassuring. The cult’s efforts to develop both chemical and biological 

weapons went unnoticed by Japanese civilian authorities and U.S. intelligence agencies. 

Following the attacks of September 11, I was recalled for service back into the 

Pentagon and was there when the initial reports about inhalational anthrax cases 

were first reported by the media. The National psyche after the traumatic attacks 

at the World Trade Center and the Pentagon was fragile and the anthrax letter attacks dealt another significant blow striking fear in every American heart about 

what could come next. Little did we know that the perpetrator was not al-Qaeda 

but a deranged scientist. 

This fear, however, and the uncertainty about the identity and motives of the perpetrator(s) was enhanced when U.S. forces who invaded Afghanistan uncovered a 

laboratory built by al-Qaeda to research, develop, and produce anthrax (Agent X). 

According to the 2005 Commission on the Intelligence Capabilities of the United 

States Regarding Weapons of Mass Destruction: 

‘‘al-Qa’ida’s biological program was further along, particularly with regard to Agent 

X, than pre-war intelligence indicated. The program was extensive, well-organized, 

and operated for two years before September 11, but intelligence insights into the 

program were limited. The program involved several sites in Afghanistan. Two of 

these sites contained commercial equipment and were operated by individuals with 

special training. Documents found indicated that while al-Qa’ida’s primary interest 

was Agent X, the group had considered acquiring a variety of other biological 

agents. The documents obtained at the training camp included scientific articles and 

handwritten notes pertaining to Agent X. 

‘‘Reporting supports the hypothesis that al-Qa’ida had acquired several biological 

agents possibly as early as 1999, and had the necessary equipment to enable limited, basic production of Agent X. Other reporting indicates that al-Qa’ida had succeeded in isolating cultures of Agent X. Nevertheless, outstanding questions remain 

about the extent of biological research and development in pre-war Afghanistan, including about the reliability of the reporting described above.’’ 

The possibility that al-Qaeda then and now may still harbor the strategic intent 

and pursued capabilities to attack the United States with biological weapons is a 

lingering concern that should not be ignored. 

In 2003 and 2004, I deployed to Iraq four times looking for proof of Saddam’s BW 

program and the existence of smallpox virus cultures. It was difficult challenge 

under the tactical circumstances we encountered and operated in. Despite finding 

clandestine biological laboratories run by the Iraqi Intelligence Services, the true 

nature of the work and relevance to Iraq’s offensive BW effort was never 

ascertained. Here again, despite owning the territory, apprehending and interviewing many but not all the key personalities involved, and exhaustive field investigations, the ability to uncover the truth about Iraq’s BW program was never accomplished. 

The limitations of intelligence were formally noted by the 2005 Commission on the 

Intelligence Capabilities of the United States Regarding Weapons of Mass Destruction. According to a senior CIA official interviewed for that report: ‘‘We don’t know 

more about the biological weapons threat than we did five years ago, and five years 

from now we will know even less.’’ That statement may seem astonishing but it reflects the challenge our intelligence community faces in light of the global diffusion 
13 

of technology that enables practically anyone with a biology degree the means to 

create a biological weapon. 

The risk for surprise is great. Relying entirely on intelligence assessments fails 

to understand the complex threat our intelligence community confronts. Understanding and preparing for the future biological threat will take more than intelligence. I highlight the vital contributing role of the National Biodefense Analysis 

and Countermeasure Center and two of its component entities. • The National Bioforensic Analysis Center conducts bioforensic analysis of evidence from a biocrime or terrorist attack to attain a ‘‘biological fingerprint’’ to 

help investigators identify perpetrators and determine the origin and method of 

attack. It is the lead Federal facility to conduct and facilitate the technical forensic analysis and interpretation of materials recovered following a biological 

attack in support of the FBI. • The National Biological Threat Characterization Center conducts studies and 

laboratory experiments to fill information gaps to better understand current 

and future biological threats; to assess vulnerabilities and conduct risk assessments; and to determine potential impacts to guide the development of countermeasures such as detectors, drugs, vaccines, and decontamination technologies. 

These Centers provide critical insights and information that help the U.S. biodefense enterprise understand current and emerging threats. In the case of the anthrax letters, the forerunner to the National Bioforensic Analysis Center contributed 

significantly to the investigation that led to the identification of the perpetrator of 

those attacks. Bioforensics can play an important part in a BW deterrent strategy 

that links timely and accurate attribution with the credible threat of retribution to 

any perpetrator. 

The Threat Characterization Center tests whether the hypothetical threats are 

real. Using valid scientific methods performing research and conducting experiments, the researchers there help bound a potential infinite risk with scientific data. 

They help advance the understanding of what really constitutes a threat. 

I would conclude with the observation that the risk of biological attacks on the 

United States with biological agents is an uncertain, imminent reality. Our ability 

to predict or know when this threat will manifest itself is severely limited by the 

capabilities of our intelligence services and the wide array of potential perpetrators 

who could conduct such attacks. Biological weapons could inflict grievous harm on 

America, equal to and potentially greater than nuclear weapons, and any investments to defend against them is a modest insurance policy against an uncertain future. Our best defense remains a robust defense: A credible and rapid means to detect and mitigate such attacks and equally credible means to attribute and hold 

those accountable. I thank you for this opportunity and look forward to assisting you 

further in your efforts on this subject. 

Mrs. BROOKS. Thank you. 

The Chairwoman now recognizes Dr. Inglesby for 5 minutes. 

STATEMENT OF TOM INGLESBY, CEO AND DIRECTOR, UPMC 

CENTER FOR HEALTH SECURITY 

Dr. INGLESBY. Madam Chairwoman, Ranking Member Payne, 

Members of the subcommittee, thank you so much for the opportunity to speak to you today about bioterrorism. The Nation faces 

a number of major biological threats, rising levels of multi-drug 

anti-microbial resistance, possible pandemics of influenza, SARS, 

and MERS, a lab accident in which engineered pathogens could 

start an epidemic, but among the most serious of these facing the 

Nation is of course bioterrorism. My three messages for the committee today are: (1) The capability to create and use biological 

weapons exists widely in the world; (2) the consequences of such 

weapons could be major loss of life and societal disruption; and (3) 

while progress has been made, a great deal needs to be done to 

build and sustain preparedness for this threat. 

The know-how to make biological weapons is now in the reach 

of groups or individuals with the right scientific background. Components for making biological weapons are on eBay, equipment for 

disseminating them is in hardware stores and agricultural supply 
14 

stores. The technology is dual-use. It has both good and dangerous 

practical purposes in the world. It can’t be locked away. There may 

be no obvious signal of bioweapons development, and we shouldn’t 

expect to have warning regarding its use in the future. 

The anthrax events of 2001 were shocking for the country. Letters carrying anthrax spores sickened or killed people in a number 

of States. Doctors were unfamiliar with the disease, major parts of 

Government were shut down, the source couldn’t be identified. 

Communication from Government was very unsteady. People were 

afraid of their own mail. Nothing like this had happened before in 

our country or in any country. 

It is important for this committee to know that a future biological weapons attack in the United States could look quite different 

from 2001 in terms of the size of attack, the form, and the numbers 

affected. Future events are unlikely to come with warnings that 

tell people to start antibiotics or get out of a building. It is more 

likely that the first signs of a bioterror attack will be sick people 

appearing in emergency rooms. 

In addition, what we learn from the 1960s U.S. bioweapons program is that bioweapons don’t cause normal infectious disease. As 

Dr. Kadlec said, they cause disease that was faster and more resistant to treatment. 

A lot has been done in the last 13, 14 years to improve our preparedness for bioterrorism. In my written testimony, I have described some of things that the Federal agencies and at the State 

and local level are doing, some of the valuable work being done 

there, but there is a great deal to do going forward to make us better-prepared. Here are some of the steps I would recommend: 

We need to support public health preparedness programs and 

medical preparedness programs through the CDC PHEP program 

and ASPR HPP programs. These are programs that benefit the 

front lines responding to bioterrorism, and they have been cut 

sharply in recent years. We should make good use of the new National Health Security Preparedness Index. Congress and the administration have been calling for new features of accountability, 

and I think this index will help along those lines in the future. 

We absolutely need to sustain BioShield, BARDA, and the FDA 

program that we need to develop medicines and vaccines against 

biological threats. That process is generally working and is crucial. 

We need to move ahead on biosurveillance by doing a number of 

things. We need to set up programs that gather information from 

where people are getting sick in hospitals and clinics. To some extent that is going on, but we could do a better job using electronic 

health records that are being built across the country. We absolutely need to coordinate across Federal agencies. Critical information is being collected in a variety of Federal agencies, and it is 

very important to collect that and make that viewable by all. 

We need to sustain well-performing laboratories. When you ask 

practitioners what kind of information they value the most in surveillance, they always say laboratory information because it is the 

most reliable. Of course, we need reliable diagnostic tools to tell us 

when something is going on. 

Finally, we need to work together internationally. Our partners 

need the same protections that we do here in the United States, 
15 

from pandemics, from anti-microbial resistance, and from bioterrorism, so we should work particularly hard on building this kind 

of global health security going forward. 

Thank you again for the chance to speak to you today, and I look 

forward to your questions. 

[The prepared statement of Dr. Inglesby follows:] 

PREPARED STATEMENT OF TOM INGLESBY

FEBRUARY 11, 2014 

Madame Chairwoman, Ranking Member Payne, and Members of the subcommittee, thank you for the chance to speak to you today on issues regarding the 

threat of bioterrorism. 

My name is Tom Inglesby. I am the director and CEO of the UPMC Center for 

Health Security of the University of Pittsburgh Medical Center (UPMC) and associate professor of medicine and public health at the University of Pittsburgh. I’m 

an infectious disease physician by training. 

The Center for Health Security is an independent, nonprofit organization of 

UPMC. Our center’s mission is to protect people from the consequences of epidemics 

and disasters and to build resilience in communities against these challenges. My 

colleagues and I have been working on issues related to preparedness for bioterrorism and other major threats for the last 15 years. 

There are a number of major biological threats that confront the Nation. Among 

these are the rising levels of antimicrobial resistance in American hospitals leading 

to increasing numbers of untreatable infections; the prospect of new pandemics of 

influenza or other novel emerging infections like SARS or MERS; the possibility of 

a laboratory accident in which engineered contagious pathogens cause epidemic disease; and, of course the issue prompting today’s hearing, the potential for the use 

of biological weapons in acts of terrorism. There are many commonalities between 

bioterrorism and these other biological threats, and there are also aspects of the bioterrorism threat that require specific, major planning and action. 

My three main messages for the committee are the following: 

• The capability to create and use biological weapons exists widely in the world. 

• The consequences of the use of such weapons could be substantial loss of life 

and societal disruption. 

• While substantial progress has been made in past years, there is a great deal 

that needs to be done to prepare to respond to bioterrorism. 

I’ll elaborate on these messages in my testimony. 

THE CAPABILITY TO MAKE BIOLOGICAL WEAPONS

The interest in biological weapons has been age-old in the world, as has been the 

capability to use them. Biological weapons have been used at various times in recorded human history at levels of sophistication consistent with the time. In ancient 

times, biological weapons were crude. In modern times, they became sophisticated 

and highly lethal. In the 1960s, the capacity to make, disseminate, test, and evaluate biological weapons was transformed. At that time, the U.S. Government funded 

vast programs to develop biological weapons using science and technology that was 

cutting-edge for those years. In those programs, they discovered how to make 

aerosols more stable in the environment; how to make particles float further; how 

to grow pathogens in high quantities; how to disseminate bacteria and viruses without inactivating them; and, much more. At the same time, other countries in the 

world were also studying biological weapons with their own dedicated, highly-funded 

programs. 

