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S. Hrg. 107–507

THE STATE OF PUBLIC HEALTH PREPAREDNESS

FOR TERRORISM INVOLVING WEAPONS OF

MASS DESTRUCTION: A SIX-MONTH REPORT

CARD

HEARING

BEFORE THE

COMMITTEE ON

GOVERNMENTAL AFFAIRS

UNITED STATES SENATE

ONE HUNDRED SEVENTH CONGRESS

SECOND SESSION

APRIL 18, 2002

Printed for the use of the Committee on Governmental Affairs

(

(II)

COMMITTEE ON GOVERNMENTAL AFFAIRS

JOSEPH I. LIEBERMAN, Connecticut, Chairman

CARL LEVIN, Michigan

DANIEL K. AKAKA, Hawaii

RICHARD J. DURBIN, Illinois

ROBERT G. TORRICELLI, New Jersey

MAX CLELAND, Georgia

THOMAS R. CARPER, Delaware

JEAN CARNAHAN, Missouri

MARK DAYTON, Minnesota

FRED THOMPSON, Tennessee

TED STEVENS, Alaska

SUSAN M. COLLINS, Maine

GEORGE V. VOINOVICH, Ohio

PETE V. DOMENICI, New Mexico

THAD COCHRAN, Mississippi

ROBERT F. BENNETT, Utah

JIM BUNNING, Kentucky

JOYCE A. RECHTSCHAFFEN, Staff Director and Counsel

MICHAEL A. ALEXANDER, Professional Staff Member

MICHELLE MCMURRAY, Congressional Fellow for Senator Lieberman

RICHARD A. HERTLING, Minority Staff Director

JAYSON P. ROEHL, Minority Professional Staff Member

MORGAN P. MUCHNICK, Minority Professional Staff Member

DARLA D. CASSELL, Chief Clerk

(III)

C O N T E N T S

Opening statement: Page

Senator Lieberman ........................................................................................... 1

Senator Collins ................................................................................................. 3

Senator Cleland ................................................................................................ 4

Senator Bunning ............................................................................................... 7

Senator Akaka .................................................................................................. 8

WITNESSES

THURSDAY, APRIL 18, 2002

Hon. Tommy G. Thompson, Secretary, U.S. Department of Health and

Human Services, accompanied by Jerry Hauer ................................................. 10

Margaret A. Hamburg, M.D., Vice President for Biological Programs, Nuclear

Threat Initiative ................................................................................................... 36

Thomas V. Inglesby, M.D., Deputy Director, Johns Hopkins Center for Civilian Biodefense Strategies .................................................................................... 38

Thomas L. Milne, Executive Director, Governance Support Team, National

Association of County and City Health Officials (NACCHO) ........................... 40

ALPHABETICAL LIST OF WITNESSES

Hamburg, Margaret A., M.D.:

Testimony .......................................................................................................... 36

Prepared statement with an attachment ....................................................... 54

Inglesby, Thomas V., M.D.:

Testimony .......................................................................................................... 38

Prepared statement .......................................................................................... 67

Milne, Thomas L.:

Testimony .......................................................................................................... 40

Prepared statement .......................................................................................... 74

Thompson, Hon. Tommy G.:

Testimony .......................................................................................................... 10

Prepared statement .......................................................................................... 41

APPENDIX

Article entitled ‘‘Public Health Preparedness,’’ Science magazine, February

22, 2002, submitted by Dr. Hamburg ................................................................. 66

Chart entitled ‘‘Bioterrorism Funding for Selected HHS Agencies’’ (submitted

by Sen. Cleland) ................................................................................................... 83

Chart entitled ‘‘Federal Bioterrorism Preparedness and Response Activities’’

(submitted by Senator Cleland) .......................................................................... 84

Chart entitled ‘‘Sources of Formal Authorities and Responsibilities of Various

Federal Agencies In the Event of Bioterrorism—Executive Documents’’

(submitted by Senator Cleland) .......................................................................... 85

Chart entitled ‘‘Sources of Formal Authorities and Responsibilities of Various

Federal Agencies In the Event of Bioterrorism—Statutory Authorites’’ (submitted by Senator Cleland) ................................................................................. 86

Questions for the Record and Responses from:

Hon. Thompson ................................................................................................. 87

Dr. Hamburg ..................................................................................................... 91

Dr. Inglesby ....................................................................................................... 95

Mr. Milne .......................................................................................................... 99

(1)

THE STATE OF PUBLIC HEALTH PREPAREDNESS FOR TERRORISM INVOLVING WEAPONS OF MASS DESTRUCTION: A SIX-MONTH

REPORT CARD

THURSDAY, APRIL 18, 2002

U.S. SENATE,

COMMITTEE ON GOVERNMENTAL AFFAIRS,

Washington, DC.

The Committee met, pursuant to notice, at 9:35 a.m., in room

SD–342, Dirksen Senate Office Building, Hon. Joseph I. Lieberman, Chairman of the Committee, presiding.

Present: Senators Lieberman, Cleland, Akaka, Dayton, Carper,

Collins, and Bunning.

OPENING STATEMENT OF CHAIRMAN LIEBERMAN

Chairman LIEBERMAN. The hearing will come to order. Good

morning and thanks to all of you for being here.

Today, the Committee on Governmental Affairs examines the

Public Health System’s readiness for a terrorist attack involving biological, chemical, or radiological weapons. This hearing, which was

specifically requested by our friend and colleague, Senator Cleland

of Georgia, follows up on a session the Committee held last October

that exposed a public health system underprepared to respond to

a series of biological attacks that had occurred in the form of anthrax sent through the U.S. mail.

I thank Senator Cleland particularly because he has led the way

on so many of these issues. You arrived just in time to hear me

praising you. It could not be better timing or more well deserved,

thanking you for your thoughtful and impassioned work to increase

the security of the American people at home. In particular, I want

to recognize Senator Cleland’s efforts to strengthen our country’s

ability to respond to biological weapons by crafting legislation that

would establish a much needed central coordinating office at the

Centers for Disease Control.

Senator Cleland will, I am pleased to say, assume the chairmanship of the hearing as we go forward and I must leave to go on to

other commitments.

Let me go back to the anthrax attacks of last fall. Five Americans lost their lives because of their exposure to anthrax last fall.

It was a vicious, fast-acting terror weapon that we knew very little

about. But our ignorance of anthrax and how it works was compounded by bureaucratic labyrinths that prevented critical information from getting to those who might have helped save lives. FortuVerDate 11-MAY-2000 13:06 Aug 13, 2002 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 80296.TXT SAFFAIRS PsN: SAFFAIRS
2

nately, the anthrax attack, deadly as it was, was on a relatively

small scale. Had it been a wider attack, I think it is clear that the

public health system would have been quickly overwhelmed.

Today, we are gathered here to ask for a 6-month assessment of

the Federal Government’s ability to prepare for and respond to a

future attack, and specifically for an update on the coordination between public health and law enforcement agencies, which ran afoul

of each other in the midst of last year’s terror.

We are very pleased and grateful to have Secretary of Health

and Human Services Tommy Thompson return as a witness today

to speak about the progress his Department has made on these

fronts.

The first thing that we all learned about a biological or chemical

attack is that it differs from a conventional terrorist attack and,

therefore, requires a different response. A biological attack would

probably follow a more insidious course. It is a stealth attack, in

effect, that might make itself known slowly and perhaps only intermittently and in places that are disparate, such as doctors’ offices,

health care clinics, or hospital emergency rooms.

As an oversight committee, it is our duty to ask if the government is prepared to protect American lives should the unthinkable

occur, and the answer today, I believe, is that despite some promising progress, Americans are still at risk. Ten major agencies and

dozens of bureaus, including the Defense Department and the intelligence agencies, are responsible for threat assessments, surveillance of disease outbreaks, the protection of food and water supplies, developing and stockpiling vaccines, and assisting State and

local governments in planning, training, and responding to attack.

Secretary Thompson’s Department alone has six different agencies

involved in response preparation to bioterrorism and chemical terrorism.

The problem is that each of these dozens of offices, as is commonly the case throughout government, communicates with its own

particular constituency but too frequently fails to speak and coordinate with other agencies involved in the same undertakings. I must

say that if we have learned anything from our examination of

homeland security in this Committee over the last 6 months, it is

that poor communication and coordination among Federal agencies

and between Federal, State, and local governments is clearly one

of the greatest impediments to adequately protecting the public.

I know that Secretary Thompson and the administration are

aware of the daunting task before them. Since October, the administration has set aside over $1 billion to help States respond to public health emergencies resulting from terrorism and it has requested an additional $4.3 billion in the fiscal year 2003 budget,

which is an increase of 45 percent over the current fiscal year, and

all of it to prevent, identify, and respond to bioterrorist attacks.

Last fall, Secretary Thompson appointed a special assistant to coordinate the agency’s bioterrorism programs and HHS has developed a central command center where it can monitor information

about bioterrorist attacks and respond accordingly.

As I understand it, the administration also plans to expand

CDC’s health alert network, which would connect every county

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health system in America to CDC through the Internet, and halfa-billion dollars is slated for a program to help local hospitals.

Despite these steps, the Federal Government, I conclude, is still

a long way from where we need it to be, and in the longer term,

we need to build a more robust public health system with aggressive health surveillance programs to detect the onset of illnesses,

and we need better coordination and better support for State and

local governments and their health care systems.

So it is up to us. Only the Federal Government can ensure that

the necessary programs and structures are in place to protect the

American people from a biological, chemical, or radiological attack

and we must work together, Executive Branch, Legislative Branch,

and private sector and nonprofit private sector. We must work together to make sure we are operating from a position of strength

and unity to fulfill our duty in this new post-September 11 age to

protect the American people.

Senator Collins.

OPENING STATEMENT OF SENATOR COLLINS

Senator COLLINS. Thank you, Mr. Chairman, and thank you for

calling this hearing to look at the progress that has been made

since the anthrax attacks last fall and to assess what remains to

be done to strengthen the Public Health System’s ability to prepare

for and respond to a biological or chemical attack.

The tragic events of last September and October were a powerful

reminder of just how vulnerable our Nation is to terrorism and how

woefully underprepared much of our public health system was to

respond to such an attack. Moreover, the attacks have heightened

our fears that we could face an even more devastating attack in the

future, including the possibility of a mass casualty attack with a

deadly biological agent like smallpox.

Bioterrorism is unlike any other form of terrorism. While explosions or chemical attacks cause immediate and visual casualties,

the intentional release of a biological agent, such as smallpox, may

at first go unnoticed and, thus, could be far more insidious. It

causes a ripple effect that unfolds over the course of days or weeks.

If not contained, it can spread to others who were not initially exposed, causing a major epidemic and posing a real threat to the

survival of our population.

The long-term threat of biological weapons is very real. Moreover, future advances in technology will not only make these weapons more dangerous, but also make them more accessible and affordable to those who would do us harm. Tragic as they were, the

anthrax attacks in the fall were, in effect, a dress rehearsal for

what we may very well face in the future.

It is, therefore, extremely important that we take a close look at

what happened last fall, as we are doing in this morning’s hearing,

and analyze dispassionately what went well and what did not.

The hearing held by this Committee 6 months ago in the wake

of the terrorist attacks revealed our Nation’s lack of preparedness

to cope with an attack using a biological or chemical weapon. Witnesses identified a number of weaknesses as well as a number of

factors that are critical to the rapid detection and response to such

an attack. I remember the testimony that we had about the alert

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public health lab in Florida that identified that the first exposure

was, in fact, anthrax. Had that sample been sent elsewhere, who

knows whether the initial case would have been identified as anthrax as quickly as it was.

Witnesses told us that we need alert health providers who are

trained to recognize the symptoms and signs of a biological attack,

as well as trained to treat such diseases. We need a core of well

trained public health professionals engaged in disease surveillance.

We need an adequate supply of necessary drugs and vaccines,

something that I know that the Secretary has taken considerable

steps to bring about. We need seamless coordination and communication, as the Chairman indicated, in order to avoid the problems

that we saw last fall. We need a network of up-to-date public laboratories. And we need strong safeguards to protect our Nation’s

food and water supplies.

In addition to strengthening our Federal response, we must remember those who are going to be the first responders, our emergency medical personnel, our fire fighters, our police officers, and

our labs throughout the country. Those are the people who stand

on the first line of defense in the event of any major biological or

chemical attack. We must ensure that they have the capacity to

identify the signs of an attack and the resources to be prepared.

I am, therefore, pleased to have helped to draft the Bioterrorism

Preparedness Act, which passed the Senate last December and is

now in conference. This bill takes major steps not only to strengthen our Federal response, but to provide additional substantial new

funding to States, local governments, and hospitals.

Mr. Chairman, our world was forever changed on September 11,

and unfortunately, the threats of terrorist attacks that were once

unimaginable are today horrifyingly real. But just as the terrorist

attacks of September and October have caused us great concern

and considerable pain, they have also strengthened our resolve. I

am confident that we are making progress and I look forward to

hearing the Secretary’s testimony this morning and I thank you for

holding this important hearing.