In 1969, President Nixon unilaterally ended the U.S. offensive program. Then in 

1972 he signed the Biological Weapons Convention saying that the United States 

already had enough seeds of its own destruction. That treaty led to the end of the 

U.S. offensive program and to the end of any country admitting it had a bioweapons 

development program, even though a number of countries were discovered to have 

had clandestine BW programs in the years since. 

Now 40-some years after the signing of that treaty, the technology and know-how 

that was once the domain of governments, is now within reach of small groups of 

scientists around the world, even individual scientists with the right backgrounds. 

The methods for making aerosols stay airborne are widely available. The tools for 

making pathogens in high quantities in fermenters are on ebay. The recipes for 

making stable formulations of pathogens are on the internet. The equipment for dis-
16 

seminating these weapons is in hardware or agricultural supply stores. This information and technology is almost entirely dual-use—in the sense that it has both legitimate and dangerous uses in the world. It can’t be locked away, and it wouldn’t 

be in our interest to do so. 

I understand that this committee will soon have a Classified hearing on the threat 

assessment. That will be important in giving you the U.S. Government assessment 

regarding what specific countries and groups are doing now with respect to research 

or development or stockpiling of biological weapons. All I will say related to this is 

that the workforce of scientists with microbiology and related relevant backgrounds 

that have enough knowledge to turn information and technology into bioweapons is 

countless and global. While particular threat briefings should help direct focus regarding specific terrorist groups’ or countries’ immediate interests in pursuing biological weapons, it is critical to understand that a country or group could change 

its direction on biological weapons in short order, quite possibly without any obvious 

signal. The former Soviet Union had a massive BW program for decades that was 

not visible to the outside. Given that small groups or even individuals are capable 

of making biological weapons and using them, we should expect not to have advanced warning regarding the development and their use. 

In summary, the know-how and capability to create and use biological weapons 

exists widely in the world. This will only grow with time as the tools and techniques 

of biotechnology become more broadly disseminated, less expensive, and valuable to 

growing economies globally. 

THE CONSEQUENCES OF BIOLOGICAL WEAPONS

The anthrax events of 2001 were shocking for the country. Letters carrying anthrax spores were sent to a number of people in different cities. Hospitals, doctors, 

and nurses at the time were largely unfamiliar with the disease. Elements of all 

three branches of Government were each affected and closed at some point. Buildings had to be evacuated for prolonged periods. Cases appeared over weeks in different places. A number of people were sickened and killed. The source of the anthrax could not be identified. The communication about it from our own Government 

was often uncertain and changing. The media coverage was constant. People were 

afraid of their own mail. Nothing like this had happened before in our country or 

any country. 

A great deal has been done to improve our ability to recognize and respond to biological weapons events since that time. I will say more about that below. But it is 

important for this committee to know that a future biological weapons attack on the 

United States could look quite different that the 2001 anthrax incident—in terms 

of size of attack, form, and the numbers affected. 

The anthrax letters of 2001 came with a warning in them, which allowed some 

people to begin taking protective antibiotics and initiate evacuation. Future events 

are unlikely to come with warnings like that. It is more likely that the first sign 

of a bioterror attack will be sick people appearing in clinics and emergency rooms. 

And while the anthrax letters of 2001 came through the mail, future bioterrorism 

attacks could come in many different kinds of form. There are many means of creating aerosols. And there are clearly other means of using biological weapons 

against the public. 

We also need to understand that the scope of future bioweapons events could be 

far, far greater that what we saw in 2001. In 2009, the U.S. National Security 

Council said: ‘‘The effective dissemination of a lethal biological agent within an unprotected population could place at risk the lives of hundreds of thousands of people. 

The unmitigated consequences of such an event could overwhelm our public health 

capabilities, potentially causing an untold number of deaths. The economic cost 

could exceed $1 trillion for each such incident.’’ The use of such weapons could lead 

to substantial loss of life and great societal disruption. Even with a small or modestsized attack, the social and economic impact would be significant. 

BUILD OUR ABILITY TO RESPOND

In the last 10 years, progress in preparedness has been made in a number of 

areas. There are now a cadre of Government officials, public health experts, doctors, 

nurses, and scientists who have become knowledgeable and skilled in thinking 

through and planning for biological terrorism. That community of experts in and out 

of Government didn’t exist in 2001. There are also a series of major biopreparedness 

programs across the U.S. Government, some of which I will cite here. HHS/ASPR 

has funded hospital preparedness programs around the country and runs valuable 

programs like the National Disaster Medical System. NIH has a basic research program for biodefense. BARDA has developed a number of medications and vaccines 
17 

that could be critical in future bio responses. CDC has funded State and local public 

health agencies to prepare for bioterrorism (among other crises and disasters) and 

it oversees laboratory research in this area, manages a strategic National stockpile 

of medications for use in an emergency, and has an Emergency Operations Center 

that is a model for other health agencies around the world. DHS has created a risk 

assessment and threat characterization process to help guide planning. FDA has 

created an office that deals explicitly with the regulation and approval of products 

only to be used in the event of bioterrorism, pandemics, or other urgencies or emergencies. The DOD and DOS have important programs dedicated to addressing the 

issue overseas through science and technology as well as cooperative threat reduction. Taken together, these efforts, combined with the substantial hard work of 

State and local public health agencies, hospitals, emergency management and civic 

organizations, have put the country on a better footing in its ability to respond to 

major biothreats. 

Our Center’s 2013 study of the U.S. Federal biodefense funding found that 90 percent of the biodefense budget served additional purposes beyond biodefense. The 

good news in that number is that these additional purposes are valuable such as 

public health agency preparedness for disasters, hospital planning for crises, and research that improves our response to infectious diseases. The down side of that 90 

percent number is that there has been an inflated sense of what is actually been 

spent on biodefense; that effort is not nearly as big as it looks at first pass. 

The more work that is done in this field, the more it becomes clear what we still 

need to prepare for to respond to bioterrorism and to sustain the preparations that 

have been made to date. What follows are my recommendations for what we need 

to pay particular attention to in the years ahead in terms of biopreparedness. 

STRENGTHEN MEDICAL AND PUBLIC HEALTH PREPAREDNESS

In the event of bioterrorism, the people who would be on the front lines responding are largely comprised of public health, medical, and hospital professionals. They 

will be the ones most likely to discover that something has gone wrong and to initiate laboratory testing for what is behind it. They are the ones who will be called 

to rapidly investigate what is happening, and where and how the bioterrorism occurred. Following an act of bioterrorism, there may be no announcement, and there 

is likely to be no ‘‘site’’ that can be cordoned off—just sick people appearing in emergency rooms and clinics. Public health and medical leaders will be asked to advise 

our political leaders on the right course of action for administering prophylactic care 

to prevent illness, for treating those who are sick, for identifying those at greatest 

risk of falling ill. And they will be the ones who are providing medical care within 

hospitals. 

Given the importance to bioterrorism preparedness of these professionals and the 

agencies and institutions in which they work, their work needs to be supported. 

Funding for the public health emergency preparedness program (PHEP), which 

funds State and local health agencies to prepare for bioterrorism and other disasters, has been cut by more than $100 million in the last 5 years. In addition, funding support for the National hospital preparedness program fell 33% last year, and 

is down nearly 50% from its inception. I’m really concerned about these reductions 

and trends, and how this sharp decline in funding will weaken these programs. In 

fact, we are already seeing a dramatic reduction in total per capita funding for 

emergency preparedness in the States, which will inevitably results in a reduction 

in our capability to respond when emergencies strike. 

It is worth calling your attention to the National Health Security Preparedness 

Index that was launched in December by 20 collaborating organizations. This is a 

first-of-its-kind index that has as its purpose the measurement of the level of National and State health security preparedness. It uses 128 indicators that gauge 

State capacities and capabilities in the domains of health surveillance, incident and 

information management, countermeasure management, community planning and 

engagement, and surge management. Based on those indicators, scores are calculated that State and local preparedness communities and National policy makers 

can use to judge how well prepared we are, and how to continue to strengthen the 

collective efforts. The overall score for the country in December was 7.2 out of 10, 

with varying results in the States around the country. This score shows that we 

have built some capacity in a number of realms. But it also makes clear how much 

more we need to do. To make these scores improve will require focus and more resources. If, on the other hand, resources for these key National programs continue 

to slide, then I am concerned that index scores in the coming years will decline. We 

shouldn’t let that happen. 
18 

Another critical element of our public health and medical preparedness is the development of medicines and vaccines for use following a biological attack. Development of these products is a complex, sometimes decade-long process with inherent 

risks of failure, as is the case with drug and vaccine development more broadly. It 

is difficult to persuade the major pharmaceutical companies to engage in this effort 

because of the uncertainties of Government policy and action, and because of the 

opportunity costs associated with doing this work as opposed to other more economically-valuable opportunities. A variety of programs and policies have been established over the years to try to deal with this challenge. Earlier critical steps to deal 

with this were the creation of the BioShield fund and the establishment of the 

BARDA advanced research and development program. The loss of the multi-year 

BioShield fund has been a setback for the USG effort to develop countermeasures. 

It creates new uncertainty for the private sector. The single-year BioShield appropriation for fiscal year 2014 is about equivalent to half of what had been available 

annually in years prior. 

On the other hand, there has been a positive change in the way BARDA is now 

funded. In past years, advanced development at BARDA had been funded by diverting BioShield funds, which was not how the funds were intended. Fiscal year 2014 

is the first year since fiscal year 2008 that BARDA advanced research and development has received funds from Congress directly and not from BioShield. It is important that BARDA continue to receive appropriations that are separate and distinct 

from BioShield. The purposes of BioShield and BARDA are distinct and should be 

funded accordingly. 

Another major contributor to success in the program to develop countermeasures 

is the FDA program, established explicitly to support the regulatory process for 

these medicines and vaccines. This has been a highly successful program and should 

continue to get strong support. 

It is worth underscoring again in the context of countermeasure development that 

we really need to come to grips with what was learned in the bioweapons programs 

from the 1960s. From those programs we learned that some biological weapons did 

not cause illness in the same patterns as naturally-occurring infectious diseases. 

Among other things, they caused illness on an accelerated time course, and they had 

the ability to overwhelm traditional treatment strategies. As we continue to improve 

and build our countermeasure development efforts and broader planning efforts, we 

need to make sure our planning for today takes into account what we learned from 

those earlier years. 

MAKE WISE INVESTMENTS IN BIOSURVEILLANCE

The U.S. Government definition of biosurveillance comes from Homeland Security 

Presidential Directive 21. There it is defined as ‘‘the process of active data-gathering 

with appropriate analysis and interpretation of biosphere data that might relate to 

disease activity and threats to human or animal health—whether infectious, toxic, 

metabolic, or otherwise, and regardless of intentional or natural origin—in order to 

achieve early warning of health threats, early detection of health events, and overall 

situational awareness of disease activity.’’ 

We need biosurveillance systems to help us detect and understand new outbreaks 

and to discover specific signals related to bioterrorism or other health events. There 

are many information needs that would immediately and urgently arise following 

an act of bioterrorism: How many people are sick? By what means is the disease 

spreading? What are the risk factors and how do we control them? What public 

health interventions are working? Are treatments working safely and effectively? 

And many other related questions. We need systems that can answers these questions. 

To do this requires good information systems, analytic capability and health expertise. At the Federal level, that means sharing information across the agencies 

quickly. Information that can bear directly on outbreak discovery and control can 

come from public health, the agricultural sector, commerce, private industry, overseas disease surveillance networks, and many other channels. Programs like NBIC 

that are intended to share and organize that information across Federal agencies 

and with State and local partners are critical. We should also support innovation 

and research into whether we can use social media and mobile technologies to identify outbreaks early. 

At the local level, public health leaders also need information systems that give 

them insight into what is happening within hospitals during outbreaks. This requires collaboration between medical institutions and public health agencies in ways 

that helps them identify new patterns of disease in outbreaks, and gauges the effectiveness and safety of medicines and vaccines in automated, rapid fashion. 
19 

Disease surveillance also requires good laboratory diagnostics. When you ask public health officials what kind of surveillance information they place highest value 

on, they consistently tell you that laboratory data is the most prized because it provides definitive diagnosis of an illness or an outbreak. Laboratory diagnoses of serious infectious diseases that are made in a clinic or a hospital are not always automatically transmitted to public health officials who would be responsible for communicating about them to the public and to political leaders. We also need to continue 

to push ahead to develop rapid diagnostic tests for bioterrorism-related and other 

infectious diseases, recognizing that there is no commercial market for these products, so they will need continued Government development support and Government 

purchase. 

A few words on environmental surveillance. I understand you will be holding a 

future hearing on this issue. So I will only comment here to say that there is a clear 

need for environmental surveillance, but it has to work in the real-world situation 

where it will reside. If State and local public health agencies are to be part of the 

system (and they have expertise and tools that are needed for these systems to 

work), then they need to understand and believe in the value and the effectiveness 

of these systems. If State and local leaders don’t have the confidence to take action 

following an environmental surveillance alarm when it goes off, then that is not a 

well-functioning system. So in addition to all the development, testing, and evaluation of these environmental systems, a continued examination and testing of how 

they are actually working in places around the country is critical. 

IMPROVE GLOBAL HEALTH SECURITY

The work we need to do to prepare for bioterrorism has much in common with 

the work we need to do to respond to pandemic influenza, emerging infectious diseases, and antimicrobial resistance, particularly as we work with our international 

partners around the world on these challenges. 

Each of these problems requires a workforce that knows how to recognize new 

outbreaks and new patterns of infectious disease. Each of them depends on scientific 

research to improve our understanding. Each of these issues could cause serious response challenges in the medical and public health communities. And in each of 

these realms, we have to cope with the reality that markets themselves have not 

been enough to create the new medicines, vaccines, and diagnostics that are needed. 

The required preparations and responses to these issues are the same for our international partners as they are for us. It is important to see the ways in which working together on them makes sense and can create valuable synergy. 

In conclusion, there has been consistent progress in recent years in our efforts to 

prepare for bioterrorism and related threats. But there remains a great deal of critical work to be done. Over the last decade, we have witnessed a slow but steady 

decline in attention to bioterrorism preparedness issues, in part because we haven’t 

experienced another bioterror attack since 2001. But we have no reason—from a 

technical perspective or consequence management perspective—to let our guard 

down. I thank you for holding this hearing to address these issues. The efforts of 

this committee as well as other efforts in Congress can help to ensure we make continued forward progress in areas of great National importance in preparing for bioterrorism. 

Mrs. BROOKS. Thank you, Dr. Inglesby. 

The Chairwoman now recognizes Dr. Cole for 5 minutes. 

STATEMENT OF LEONARD A. COLE, DIRECTOR, TERROR MEDICINE AND SECURITY, DEPARTMENT OF EMERGENCY MEDICINE, RUTGERS NEW JERSEY MEDICAL SCHOOL 

Dr. COLE. Thank you. Chairwoman Brooks, Ranking Member 

Payne, distinguished Members of this subcommittee, and of the 

larger and full Homeland Security Committee, thank you for inviting me to speak on the threat posed by bioterrorism to the American homeland and elsewhere. I am grateful as well to the full committee’s Chairman McCaul and Ranking Member Thompson for 

their leadership on Homeland Security. Since I see he has come 

back, I must also recognize the Congressman who, on many—for 

many reasons I have huge regard for, and in the neighboring coun-
20 

ty—represents people in the neighboring county to the one I live 

in, so we need you on our side. 

In 2012, and again last year, I was privileged to address the Subcommittee on Counterterrorism and Intelligence during which I referenced the 2012 paper titled, ‘‘WMD Terrorism.’’ The paper was 

produced by the Aspen Institute’s Homeland Security WMD Working Group of which I was a member. One of the paper’s conclusions, still valid, is that bioterrorism remains a continuing and serious threat. 

In the wake of last April’s Boston Marathon bombings, Ricinlaced letters were mailed to several public officials, including one 

to President Obama. Just last week, Israel’s Supreme Court upheld 

an indictment against a detained Palestinian operative for alQaeda who was charged with developing biological weapons under 

the direction of the organization’s leader, Ayman al-Zawahiri. 

Since the anthrax attacks in 2001, the U.S. Government has 

spent more than $60 billion on biosecurity programs. They range 

from enhancing methods of disease detection to developing more effective antibiotics, vaccines, and other countermeasures. 

Despite progress in the Nation’s preparedness and response capabilities, deficiencies remain. I cite three here that I think warrant particular attention. The first is the need for expanded education and training throughout the medical community. The level 

of preparedness for a biological assault varies from one location to 

another. Where drills are conducted frequently and in realistic settings, optimal outcomes are more likely. The effective medical response at the Boston bombings was credited not only to the availability of excellent personnel and hospitals, but to the high quality 

of pre-event drills. 

These exercises included mock biological attacks. In many locations, budget pressures and human inertia have resulted in cutbacks in the frequency and quality of exercises. Failure to maintain 

proper levels of education and training diminishes the likelihood of 

a successful medical outcome at an actual incident. 

A second area of concern relates to the special needs of children, 

and I reference as well the concerns of Representative Payne, 

Ranking Member Payne on this issue, the special needs of children 

during a biological attack. Children are particularly vulnerable to 

biological agents because of their more rapid respiratory rate, 

greater skin permeability, and lower fluid reserve than that of 

adults, yet medical response plans typically are adult-specific and 

do not include allowances for these differences. Compounding this 

concern, a 2013 article cited studies showing that most physicians 

feel unprepared to address a bioterrorism attack. These studies included a survey of Michigan pediatricians who were deemed ‘‘overwhelmingly underprepared to deal with an event.’’ 

The third issue that deserves particular attention is the need for 

legislation that directly addresses the threat of biological and other 

weapons of mass destruction. I understand that Representatives 

Pascrell and King are reintroducing the WMD Preparedness and 

Response Act. Although previous incarnations of the bill have 

drawn unanimous endorsement from the House Committee on 

Homeland Security, it is not yet law. Regarding the biothreat, the 

act would heighten laboratory security, help create uniform stand-
21 

1 Unless otherwise indicated the views expressed here are my own and not representative of 

any institution. 2 A course on Terror Medicine is being taught this semester at Rutgers New Jersey Medical 

School, to my knowledge the first such course at an American medical school. 

ards for handling dangerous biological agents, and support appointment of a special assistant to the President to coordinate biodefense policy. The proponents of this bill deserve high praise, and 

I wish them every success toward its enactment. 

In concluding, I note that it is no more possible to completely 

eliminate bioterrorism than it is to completely eliminate infectious 

disease. Still, enhancing security measures reduces the portals of 

opportunity for a would-be perpetrator. Further making biological 

terrorism more difficult to actuate is bound to discourage individuals and groups from even trying. Diminishing the threat is surely 

a worthy goal shared by people of good will everywhere. Thank 

you. 

[The prepared statement of Dr. Cole follows:] 

PREPARED STATEMENT OF LEONARD A. COLE 1

FEBRUARY 11, 2014 

Chairman Brooks, Ranking Member Payne, distinguished Members of this subcommittee, thank you for inviting me to speak on the threat posed by bioterrorism 

to the American homeland and elsewhere. I am grateful as well to the full committee’s Chairman McCaul and Ranking Member Thompson for their leadership on 

homeland security. In 2012 and again last year, I was privileged to address the Subcommittee on Counterterrorism and Intelligence during which I referenced a 2012 

paper titled WMD Terrorism. The paper was produced by the Aspen Institute’s 

Homeland Security WMD Working Group, of which I was a member. One of the paper’s conclusions, still valid, is that bioterrorism remains a continuing and serious 

threat. 

Pathogenic microorganisms and toxins such as anthrax bacteria or botulinum 

toxin are relatively easy to acquire and grow. Disseminating anthrax can be as simple as sending dried spores through the U.S. mail, which is exactly what happened 

in the weeks following the 9/11 attacks. About half-a-dozen anthrax letters infected 

at least 22 people, 5 of whom died. Spores were later found to have leaked from 

the letters during mail processing and delivery. As a result, scores of buildings including U.S. House and Senate office buildings had become contaminated and were 

shut down—some for several years. More than 30,000 people at risk of exposure received prophylactic antibiotic treatment. 

The bio-threat continues. In the wake of last April’s Boston Marathon bombings, 

ricin-laced letters were mailed to several public officials, including one to President 

Obama. Just last week, Israel’s Supreme Court upheld an indictment against a detained Palestinian operative for al-Qaeda, who was charged with developing biological weapons under direction of the organization’s leader, Ayman al-Zawahiri. 

Since bacteria and viruses reproduce and multiply, unlike any other weapon they 

can make an environment more dangerous with the passage of time. If resistant to 

medical countermeasures they could kill many thousands. Yet much can be done to 

minimize this risk. Since the anthrax attacks in 2001, the U.S. Government has 

spent more than $60 billion on biosecurity programs. They range from enhancing 

methods of disease detection to developing more effective antibiotics, vaccines, and 

other countermeasures. Despite progress in the Nation’s preparedness and response 

capabilities, deficiencies remain. I cite three here that I think warrant particular 

attention. 

The first is the need for expanded education and training throughout the medical 

community.2 The level of preparedness for a biological assault varies from one location to another. Where drills are conducted frequently and in realistic settings, optimal outcomes are more likely. The effective medical response at the Boston bombings was credited not only to the availability of excellent personnel and hospitals 

but to the high quality of pre-event drills. Those exercises included mock biological 

attacks. 

In many locations budget pressures and human inertia have resulted in cutbacks 

in the frequency and quality of exercises. Failure to maintain proper levels of edu-
22 

3Following are links to references about preparedness and the vulnerability of children to a 

biological attack: http://journals.lww.com/smajournalonline/Fulltext/2013/01000/PreparednessloflRurallPhysicianslforlBioterrorist.7.aspx; http://www.aap.org/en-us/advocacyand-policy/aap-health-initiatives/Children-and-Disasters/Pages/Biological-Terrorism-andAgents.aspx; http://globalbiodefense.com/2013/02/05/bioterrorism-preparedness-the-forgottenpatient-population/#sthash.X9whD34M.dpuf; http://www.ncbi.nlm.nih.gov/pubmed/19194343. 

cation and training diminishes the likelihood of a successful medical outcome at an 

actual incident. 

A second area of concern relates to the special needs of children during a biological attack. On its website, the American Academy of Pediatrics notes that children 

are particularly vulnerable to biological agents because of their more rapid respiratory rate, greater skin permeability, and lower fluid reserve than that of adults. 