Chairman LIEBERMAN. Thank you very much, Senator Collins.

Senator Cleland, thank you again for your leadership in bringing

this hearing together.

OPENING STATEMENT OF SENATOR CLELAND

Senator CLELAND. Thank you very much, Mr. Chairman. May I

just say that I first got into this whole issue of biological and chemical warfare about 3 years ago in hearing former Secretary of Defense James Schlesinger talk about the new threats we faced. As

a fellow member of the Armed Services Committee, you might have

been there, too.

It struck me—I shall never forget what he said. We were discussing nuclear weapons and the scientific challenge that produced.

You had to have some skill, you had to have some talented people,

and you had to have a delivery system, probably a missile system.

But Jim Schlesinger said that, in terms of biological and chemical

weapons, he said you can make a biological weapon if you can brew

beer and you can make a chemical weapon if you can make fertilizer.

5

That really shocked me. It put me on notice that, in many ways,

for terrorists particularly, working off of a low-tech agenda, that

the biological and chemical attack was in many ways the poor

man’s atom bomb, the poor man’s weapon of mass destruction. And

so I became concerned that the country was not quite adequately

prepared to deal with this, in a sense, stealth or under-the-radar

attack.

We went through September 11 of last year and we had the attack on the World Trade Center and the Pentagon. We scrambled

the jets. Now we are prepared militarily in a second’s notice to

scramble more jets. Secretary of Defense Rumsfeld has created a

four-star command looking after the continental United States,

Mexico, and Canada, stationed near the NORAD headquarters in

Colorado. We have nerve centers in the Pentagon and the situation

room in the White House that addresses itself to an instantaneous

response to literally a military or terrorist attack.

My problem is that I do not think we are that well prepared in

terms of a biological or a chemical attack and I have been searching for a strategy, searching for the elements of quick response, coordination, cooperation, and communication in our strategy for defending our homeland in case of a biological or chemical attack.

I would like to thank Secretary Tommy Thompson for being here,

a friend, and a great public servant.

The state of our public health preparedness for terrorism, I

think, is lacking in many ways. We are a country looking for a

strategy in how to deal with this issue. I am grateful to you, Mr.

Chairman and Senator Thompson, for calling this hearing to assess

the progress we have made to date to ensure that our commitment

to implementing a strong homeland defense against bioterrorism

does not wane.

Even as the anthrax crisis of last fall recedes, and Senator Collins mentioned a health agency in Florida that found that it was

anthrax down there in Boca Raton. The interesting story about

that is that the doctor reported it to the public health entity in the

State of Florida, the State public health operation in Jacksonville,

which had just had an employee get training at the CDC on anthrax. They forwarded the spores to the CDC and at 3:30 a.m., the

CDC said, it is anthrax.

So in many ways, that kicked off this whole discussion of how

does all this work? How does the public health sector work? What

is the role of the CDC? What is the role of HHS? What is the role

of the FBI, and the law enforcement agencies?

In so many ways, our homeland and its defense as an issue

looms as ominously as ever over our heads. I am pleased to continue our ongoing dialogue with Secretary Thompson on the matter

of bioterrorism preparedness. I, and I think I speak for all of my

colleagues, as well, would like to express our gratitude to you and

to your entire team at HHS for your efforts to guide our Nation

through a very, very difficult time.

At the outset, I would just like to express my strong conviction

that combatting the threat of bioterrorism will demand the commitment and full cooperation of us all, of every relevant resource. Congress and the Executive Branch must work together toward our

common goal, and let me signal to you this morning, Mr. Secretary,

6

my unequivocal desire to work with you and the Department of

Health and Human Services and the administration and the Office

of Homeland Security and other relevant Federal, State, and local

authorities to build a strong national defense and a strategy to deal

with bioterrorism.

I would like to commend you and the administration for a number of steps you have already taken. In the next fiscal year, the administration has proposed dedicating an unprecedented $4.3 billion

to HHS’s bioterrorism initiative, a 45-percent increase. Mr. Secretary, you have named Dr. D.A. Henderson, the pioneering former

Centers for Disease Control and Prevention official who led the

campaign to eradicate smallpox, an eminently qualified expert on

bioterrorism, to head the new Office of Public Health Preparedness.

We are looking forward to seeing how that office relates to the

other entities involved in bioterrorism. I think the existence of a coordinating office such as this one is actually essential as a step forward in coordinating the bioterrorism response.

I am particularly interested this morning in hearing more from

you, Mr. Secretary, on three issues I would like to explore in depth

within the larger subject of our discussion, which bear strongly on

our Nation’s preparedness to deal with the public health consequences of terrorism involving weapons of mass destruction.

First, I believe we in the Congress have got to provide you and

your Department with whatever resources you need and think are

necessary to protect our country from bioterrorism. We made a

good start when we finalized the budget for the current fiscal year

by increasing bioterrorism funds in HHS ten-fold. I must express

my concurrence with Senator Frist’s guarded assessment, however,

that while that is ‘‘enough to take us from an unprepared state to

a more prepared state,’’ we cannot yet say that the public health

sector is actually adequately prepared to deal with the public

health implications of terrorism with weapons of mass destruction.

We must keep in mind that we started this race to catch up a

lagging public health infrastructure just 3 years ago, and then from

a virtual standstill. I think it is, therefore, worth asking whether

the administration’s proposed increase for bioterrorism defense,

significant though it is, is actually sufficient. The magnitude of the

threat and the potentially catastrophic consequences of underestimating our needs demand that we ask that question, and I will

detail several specific resourcing concerns when we reach the question and answer period.

Second, Mr. Secretary, I look forward to receiving the specific details of HHS’s One Department initiative. As I understand it,

under the initiative, the Department would consolidate each of the

public affairs and legislative liaison offices of all the agencies within HHS into one office for each function under the Secretary. I certainly share a desire to address the communication challenge, particularly in terms of, shall we say, an attack when confusion reigns.

I remember one old sergeant down at Fort Benning told me that

war was the most socially disorganized human endeavor. So when

one is under attack, the ability to speak clearly in communications,

we put a premium on that. It can actually lessen the fear and lessen the terror.

7

I do have concerns that this proposal, though, while potentially

improving the consistency of communication, might have at the

same time the undesirable and unintended effect of actually slowing the movement of information from public health experts in the

Federal Government to their State and local counterparts, and so

I am eager to hear more details from you.

Finally, I believe that today, we have got to address the coordination and communication failures that encumbered the interaction

between public health officials and their law enforcement partners

in last fall’s anthrax crisis. We are not looking here for a witch

hunt. We are just looking to figure out exactly where we are and

move forward.

My interest this morning is not in placing blame for past failures

or in revisiting old ground, but we cannot afford to suffer again the

profound disconnect between public health and law enforcement

that we saw last fall. I would very much like to hear from you, Mr.

Secretary, about what has been done since then to strengthen protocols of coordination and cooperation and communication between

public health entities and law enforcement, and I proposed some

legislation last year to deal with that and we can get into that.

May I say, in addition, I would just like to offer for your consideration and input, Mr. Secretary, a proposal I introduced in the

Senate last week to address what I see as an urgent need for a single center in the Federal Government whose sole mandate is to

counter the threat of domestic terrorism, in other words, help the

country prepare and then help the country respond. This legislation

would create a dedicated National Center for Bioterrorism Preparedness and Response in the CDC.

Why the CDC? It has got 8,000 employees and they are located

in 39 different countries around the world. It probably is the finest

single public health network in the world and certainly is a great

asset to this Nation, and it operates based on several centers that

are within CDC. So much of CDC’s time now is taken up with planning, executing, and helping to respond to bioterrorism, somewhere

around, I think, 40 percent of their time now, except there is no

center there to focus their energies and to actually help focus monies and to actually help us all understand how the monies are

being spent and see if they are being spent wisely.

In closing, Mr. Secretary, I would like to convey to you my empathy for the difficult task before you. I used to be head of the Veterans’ Administration under President Carter. I have sat in your

seat many times, not with your specific responsibilities, but I understand the challenges that you face and we look forward to hearing from you this morning. Thank you very much for being here.

Chairman LIEBERMAN. Thank you, Senator Cleland. Thanks very

much.

Senator Bunning.

OPENING STATEMENT OF SENATOR BUNNING

Senator BUNNING. Thank you, Mr. Chairman, and welcome, Secretary Thompson and all other witnesses today.

The anthrax attacks on the Capitol last year gave us a firsthand

experience in dealing with a bioterrorist attack and we got to see

exactly where our weaknesses were. To put it bluntly, we have a

8

long way to go in ensuring that our Nation can respond to a largescale biological or chemical attack. We need better communications,

as everyone has said, between the Federal, State, and local governments. We need more training for first responders and we need to

be able to swiftly identify the illnesses that are the cause of the attack.

One of the most important things we need during a crisis is honesty. Those responding to a terrorist attack need to be able to

admit they do not know everything. The American people are very

savvy and the Federal Government will lose all credibility if conflicting and inaccurate information is given. During a public health

crisis, it is critical that people have faith in their government that

the government is being straight with them.

The President has made preparing for a biological attack a very

high priority. As you well know, and it has been stated, in his 2003

budget, the President has requested $5.9 billion, of which $1 billion

is already up front, to prepare for such an attack. This money

would help State and local governments prepare, conduct more research and development, enhance the safety of our food supply, and

improve our Federal response capabilities.

All of these are extremely important and I hope that sometime

in the near future, we will begin to feel comfortable that our responders are trained, our hospitals are equipped, and that we can

handle any attack that might come.

I want to thank our witnesses for being here today and I look

forward to gaining their perspective on this important issue. Thank

you, Mr. Chairman.

Chairman LIEBERMAN. Thanks, Senator Bunning.

Senator Akaka of Hawaii has also been very active in a leadership role in regard to the threat of bioterrorism and I am happy

to call on him.

OPENING STATEMENT OF SENATOR AKAKA

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

you for holding today’s hearing on an issue that has occupied the

Committee’s attention well before the terrorist attacks on September 11 and the anthrax mailings last fall.

As Chairman of the Subcommittee on International Security,

Proliferation, and Federal Services, I want you to know that I appreciate the work we have done together in this Committee on Federal efforts to prepare for acts of terrorism. I also wish to thank

the Secretary for joining us today. I read your statement with interest, and I want to commend you for moving so quickly in enhancing your efforts and facing the issue of biological and chemical

acts of terrorism. As you said, we have lots to do, and we will do

it. What I am saying now, we will try to do it together.

Secretary THOMPSON. Thank you.

Senator AKAKA. Thank you, Mr. Secretary.

A clear refrain from the hearings we have held was that a cultural divide existed between the law enforcement and public health

communities. It was evident then that the United States lacked a

cohesive strategy to respond to terrorist attacks involving weapons

of mass destruction. The following points were apparent from our

joint hearing in October.

9

Local first responders lack the resources to respond quickly.

Emergency responders must be able to communicate and coordinate seamlessly in the event of terrorist attacks with WMD. Local

public health officials lack the capability to detect and identify

harmful biological agents rapidly.

At the October hearing, Secretary Thompson and I agreed that

current methods were not adequate to deliver continuous monitoring of the air, water, and food supplies of the United States. We

are not effectively coordinating biological agent detection research

at Federal agencies and academic and industrial laboratories. The

Federal Government is not unprepared to deal with WMD terrorism, but preparedness levels are not uniform across the United

States.

Much deserved attention has been paid to our crumbling public

health sector. However, efforts to improve our public health infrastructure will not automatically trickle down to the medical community. Adequate WMD terrorism training of health care professionals has been hindered by a lack of economic incentives for hospitals and clinics. Local and community hospitals should have the

best training and information in order to protect and treat Americans.

I recently introduced legislation, Mr. Chairman, to support the

development of technologies to minimize the impact of bioterrorism

by alerting authorities and medical personnel to a biological threat

before symptoms occur. Another bill I introduced will use existing

capabilities in the national disaster medical system to strengthen

bioterrorism preparedness and to expand WMD emergency training

opportunities for health care professionals. This legislation will

continue the dual national goals of advanced biological agent detection technologies and improved emergency medical response training.

Again, I want to welcome the Secretary to the panel and our

other witnesses today for our hearing and I look forward to learning what the Department of Health and Human Services has done

in its enhancement in the past 6 months to improve our public

health and professional medical response to potential terrorist attacks with weapons of mass destruction.

Thank you very much, Mr. Chairman.

Chairman LIEBERMAN. Thank you, Senator Akaka.

Senator Dayton, would you like to make an opening statement?

Senator DAYTON. Mr. Chairman, thank you very much. I would

not. I would just like to hear from the witness and I would like to

thank him for his continuing excellent service to our Nation following up on his distinguished service as governor.

Chairman LIEBERMAN. Thank you, Senator Dayton.