Yet medical response plans typically are adult-specific and do not include allowances for these differences. 

Children comprise 23 percent of the population. Making a diagnosis in this group 

can be complicated especially among the very young who are unable to describe 

their symptoms or discuss how they might have been exposed. 

Compounding this concern, a 2013 article cited studies showing that most physicians feel unprepared to address a bioterrorism attack. The studies included a survey of Michigan pediatricians, 85 percent of whom had never participated in a bioterrorism training exercise. The authors of the survey concluded that these pediatricians were ‘‘overwhelmingly underprepared to deal with an event.’’3

The third issue that deserves particular attention is the need for legislation that 

directly addresses the threat of biological and other weapons of mass destruction. 

I understand that Representatives Pascrell and King are reintroducing the WMD 

Preparedness and Response Act, versions of which they have sponsored in the past. 

Although previous incarnations of the bill have drawn unanimous endorsement from 

the House Committee on Homeland Security Committee, it is not yet law. 

In 2008 the bipartisan WMD Commission called for measures now part of the bill 

including the establishment of a National strategy to counter the threat of weapons 

of mass destruction. Regarding the bio-threat, the act would heighten laboratory security, help create uniform standards for handling dangerous biological agents, and 

support appointment of a special assistant to the President to coordinate biodefense 

policy. The proponents of this bill deserve high praise, and I wish them every success toward its enactment. 

In concluding I note that it is no more possible to completely eliminate bioterrorism as a threat than to completely eliminate infectious disease. Still, enhancing 

security measures reduces the portals of opportunity for a would-be perpetrator. 

Further, making biological terrorism more difficult to actuate is bound to discourage 

individuals and groups from even trying. Diminishing the threat is surely a worthy 

goal shared by people of good will everywhere. 

Mrs. BROOKS. Thank you, Dr. Cole. 

At this time, the Chairwoman is now just pleased to recognize 

Congressman Pascrell, and so pleased that you could be here because of your extensive work on this issue, and so we appreciate 

you taking time out of your calendar to make sure you can be here 

today. As much time as you may consume. 

Mr. PASCRELL. Madam Chairwoman, it is an honor to be here, 

and with our Ranking Member, and it is good to hear the experts 

that you have called and assembled here. I am very, very familiar 

with Dr. Cole, and we have been at this a long time, at least it 

seems a long time anyway. 

We have to go back to 9/11 reports to the Congress of the United 

States, and this is the one area, Madam Chairwoman, this is the 

one area that we have been absolutely negligent. We have not done 

near enough to address the issues which the 9/11 Commission laid 

before us. I articulated it to the ‘‘nth’’ degree. 

As a Member, original Member of the Homeland Security, we 

tried to do our best to implement the recommendations of the 

9/11 Commission. They weren’t all implemented immediately, as 

we well know. This has a long, long history, unfortunately, but I 
23 

don’t sense, Madam Chairwoman, the urgency about this, and I 

think our three—I did read Dr. Inglesby’s testimony, they have all 

basically said the same thing, too, about that issue. Why isn’t it 

that we are not addressing it? I mean, we spent over $60 billion, 

and so like a lot of money we spent in Homeland Security that 

went for naught because if we don’t have a coordination of agencies, then nothing is going to work. This is serious business, regardless of which part of this, you know, we are talking about. So 

I want to thank you and Ranking Member Payne for allowing me 

to say a few words today. 

We are going to reintroduce, Peter King and myself, the Weapons 

of Mass Destruction Preparedness and Prevention Act today. For 

the past three Congresses, I worked with Mr. King to enact this 

much-needed legislation, to establish comprehensive protection and 

response in addressing a threat of weapons of mass destruction. 

This wide-ranging bill addresses all aspects of our preparedness 

frame-working. It touches upon prevention, protection. Prevention, 

you have heard our witnesses talk about education, tremendously 

lacking, directed only to one subgroup and not to the entire population, particularly to our kids; the protection of our population and 

what responses we have, God forbid, when any—whether it is 

chemical, biological, radiological, or nuclear attacks occur, what do 

we do? Are we prepared? You have heard what our witnesses said. 

So, we have a long way to go. Then finally, recovery. How do we 

recover from such a dastardly situation? Are we prepared to recover? We live in a very important and critical age. It has brought 

us some terrible things, but it is also hope for the future that not 

only we can prevent these things—and it is never going to be seamless, we know that. I am glad you are bold enough and brave 

enough to say that. Most relevant, I think, to the topic to today’s 

discussion, this legislation requires a new top-down strategy from 

the White House for a better intergovernmental approach, meeting 

the need for Nation-wide monitoring of biological threats. That is, 

I think, very paramount to our efforts. We may—we need to make 

this issue a priority. 

Remember, we created the Talent/Graham Weapons of Mass Destruction Commission because of the extreme gravity of this threat, 

particularly from a biological attack. Madam Chairwoman, that is 

a long time ago we did that. After 12 years, we still do not have 

a comprehensive strategy. Versions of the WMD Prevention and 

Preparedness Act have passed out of this committee twice, but unfortunately, it never made it to the floor. 

When you guys were the Majority, when we guys were, so I 

mean, there is enough concern around here to go around. Meanwhile, there does not appear to be any momentum in this administration to tackle the pressing issue of terrorism, bioterrorism. I was 

encouraged to see that the White House released the National 

Strategy on Biosurveillance in July 2012. It fell short on substance. 

The strategy was far from what Congressman King and I envisioned in the WMD bill. I hoped—I had hoped that the implementation plan, which was supposed to be released by December 2012 

would fill the gaps. It still hasn’t been released. That is totally unacceptable. I mean, this is either a priority or it is not, and when 

everything is a priority, nothing is a priority. 
24 

I am pleased that Mr. King has agreed to work with me on this 

by introducing the measure today. I think this is a matter of life 

and death. It has been over 2 years since the WMD Center, the 

successor to the WMD Commission released its ‘‘Bio-Response Report Card.’’ You look at that report card, and you have to wonder, 

and it would scare legislators, so think about what it will do the 

public. It has been made public. I don’t know if anybody ever read 

the darn thing. 

In the absence of progress on robust legislative initiatives, such 

as this bipartisan bill, little has changed. Doctor, can I just ask Dr. 

Cole? 

Mrs. BROOKS. Absolutely. 

Mr. PASCRELL. Dr. Cole, I am highly concerned, as all three of 

you are, with the continued lack of progress in our preparedness. 

The WMD Prevention and Preparedness Act calls for a comprehensive strategy across the entire Federal Government to counter bio 

threats. What is the current level of coordination between agencies 

on these issues as you see it and how do you believe we can improve it? Because I think that is at the core of us moving and getting out of our quicksand here. 

Dr. COLE. I wish I had a very good answer for this. I do not. In 

part, I am not part of the Governmental apparatus and the dayto-day affairs of interagency cooperation. I am aware of several initiatives that are being directed at this problem, certainly in the 

Health and Human Services Department and advances in BioShield in particular. I don’t know how one can raise the level of 

consciousness to an appropriate degree. A lot of this is psychological. We can all imagine, God forbid that it should happen, that 

if there were a major biological incident in the next week, 1 minute 

after the word got out that this was the case, there would be attention around the country and would be again revved up. 

My short answer has to be that holding hearings like this with 

prominent spokespersons reminding everybody of the importance of 

this issue can only be to the good. As I said in any remarks, I think 

it is terrific that you and Representative King are going to be reintroducing the WMD bill. 

Mr. PASCRELL. Well, we are not going to be discouraged. You 

know, we don’t give up. We are not smart enough to give up. Would 

either two gentleman like to jump in and briefly respond to that? 

I would appreciate it. 

Dr. KADLEC. Well, I may have a little more insight than Dr. Cole 

other than to say that it really does take some leadership at the 

very top to basically drive this problem. In my experience, and I 

had the title, was basically, you know, working the issue 24/7, 365. 

I think that is really what it takes, and it basically is more than 

just an individual. It takes, you know, literally the President to 

make this a priority. I will just highlight his making the nuclear 

terrorism issue a priority has made a difference, has mobilized not 

only the world, but the U.S. Government to work against that problem, and clearly this is a similar nature that requires the same 

kind of attention and commitment, too. 

Mr. PASCRELL. Dr. Inglesby. 

Dr. INGLESBY. I agree. Well, I think the first dilemma for all of 

us is that the functions of biodefense are really going to have to 
25 

reside in different agencies. It is very hard to imagine at an implementation-level point that we gather because HHS has to do certain things, CDC has to do certain things, DOD, et cetera, so there 

is going to be challenge for coordination, so it is really important 

what you pointed out. I think the people actually leading those programs, their personalities and their ability to stay on the issue is 

really fundamental. I think we do both when Bob was in office and 

now, I think there are a lot of very impressive people running those 

programs, but obviously we could always get—we need to improve 

coordination. 

Mr. PASCRELL. Madam—Thank you. Madam Chairwoman, I don’t 

know if we have to work backwards for folks to understand how 

devastating any of these attacks could be on a small level and a 

large level. We—we need to get—make sure that there is a sense 

of urgency on this administration and future administrations about 

this very critical issue, and I applaud you for what you are doing, 

both of you, in order to get this in front of the public again, because 

if we don’t address it, we saw what happened on what we would 

consider to be, relatively speaking, smaller attacks. 

I mean, when you—when you look at what could happen in what 

we call ‘‘Oil Alley,’’ the New Jersey Turnpike up in through the 

Elizabeth area, which is—FBI has called probably the most dangerous area in the entire country, I mean, you have a catastrophic 

incident there, you will put immediately 1.5 million people in jeopardy. I don’t know how better to say it. I mean, if that doesn’t 

make you think about what the heck we are doing, nothing will. 

Our bill won’t, discussions won’t, this is serious business, and I 

thank you for your work. 

Mrs. BROOKS. Well, I thank you, Congressman Pascrell, for your 

leadership, for you and Congressman King continuing to fight this 

battle Congress after Congress, and I assure you that this committee and—will continue to fight the battle as well. Thank you for 

pointing out the Bio-Response Report Card, which while it was in 

our materials, it shows—and while we are all used to A through 

F grades, there are no As on this report card. There are a lot of 

Fs on the report card, a lot of Ds, such as medical countermeasure 

development and approval process, such as medical countermeasure availability, and medical management, all of the things 

that our witnesses have talked about, and so it is—it is clear that 

we are not yet prepared and that we have a long way to go, even 

though there have been, you know folks like yourselves working on 

this for quite sometime. 

So, we appreciate, we look forward to working with you on movement of your bill and with hopeful passage and very much appreciate your leadership in this Congress. Thank you. 

At this time, I will recognize myself for 5 minutes of questioning, 

and I want to build a bit on some of the points that have already 

been made. Again, talking a bit about the coordination. Because 

there is no leadership, a biodefense advisor as you were, Dr. 

Kadlec, to President Bush, there is, at this time, not a person singularly responsible for this. 

The GAO testified before the subcommittee in April 2011 that development of medical countermeasures for biological and other 

threats is a complicated business, and as I just brought up with 
26 

this biodefense report card, we are really not doing well on that— 

on that measure. The business starts with a declaration by Department of Homeland Security that a virus or bacteria or chemical or 

other agent is a material threat. It then becomes incumbent, as you 

said, Dr. Inglesby, upon HHS to work with industry to develop 

pharmaceuticals that can help meet the threat. GAO has reported 

that the coordination between DHS and HHS has not been optimal 

and could benefit from clarification between the two agencies on 

time frames, milestones, and written procedures. 

This is a question for the entire panel: How do you think these 

agencies are working? What should we be doing to encourage or require DHS to be doing to facilitate the smooth transition of threat 

information to HHS to assist with this counterdevelopment, development process? Because, as we have seen from this report card, 

we are simply not prepared. 

So, I would like to start out with you, Dr. Kadlec, and then each 

of the panel to talk about our preparedness and the coordination 

between those agencies, and working also with industry. 

Dr. KADLEC. Certainly. There exists within the enterprise, if you 

will, this Public Health Emergency Medical Countermeasures Enterprise, PHEMCE, which is really a way to convene the interagency group at levels below the White House levels. While I think 

that is effective in terms of what is a polite coordination, the question is, is whether or not the priorities that have been outlined by 

DHS have been effectively acted upon by HHS, and quite frankly, 

that is not a polite conversation that has to happen, and clearly, 

I think, has to go a level above. 

To think about how you could effectively maybe encourage, or coerce better coordination, you have the report card that you identify 

doesn’t get into details that have been identified, but I do know 

that there have been 12 agents on them, material threat determinations have been made, and it may be helpful to have a report 

card issued each year that looks at the progress against those 12 

different agents. I through you would find that probably you will 

find some real progress in one area, or maybe two, but not much 

progress in other areas. 

So I think the question is, is I think that is one way to monitor 

this effort. I do believe that in some ways the role of the White 

House reigns supreme here, and while we are fixated on the idea 

of a senior leader in that position, I also think that one of the important roles of the Government is really with the Office of Management and Budget, and they were our greatest ally to basically 

have these kinds of conversations with the interagency, subject to 

the progress or nonprogress that has been made. 

So I think in some ways it really does require good oversight by 

Congress, and certainly transparency in terms of the progress that 

is being obtained, as well as leaders inside and outside the process 

to ensure that it is met. 

Mrs. BROOKS. Thank you for those suggestions. Dr. Inglesby. 

Dr. INGLESBY. Yes, this is a really complicated process, and I 

think it has been evolving—I am sorry. Thank you. It is a very 

complicated process. It has been evolving, I think, in the right direction, albeit not as fast as we would like over the years. I think 
27 

that my sense from the outside is that DHS and HHS are communicating better about the risk assessment process than before. 

I don’t know that the risk assessment process is what is rate limiting right now as much as is resource and decisions, terrible decisions that have to be made between do we develop this versus this 

versus this. At some point, I think the whole process run into a resource dilemma. If you took what they are being asked to do and 

gave it to the private sector, the private sector developing its own 

medicines and vaccines could not do in terms of resource what we 

have asked the Government to do, to make new medicines and vaccines. 

So I think overall there is a resource limitation. I do think, at 

Bob’s idea of looking at what of the 12 things that are material 

threat determinations, how much progress we have made on those, 

always thinking about whether or not we need to elevate something new as a new material threat. I think that is a very logical 

way to go, and we have much further to go on all those things, but 

my sense is that, in the end, that is largely what we are able to 

make available, given budget austerity. 

Mrs. BROOKS. Thank you very much. Dr. Cole. 

Dr. COLE. The situation, as I hear it being discussed, and I have 

thought about it myself, reminds me of the dilemma that was 

posed some years back, not too many years ago, before there was 

a Director of National Intelligence. There was not one single person 

with an authority even to convene the various intelligence agencies. 

Now, the 16 or so intelligence agencies are part of an umbrella 

that is directed by an individual, a capable individual, we always 

hope to be capable, and I would think that same importance should 

be applied to this. Now, Bob Kadlec made some remarks, and I 

think perhaps he is being overly modest, but he can refer to his 

own experience about the advantage not only of having a single coordinator, but one who is stationed in the White House and therefore draws the prestige of the Presidency in the White House when 

he or she were to call meetings to gather together to come to some 

kind of coordinated and coherent policy. 

Mrs. BROOKS. Thank you very much. I now recognize Ranking 

Member Mr. Payne from New Jersey for questions. 

Mr. PAYNE. Thank you, Madam Chairwoman. 

Dr. Cole, as I indicated in my opening statement, I am concerned 

about the 40 percent of countermeasures in the Strategic National 

Stockpile are not approved for children. That gives me great reason 

for pause, and what are our greatest challenges to developing countermeasures for children? 

Dr. COLE. Well, I think this relates to some of what I referred 

to before as raising the issue of concern in appropriate quarters. I 

would be happy to think of the White House having a coordinator 

who could then underscore the importance of the filling some other 

gaps as well, but particularly this one as it applies to children, and 

which you so appropriately made reference to. 

Now, this is not just your or my concern. The various pediatric 

associations, I believe it is the American Academy of Pediatrics has 

made a very clear concern about this. In terms of how this would 

be approached in the National Strategic Stockpile, that would be 

just one element in terms of helping to prepare better defenses and 
28 

responses on behalf of children, and that would include, as I referenced, medical training, appropriate individuals being informed, 

local public health authorities, right through what is placed into 

our stockpile for defenses. 

Mr. PAYNE. Dr. Inglesby. 

Dr. INGLESBY. Well, I certainly agree with your judgment that we 

need to do more for the pediatric population. I think Dr. Cole’s 

comments are very logical and sensible. I think part of that education comes from what HHS is trying to do with hospitals in the 

hospital preparedness program and what we are doing to prepare 

kids—prepare for kids’ illnesses and injuries at the hospital level. 

I do think the countermeasure development program needs to 

much more carefully incorporate pediatric needs. The dilemmas are 

not just financial there, but they are ethical. I know that you-all 

know very well how difficult it is to develop a medicine for a child 

that would only be used in the event of a National emergency. 

I mean, the ethics systems that we have now require us to only 

test medicines in kids when they can have a direct benefit and— 

so, it poses a new and very difficult problem that the President’s 

Bioethics Commission took on very well. That doesn’t get us out of 

having to spend much more thought and time and resource on the 

problem, so I do agree with you and think we should. 

Mr. PAYNE. Dr. Kadlec. 

Dr. KADLEC. Sir, I would just endorse the comments made by Dr. 

Cole and Dr. Inglesby. I do believe the ethical issues are certainly 

significant and no trivial matter. I do believe there is an element 

of priority though, and focus on this to understand that in some 

ways we have a very significant obligation to those most vulnerable 

in our society to protect them, and I think in some ways that is 

a reminder that needs to pervade the whole effort, whether it be 

the policies, whether it be the programmatics, the advanced development, the procurements, as well as the FDA testing that goes 

around this to ensure that we do keep an eye to that problem. 

It is not an easy problem and certainly one that would benefit 

from some more resources, but I do believe more attention, and, as 

you pointed out, sir, very eloquently, the realization that we have 

this very significant obligation to these children. 

Mr. PAYNE. Okay. I would just like to ask each one of you: How 

can Government in our part and industry efforts improve to better 

protect our children? 

I hear the ethical issue, which seems like it is probably pretty 

difficult to get around that. But what can we do to work with industry to protect our children from these dangerous bioagents? 

Dr. KADLEC. Well, I will just give you a tangible one. I think, in 

terms of the annual—or the—they are not frequent, but I think the 

notion that the frequent requests for proposals that come from the 

Government—I can’t recall one that specifically calls out the children in any form or fashion. It would seem to me that would be 

an appropriate thing to do, to identify particular products or product preparations that would be more amenable for children. 

I just note that in some ways some antibiotics that we have in 

the Strategic National Stockpile are not formulated in a way that 

would be easy to give to the children—for either the parents to give 
29 

or the children to accept. So I think that is one little example of 

what you could do practically to address that. 

Mr. PAYNE. So be more specific in the RFP. 

Dr. KADLEC. As well as have specific RFPs for pediatric preparations. 

Dr. INGLESBY. I think that is a good idea. I think maybe another 

thing to consider is whether or not we should be more explicit in 

our requirement-setting process. 

Because the Government really is driven by requirements and, if 

we formally establish in some way some requirement for pediatric 

formulations, then that would drive work and direction. 

I am not sure I have a proposal on how to do that. But to the 

extent that it is not happening now, we should consider doing that. 

Dr. COLE. I have the strange thought that, (A), because we are 

talking about children, there would be much greater sensitivity to 

this issue as there would be about our treatment and concern for 

children across the board. 

By creating this consciousness of disparity in terms of preparation and capabilities for response with children, in a way, that is 

a vehicle to alert the entire population and answer some of the 

questions that have been raised, in general, about our concern for 

preparedness. 

Or I guess in a sentence I can say, if we are very concerned 

about the welfare of our children in this area, bioprotection, then, 

surely, if we are going to take steps to advance that kind of capability on behalf of children, the indirect effect as well would be to 

raise consciousness about the concerns we have for the biothreat, 

in general. 

Mr. PAYNE. Thank you. 

Thank you, Madam Chairwoman. Thank you for your indulgence. 

Mrs. BROOKS. Thank you. Very, very important question. 

I yield 5 minutes to the gentlelady from New York. Thank you 

for being here. 

Ms. CLARKE. Thank you so much, Madam Chairwoman. 

I thank our experts this morning, and just wanted to sort of concur with Congressman Pascrell because part of his motivation for 

his legislation spoke about the petrocorridor and how a bioterrorism attack would impact the immediate population of about 1 

million or more residents in New Jersey. 

Being his neighbor to the north, coming from New York City, I 

could see such an event having catastrophic consequences. So I 

think that this subject matter is something that requires far more 

attention. I want to thank the leadership here for holding this 

hearing today. 

My first question is to Dr. Kadlec. In 2011, you testified at a 

joint hearing before the subcommittee on the WMD Prevention and 

Preparedness Act of 2011 and, at the time, you observed that we 

had spent about $50 billion on biodefense and that there are legitimate questions as to whether we spent too much in certain areas 

or overlooked others. 

So my question is: Has Federal visibility of biodefense investments improved? If so, how so? If not, how can we get a better idea 

of where our dollars have been invested and how to prioritize and 

coordinate future spending? 
30 

Dr. KADLEC. Thank you, ma’am, for that question. I think the answer is there has been some improvements and, again, they are 

kind of buried deep in the bureaucracy. 

But one of the issues that occurred, I think, early on in the tenure of the Obama administration was to demand a cross-cutting 

budget analysis by OMB. 

I don’t know if that has ever been shared with Congress, but it 

would certainly be illustrative, maybe, of a better idea of where the 

money is going and how it is flowing. I think, quite frankly, whether we have spent too much or too little, the question is whether we 

have spent effectively. That is a big issue, and I will use one example. 

One of the great things that Congress did collectively in a bipartisan fashion in 2004 is create the Strategic Reserve Fund, which 

is also known as BioShield and Project BioShield. With it, it understood very clearly the necessary incentives to have industry basically come to the table and work actively in this space, particularly 

for countermeasures that don’t have commercial—if you will, commercial benefit to their shareholders and to their companies. So 

that is something that has gone forward. 

With the reauthorization of that and with the reauthorization of 

the Pandemic and All-Hazards Preparedness Act, again, Congress 

said, ‘‘Instead of a 10-year outlay, we will give you a 5-year outlay 

of approximately $2.6 billion.’’ The challenge is to kind-of get the 

Government as it stands to appropriate that money and to ask for 

that money in Presidential budgets and appropriations to—again, 

to reaffirm the commitment of the Government around it. 