Secretary Thompson, on behalf of all of us, thanks for the job you

are doing, thanks for being here, and we now look forward to your

testimony.

10

1The prepared statement of Secretary Thompson appears in the Appendix on page 41.

TESTIMONY OF HON. TOMMY G. THOMPSON,1 SECRETARY, U.S.

DEPARTMENT OF HEALTH AND HUMAN SERVICES, ACCOMPANIED BY JERRY HAUER

Secretary THOMPSON. Thank you very much, Chairman Lieberman. It is an honor to be in front of you. It is a real honor for me

to get an opportunity to tell this Committee what the Department

of Health and Human Services is doing and has done and will continue to do. Senator Thompson, who is not here, Senator Collins,

Senator Cleland, Senator Akaka, Senator Dayton, and Senator

Bunning, it is my privilege to be in front of you today and thank

you so very much for inviting me.

All of you have been staunch supporters of our efforts on the

homefront in this war. We share a commitment and a passion to

ensuring that Americans can live their lives in safety and security.

Let me begin by thanking you so very much for your dedication

and your patriotism.

Building America’s preparedness for a bioterrorism attack is absolutely of paramount importance to the security of our country.

Should an attack occur, the President is absolutely committed to

making sure that we are ready to handle it quickly and successfully. Over the past 6 months, the President has put forth bold

plans to build America’s homeland security. We appreciate the support of Congress for the administration’s supplemental request last

year and we appreciate your continued support as we work out a

2003 budget.

As you know, the Department of Health and Human Services

and my office have been working at breakneck speed to build our

bioterrorism preparedness, particularly since the attacks of September 11. This has included everything from enhancing our pharmaceutical stockpiles to building a stronger public health infrastructure, which all of us have to admit was in disarray and now

needs to be bolstered, built, and completed. The speeding up of research and to do medicine and diagnostic tools. We continue to get

stronger each and every day and I am extremely proud, Mr. Chairman and Members, to be able to come to you today to report on

the progress that we have made with your support.

Today, I would like to update you on some of the measures that

the Department of Health and Human Services has taken already

to bolster our overall preparedness and our ability to respond. Let

me begin with our efforts in strengthening the partnership between

the Federal, the State, and the local governments. In short, we are

building a much more cohesive public health system and doing so

faster than many people thought possible.

Within just 3 weeks after the President signed the supplemental

appropriation on January 10, our Department, working almost

around the clock, put together a program in structure for dispensing $1.1 billion to the States for public health system improvements. We are quite confident that no Federal program of similar

size has been created so quickly or that money of this caliber was

moved out of the Federal coffers so quickly after our legislation became law. But it is a sign of our commitment and our passion to

build correctly, but build rapidly.

11

By January 31, we gave States 20 percent of their share, 3 weeks after the signing of the law, of the $1.1 billion program and asked

them to get back to us by April 15, which was this week, a comprehensive plan for how they would spend the remaining 80 percent to be able to build a stronger, more unified public health system in their respective State. The vast majority of the States gave

us the proposed plans. They came in this week. And the CDC and

HRSA are beginning to review them. We have given about 12

States and territories a dozen extensions.

The very infusion of this unprecedented level of money into

States is going to force cooperation and the strengthening of our

Nation’s health system, and I would like to report that we are

going to analyze and critique and get back to the States within 30

days all of the reports and give out the remaining 80 percent of the

money. That is how fast we are moving.

States, counties, and communities, law enforcement, hospitals,

and the medical community are all going to have to come together,

and we are forcing them to develop that cohesive, comprehensive

public health system that will be able to handle a bioterrorism

event, and those efforts are going to be linked and coordinated with

the Federal Government, and that is what the comprehensive plan

is all about.

And to further strengthen our public health system, the budget for 2003 provides for another $518 million specifically to build up

hospital preparedness. We had $135 million in the supplemental

bill that went out to hospitals under HRSA. Now we are requesting

an additional $518 million to build upon that comprehensive, especially in the area of surge capacity for regional hospitals. We expect

this money to be used to upgrade the capacity of hospitals, outpatient facilities, emergency medical service systems, as well as

poison control centers to care for victims of bioterrorism.

In addition, the CDC is going to provide support for a series of

exercises to train public health and hospital workers on how to

treat and be able to control bioterrorism outbreaks together. So, as

you can see, one of our highest priorities right now is building a

stronger and a much more coordinated public health system that

works closely together in a time of crisis. And again, we are moving

as fast as possible and getting stronger as each day passes.

A crucial part of bioterrorism preparedness is the development of

vaccines and the maintenance of the National Pharmaceutical

Stockpile. We are purchasing enough antibiotics to treat up to 20

million individuals for exposure to anthrax. We are purchasing sufficient smallpox—and I would like to point out, when I took over,

there was only an order for 40 million doses of smallpox vaccine to

be delivered either in 2004 or in 2005. Since I took over, we have

increased that 40 to 54 million from one company, 155 million from

another company, and we have 15.4 million in our stockpile which

can be distilled down five-to-one for 77 million, plus we just picked

up an additional 85 million doses from Aventis Pasteur, which will

give us well over 286 million doses of vaccine, enough for every

man, woman, and child, by October of this year. Nobody thought

it could be done.

We are purchasing also additional push packages, going from 400

tons of medical equipment in antibiotics and other medicines, from

12

400 tons to 600 tons, from eight push packages, which are now

strategically located around the United States and in Hawaii, to

12. So we will have much more medicine supplies available and be

able to move it. Our plan is to be able to move it within 12 hours,

but we were able to move within 7 hours to the City of New York

on September 11. That is how fast we are able to respond.

We found that one of the problems was we can move it faster

than the local units of government can handle it once it reaches the

tarmac at a particular community. So we are now, in our comprehensive planning, we are finding ways in how we can bolster

that so not only can we move it rapidly, but the local individuals

will be able to dispense and be able to break it down faster to get

it to the hospitals and to the areas where it is needed.

We are also taking aggressive steps to improve laboratory security and to be able to protect our food supply that you, Senator, and

I have discussed many times, and accelerate the research necessary.

While we are doing a great deal right now to strengthen our infrastructure, we have also made it clear that improving our bioterrorism readiness will be an ongoing endeavor. That is why the

President has put forth a bioterrorism budget for HHS of $4.3 billion, which is a 45 percent increase.

Mr. Chairman, this is the largest one-time investment in the

American public health system ever. We are absolutely doing what

it takes to make America secure and we are working to ensure that

our efforts are coordinated from the highest levels of the Federal

Government to the most local levels of health care delivery.

And along with the new monies I just mentioned for hospitals,

the President’s budget provides $1.7 billion for the National Institutes of Health for research into new vaccines and diagnostics. We

are ready for smallpox, but we want to go to the next level for anthrax. We want to develop a new vaccine that is better than the

one that is currently being used. We are also looking for ways for

plague, botulism, the hemorrhagic fever viruses, and tularemia.

The FDA is also going to see an increase for its review of vaccines

and diagnostics and the CDC will see increases for the security of

its facilities, as well as updating their badly needed lab capacity.

Nine-hundred-and-forty million dollars for State and local organizations to continue their laboratory capacity, increase epidemiological expertise. We want to get an epidemiologist in every community that has a county of over 150,000. Provide for better electronic

communication and more distance learning. And support expanded

focus on cooperative training between public health agencies and

local hospitals. This includes funding for the Laboratory Response

Network, which we have set up, which improves a system now of

over 80 public health laboratories specifically. And to be able to develop for identifying pathogens that could be used for bioterrorism.

We are working to connect every major county and metropolitan

region with the Health Alert Network. We are at 68 percent capacity right now. We think by the end of this year, with this new

money, we can go from 68 percent to 90 percent of the population

in the United States to be covered by the Health Alert Network.

Five-hundred-and-eighteen million dollars under the Hospital

Preparedness Program to support outbreak response and control. It

13

includes funding for the training of public health and hospital

staffs. The increased focus on local and State preparedness serves

to provide the funding where it best serves the interests of this

great Nation.

One-point-seven billion dollars for research. The NIH is researching for better anthrax, as I indicated, plague, the hemorrhagic

fever viruses, and so on.

Ninety-eight million dollars, and thanks to you, all of you, for

supporting this, in order to keep our food supply. I have testified

in front of this Committee and others that I am more worried

about food pathogens right now because we only inspect less than

one percent of the food coming into our Nation. We only have 125

food inspectors, ladies and gentlemen, for 175 ports of entry. It tells

us that this is an area that we have to look at. We have been able

now, because of your support, to be able to double the number of

inspectors we have at FDA. Our budget proposal is going to support a substantial increase in this number of safety inspections for

FDA-regulated products that are imported into this country.

A-hundred-and-eighty-four million dollars to upgrade our Federal

laboratory facilities and capabilities. This includes money for the

completion of a second infectious disease laboratory, an environmental laboratory, an infectious disease bioterrorism laboratory in

Fort Collins, one that they can only do research once in a while because of the decrepit conditions of that particular laboratory. I have

pictures that I would like to show the Committee and you could see

why it is badly needed for this particular laboratory.

We are going to have an environmental toxicology lab and a communication and training facility in Atlanta. This funding will enable the CDC to handle the most highly infectious, Senator

Cleland, and lethal pathogens in the world.

We hope the Senate will continue to support the administration’s

effort to strengthen our public health system throughout the Nation. We need this partnership in a bipartisan way and I thank you

for your past support.

Here at HHS, we are strengthening our coordination, as well.

When I first arrived a little more than a year ago, I began elevating the bioterrorism efforts into my office and found that there

was nobody there when I came in that actually coordinated our activities. I named Scott Lillibridge, Dr. Lillibridge from CDC, as my

special assistant on bioterrorism. This was the first time that bioterrorism had been given such attention at the highest levels of

HHS.

Since then, we now have created—I took one of my hearing

rooms, my big conference room right across from the Secretary’s office and I have turned that into the Office of Public Health Bioterrorism, which we are able to monitor things 24 hours a day, 7 days

a week from all over the country. We are able to deploy personnel

and medicines from there at a minute’s notice, which has the

task—this office has the task of coordinating and overseeing the

bioterrorism preparedness and the response activities of all the

various agencies within HHS.

This office coordinates our efforts and makes sure that HHS is

coordinated with also the other Federal departments, State and

14

local governments, and other stakeholders. It also makes sure that

our efforts are well executed.

I have assembled a virtual bioterrorism dream team to staff this

office. Dr. D.A. Henderson, an internationally acclaimed leader in

public health, is the Director, and working side by side and also

with me today is Jerry Hauer, a world renown emergency response

expert who we were fortunate to get from New York City. Also on

the team is retired Major General Dr. Philip Russell, one of the Nation’s preeminent virologists, and Dr. Mike Asher, one of our Nation’s leading laboratory experts.

We also have strong relationships with our Federal counterparts,

most notably homeland security. Tom Ridge and I have a very

strong working and personal relationship going back to our days as

governors. We and other teams have worked flawlessly together

and I am very pleased with our working relationships also with

Justice, the FBI, and the Department of Defense. In fact, the Department of Defense, with all their surgeon generals, were over

this week in my Department and we were planning how we could

interact their research and their medical teams with our medical

teams. We work closely together and we share information effectively.

The President is creating a strong and united team for defending

our homeland and preparing for our response to an emergency.

Mr. Chairman, you also requested that I mention a component

of the President’s management agenda that involves the consolidation efforts within the Department. In this budget, we are taking

further steps to coordinate a variety of activities by consolidating

our human resource, our building and facilities management functions, as well as public affairs and legislative affairs functions.

These functions are very splintered right now, even within each

agency.

Mr. Chairman and Members, we have over 50 public relations

departments. We have over 46 personnel departments. We have

over 200 different computer systems. We have five bookkeeping

systems. We have some of our computers that have 30-year-old

software, and we are trying to bring this now into an integrated

system, and that is what the management is all about.

By consolidating and coordinating these operations, we will make

sure that we are managing the taxpayers’ dollars more efficiently

and speaking to Congress and the American public in a clear, confident, accurate, honest, straightforward, and efficient manner.

It is a common sense effort to make sure that when we communicate, it makes sense to the American people and the members of

the House and the Senate. And in times of national emergency,

clarity and accuracy are absolutely essential.

In summary, our comprehensive effort shows that we are using

all our resources at our disposal, from Federal agencies to States

and localities, to build the strongest defense and response to bioterrorism. We are doing this quickly and smartly.

Mr. Chairman, the Department of Health and Human Services

is absolutely committed to working with you, the Members of this

Committee, and Congress, as well as the other Federal agencies,

the law enforcement communities, and our State and local public

health partners to ensure the health and the medical well-being of

15

all of our fellow Americans. We have made substantial progress to

date in enhancing the Nation’s capability to respond to biological

or chemical acts of terrorism, but there is much more that we can

do and will do to strengthen that response.