So in some ways it is not that we haven’t put the money on the 

table; it is how we put the money on the table and what reassurances we have. That is just one example. 

I think there are many other examples where we have been 

penny-wise and pound-foolish, in hospital preparedness programs 

where the budget was cut a third this year, or in the metropolitan 

medical response programs that Representative Payne highlighted. 

So I think the thing is that, as the attention to this issue has 

kind of waned—and Representative Payne talked about the ebbs 

and flows; it happens in many levels and many different fashions— 

that is one where we just need to have a consistent level of sustainable funding to ensure that the preparedness that we achieve is 

something that we can continue and build upon. 

Ms. CLARKE. Thank you for your response. 

Clearly, the ebb and flow of this does not bode well when you 

want to remain protected and have a robust infrastructure to deliver. 

As I said, I am from New York City and, when you have over 

8 million people that have to be attended to in an event, it becomes 

very challenging if your hospital infrastructure gets overwhelmed 

and it does not have the capacity. So I can appreciate your response about the funding. 

Dr. Inglesby, in your testimony, you note that, over the past 10 

years, through significant investment, a cadre of people with expertise and planning for biological terrorism has emerged and a series 

of major biopreparedness programs have been launched. 
31 

In your opinion, are these programs effectively coordinated across 

various levels of Government and with the private sector? 

Dr. INGLESBY. Well, in an enterprise as big as biodefense, I think 

coordination could always be better and I think communication 

with industry could always be better. Sometimes I think it is a 

common refrain to hear from industry that they don’t know enough 

about what the Government wants or in what form it wants it. 

So that is a challenge, and it is a challenge for the Federal officials who want to communicate with industry, but also are worried 

about procurement rules and the way that that operates. 

I would say that I am worried about the support of some of the 

critical programs. You mentioned the budget a moment ago. I think 

the number $60 billion—in our center, we put out an annual analysis of the biodefense budget. So that number is about in line with 

what we have calculated that has been spent over time. 

But it is a misunderstood number because more than 90 percent 

of that money is also being spent—it is being spent in the name 

of biodefense, but it is actually being used for many other purposes, 

which isn’t necessarily a bad thing. It is often a good thing. It’s 

dual-use purposes for research or for preparedness. 

But some people will swing around the number like a bludgeon and say, ‘‘We’ve spent $60 billion,’’ but, in reality, what we have 

spent for biodefense in a dedicated way has been much smaller, 

much, much smaller. 

I am worried that some of the key programs that biodefense 

planning depends on—the CDC programs, the hospital preparedness programs, the BARDA and BioShield programs—are under a 

lot of pressure and that, if we continue to erode those problems we 

will absolutely see a decrease in capability. 

So it is important for Congress particularly to know what those 

key programs are and think a lot about that as they consider their 

funding choices in the year ahead. 

Ms. CLARKE. In both of your responses, I kind of get the feeling 

that, if you don’t use it and maintain it, you lose it, and I think 

that that is something that we have to be very conscious of as we 

address these threats that are very present and ever present in our 

civil society. 

I yield back, Madam Chairwoman, and thank you. 

Mrs. BROOKS. Thank you. 

At this time we will begin the second round of questioning. As 

I noted in my opening statement, this hearing is part of a series 

that we plan on taking on of oversight activities on the Federal biosurveillance efforts, particularly BioWatch and NBIC. 

Tomorrow, Secretary Johnson comes before the full committee. I 

am interested in your perspective, specifically on BioWatch, on 

thoughts with respect to Gen–3, and the NBIC. 

Are these initiatives that we are investing significant dollars 

around the country, are they working, or what changes would you 

recommend to the new Secretary or to the committee? Dr. Kadlec? 

I would love to hear from all of you. 

Dr. KADLEC. Thank you, Madam Chairwoman. 

So subject to the BioWatch program, I have an intimate understanding of the program, having been in the White House at the 

time of its creation. 
32 

I would just point out that the intent of that program was simply 

to provide public health officials early warning to the risk of a 

large-scale release of a biological agent. I think that remains as a 

consistent threat that goes on. 

The idea was, though, spiral development of the program as it 

went on. When the program was first deployed, it was very rudimentary and the idea was that, over time, improvements could be 

made in an incremental way. 

I think there was a decision made—an investment decision made 

that I think, quite frankly, in retrospect, wasn’t probably the wisest 

one. 

We basically took a lot of that investment money and put it 

against the next generation of BioWatch detectors, and we know 

the rest of story there at least right now. 

So I think, in some ways, BioWatch deserves improvements. 

BioWatch can be improved by things improving the chronological, 

if you will, assessment that it can provide when a release occurs. 

It can also increase the density of collectors. 

Certainly there can be improvements subject to the time at 

which these collectors can be sensed in terms of looking for particles in the atmosphere that could at least trigger a warning or at 

least an alert to go pull the filters earlier. 

So I think there are very substantive things that can be done 

now. To the idea of an automated system down the road, clearly 

that is the idealized end-state and clearly that is something that 

is worthwhile. 

But I think sometimes the discussion to date has been a tradeoff between environmental detectors and improved clinical diagnosis and the answer is, you can’t have either without the other. 

So the idea that there is somehow a competing idea out there for 

clinical diagnostics, point-of-care diagnostics, for example, I think 

is something that is necessary and invaluable, but you can’t eliminate the idea of an environmental detector. I think it is something 

that we have to continue to work on. 

I noticed the idea of anti-ballistic missile defense was one that 

came in the 1960s and it only occurred decades later in terms of 

its realization, not because we gave up on it, but we continued to 

work on it and find the technology to make it work effectively. So, 

with that, I will just end my comments. 

Mrs. BROOKS. Thank you. 

Dr. Inglesby. 

Dr. INGLESBY. On the two issues, the first on the NBIC program, 

I think NBIC has had a challenging history. It has had multiple 

directors over the years and a change in course a number of times. 

I would say that I am really pleased with how NBIC has changed 

over the last year. I think it has garnered a lot more respect in the 

interagency. I think it has a very strong director. 

I know that they have weekly conference calls where all the Federal agencies that are doing biosurveillance get on the phone every 

week, I think every Friday. I think they have a requirement now 

that they can convene that group within 60 minutes at the White 

House’s request, and have done so. 

I haven’t been on the calls; so, I can’t speak—you will have to 

ask the users whether it is valuable to them. But I do think that 
33 

they have really evolved in a positive direction and are very purposeful and recognize their role as a coordinating entity. 

They do a number of other things that are more innovation and 

local, ground-up surveillance work that I think are pilot projects. 

But I think their fundamental core is around coordination and I 

think it is moving in the right direction. 

On BioWatch, I do think there is a role for environmental surveillance and I agree with Dr. Kadlec that it should not be zerosum with clinical diagnostics, which are also vital. 

I think the problem with BioWatch in a general sense is that the 

public health community, which it was built, as Bob says, to inform, in many places don’t have a lot of confidence or at least have 

confidence that they should take action based upon the results. 

That exists for a number of different reasons, and I am sure the 

AOA, which I have not seen, probably will go into that. 

But I think—if we are going to continue to invest in the 

BioWatch program or even expand it, I think the public health departments—it is their laboratorians and health officials that are 

being asked to both do work around it and then trust the results 

and take action based on it and, if they don’t trust it, then they 

won’t act on it and then this will not be a useful investment. 

So I think we do have to at a fundamental level build it in concert with that community so that they trust it, understand it and 

will act on it if there is useful information. 

Mrs. BROOKS. Thank you. 

Dr. Cole. 

Dr. COLE. I would like to comment and add perhaps in the area 

of BioWatch to the otherwise excellent remarks that we have just 

heard. 

The way I look at it is that the BioWatch ideal is to create a situation that would identify a dangerous biological agent at some location before somebody has symptoms, before anybody actually would 

be going to a doctor or finding out what would be bothering them 

or, putting it another way, before the ideal environmental surveillance capability would exist and, in some respects, already does 

exist, we were all canaries in the coal mine. 

The first way you would identify that there had been a biological 

attack, unless you had advanced warning from the perpetrator, 

which is unlikely, would be when people start getting sick. 

So I very much feel the ideal ought to be respected and that, yes, 

there have been disappointments in both the speed and the reliability of the detection mechanisms as they have progressed. 

But, by all means, I think to forgo continuing efforts to develop 

research and engineering efforts would be a terrible loss to what 

I think is an appropriate and attainable end result that we all 

want, namely, to have effective identification of suspicious organisms when they are actually in the environment and before anybody becomes ill. 

Mrs. BROOKS. Thank you so much for that comment. 

At this time I would ask unanimous consent to submit to the 

record the Bio-Response Report Card that we spoke of earlier. 

Without objection, so ordered. 

[The information follows:] 
34 

Mrs. BROOKS. At this time, I recognize the gentleman from New 

Jersey, Mr. Payne, for questions. 

Mr. PAYNE. Thank you, Madam Chairwoman. 

Just to stay on that topic with the report card, you pointed out 

the Ds and the Fs. I know, when I brought my report card home 

and it looked like that, my father would say it is unacceptable. So 

to that vein, this is absolutely unacceptable, what we see before us. 

Mrs. BROOKS. I doubt that ever happened, Mr. Payne. 

Mr. PAYNE. The WMD Center Bio-Response Report Card, which 

we are talking about, released in 2011 gave the Nation a D for its 

ability to detect and diagnose large-scale attacks, as we have been 

discussing. 

Since 2011, do you think the Nation has made any progress in 

that category? If so, how, Dr. Kadlec? 

Dr. KADLEC. Well, sir, I think the progress is negative at this 

point. Quite frankly, there are just a lot of—obviously, the economic situation we find ourselves in has put a lot of pressure on 

a lot of these programs. 

I think the attention has moved to other areas, quite frankly, 

without the kind of oversight from the White House and certainly 

involvement like your committee’s. I think no one is disinterested, 

but have forgotten about it. We are far away from the events of 

2001. 
35 

So what I am concerned about is that, as time continues to move 

forward, many of these fundamental capabilities will ebb away, to 

use your ebb-and-flow analogy. So I have deep concern about that. 

It is very hard to believe that, in today’s world, we could be so 

vulnerable and become more vulnerable than we may be today, but 

I am very worried about very simple things. 

I think Representative Clarke mentioned about the infrastructure—the public health infrastructure. Even though we may have 

things in the Strategic National Stockpile, we may not be able to 

get them to the people who need them in time because we don’t 

have the infrastructure and the logistics supply chain in place to 

do this. 

So I am very concerned about this, and I am just so glad that 

this committee has taken upon itself, along with Representatives 

King and Pascrell, trying to get the visibility of this issue where 

it is supposed to be, in the front and center of our National security 

and homeland security discussions. 

Mr. PAYNE. Dr. Inglesby, the Nation received another D for its 

ability to determine the source of a biological event. 

Do you think we have made any progress since 2011 in that respect and, if so, how? 

Dr. INGLESBY. I do think that we are continuing to improve, as 

a whole, microbial science. So we are getting—we do learn more 

about pathogens and what differentiates them. 

I think the problem with biological weapons is that, even if we 

know exactly what beaker a pathogen is made in, someone could 

make it in this room and then launch it in India and we wouldn’t 

know that it came from this room. 

We may be able to say that it is very much like another bacteria 

in the same beaker, but you can’t attribute a geographic spot to the 

bacteria itself. So that is always going to be a challenge that lives 

with us. 

It is very different from watching where a missile came from on 

a map or ballistics from a particular gun. Bacteria can be multiplied. They start in one beaker. They can be put in someone’s pocket and moved to another place. I think that is going to be a fundamental challenge for us and we are going to have to rely on different kinds of things to figure out the source. 

Mr. PAYNE. Dr. Cole, how do you think we can improve around 

these issues our capabilities? 

Dr. COLE. Well, the bottom line obviously is continuing research 

and development. I would add this, though, to the general conversation. 

Before 9/11 in 2001, there was very, very little thought about a 

multiple number of airplanes being hijacked and crashed into 

buildings virtually at the same time, simultaneously. 

Before the anthrax letters were sent, there were very, very few 

people and none in the United States Government that I am aware 

of who had actually projected among the many possible means of 

delivery of a biological agent as a weapon sending spores through 

the mail. 

By coincidence, about 8 or 10 months before the actual anthrax 

letters were sent there was an experiment up in Canada and it did 

indicate that these spores could spread and leak from envelopes, 
36 

but nothing on a large-scale measure as what we faced, which I 

guess answers—is a very unfortunate answer, but an accurate one. 

We don’t know altogether how and in what manner the next attack on us—whether biological or otherwise—could be. It could well 

be in a manner that none of us have imagined or been creative 

about. So we do need generic bases for concern. 

So on that basis, I would—in picking up with what Dr. Inglesby 

just said, I wouldn’t worry as much about the source. Yes, it is not 

nice to get a D or certainly an F in any course you take. 

I would be much more interested in what we can do about intercepting once the source or once the distribution or the release of 

biological agents have taken place. 

So I am very much concerned about response—preparedness for 

response as well as identification early on where the material came 

from. 

Mr. PAYNE. Thank you, sir. 

Mrs. BROOKS. Thank you. 

The Chairwoman now recognizes the gentlelady from New York 

for questions. 

Ms. CLARKE. Thank you very much, Madam Chairwoman. 

Picking up on Dr. Cole’s last comment, I would like to ask Dr. 

Kadlec—there are numerous and unique challenges related to detecting and responding to a WMD attack, especially bioterror attacks. 

What do you think that Congress can do to ensure that first responders, emergency services personnel are effectively prepared to 

respond during a biological attack? How can these people be best 

utilized during a response? 

Dr. KADLEC. Thank you for that question. 

I would just simply say we need to protect our first responders 

and their families. Simple as that. We have the means to do so 

today in many respects in terms of vaccines that we have in our 

stockpile as well as the ability to basically develop antibiotic kits 

that can be kept at home safely and securely to ensure that, should 

there be an emergency requiring our first responders and every 

first responder to respond—because, as we heard from Representative Pascrell, these are not going to be small events, potentially. 

These are going to be very large events affecting several hundred 

thousand—millions of people, in New York, 8 million. So you would 

like to believe that every fireman, every policemen, every public 

health worker, every sanitation worker who is going to be needed 

to man pods, maybe every postal worker who in some jurisdictions 

are going to deliver antibiotics to the general public, have the 

means to protect themselves and their family and the confidence 

they can go out into that environment and do their duty without 

concern for themselves or their family members. 

Ms. CLARKE. So old habits die hard. One of the challenges 

around the 9/11 event is that the instinct of the responder is to go 

and respond irregardless of what the dangers may be to that individual. 

What type of measures need to be put in place to really do the 

type of behavior modification that enables our responders to do 

their work effectively and not have the ripple effects that we have 

seen as a result of just their instincts? 
37 

Dr. KADLEC. Thank you, ma’am. 

I would just recall Dr. Cole’s comments early on in his statement 

about the vital importance of education and training. That is transformational in the sense of how we would raise awareness and, if 

you will, give our first responders and the public, in general, information they could use in those kind of circumstances. 

I think one of the great issues—and it was talked about earlier— 

are the psychological effects of biological warfare insofar as, in 

some ways, they prey on the worst ruminations of people’s minds. 

In some ways, you can dispel a lot of those concerns and at least 

inform people in a way that they do have control of their environment and there are things substantively they can do to protect 

themselves and their families. 

Ms. CLARKE. My question to you would be—and to the entire 

panel is: Is there evidence in the training academies across this 

Nation from the municipal on up that this type of adjustment is 

being made? 

You know, as we sit here, graduating classes, the training that 

is taking place, you know, are they playing from the old playbook 

or have you seen an integration of practices that would protect 

them? 

Dr. KADLEC. Well, ma’am, I can’t comment broadly, other than 

to say that I believe—in the professional education and training 

areas, particularly within the medical public health areas, I don’t 

believe that they are institutionalized in a way that bring the best 

practices to care for people in a WMD environment. 

I think there were some earnest efforts after 9/11. Those efforts 

haven’t been sustained. They have become somewhat fragmented. 

They are not part of the course load of any given curricula, I believe, in any profession, whether it be physicians, nurses. 

I would just say that EMS is probably the best position to date. 

They have generally instituted many of these ideas and curricula 

changes. 

But I believe that we are far from where we need to be in basically having everyone have a basis of understanding of what to do 

in a disaster, whether it be a WMD event or even a natural event, 

for that matter. 

Ms. CLARKE. Dr. Cole. 

Dr. COLE. If I could add something, it is sort of an advertisement 

plug, I guess. 

At the school at which I am an adjunct professor of emergency 

medicine, there is a course being taught for the first time, to my 

knowledge, in any American medical school on terror medicine, 

which deals with the unique aspects and distinctive aspects that 

apply to responding to a terror event. 

Now, there is a lot of overlap with disaster medicine and emergency medicine. But when one looks carefully, there are a whole series of issues, including how one has to deal with a biological agent 

used for hostile purposes, that would not apply otherwise. 

So, yes, there are spots. But to your question, which is very important—why and how widespread is training appropriate?—I don’t 

think we know. I don’t think there has been an adequate recent 

survey on what is being taught, if anything, about these areas. 
38 

But I did refer in my oral statement and written remarks to the 

fact that a recent poll of hundreds of pediatricians in the State of 

Michigan—after the surveyors looked at this, they concluded that 

85 percent of them had not had any serious training and that, in 

general, these people were totally unprepared for a biological event. 

Ms. CLARKE. Thank you very much, Madam Chairwoman. 

Mrs. BROOKS. Thank you, as always, for your concern for our 

first responders. I very much appreciate that. 

I have one last question that I would ask each of you to help us, 

which I think would also help Congressman Pascrell and Congressman King. 

As we try to elevate the importance of this continued discussion 

and focus on bioterrorism, how can we do a better job in describing 

what the impact is? 

So when you are educating people, whether it is in classrooms or 

whether it’s at a dinner party, about bioterrorism, do you have a 

way to help us describe what a horrific significant impact a bioterrorism attack would have on our country and our citizens? 

Anyone want to jump in to give us the elevator speech, so to 

speak, to help us explain the importance of this topic as to what 

the impact might be? Dr. Kadlec. 

Dr. KADLEC. Well, I would just simply say the elevator speech I 

would use is basically the United States demonstrated in the 1950s 

and 1960s the plausibility of this form of warfare. 

It became so significant in our concerns that we tried to eliminate it as an acceptable form of warfare by basically engaging in 

a treaty with a number of nation-states, the Biologic Weapons Convention, and certainly our worst fears were realized when we recognized that other nations could assume this capability and certainly 

terrorists. 

So we have empowered now individuals, groups of individuals, 

with the ability to kill as many people as a nuclear weapon and 

they can do so at a fraction of the cost without the technical burdens or liabilities associated with nuclear weapons. 

I think that should be a chilling—chilling story for any person 

who lives in a major metropolitan area, like Representative Clarke, 

or in the corridor, as Representative Payne, or Madam Chairwoman, even in Indianapolis. 

I believe that no part of the country could be spared from this, 

and I think that is the issue that has to be conveyed, is that we 

are all vulnerable. 

The fact of the matter is that there are substantive things that 

we can do to reduce our vulnerability. We can’t eliminate it. We 

can reduce our vulnerability in a way that would basically at least 

make this a manageable risk, not an unmanageable risk, as it is 

today. 

Mrs. BROOKS. Thank you. 

Dr. Inglesby. 

Dr. INGLESBY. I guess in my elevator speech I would say it is important for those who don’t remember it to recall that a series of 

letters containing anthrax which led to less than 10 deaths nearly 

paralyzed our Federal Government and put the Nation on edge for 

months and that those bioattacks were delivered in the crudest 

imaginable form and that technology now exists to create and to 
39 

disseminate biological weapons on a scale that is far, far greater 

than what we experienced in 2001. 

Our strongest defense is to become resilient and prepared for 

those kinds of attacks. It is in our capability to do that, but we 

have to actually plan for it and do it. 

Mrs. BROOKS. Thank you very much, Dr. Cole. 

Dr. COLE. If this were a very long elevator ride—— 

Mrs. BROOKS. I understand you have a train to catch; so, it may 

have to be a short elevator ride. 

Dr. COLE. Not only would I incorporate—or try to synopsize what 

we just heard from Dr. Kadlec and Dr. Inglesby, I would make two 

additional points. 

One is that, unlike any other weapon, we are all familiar at some 

level with the effects of infectious disease. All of us have had colds. 

Many have had flu and others. 

One can remember—certainly in my own family, in my own 

mind, I can remember some very serious consequences, maybe not 

critical, but enough to know that this is not a pleasant thing. 

Can one then imagine becoming infected by something that was 

intended to cause you not only to become ill, but possibly to die? 

There is a culture kind of connection to this, to biologicals, that we 

don’t have in another areas of hostility and weaponry. 

Second, I would speak to the moral question, the moral issue. 

The Biological Weapons Convention treaty that prohibits the use or 

even the development or stockpiling of biological weapons was first 

put on the table in 1972, and it contains a unique phrase that I 

think all of us ought to treasure as to its wording: ‘‘The use of 

these kinds of weapons’’—and I am quoting from this convention— 

‘‘is repugnant to the conscience of mankind.’’ 

That was the first treaty that ever used that kind of language, 

that really elevated the moral and ethical issue to the point where 

it has, I think, a personal and a psychological effect, because it was 

the forerunner of then continuing usage of ethics and morality in 

other treaties as well. 

So I would emphasize those points, particularly the familiarity 

we all have with moderately effective biological agents, and then 

how important it is for us as a society to be aware of how awful 

this kind of thing is, which, in effect, indirectly can minimize the 

likelihood of its use. 

Even those societies, civilizations, countries that have no moral 

compunctions about using biological weapons would then understand that, for many in the world, whatever the purpose of their 

aggressiveness or bad behavior would be, it would be so repulsive 

that it could act as an additional deterrent to them wanting to use 

it in the first place. 

Thank you. 

Mrs. BROOKS. Thank you very much. I think that is an appropriate way to conclude today’s hearing. 

I want to thank each you for dedicating your careers to this incredibly important topic to our country and to mankind, as you so 

eloquently stated, Dr. Cole. I want to thank the staff for getting 

such incredible witnesses before the subcommittee. 
40 

We will do our best to continue to move this discussion forward. 

The Members of the subcommittee may have additional questions 

for you and will ask you to respond to these questions in writing. 

Pursuant to Committee Rule 7(e), the hearing record would be 

open for 10 days. 

Without objection, the subcommittee stands adjourned. 