In April 1861, as danger loomed before the Union, Abraham Lincoln issued a two-sentence directive to the then-Governor of Pennsylvania who had asked his opinion on what to do. He said, ‘‘I

think the necessity of being ready increases. Look to it.’’ It is in

that spirit of swift, effective preparation for the unknown that we

pursue our efforts. We will not rest and we will not falter until

America is as prepared as it possibly can be.

So I thank you for your support, Mr. Chairman and Members,

very much for your time, as well, this morning. I would be pleased

now to answer any questions you or Members of the Committee

may have.

Chairman LIEBERMAN. Thanks very much, Secretary Thompson,

for all you have done since last you were here. I think we all agree

that we have come some way and we have got a ways to go to prepare our Nation to cope with chemical and terrorist attacks.

If I asked you on a scale of one to ten, with ten being the highest

level of preparedness, where would you say we are now as a Nation?

Secretary THOMPSON. Once the money is out, I would say we are

at six, going on seven.

Chairman LIEBERMAN. OK, so we have come some ways, but we

have got to go some ways together yet.

Secretary THOMPSON. Absolutely.

Chairman LIEBERMAN. I appreciate that, and that would be

about my estimate if you asked me that question.

Let me ask you about what you said about funding for hospitals

to meet surge capacity. First, just for the record and for those who

are listening, give us a little bit of a definition of what surge capacity means in this case.

Secretary THOMPSON. Surge capacity means being able to take

care of a minimum of 500 to 1,000 individuals immediately in case

of an event such as a bioterrorism attack, such as anthrax, such

as a chemical spill, such as a chemical terrorist attack, such as a

nuclear attack.

What we are doing in that regard, is asking the local health departments to meet with the State health departments and for the

State medical system to develop a regional surge capacity right

now, within their States, within their comprehensive plans. Then

2 days ago, I met with the surgeons general of the Department of

Defense with regard to being able to incorporate—to be able to

move in some of their mobile hospitals in case a more calamitous

type of event takes place.

So we want to integrate with the Department of Defense. We

want to integrate with the State health departments so that we

have surge capacities in every region of the country taken care of

immediately. We want to make sure this year we are able to have

surge capacities in every State, hopefully up to 500, and then,

hopefully, up to 1,000 within the next 18 to 24 months.

Chairman LIEBERMAN. So that is the goal now, that within every

State, we would have surge capacity up to 1,000 in every State?

16

Secretary THOMPSON. Yes.

Chairman LIEBERMAN. Do we have—— Secretary THOMPSON. Now, in the case of smallpox, that is different, if I might.

Chairman LIEBERMAN. Yes, please. That is exactly what I was

thinking about.

Secretary THOMPSON. With smallpox, what we would like to do— we would like to be able to have a large area to be able to quarantine. We may have a convention center. What we would do, is

go in and inoculate—vaccinate the first responders, the medical

personnel, and then those that would be sick, if, in fact, there was

ever a smallpox outbreak. We would then have concentric circles

around which we would vaccinate all those individuals, and then

we would build a larger circle, and that is how it was worked out

before. So, on chemical emergencies and smallpox, we have different ways and different opportunities as to how we would handle

a surge capacity need.

Chairman LIEBERMAN. I think, as I hear you answer the question

in that detail, that we have entered a surreal world which you and

I would not have guessed we would be talking about a year ago,

but it is where we are and I think it is very important that you

do exactly what you are doing, which is to work through the scenarios that are worst case so we are ready for them.

I hope that you will push both the administration and us in Congress in terms of funding. As significant as the additional funding

requests by the President have been, if you decide that we need

more in the years ahead, I just think this has to be now our No.

1 priority. We have to do whatever we can to meet it.

Let me go on to a different area and that is the question about

the weakness in our preparedness because of the lack of efficient

mechanisms to communicate. One of our witnesses on the next

panel in his written testimony points out that the Chief of Infectious Diseases at one of America’s best hospitals said that in the

midst of the anthrax crisis, he had to get his medical information

from CNN. If we had another biological attack today, would those

communications problems be any less severe, and if so, why?

Secretary THOMPSON. We have right now 68 percent of the population covered by CDC’s Health Alert Network. We are going to be

able to expand that this year, up from 68 percent of the population

being covered to 90 percent. My goal is to have every health department eventually hooked up to the Health Alert Network.

CDC, and I do not want to question the individuals who are

going to be following me in this testimony, but CDC puts out weekly reports to doctors. Their medical report went out on infectious

diseases, especially on anthrax. We had weekly communications

with doctors and State medical societies and hospitals and emergency workers hooked up with CDC. We are going to be able to expand that, especially with the additional money that is going out,

and we are hopeful that we are going to be able to get this information very quickly.

We are also going to be putting exercises out into the States. The

health departments—part of the comprehensive plan is that the

health departments have got to put an educational program put

out by CDC into the hands of emergency workers and the emerVerDate 11-MAY-2000 13:06 Aug 13, 2002 Jkt 000000 PO 00000 Frm 00020 Fmt 6633 Sfmt 6633 80296.TXT SAFFAIRS PsN: SAFFAIRS
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gency doctors, because that is where the problems would first arise.

So we are already taking that into consideration. That is all part

of the plans that the States put in.

We have also divided the country up into different areas so that

we can send experts in from CDC as well as from our medical assistance teams. We have about 82 medical assistance teams across

America right now, about 7,000 personnel that we can send in

within hours after an event.

Chairman LIEBERMAN. Is the communication network also going

to make use of existing media, television, radio, and satellites?

Secretary THOMPSON. That is one of the new buildings that is

going to be built. Hopefully this year, the planning is going to start

for a new communication building on the CDC campus. It is one

of their next major capital expansions. Also, we have a website that

every day has got new information on it through CDC and NIH

and through the Department of Health and Human Services.

Chairman LIEBERMAN. Let me ask a final question before my

time expires. As you know, during the anthrax crisis, there was

some concern about exactly who was speaking for the administration, which led to some confusing and conflicting messages. In the

event of an attack today, is it clear who would oversee communication with the public?

Secretary THOMPSON. Yes. Right now, it would be our new Center for Bioterrorism, which is headed by Dr. D.A. Henderson and

the doctors that I mentioned, in collaboration with CDC, NIH, and

FDA.

Chairman LIEBERMAN. So that Dr. Henderson——

Secretary THOMPSON. That would be the health thing.

Chairman LIEBERMAN. Right.

Secretary THOMPSON. But then the White House would have

their spokesperson and Homeland Security would have their

spokesperson. But as relates to health information coming out of

the Department, it would come out of our Center for Bioterrorism

Preparedness.

Chairman LIEBERMAN. I presume, or let me ask, would there be

coordination between the three, between that center, Governor

Ridge, and the White House?

Secretary THOMPSON. Yes. There is right now and I am sure

there would continue to be. I cannot imagine—but as far as the Department, it is well coordinated right now and it would all go up

through the Office of Public Health Preparedness.

Chairman LIEBERMAN. Thanks, Secretary Thompson.

My time is up. I am going to yield to Senator Collins and I am

going to give the gavel to Senator Cleland, as I have got to go off

and participate in a debate on the floor. But I thank you very much

and look forward to continuing to work with you.

Secretary THOMPSON. Thank you very much, Mr. Chairman, for

being here, and thank you for calling us.

Chairman LIEBERMAN. Senator Collins.

Senator COLLINS. Thank you. Secretary Thompson, let me begin

by thanking you for your strong and effective leadership. I think

we are very fortunate to have you serving in this critical post at

this very challenging time.

18

I also want to thank you for again recognizing this morning the

vulnerability of our Nation’s food supply and the gaps in the regulatory framework. As you know from our previous discussions, back

in 1998, I chaired hearings in the Permanent Subcommittee on Investigations that looked at the safety of imported foods. We did an

in-depth investigation that revealed the statistic that you quoted

this morning, that fewer than 1 percent of imported food shipments

are inspected, and we also found that the system was very easily

circumvented by unscrupulous shippers.

For example, tainted food that was checked at the border and inspected and rejected often was reshipped into the United States

through another port. There was port shopping because the food

was not required to be destroyed, nor was it clearly marked as rejected.

That gives me great concern, because if the system was that easily circumvented by an unscrupulous shipper, think what a concerted, sophisticated terrorist network could do.

So I am very pleased that there are additional inspectors on the

way. I understand that the FDA intends to hire an additional 670

employees, which will include inspectors, scientists, and compliance

officers. Given this significant increase in the number of inspectors,

do you have a goal for how many inspections will be performed?

There are a lot of other steps that need to be taken that are included in the legislation that has passed the Senate, but do you

have a goal for increasing the number of inspections?

Secretary THOMPSON. We do not have a goal, Senator. We are

going to address that when we get all our inspectors trained. We

also want new equipment because we have a very antiquated system right now. You bring food in. It may be tainted. It has to be

taken off of a truck or off the airplane, then it has got to be sent

to a lab, maybe in Kansas, and then the shipment has to be held,

impounded until we get the lab analysis back. We are trying to

make sure that we have faster and better lab analysis at the place

that the food is taken off, to check it and make sure it is not tainted.

We also, of course, as you know, support your language in the

legislation. It is very powerful language as far as shipments coming

into ports. We support you for your leadership on that.

The conference committee is working on this particular bill right

now. There are a lot of good things in there. We want to be able

to reject food at the port of entry, send it back. We want to be able

to tell a company or an individual that has sent in tainted food before, prevent them from shipping again. We want to be able to

track back where this food is coming from.

All of these provisions are in the legislation. We are hopeful that

the conferees will be able to reach an agreement and get it to us

because we badly need those tools.

Senator COLLINS. I am very pleased to hear you endorse those

provisions, which I worked very hard to have included in the bioterrorism bill. They have been subject to criticism by some. I hope

we can hold the line because I believe they are absolutely essential

if we are going to improve the safety of imported food and close

what I think is a real gap that makes us extremely vulnerable.

19

I want to follow up on an issue that Senator Lieberman raised.

One of the major criticisms of our handling of the anthrax attacks

involved the problems of communication and coordination. Obviously, we need to do everything we can to improve communication

among the various levels of government as well as providing

prompt and accurate information to help professionals and hospitals. I, too, was struck by the statement in the written testimony

of the witness to come, who is Chief of Infectious Diseases at one

of our Nation’s best hospitals, and yet he said that he learned a

lot of the medical information from CNN.

Is part of the rationale behind the consolidation plan that you

have outlined today intended to improve the flow of information

and better ensure health care professionals are receiving consistent, accurate, and clear information?

Secretary THOMPSON. The consolidation would not have much of

an impact on that because the information going out to the emergency wards, going out to departments of health, and so on, for

medical personnel comes from CDC. That will continue. It has to

come from CDC because they are the experts and they are the ones

who get the information. It will be better coordinated and it will

be faster and better. But right now, we want to make sure we get

the Health Alert Network up.

What we are talking about in consolidation is to make HHS more

effective. We have over 50 public affairs departments, divisions in

the Department of Health and Human Services and it is impossible

to get a coordinated and correct dissemination of the information

that is necessary to the public out properly. We want this to flow

up in collaboration with CDC, NIH, FDA, through the Office of

Public Health Preparedness, which is headed by Dr. D.A. Henderson, so that we are able to make sure that it is correct, that it is

straight, and is fast and gets out there.

But as far as the medical information, that will come through the

Health Alert Network. It will come on the website at CDC. It will

come also from the direct communications from the laboratories.

We have a communications system set up with 80 laboratories

across America, connected with CDC. All of these things will still

continue out of CDC.

Senator COLLINS. Thank you. My related question is actually a

suggestion that results from a conversation that I had recently

with medical director of the Anthem Blue Cross/Blue Shield insurance company. He pointed out to me that Blue Cross/Blue Shield

has electronic links and E-mails to virtually every doctor’s office

and hospital in the United States, and he suggests that in the

event of an emergency, it, too, might be a network that the Department could use to disseminate information.

I want to pass that on to you and I was interested to know

whether there are any discussions with Blue Cross/Blue Shield or

other insurers that might have the infrastructure that perhaps the

Federal Government lacks at this point.

Secretary THOMPSON. Absolutely. We are working on that right

now. Jerry Hauer has met with the American Association of Health

Plans, has met with Blue Cross/Blue Shield, how we can tap into

their database. We are doing all these things. We also got the pharmaceutical companies, through all of their agents, distributing inVerDate 11-MAY-2000 13:06 Aug 13, 2002 Jkt 000000 PO 00000 Frm 00023 Fmt 6633 Sfmt 6633 80296.TXT SAFFAIRS PsN: SAFFAIRS
20

formation to doctors’ offices on various pathogens and how to discern various infectious diseases, such as anthrax poisoning. And so

we are bringing all the private sectors we possibly can, using them

for the dissemination of information across America to doctors.

In our plans, we are also going to be setting up information and

evaluations in emergency wards across America. These are going to

be put out by CDC through the State health departments so that

we get this information into the emergency wards of our hospitals

so that they will be able to be better educated, be able to discern

more quickly anything that might come up. Then they would report

that through the Health Alert Network to CDC. They would report

it to the laboratories. Those laboratories are connected with CDC

and it would be almost instantaneous.

Senator COLLINS. Thank you, Mr. Secretary.

Senator CLELAND [presiding]. Senator Carper, do you have any

comments, remarks, or questions?

Senator CARPER. I have some questions, but I do not want to go

out of line. I think others were here before me.

Senator CLELAND. Senator Bunning, do you have any comments

or questions?

Senator BUNNING. First off, a lot of attention seems to be focused

on combatting bioterrorism in an urban setting. However, much of

Kentucky, as you might suspect, is not urban. It is rural. How will

combatting a bioterrorist attack in a rural setting be different than

in a city? Is there anything you are doing to specifically help rural

communities?

Secretary THOMPSON. Absolutely. What we are requiring in our

planning is we are requiring every State health department to

work with the local health departments, to work with the local first

responders, and the law enforcement officials to develop these comprehensive plans that are coming in.

Kentucky has sent in their plan this week and their plan is going

to be evaluated first by CDC. It is also going to be evaluated by

HRSA for their hospitals. Then it goes to our Office of Public

Health Preparedness and they will evaluate it and make suggestions, if needed, may approve it, may make suggestions. We have

also sent out templates to all the health departments with regard

to what are the best practices that we have been able to find so

they have something to work from.

In the case of Kentucky, they will be working on how to make

sure that rural areas in Kentucky are properly prepared, working

with the first responders, the public health departments, as well as

everybody else, and we have sent out templates and we have got

people from various States, both rural and urban, coming in to

offer consultation to us with regard to these plans.

Senator BUNNING. I understand that, Mr. Secretary, but as far

as our health care system and public health facilities in Kentucky,

most of the rural people have to come to urban areas to get their

health care public health services.

Secretary THOMPSON. Right.

Senator BUNNING. Therefore, if some kind of bioterrorist attack

would occur, say, in Laurel County, in London, Kentucky, the closest city is Lexington, which is about 65 or 70 miles. A lot of infecVerDate 11-MAY-2000 13:06 Aug 13, 2002 Jkt 000000 PO 00000 Frm 00024 Fmt 6633 Sfmt 6633 80296.TXT SAFFAIRS PsN: SAFFAIRS
21

tion can happen, if it happened to be smallpox, by just going into

Lexington. So are you telling me that—— Secretary THOMPSON. In the case of smallpox, we would quarantine that area. We would move in immediately.

Senator BUNNING. If you knew it was there.

Secretary THOMPSON. But we have to find out where it is, and

then we move in immediately.

Senator BUNNING. You would quarantine the area that you

would find—— Secretary THOMPSON. Immediately.

Senator BUNNING. Immediately.

Secretary THOMPSON. And we would send in people——

Senator BUNNING. And try to spread out a—would it not be——

Secretary THOMPSON. We would be able to ship in medical supplies, medical personnel, and experts from CDC within hours after

that takes place. That is what the Health Alert Network is set up

to do.

Senator BUNNING. OK.

Secretary THOMPSON. That is what the laboratory analysis is set

up to accomplish.

Senator BUNNING. Would it not be better if we inoculated and

vaccinated our first responders up front?

Secretary THOMPSON. We are looking at that right now, Senator,

but there are problems with the inoculation of the smallpox vaccine.

Senator BUNNING. Sure there are. I mean, if you did 270 million

people, you would have 2,000 or 3,000 deaths.

Secretary THOMPSON. That is right.

Senator BUNNING. I understand that.

Secretary THOMPSON. And there are some——

Senator BUNNING. But if you are doing the first responders, you

are not doing 270 million people.

Secretary THOMPSON. And that is what we are looking at right

now. We have got a group of specialists from CDC and NIH and

from my office that are working on this right now, along with State

medical societies and input from other medical personnel. They are

evaluating right now whether or not first responders should be inoculated.

Senator BUNNING. Well, you are going to have to do it if you have

an attack.

Secretary THOMPSON. That is correct.

Senator BUNNING. And as long as it is good for how many years,

an inoculation? It used to be 10 years. I do not know what your

new or improved version might be, but——

Secretary THOMPSON. The common position is it is good for 10

years, but there seems to be, from the experiments and the evidence we have right now, it is longer than that, Senator Bunning,

that there is a residual reserve capability or capacity to prevent

smallpox.

Senator BUNNING. I want to go back to a ‘‘60 Minutes’’ interview

last September. You made a statement that the United States was

‘‘prepared to take care of any contingency, any consequence that

develops, for any kind of bioterrorism attack.’’ You also said that ‘‘we would advise on television, on radio, exactly what to do’’ and

22

that we would ‘‘have people there within hours to take care of it,

set up an action plan and we will implement it.’’ In light of all that we have learned about our preparedness to

handle a bioterrorist attack during the anthrax attacks, do you

think making this generalized statement was a mistake or just premature?

Secretary THOMPSON. I think that we are better prepared—of

course, we are much better prepared today than we were then. We

were much better prepared than a lot of people thought. There are

a lot of consequences that came in. The statement was too broad.

But I wanted to make sure that people were—— Senator BUNNING. Well, I understand the calmness and the assuring of the American people.

Secretary THOMPSON. But we responded very effectively, Senator

Bunning, and there were billions, in fact, trillions of spores of anthrax that were sent through the mail—and it was the great medical personnel that we had at CDC and the local health departments that prevented a lot more deaths. Am I satisfied with the

five deaths? Absolutely not.

Senator BUNNING. No one is satisfied, but I think that attack

was limited very well as it turned out.

Secretary THOMPSON. It was, and it was because of the expertise

that we had and the preparation that had been made by the Department of Health and Human Services, CDC, and NIH. And now

we want to go to the next step.

There is no question, Senator, that the local and State public

health system in America needs a lot more infusion of dollars and

better preparation. That is why we are demanding these plans be

submitted, and we are hopeful with this planning process and the

$1.1 billion that we will be sending out that we can build a local

and State public health system that is national in scope, that will

be able to handle a bioterrorism attack, and that is what we are

getting prepared for. It is a legacy that you can have and the Department can have and America can have.

Senator BUNNING. I pray for you, then, today and into the future,

because we not only have to be prepared, we are going to have to

be also very fortunate to be able to identify and quickly treat any

kind of a bioterrorism attack and I wish you godspeed.

Secretary THOMPSON. Thank you very much, Senator, but if I

could just quickly respond, that is why we divided the country up

into medical assistance teams, individuals we can activate quickly

to be sent in at a very short period of time. That is why we have

expanded our push packages from 8 to 12, our medical supplies,

our medicines, our medical equipment from 400 tons to 600 tons,

and we have reduced the time from 12 hours, hopefully, down to

7 or 8 hours, that we can get 50 tons of medical supplies into Kentucky within 5 to 6 hours after an event. As soon as we are notified, we can dispatch that, and that is what we are hopeful to be

able to accomplish and that is the planning that it is working on

right now. And we are fairly certain that we can deliver on this.

Senator BUNNING. Thank you.

Secretary THOMPSON. But the problem is, once it gets there, we

have got to make sure that the local individuals are going to be

able to use that equipment, use the medical supplies, and get it to

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the individuals quickly. And that is what the planning process is

all about.

Senator BUNNING. Thank you. Senator Dayton.

Senator DAYTON. Thank you, Mr. Chairman. I appreciate the opportunity to speak. Thank you.

Mr. Secretary, first of all, I want to say that what you have described here today is highly commendable. The speed with which

you have responded and the progress you have made in terms of

getting money out and getting supplies stockpiled, I think, is just

outstanding and I think our Nation owes you a debt of gratitude

for your efforts on our behalf, so thank you, sir.

Secretary THOMPSON. It was the Department, sir, it was not me.

Senator DAYTON. I understand that, but it starts at the top.

Secretary THOMPSON. Thank you.

Senator DAYTON. But it is a team effort, so I agree with you.

Since you referenced the Kentucky plan, I have to evidence a parochial interest. Has Minnesota submitted a plan? I am not sure

of the status.

Secretary THOMPSON. Minnesota asked for a postponement this

week.

Senator DAYTON. All right.

Secretary THOMPSON. Minnesota asked for an extension to May

15 to deliver their plan, Senator.

Senator DAYTON. Thank you. You mentioned the money that you

have put out to the States and that you will be distributing additionally. In terms of local governments and local hospital units,

public health facilities and the like, does that money go through

the States to the local or does any of that go directly from your Department?

Secretary THOMPSON. It goes directly from CDC and HRSA to the

State health departments to implement their plan. They received

20 percent. Minnesota has received 20 percent of their amount of

money. What is Minnesota going to receive? Minnesota will go

through the State health department.

But what we are forcing the State health departments to do, in

conjunction with the governor, is to work with the city health departments, the county health departments, the hospitals, the State

medical system, the first responders, and the law enforcement officials to develop a comprehensive plan for the State of Minnesota,

and we have sent out templates of what we think a good plan

should provide for. The State of Minnesota will send that.

It will first be evaluated by CDC down in Atlanta. Then it will

be evaluated by HRSA. Then it comes up to Washington, DC,

where we have 11 teams to evaluate these plans after CDC and

HRSA. Experts—doctors and so on from around the country, come

in and evaluate the plans and make recommendations, and then

they will be in consultation with the State health department officials about those corrections or modifications if there are any. And

then the money will go out, hopefully by May 15, to those States

that have submitted their plans and had them approved.

We want the money to go out 30 days after a State has submitted a plan, and that is why we set up 11 teams and that is why

CDC and HRSA are working this weekend to make the first evaluation.

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Senator DAYTON. That is tremendous. Thank you.

Secretary THOMPSON. Minnesota is going to receive $18,107,000.

Senator DAYTON. If they get their plan in eventually?

Secretary THOMPSON. Yes.

Senator DAYTON. Thank you. It refers more to Governor Ridge’s

operation than your own, but I just want to ask the same question.

I have had some complaints and a lot of concern by local officials

in Minnesota that they feel they are out of the loop. They feel they

do not have access to information regarding these developments

and what their roles are supposed to be. Is that, as it relates to

your department, then, the responsibility of the States to communicate with local units of government, as well, or is there a way in

which they can directly access information, web pages, answering

service, or anything?

Secretary THOMPSON. The way we have got it set up, Senator, we

have a web page both at NIH, at CDC, HRS, and the Department

of Health and Human Services to get out the information. We have

the Health Alert Network, which now is connected with 68 percent

of the counties and the population of America. And by the year’s

end, with the money that is going to be sent out, that should go

up to 90 percent.

Then we have what is called the laboratory network in which we

have 80 laboratories, all the State laboratories plus some other laboratories, hooked up so that they have instant analysis, can communicate back and forth with one another and with CDC.

And then if an incident breaks out, we will send an expert or experts from CDC immediately. If something would happen in St.

Paul and there was an evaluation that there was anthrax, we

would then send that to the State lab, send it to the CDC lab, get

an evaluation. But in the meantime, we would send a team of experts from Atlanta to St. Paul to work with the local health department in St. Paul in the hospital, the emergency work to go over

that patient to find out what needs to be done.

Senator DAYTON. The reference was made to CNN as a source of

information. I would say that I received in the first 12 hours a good

part of my information from CNN and what I found, and I think

other members of Congress found, too, is that our normal communication lines were ruptured or were so overloaded that communication was extremely difficult, sometimes impossible.

You talk about the lines of communication you have established

with States and with the public health centers that would be called

upon in an emergency. How have you adapted that to the very real

possibility that these traditional lines of communication might once

again be disrupted or even ruptured?

Secretary THOMPSON. Senator, we think we have taken that into

consideration through the planning process and through the Health

Alert Network, by expanding that through the websites and

through the conference calls.

At the height of the anthrax, we used to have weekly conference

calls with CDC and with my office and sometimes with public

health department officials. Anybody could call in and be connected. It happened either on a Thursday or a Friday. We also did

it with the State medical societies. We did it with the emergency

doctors. And those are the kinds of things, when there is an emerVerDate 11-MAY-2000 13:06 Aug 13, 2002 Jkt 000000 PO 00000 Frm 00028 Fmt 6633 Sfmt 6633 80296.TXT SAFFAIRS PsN: SAFFAIRS
25

gency, we would start that once again. But in the meantime, when

there is not an emergency, we use the Health Alert Network, the

web pages, and what is put out by CDC on a weekly basis on updates on medical analysis.

Senator DAYTON. Thank you, Mr. Secretary. Thank you, Mr.

Chairman.

Senator CLELAND. Senator Carper, do you have any comments or

questions?

Senator CARPER. I do. Governor, welcome.

Secretary THOMPSON. Senator, how are you?

Senator CARPER. I am fine. How are you, my friend?

Secretary THOMPSON. Good, my friend.