[Whereupon, at 11:40 a.m., the subcommittee was adjourned.] 
(41) 

A P P E N D I X 

QUESTIONS FROM HONORABLE STEVEN M. PALAZZO FOR ROBERT P. KADLEC

Question 1. Our country has been subjected to numerous, potentially catastrophic 

biohazard exposures in recent years in our agricultural industry; the outbreak of the 

H1N1 (Swine Flu) and the H5N1 (Bird Flu) viruses come to mind. Fortunately, none 

of these exposures have resulted in any large-scale damage. 

However, agro-terrorism, which is the malicious use of plant or animal pathogens 

to cause devastating disease in the agricultural sector, is a concern. But it doesn’t 

stop there. Natural or accidental biological events can have the same devastating 

impacts as those which are intentionally caused. 

To give you a scenario, in 2001, Foot & Mouth Disease affected 9,000 farms in 

the United Kingdom and required the destruction of more than 4 million cows. 

USDA researchers believe that a similar outbreak in the United States would cost 

taxpayers up to $60 billion. Given the relative size of the United States to the 

United Kingdom, this could result in the need to destroy 20 million head of cattle 

in a short period of time with little advance notice. 

Does the Federal Government have a plan in place and the attendant resources 

to handle a disaster of this magnitude? Please identify with specificity this plan and 

those dedicated resources of people and equipment. Specifically, how would the decomposing and potentially infectious carcasses be disposed of? How quickly would 

this response occur, and what would its effectiveness be? 

Answer. Response was not received at the time of publication. 

Question 2. What is the Federal Government’s response plan for a large-scale 

avian influenza outbreak in the poultry industry? Specifically, how would the diseased and infectious birds be disposed of? How quickly would this response occur, 

and what would its effectiveness be? 

Answer. Response was not received at the time of publication. 

Question 3. When a natural or man-caused biological event occurs in the homeland and that affects our livestock or other agricultural interest, we need to ensure 

we have a comprehensive, pre-planned, pre-resourced, and pre-positioned response 

plan in place. 

What recommendations would you make to FEMA to ensure our agricultural interests are protected and that we are prepared to respond in the event of a agroterrorist attack or an epidemic? 

Answer. Response was not received at the time of publication. 

QUESTIONS FROM HONORABLE STEVEN M. PALAZZO FOR TOM INGLESBY

Question 1. Our country has been subjected to numerous, potentially catastrophic 

biohazard exposures in recent years in our agricultural industry; the outbreak of the 

H1N1 (Swine Flu) and the H5N1 (Bird Flu) viruses come to mind. Fortunately, none 

of these exposures have resulted in any large scale damage. 

However, agro-terrorism, which is the malicious use of plant or animal pathogens 

to cause devastating disease in the agricultural sector, is a concern. But it doesn’t 

stop there. Natural or accidental biological events can have the same devastating 

impacts as those which are intentionally caused. 

To give you a scenario, in 2001, Foot & Mouth Disease affected 9,000 farms in 

the United Kingdom and required the destruction of more than 4 million cows. 

USDA researchers believe that a similar outbreak in the United States would cost 

taxpayers up to $60 billion. Given the relative size of the United States to the 

United Kingdom, this could result in the need to destroy 20 million head of cattle 

in a short period of time with little advance notice. 

Does the Federal Government have a plan in place and the attendant resources 

to handle a disaster of this magnitude? Please identify with specificity this plan and 

those dedicated resources of people and equipment. Specifically, how would the de-
42 

* [Note.—My bioterrorism expertise is largely focused on the direct effects on people, not 

plants or animals. In providing answers to the questions I have searched Government websites 

and other literature. I also benefited from conversation with veterinary expert Dr. Sandra San 

Miguel, Associate Dean of Engagement at Purdue University. Before addressing the posed questions, I note that protection regarding any outbreak of animal disease involves layers of interested parties. Federal law requires that serious animal diseases, such as Foot and Mouth Disease, be reported immediately. Federal oversight is largely under the purview of the U.S. Department of Agriculture (USDA) and its Animal and Plant Health Inspection Service (APHIS). 

States also maintain agencies responsible for oversight and control of animal disease outbreaks. 

For livestock events involving reportable diseases the emergency response is Federal first (led 

by APHIS), and then local assistance is used. For responses involving natural emergencies 

(flood, tornado, etc.) the response usually goes local first. If local resources become exhausted 

Federal aid is sought. 

Personal and economic interests buttress the likelihood of early reporting. The following parties are positioned and obliged to report disease as soon as recognized: Veterinarians, farmers, 

slaughter facilities, truckers and other transporters, Federal and State plant inspectors, even 

4–H youngsters—in short, everyone in the livestock industry. Given this array, Dr. San Miguel 

believes that any clinical signs of disease would be recognized quickly. However, before such 

signs are visible, an infected animal may already have been exposed to other animals.] 

composing and potentially infectious carcasses be disposed of? How quickly would 

this response occur, and what would its effectiveness be? 

Question 2. What is the Federal Government’s response plan for a large-scale 

avian influenza outbreak in the poultry industry? Specifically, how would the diseased and infectious birds be disposed of? How quickly would this response occur, 

and what would its effectiveness be? 

Question 3. When a natural or man-caused biological event occurs in the homeland and that affects our livestock or other agricultural interest, we need to ensure 

we have a comprehensive, pre-planned, pre-resourced, and pre-positioned response 

plan in place. 

What recommendations would you make to FEMA to ensure our agricultural interests are protected and that we are prepared to respond in the event of a agroterrorist attack or an epidemic? 

Answer. Belated thank you for the follow-up email and the questions from Congressman Palazzo. Those are all very important questions, and I would have liked 

to have been able to address them. 

But unfortunately neither I nor my colleagues at the UPMC Center for Health 

Security have the expertise or backgrounds to be able to answer those questions 

competently. Our Center has a focus preventing and responding to threats to human 

health, and we don’t have animal health experts on staff. I am sorry that I am not 

of any assistance in responding to them. 

QUESTIONS FROM HONORABLE STEVEN M. PALAZZO FOR LEONARD A. COLE

Question 1. Our country has been subjected to numerous, potentially catastrophic 

biohazard exposures in recent years in our agricultural industry; the outbreak of the 

H1N1 (Swine Flu) and the H5N1 (Bird Flu) viruses come to mind. Fortunately, none 

of these exposures have resulted in any large scale damage. 

However, agro-terrorism, which is the malicious use of plant or animal pathogens 

to cause devastating disease in the agricultural sector, is a concern. But it doesn’t 

stop there. Natural or accidental biological events can have the same devastating 

impacts as those which are intentionally caused. 

To give you a scenario, in 2001, Foot & Mouth Disease affected 9,000 farms in 

the United Kingdom and required the destruction of more than 4 million cows. 

USDA researchers believe that a similar outbreak in the United States would cost 

taxpayers up to $60 billion. Given the relative size of the United States to the 

United Kingdom, this could result in the need to destroy 20 million head of cattle 

in a short period of time with little advance notice. 

Does the Federal Government have a plan in place and the attendant resources 

to handle a disaster of [great] magnitude? Specifically, how would the decomposing 

and potentially infectious carcasses be disposed of? How quickly would this response 

occur, and what would its effectiveness be? 

Answer.* Since the United States has not experienced a catastrophic outbreak of 

Foot and Mouth Disease or other livestock disease in recent memory, response plans 

are based largely on extrapolations from routine disposal methods and lessons from 

major outbreaks elsewhere, specifically in Europe and Taiwan. A review by the U.S. 

Department of Agriculture (USDA) indicates four principal methods of disposal of 

infectious carcasses: Burial (on-site), incineration, rendering (conversion to other 

products), and composting (breakdown into fertilizer). 
43 

Strengths and limitations are associated with each method. Burial of numerous 

carcasses in large pits can be relatively quick, though inadequate protective treatment and insulation (with chemicals and barriers) around the pit risks soil and 

groundwater pollution. 

Contained incineration can be effective but the number and availability of enclosed incinerators is limited. Open-air burning, while quick, contaminates surrounding air. Rendering and composting requires transporting numerous carcasses 

perhaps to distant facilities, which also are limited in numbers. Carcass disposal options are more fully reviewed in a 2004 report by the National Agricultural Biosecurity Center at Kansas State University. (https://krex.k-state.edu/dspace/handle/ 

2097/662) 

I am unaware of a Federal plan to dispose of carcasses explicitly resulting from 

a catastrophic disease outbreak. Oversight responsibility for this would fall to the 

USDA’s Animal and Plant Health Inspection Service. The response presumably 

would be a ramping up of existing methods as suggested by an observation in a 

USDA publication: ‘‘Past experiences of epidemic disease outbreaks in Taiwan and 

Europe indicate that use of several disposal methods in combination may be required to deal with catastrophic mortality disposal.’’ (‘‘Swine Carcass Disposal Options for Routine and Catastrophic Mortality,’’ Council for Agricultural Science and 

Technology (CAST), Issue Paper No. 39, U.S. Department of Agriculture, July 2008.) 

Question 2. What is the Federal Government’s response plan for a large-scale 

avian influenza outbreak in the poultry industry? Specifically, how would the diseased and infectious birds be disposed of? How quickly would this response occur, 

and what would its effectiveness be? 

Answer. Unlike for livestock, and particularly large animals, disposal of birds infected with avian influenza should not include burial. The virus is highly contagious 

and burial and land containment cannot be sufficiently controlled to preclude its 

spread to other birds or mammals. Thus, incineration is the method of choice. But 

because of the virus’s high infectivity potential, transporting birds to standard apparatus such as solid municipal waste incinerators or autoclaves is not advised. Rather, portable (truck driven) ‘‘refractory walled’’ fire boxes are deemed the most suitable to dispose of suspect bird carcasses. (Avian Influenza Bird Carcass Disposal, 

Disposal of Culled Birds and Dead Wild Birds at Remote Locations, USDA Animal 

Welfare Information Center, http://www.airburners.com/DATA-FILESlPrint/ABBirdlFlul%20CarcasslDisposal-v0306d.pdf) 

The speed and effectiveness of disposal, like response capabilities in other areas 

of disaster management, doubtless vary from one location to another. Some areas 

will have quicker access to the required equipment, more appropriate personnel, and 

perhaps have undertaken more frequent and realistic preparedness exercises. 

Question 3. When a natural or man-caused biological event occurs in the homeland and that affects our livestock or other agricultural interest, we need to ensure 

we have a comprehensive, pre-planned, pre-resourced, and pre-positioned response 

plan in place. 

What recommendations would you make to FEMA to ensure our agricultural interests are protected and that we are prepared to respond in the event of a agroterrorist attack or an epidemic? 

Answer. For every disease of concern, the USDA’s Animal and Plant Health Inspection Service (APHIS) has plans in place including provision of medications, euthanasia, and personnel protection. The Federal Emergency Management Agency 

(FEMA) should be working with APHIS in furtherance of these and other response 

methods. According to Dr. San Miguel, this cooperation exists at the State level in 

Indiana and elsewhere. 

For example, the lead oversight agency in Iowa is the State’s Department of Agriculture and Land Stewardship (IDALS), which includes a network of 330 veterinary 

and animal health professionals trained to respond to disease emergencies in the 

State. The IDALS response plans explicitly include working with the Federal DOA– 

APHIS. (http://www.cfsph.iastate.edu/AnimallResponse/English/pdf/A4lSPNlBusinessOverview.pdf) 

Gauging cooperation at the Federal level between DOA–APHIS and FEMA would 

require further inquiries into activities of the two agencies and of other relevant 

bodies. 

Æ