Senator CARPER. Glad that you could be with us today. We have

gathered in our capital today, and this week, volunteer firemen and

firewomen from around the country. About 250 will be at the National Fire Institute dinner this evening. I think the President is

going to come to address them. We are having a ceremony honoring

one of our fallen in Delaware, literally in the Capitol this afternoon. In some respects, they are our first line of defense in all

kinds of emergencies, as you know.

I would just ask, is there any message or anything that you

would especially want me to convey to them on your behalf?

Secretary THOMPSON. I would just say thank you. Thank you for

the tremendous job that the men and women of the fire departments, volunteer as well as the paid officials, did during September

11. They were the calming influence in all communities across

America. They truly did a yeoman’s job and we are in their debt

and I just would like to say thank you.

Senator CARPER. I will be happy to convey that.

We had a hearing about, I want to say about 6 months ago when

we were reeling with September 11 and then the anthrax attacks

and have had an opportunity to do a whole lot. You have been very

busy, your folks have, as well, and we thank you for your stewardship and for your leadership in some difficult times.

I know that Senator Kennedy and Senator Frist have introduced

legislation, I think it is called the Bioterrorism Preparedness Act.

You may have commented on it in your testimony. I would ask you,

could you share with me a thought or two that you have on what

is good about it and maybe how it perhaps should be changed?

Secretary THOMPSON. I think it is a wonderful piece of legislation

right now. It sets up an Assistant Secretary for Biopreparedness

Emergency in the Office of the Secretary. That office is currently

being handled by Dr. D.A. Henderson. Jerry Hauer is the second

in command there.

It also allows us to do a lot for food inspections. It allows us to

reject food that has been tainted in the past from a supplier, from

a country. It also allows us to trace back the tainted food to the

supplier. It also allows us to expand our inspections by giving us

some additional personnel that we badly need. It also allows us to

have a much better coordinated effort in bioterrorism through the

Department of Health and Human Services.

There is another big thing that the Senate, Senator Feinstein

was very active in, and this was, of course, on the agents, the special agents. We had a meeting in the White House about it this

26

week and what we are going to do is we are going to set up a register in the Department of Health and Human Services for all

these agents, and then the Department of Agriculture has some of

their own agents. We have duplication. And so the Department of

Agriculture is going to have a list and be able to find out what

agents are being utilized for laboratory investigations, what is

being transported, and so on. The Department of Justice will have

the opportunity to have instant access to the registers in the Department of Health and Human Services and the Department of

Agriculture.

Right now, the law is, Senator, that we can only—the only thing

we monitor is the transportation, the transporting of these bioagents. We do not know how they are used. We do not know if they

have been used. We do not know what is in stockpile or so on. And

this information, now, that this legislation is going to give us, is

going to help us a great deal.

Senator CARPER. Good. In Delaware, we have been working over

the last couple of years to put into place a disease tracking system.

There is a name for it, the Delaware Electronic Reporting System.

It would——

Secretary THOMPSON. It is the best in the country, I might add,

Tom.

Senator CARPER. Thanks for saying that. I wish I could take

credit. Well, I will take credit for it. [Laughter.]

Secretary THOMPSON. It happened while you were governor, so

take credit for it.

Senator CARPER. One of the things I learned as governor is when

things go wrong, accept the blame. When things go right, share the

credit, so in this case we will give the credit to a lot of other folks.

But I know that your Department is working on, I think, a similar national monitoring system and I was just wondering, how is

it going? How far are you along there?

Secretary THOMPSON. We have taken the template from Delaware and we have sent that to all the 50 State health departments

saying this is a good example of how to be able to accomplish this

objective. And so we have done that in many different areas, in

communications, emergency preparations, and surge capacities,

and we are sending that out and we are hopeful that they will use

these templates to be able to build a very positive, comprehensive

plan. But Delaware should get the credit because we have used it

and I thank you for it.

Senator CARPER. Thank you. Thanks for sharing that credit.

I have heard some people argue that a system like the one we

are talking about, at least on a national level, would not enable us

to detect future attacks like last fall’s anthrax attacks. I do not

know if you agree, and if you do, does this mean it is maybe a less

worthwhile investment for us to make as a Nation?

Secretary THOMPSON. What was that, Tom?

Senator CARPER. There are some who said that a system like we

have in Delaware and that we are trying to spread across the country would not enable us to detect attacks like the anthrax attacks

of this past fall. I do not know if you agree with that assessment,

but whether you do or not, I wonder if that tempers at all your beliefs as to whether or not this is a worthwhile investment.

27

Secretary THOMPSON. I think it is a very worthwhile investment

and that is why we are trying to get it incorporated in all the State

plans because we think it is important, that information.

We also are looking for new innovations, Senator, on how to detect bioterrorism agents. There are some new innovations out there

and we are hopeful to be able to maybe in the future get them in

public buildings and the Capitol, and so on and so forth, that could

discern if there is anthrax in the area. They have not been perfected yet. There are some out there, but there are a lot of innovations, a lot of new things that are coming to the Department, not

only to our Department but the Department of Defense, and hopefully they will be able to discern when there is an agent in the vicinity.

Senator CARPER. I am struck by the number of usually fairly

small businesses, small technology businesses, just in my own

State who have been to see me to say, we have this technology, we

have this device which we think is quite effective, whether it is detecting anthrax or some other agent. We have tried to provide a

forum for them through the administration with the help of the

Small Business Administration so that they may have an opportunity to present to the administration and the relevant agencies

what they have worked on and what they have developed.

I am just seeing what has come out of one little State. I cannot

imagine what must be coming out of the rest of the country. My

suspicion is that in Minnesota and Georgia and other places, that

Senator Cleland and Senator Dayton are hearing from their businesses who are coming up with similar kinds of models that, frankly, we had not thought much about in recent years.

Secretary THOMPSON. I think it is very positive.

Senator CARPER. The last subject is quite a different subject and

I will just mention this as an aside. The administration was kind

enough, I suspect with your urging, to invite a number of us in the

Senate and in the House who were interested in next steps in welfare reform to a forum at the White House this afternoon that I

am not going to be able to attend. I mentioned earlier we have a

ceremony honoring one of our fallen fire fighters that will be in the

Capitol literally right in the time frame that the event at the White

House will be occurring on welfare reform. Do not judge my absence as a lack of interest.

Secretary THOMPSON. I know.

Senator CARPER. We look forward to working with you on it.

Thanks.

Secretary THOMPSON. Thank you very much, Senator Carper.

Senator CLELAND. I thank all of the Members of the Committee

for involving themselves in this discussion today, and again, Mr.

Secretary, we thank you very much for your help here.

I just want to get into some basic, fundamental conflicts, if you

will, challenges, problems that we need to work out together, and

I would like to just say again, I would like to work it out with you,

with the Members of the Committee.

Congressman John Lewis has said it beautifully, that we may

have come to this country in different ships, but we are all in the

same boat now, so we are in the same boat here.

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I was just sitting here thinking about the difference, the dramatic difference, I think, between, shall we say, a military/terrorism attack on the country and when that attack goes biological.

First of all, I think an attack on the country requires some delivery

system. We saw that initially the al Qaeda went after us at the

Khobar Towers with a car bomb, then later with a truck bomb at

the World Trade Center, the two embassies in Africa, then ultimately a boat bomb against the U.S.S. Cole, and finally a plane

bomb against the World Trade Center and the Pentagon.

So some overt attack to create mass destruction or confusion,

which is the object of terrorism, which makes it so terrifying, requires some kind of delivery system. But if you take that attack biological, that really is very difficult to detect. The delivery system

for killing 100,000 people could be one envelope delivered to Senator Patrick Leahy’s office. The anthrax spores there, I am told,

were enough to kill 100,000 people.

Secretary THOMPSON. That is true.

Senator CLELAND. So I think we have a new ballgame when the

attack goes biological or chemical and it is interesting how there

is really a dichotomy in law and a dichotomy in many ways in

practice that we have now and that we have got to resolve and

work out somehow that led to some of the problems, the initial

problems with responding to anthrax.

In many ways, I could boil it down this way. One part of our law,

based on Presidential directive, says, in effect, the FBI is the lead

dog, the lead agent, and HHS is in support of FEMA, a back-up

agency, in terms of biological help. The other part of our law, which

is actually in law, authorizes the Secretary of HHS to actually initiate certain things—we can get into that—to include investigations.

It is interesting, too, we have a FBI and then we have a bug FBI.

The bug FBI is the CDC. They have the epidemiological investigative service. So when things get buggy, they are the agent, in many

ways, of expertise. They have been around 50 years there in the

CDC.

Secretary THOMPSON. That is right.

Senator CLELAND. What I am trying to do is try to make sense

of these great assets and instill or work out some kind of better coordination, cooperation, and communication.

First of all, I think we have got to acknowledge some of the problems. Last fall with the anthrax attack, a bug attack which, thank

God, the CDC quickly identified, therein, though, once the CDC

identified it, it became this tug of war between public health agencies and law enforcement agencies. Just some examples.

In Trenton, New Jersey, the FBI and public health agencies

could not agree on who should take environmental samples, so they

both did. In Washington, DC, health officials first learned that

there was contamination in several Federal agencies from the news

media, I guess CNN.

In New York, law enforcement officials knew but failed to notify

city health officials that a suspicious letter had been sent to NBC

News until after the first case of infection surfaced. When the FBI

took over in Florida after the CDC had identified the substance as

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anthrax, when the FBI took over in Florida, press briefings by public health officials halted at the FBI’s request.

Another example. Samples collected by the FBI in Washington,

particularly in terms of the Daschle letter, were sent to military

laboratories, Army labs at Fort Detrick, Maryland, for analysis, not

to CDC.

Finally, a Canadian study on anthrax showed that anthrax

spores could escape sealed envelopes in large quantities. At least

half-a-dozen U.S. agencies knew about this study prior to the anthrax attacks, but because of individual stovepiping of information,

turf battles, budget battles, the CDC did not know. The CDC had

received, interestingly enough, an E-mail regarding that study on

October 9, before the Daschle letter arrived and before anyone at

Brentwood fell ill, but no one there read it until November.

The problem is, I think we have a problem. Senator Nunn has

indicated something of interest. He played the President in an exercise called Dark Winter put on by Johns Hopkins in June of last

year, about 90 days before the attack here on September 11. That

was a drill on a smallpox attack in America, and out of that, Senator Nunn testified before the Congress some challenges.

He said, ‘‘you have got an inherent conflict between health and

law enforcement,’’ and he said, ‘‘and to the extent that they have

not coordinated beforehand and do not know each other beforehand, before the occurrence took place, you would have a horror

show because law enforcement has one set of goals and health officials have another set of goals.’’

What are those goals? Well, law enforcement deals in secrecy. I

understand the FBI wants to keep things secret. The public health

entities, from the CDC on down, deal in openness. They want to

disclose and disseminate information.

I am concerned that the protocols of response, of communication

and coordination between Federal responders in the event of a bioterrorism attack are not clear.

As I mentioned, executive documents seem fairly straightforward. The U.S. Government interagency domestic terrorism concept of operation plan, called CONPLAN, issued in 2001, sets forth

how the Federal Government will respond to a terrorist incident

and how the various Federal agencies are to coordinate with one

another in the event of such an incident. The CONPLAN draws on

and is in accordance with authorities established in two Presidential directives, Directives 39 and 62, the Federal response plan,

including a lot of backup.

The CONPLAN designates the FBI as the lead Federal agency

for crisis management in the event of domestic terrorism. FEMA is

designated as the lead Federal agency for consequence management to ensure that there is only one overall lead Federal agency

at a time. And then HHS is in a support role under the CONPLAN.

Now, interestingly enough, another directive that you are caught

in is law. It seems that a law, the Public Health Threats and

Emergencies Act, gives explicit authorization to the Secretary of

HHS to declare a public health emergency on your own, in effect,

and in the event of such declaration, to do whatever is necessary

to respond to it, including conducting, not merely supporting but

30

conducting your own investigations into the cause and means and

steps to be taken.

It seems under the CONPLAN, the HHS can do only those kinds

of things in support, based on request. But the law, the Public

Health Threats and Emergencies Act, in effect, says you have authority whenever the public health is in danger.

I think somehow we have got to clarify this. I think you are

caught in a bind. There are very real scenarios under which the interest of law enforcement and public health do conflict.

May I say that the FBI, as the lead Federal agency, is generally

the first agency to obtain new information. If it decides that a new

piece of information has a bearing on public health, it then communicates that to health authorities. As a number of experts have

noted, the FBI is not a public health agency. They may not necessarily know what information can be of significance to public

health officials.

I would like to know, what is your understanding now of the relationship between the roles of law enforcement and public health

in the event of a bioterrorist attack on our country? Do you feel

that you have sufficient authority under the law to initiate action,

whether through the CDC or some other agency under your command, to, in effect, declare a public health emergency and begin

preparing to deal with it?

Secretary THOMPSON. As you know, Senator, I did declare a public health emergency on September 11, and did use that power. But

I think it does need clarifying. I think you are absolutely correct.

There seems to be some confusion, and so in order to have a more

comprehensive way of getting the information out, we have set up

what is called advisory committees. These are the committees set

up by the State and local health departments and government,

emergency management agencies, emergency medical services, Office of Rural Health, police, fire department, emergency rescue and

occupational health workers, Red Cross and other voluntary organizations, the hospital community, community health centers, and

other health care providers. These are the advisory committees

that we have asked the States to put in their comprehensive plans

so in case of an emergency, in case of a bioterrorist attack, these

committees would come together and be able to distill the information and be able to speak with one voice.

But at the Federal level, I think there is some confusion and if

we could sit down with the Department of Justice and Office of

Homeland Security, I think we could work it out. But there is very

good cooperation. I do not want you to in any way imply from my

answer that there is not good cooperation right now.

For instance, we have somebody from CDC, and I do not know

if you know this, Senator Cleland, that meets with the FBI every

week with regard to new evaluations on anthrax. So we have one

of our experts from CDC that meets with an FBI team weekly on

their analysis. Jerry Hauer meets with them every other week with

regard to the investigation on anthrax. And I meet with the Director and other members monthly as to new developments on anthrax. At the height of it, we met weekly.

31

So there is great cooperation now, but in the law, in the emergency rules, there is some confusion that I think needs to be clarified.

Senator CLELAND. And it does seem to me that in case of a bioterrorism attack, a chemical attack, you have the agencies, the resources to deal with it and you ought to be the lead dog. There are

other entities involved. I am not sure they make it better or worse

for you to take the lead. There is now the Office of Homeland Security to coordinate with and now there is Dr. Henderson in your new

office that you have created. You have got the CDC. You have got

the NIH. You have got FEMA. You have got the FBI.

I think that is my problem, is that we have got about 20 different

agencies involved in bioterrorism and what I am trying to do is

kind of sort out the protocol here before the next attack. In other

words, make sure people basically understand their role and responsibilities when the next time the popcorn hits the fan so that

we do not have to go through the drills that we went through last

fall.

Secretary THOMPSON. FEMA now defers to the Department of

Health and Human Services on anything and everything that deals

with bioterrorism, and so that has been—it is not in the rule, it is

not in executive order, but that is common practice. And the FBI

has been very cooperative. In fact, I have just been corrected. We

have a full-time official from CDC working in the FBI right now

on the anthrax question.

Senator DAYTON. Mr. Chairman, could I just excuse myself? I am

sorry to have to leave. I have a press conference call with the Minnesota press. I apologize for having to go. Mr. Secretary, thank you.

Senator CLELAND. Thank you very much.

Secretary THOMPSON. Thank you, Senator Dayton.

Senator CLELAND. In the National Journal, HHS spokesman

Kevin Keene is quoted as acknowledging that under the Department’s consolidation plan, one agency or one voice or something

like that, which is a noble enterprise, but I think we are concerned,

I am concerned about whether or not this will add an additional

layer of review by the Secretary’s office. I mean, I understand

about speaking with one voice. I also am interested in speaking

with a medical or expert voice as opposed to a political voice.

I just want to get your understanding of whether or not what you

are trying to do is going to speed up, where speed is of the essence

and communications is of the essence, or slow down information

that your Department has that needs to be disseminated to the

public.

Secretary THOMPSON. I think it is going to speed it up and I

think it is going to be much more effective, Senator. We do not in

any way want to infringe upon the scientific utilization of the

media. In fact, we encourage it. We want to make sure that CDC

continues to have the Health Alert Network, continues to have

their Public Affairs Department, continues to put out their MMWR

on a weekly basis with information. We want them to continue to

set up the conference calls with regard to how we get the information out. All of this is not going to be touched at all.

What we are trying to do—we have got 50 different public affairs

departments, 50 public affairs offices within the Department of

32

Health and Human Services. In the case of a bioterrorism thing,

we want to make sure that what is going on in CDC, at NIH, and

FDA is coordinated with the new office, and hopefully the Assistant

Secretary for Public Health Preparedness, and that is headed by

Dr. D.A. Henderson, so that we are able to speak clear, concise,

straightforward, directly, and quickly about the effect.

What we did during the height of the anthrax things, we had

people like Dr. D.A. Henderson, Dr. Tony Fauci from NIH, Jeff

Copeland from CDC, myself, and other individuals who weekly met

with the press and we had a teleconference call for any updates

with regard to bioterrorism.

We would incorporate that so that CDC, NIH, FDA, and the new

office or Assistant Secretary’s Office for Public Health Preparedness would be able to coordinate their message and get it out

quickly, and usually by a doctor.

Senator CLELAND. Maybe I am just a little stream of consciousness thinking here. When the Secretary of Defense briefs the public, the press, on, say, military operations, he always has, in effect,

the Chairman of the Joint Chiefs standing there to answer ‘‘military expertise’’ questions.

It does seem like that in the homeland defense arena, the strategy for defending our homeland, if it becomes a biological issue,

there are a number of bugs out there that we can be attacked with.

It seems to me your great agency, particularly in the CDC, has the

capability to draw upon some expert that knows about that and, in

effect, becomes your equivalent of the Chairman of the Joint Chiefs

of Staff standing there answering questions about that particular

bug or device or gas.

Secretary THOMPSON. That is why we put Jeff Copeland out just

about—we made him available every week with regard to talking

to CNN and talking to the press. We also made available the Surgeon General, David Satcher, and Dr. D.A. Henderson. They were

the spokespeople, and Tony Fauci from NIH. Those were the

spokespersons for the Department as relates to the medical provisions of bioterrorism.

Senator CLELAND. Experts in the field like Dr. Tara O’Toole,

whose colleague Tom Inglesby we will hear from in the second

panel, keep telling us that we need to have medical professionals

out there answering questions and disseminating information.

Secretary THOMPSON. I agree with that.

Senator CLELAND. It is interesting that in 1993, during the hanta

virus outbreak, then-Secretary of HHS Donna Shalala deferred and

let C.J. Peters, the Chief of Special Pathogens at the CDC, take the

lead and be the voice of the public health establishment. I am sure

you get that point.

Budget issues—in 2000, the Congress committed to a 10-year

master plan for revitalizing the CDC’s World War II era facilities.

I have visited those facilities. How did it get to be World War II?

Well, first of all, in many ways, you had a little public health operation down there just off the field of a Naval air station and they

were basically an Army operation dealing with malaria, and in

many ways, that is how that grew there. Actually, back in the

1960’s, it was Mr. Woodruff of Coca-Cola fame who worked with

Emory to donate some land across from Emory and that became,

33

in effect, the CDC headquarters. So it just kind of grew, but now

very much in need of a master plan to bring it into the 20th Century and out of the World War II era facilities. In 2000, we put together about $175 million for buildings and facilities, actually in fiscal year 2001. Last year, after the anthrax attacks, we put together about $250 million. The President came to

the CDC and praised the CDC for its work. That compressed the

10-year plan to about 5 to 7 years, which we felt was proper for

the country to begin getting on top of the master plan because we

could not wait another 10 years for some terrorist attack.

It seemed to me that the Congress committed at that time to maintaining a funding level of $250 million per year specifically for

CDC in campus buildings and facilities until the plan was complete. After we passed that legislation, we allocated an additional

$46 million for security. The administration has proposed a total of just $90 million specifically for the CDC’s master plan 2003, and I expressed my concern to you over this meager funding level and you were kind

enough to write back. In your response, you wrote that the administration proposes $184 million for buildings, facilities, and security

in fiscal year 2003 across the board, which when combined with

$296 million the CDC received for buildings, facilities, and security

last year brings a 2-year total to $490 million, seemingly close to

the needed $200 million per year.

However, the master plan that Congress committed to is for the

upgrading and revitalization of the CDC’s buildings and its facilities at its headquarters in Atlanta. Funds for needed security upgrades are not figured into it. Neither are funds for projects that

are not located at the headquarters in Atlanta. Of the $184 million the administration has proposed for fiscal year 2003, $74 million is for the construction of an entirely new facility in Fort Collins, Colorado, and $20 million for security. That

leaves just $90 million for master plan-related projects, a lower

amount even than the $175 million Congress appropriated 2 years

ago that will be required to keep us on a 10-year plan.

My question is, where does the administration’s proposed budget

for the CDC put us in terms of implementing the 10-year plan?

Secretary THOMPSON. Senator, let me tell you that I totally agree

with the need to upgrade the CDC campus. I have been there. In

fact, I spent a week there as I move my office around to various

divisions. One week out of the month, I spend the week in Atlanta

at CDC.

There are three campuses at CDC, as you know. There are 24

other rented buildings. A lot of the buildings on those campuses are

old, dilapidated, a lot of laboratories, and a lot of security problems.

There is no question that the $250 million is needed. But when you

are fighting a war both internationally and domestically through

homeland security, you have given so much in dollars, you have to

put together the best plan possible. We are putting $74 million into Fort Collins, which is a CDC

building, which is badly needed. I do not know if you have seen the

pictures, but it is absolutely badly needed. In fact, some of the research cannot be done during some of the months of the year because of ventilation and because some of the encroachment of mice

34

and rats and snakes that get into the building. So that was a top

priority. We had to do the $74 million for Fort Collins.

We have to build a new laboratory, a level four laboratory, at

Fort Detrick, and we have to remodel some labs at NIH in Montana for NIH. So we looked at the amount of dollars that we had.

We stretched them as far as we could go and that is what we ended

up with.

All I can tell you is that I fully support, and hopefully, next year,

we will be able to do more for CDC. They need to consolidate and

we need to get out of that rental space and we need to consolidate

those buildings on three campuses. But with the dollars that we

had, we put together the budget. We thought there were higher priorities this year because CDC got a nice tranche of money last year

for buildings, and hopefully, next year, we will be able to do a better job.

Senator CLELAND. You can understand the fact that I feel strongly about this and will continue to push in the Senate——

Secretary THOMPSON. I know you do, and I compliment you on

it, Senator—— Senator CLELAND [continuing]. For additional monies for the

CDC——

Secretary THOMPSON [continuing]. And I want to work with you

on it.

Senator CLELAND [continuing]. To stick to that effort that Congress committed itself to and the President, I thought, signed onto

to collapse the 10-year master plan into about a 5-year plan because we cannot wait on the next terrorist attack.

I would like to just bounce off you this idea, this concept that I

put forward, the National Center for Bioterrorism Preparedness

and Response in the CDC. Again, most of the CDC’s budget is broken down into allocations to centers—— Secretary THOMPSON. Right.

Senator CLELAND [continuing]. In an effort to enhance coordination, cooperation, and communication, and accountability for these

$6 billion or so we are spending on bioterrorism among 20 different

agencies. In an effort to put together a nerve center that would operate 24 hours a day, 7 days a week, and be available to provide

our first responders and our citizen with what we need out there,

you can understand that after looking at the master plan, I considered that it would be a logical step to put together a center there.

Now, what do we mean by a center? One of the concepts that I

had in mind is the concept by Jeff Koplan, the former CDC Director, about a $65 million center to address the most urgent security

deficiencies in the agency. The current headquarters facility and

emergency operations center are located in buildings less than 30

feet from a major street. The new, in effect, center, bioterrorism

center, would be located in a secure spot and house a secure compartmental information facility for communicating with the Secretary of HHS, the White House, and intelligence agencies during

an emergency.

We have that kind of facility in the Pentagon for outright attacks. We do not have that kind of nerve center and facility, situation room, where everybody can be tied in and can communicate to

one another really in times of a bug attack or bioterrorism attack

35

or chemical attack, and it seems to me that that would be a logical

step that we would include in the 10-year plan. Do you have any

comment on that?

Secretary THOMPSON. Senator, I agree with you. I thought it was

a great idea. In fact, we were going to look at reorganizing CDC

to accomplish that administratively. But I was dissuaded, not by

people up here, but I was dissuaded by the people in Atlanta that

that was not a good idea, and they told me the reasons why.

They said that we have bioterrorism in chronic diseases. We have

bioterrorism in infectious diseases. We have bioterrorism activities

in the National Center for Environmental Health. And we have bioterrorism activities going on at ATSDR for the Superfund. And we

have bioterrorism activities going on with the State health departments. We think if you consolidated all of that into one center, that

we would lose something in the process.

So since they were the experts, I listened to them and I went

along with that. But I have to admit that what you are saying has

some merit to it and I would like to work with you and see if we

could accomplish both objectives.

Senator CLELAND. I do not want to beat it to death. We are going

to have Dr. Inglesby in a few minutes, and his testimony and statement says there is a need for experts from a variety of scientific

backgrounds, experts in experimental biology, epidemiology, infectious disease medicine, anthrax vaccine science, and immunology to

work together on bioterrorism events. That is his testimony. The

CDC center would bring together these experts.

Interestingly enough, in terms of an attack on this country, biological agents could be combined with chemical agents like sarin

gas or weaponized in unknown ways. The combined expertise at

the center, I think, could help.

Dr. Jeff Koplan, the former Director of CDC, stated that, ‘‘Dozens

of staff representing several of the laboratories and centers are

dedicated to bioterrorism activities, but most do not focus exclusively on bioterrorism.’’ That is the point, I think, you were making.

Secretary THOMPSON. Yes.

Senator CLELAND. It is illogical to expect these staff to be more

proficient and effective as a team when 70 percent or more of their

time is spent on other duties and 30 percent or less on bioterrorism.

I would just like to put some of these points in the record, and

we will hear from Dr. Inglesby in just a moment.

But it is something that I will continue to work on because it

does seem to make sense, and also from the private sector, Bernie

Marcus, the founder of Home Depot, along with Art Blanc, just donated $4 million to the CDC for the very purpose of equipping a

nerve center like this, and I have noticed that they did not turn

that down. [Laughter.]

We will continue to press on in the vineyard.

Secretary THOMPSON. I congratulated him and thanked him very

much for that. We appreciate that.

Senator CLELAND. You have been very kind and very cooperative

today. We thank you very much. We are in the same boat, and

thank you for grabbing your oar and paddling like the dickens.

36

1The prepared statement of Dr. Hamburg appears in the Appendix on page 54.

Secretary THOMPSON. Thank you, Senator Cleland, for having

this meeting and thank you for being here, and I want to cooperate

with you and work with you on that bioterrorism thing and see if

we can work it out so that we can come up with a comprehensive

plan.

Senator CLELAND. Thank you, sir.

We will have a 10-minute break before the second panel.

[Recess.]

Senator CLELAND. The Committee will come back to order. I have

been told that we will have a vote here momentarily, so let me just

move right along.

The Committee has heard an update from Secretary Thompson

on the Department of Health and Human Services’ public health

preparedness for terrorism involving weapons of mass destruction,

particularly biological agents. Committee Members have also addressed their concerns and proposals for Congressional action.

We are very fortunate today to have our second panel of bioterrorism and public health experts to respond to our earlier discussion and to share your insights. I am very pleased to introduce our

panelists.

Dr. Margaret Hamburg is the Vice President for Biological Programs at the Nuclear Threat Initiative, put together by Ted Turner

and run by Sam Nunn. Dr. Hamburg has testified at earlier hearings and has been an invaluable resource on bioterrorism and

weapons of mass destruction.

Dr. Tom Inglesby is Deputy Director of the Johns Hopkins Center on Civilian Biodefense Strategies, a wonderful operation, and

we thank you very much. Dr. Inglesby is also a physician and specializes in infectious disease medicine. We are glad to have you.

Tom Milne is Executive Director of the National Association of

County and City Health Officials and has 15 years of experience

as a local public health director in Washington State. Welcome.

We look forward to hearing an update on public health preparedness for bioterrorism. Dr. Hamburg, would you please begin our

discussion for our second panel.

TESTIMONY OF MARGARET A. HAMBURG, M.D.,1 VICE PRESIDENT FOR BIOLOGICAL PROGRAMS, NUCLEAR THREAT INITIATIVE

Dr. HAMBURG. Thank you very much, Mr. Chairman, for the invitation today to speak today on the topic of the state of public

health preparedness for terrorism involving weapons of mass destruction. Certainly, your leadership and commitment in addressing this challenge come at a crucial time.

Since the events of the fall, considerable new money and attention has been directed towards this problem and they are vital. The

response to the anthrax letter attacks surfaced many critical concerns about public health preparedness, particularly with respect to

the issues of coordination and communication that the Committee

has indicated a strong interest in.

It underscored the difficulties of understanding and coordinating

the complex interactions between different agencies of government,

37

1The Feb. 22, 2002 article entitled ‘‘Public Health Preparedness,’’ from Science magazine submitted by Dr. Hamburg appears in the Appendix on page 66.

different levels of government, and the private sector, all of which

have important roles to play. Responding to this bioterrorist attack

required new levels of partnership between public health, medicine,

law enforcement, and the intelligence community. However, these

communities did not have enough previous experience working together and vast differences in their professional cultures, missions,

and needs clashed.

The events of the fall also highlighted the pivotal role of the

media and how an open and constructive partnership with the

media is paramount in communicating important information to

the public and reducing the potential for confusion, fear, and panic.

Last, the management of the crisis was complicated by the fragmented and under-resourced infrastructure for public health and

an already strained health care system.

Many things must be done. I have submitted much more detailed

formal testimony for the record and I am also submitting a recent

editorial I did in Science magazine on public health preparedness

for the record.1

I want to take my time now to mention a few broad concerns related to the problems of coordination and communication.

First, a comprehensive and systematic evaluation of the anthrax

response should be undertaken. Surprisingly, this has not yet been

done, to the best of my knowledge. Looking within and across the

relevant agencies of government, levels of government, and at the

relationships of private sector organizations, an informed analysis

with identification of gaps in preparedness and response and realistic recommendations for improvement will be of enormous value.

A number of entities could undertake this, but there is some urgency to do so before events fade from memory and new priorities

overwhelm us, and it cannot just be an individual agency by agency

listing of lessons learned but a true cross-cutting analysis.

Clearly, we need comprehensive integrated planning. As Senator

Cleland noted, we still need to more clearly define the relative roles

and responsibilities of different agencies involved and the mechanisms by which they will interact and work together and do this

before we are in the midst of a crisis.

In addition, we still have not adequately prepared top officials to

cope with this new type of security crisis. We have not invested

adequately in the planning exercises needed to implement a coordinated response, and we have not adequately educated the American people or developed strategies to constructively engage the

media to communicate critical information about what is happening and how to protect themselves.

The new Office of Homeland Security is clearly key to such efforts, but there are concerns. It is difficult to imagine how Governor Ridge can successfully bring together and coordinate all the

myriad agencies responsible for the different aspects of homeland

security without budgetary authority, or at a minimum, budget review and sign-off authority, and cabinet-level status making him at

least co-equal to the other members of the homeland security team.

38

1The prepared statement of Dr. Inglesby appears in the Appendix on page 67.

In addition to the Executive Branch, coordination is needed with

respect to the activities here in Congress. I am told that literally

dozens of committees and subcommittees are involved, and given

the complex and multi-disciplinary nature of the problem, it is not

surprising that a wide array of committees would have a role to

play and completely appropriately. Nonetheless, assuring the comprehensive and well-integrated strategies needed will not occur unless there is equivalent integration, coordination, and communication among committees and leadership on the Hill, and I think this

Committee is well positioned to help serve that effort.

As noted by others, key to effective public health preparedness

is public health itself. It is an important pillar in our national security framework and must be a full partner at the table. The chair

is closer today than it was before, but it still is not full square

there. Public health expertise must be a prominent component of

the new Office of Homeland Security, and a public health official,

in my view, should become part of the White House National Security Council.

And on the ground, there is an urgent need to strengthen and

extend the core capacities of our public health system. Our

infrastructure—— Senator CLELAND. Dr. Hamburg, we have a vote called. If you do

not mind, could you submit that for the record?

Dr. HAMBURG. Certainly.

Senator CLELAND. Dr. Inglesby, could you say some wonderful

things to us, and Mr. Milne? I would hate to leave here and let you

all hang. Could we move to Dr. Inglesby?

Dr. HAMBURG. Certainly.

TESTIMONY OF THOMAS V. INGLESBY, M.D.,1 DEPUTY DIRECTOR, JOHNS HOPKINS CENTER FOR CIVILIAN BIODEFENSE

STRATEGIES

Dr. INGLESBY. Senator Cleland, thank you and the other distinguished Members of the Committee for this hearing.

First, I would like to say that it is important to understand that

the anthrax attacks of 2001 produced an extremely complicated set

of management problems. CDC had to act faster than it ever had

acted before, had to work with public health agencies like it had

never done before, communicate with clinicians and nurses like

never before, on a scale and a speed which was unprecedented. So

there were professionals in all of these agencies, public health

agencies, working around the clock, extremely dedicated, with the

best intentions and a number of good successes throughout the crisis.

But with all this being said, in my analysis, there are at least

three categories of communication breakdowns that are worth calling attention to as we figure out what to do as we move forward.

The three categories were the processes of incoming communication, the processes for resolving scientific issues during the crisis,

and the processes of outgoing communication.

I mean by incoming communication the processes by which clinicians and doctors who are seeing illnesses or suspected illnesses

39

could communicate their concerns to public health agencies and to

the CDC. In addition to that, there were data streams coming from

a variety of directions regarding environmental health data and

laboratory data which were coming forward at a pace and of a scale

which had never been done before. So simply the task of integrating the data and processing it and forwarding it to public

health decisionmakers was a tremendous challenge for public

health agencies.

The second category of issues regarded what you mentioned before on the first panel, and that was the processes for resolving the

complicated science issues that arose during the crisis. Most people

look to CDC for their technical expertise to resolve scientific questions, and that is absolutely appropriate. But during the crisis, we

saw science questions that could not be solved by people within

CDC alone, and CDC certainly was aware of that and tried to develop processes to answer questions.

But as an example, we ask the question: ‘‘Who should get the anthrax vaccine, if anyone? ’’ Of those affected by the anthrax crisis?

To answer that question, you needed to know how likely it was

that anthrax spores would cause disease after weeks of being in the

body dormant? How likely was it that you could diagnose anthrax

safely early after the infection begins? How much anthrax vaccine

do we have and when will we have more? How safe are the existing

anthrax vaccine stocks? All of these questions mandate that we

have a variety of scientific competencies at the table, and you have

mentioned those already.

Senator CLELAND. Dr. Inglesby, can we have you summarize and

move on to Mr. Milne?

Dr. INGLESBY. Absolutely. So I think, in short, the highest level

recommendations I would submit for improving communication: (1)

improved connectivity between public health agencies and the medical system. There is a breakdown there that is real. Doctors and

nurses are not part of the Health Alert Network. So even if we resolve problems of the Health Alert Network, doctors and nurses are

still out of the loop.

(2) Clinical information needs to get around the system, as well.

Doctors and nurses have a responsibility for figuring out how we

are going to get information to each other, and that is a separate

problem. Once it is in our system, how do we get to each other?

(3) How do we resolve science questions in the middle of a crisis?

How do we communicate better with the public, even if it is bad

news? What is the way to do that best?

(4) And finally, exercises are extremely important, and I think a

number of initiatives that the Senate has brought up for consideration are extremely useful along these lines. Senator Carnahan has

legislation pending, Senator Lieberman has legislation, and so do

you, all of which are aimed at addressing some of these deficiencies.

Senator CLELAND. Thank you, Doctor. Mr. Milne.

40

1The prepared statement of Mr. Milne appears in the Appendix on page 74.

TESTIMONY OF THOMAS L. MILNE,1 EXECUTIVE DIRECTOR,

GOVERNANCE SUPPORT TEAM, NATIONAL ASSOCIATION OF

COUNTY AND CITY HEALTH OFFICIALS (NACCHO)

Mr. MILNE. Thank you, Senator. I am Tom Milne with the National Association of County and City Health Officials. We were

asked to provide testimony on two issues. I will be very brief on

both.

The first has to do with the relationship between law enforcement and public health. The second is a progress report to you in

terms of how the appropriation of Federal bioterrorism funding is

translating to action at the local level. Our submitted testimony

provides a great deal of detail on both issues.

Just in brief, an effective response at the local level to bioterrorism requires close collaboration between law enforcement and

public health, and I am happy to report to you, sir, that is going

very well with local law enforcement agencies and local public

health. In fact, there is a long history of the two sectors working

together.

There are many examples in my testimony. I would highlight

one: In the Fulton County Health Department and in the DeKalb

County Board of Health in your own State of Georgia, there is an

exquisite emergency plan that incorporates law enforcement, public

health, and many other first responders.

If there is a problem in collaboration between public health and

law enforcement, it is in the lack of clarity in terms of how the various channels of Federal resources can be used at the State and

local levels.

Second, in terms of how the funding is translating at the local

level, it is too early to tell much. What I can say is there have been

mixed results in terms of how the process is going between States

and locals. We have concern that enough money will not make it

to the local level to make the difference that is needed. We strongly

recommend that Federal monitoring of how the resources are ultimately used take place. There are some States where State and

local collaboration has been very effective. So there is some hope.

So in very brief summary, the public health infrastructure is critical to bioterrorism, but it also serves dual purposes to building the

national public health capacity on a much broader scale.

Senator CLELAND. Wonderful.

Mr. MILNE. Thank you very much.

Senator CLELAND. Thank you all very much. I deeply regret that

I have got only 5 minutes left for this vote. You all have been wonderful, very patient. Your testimony means an awful lot to me and

we will take it into account.

By the way, the record stays open for a week for any statement

or questions or testimony that you want to submit. We have some

questions we would like to submit to you for the record.

With that, we thank you very much for coming and thank the

staff for putting this hearing together.

The Committee is adjourned.

[Whereupon, at 12:01 p.m., the Committee was adjourned.]

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