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76–807 PDF 2002

S. Hrg. 107–213

FEDERAL EFFORTS TO COORDINATE AND

PREPARE THE UNITED STATES FOR

BIOTERRORISM: ARE THEY READY?

JOINT HEARING

BEFORE THE

GOVERNMENTAL AFFAIRS

COMMITTEE

UNITED STATES SENATE

AND THE

INTERNATIONAL SECURITY, PROLIFERATION

AND FEDERAL SERVICES SUBCOMMITTEE

ONE HUNDRED SEVENTH CONGRESS

FIRST SESSION

OCTOBER 17, 2001

Printed for the use of the Committee on Governmental Affairs

(

(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

DAVID M. BERICK, Professional Staff Member

HANNAH S. SISTARE, Minority Staff Director and Counsel

WILLIAM ‘‘BILL’’ M. OUTHIER, Minority Investigative Counsel

DARLA D. CASSELL, Chief Clerk

INTERNATIONAL SECURITY, PROLIFERATION AND FEDERAL SERVICES

SUBCOMMITTEE

DANIEL K. AKAKA, Hawaii, Chairman

CARL LEVIN, Michigan

ROBERT G. TORRICELLI, New Jersey

MAX CLELAND, Georgia

THOMAS R. CARPER, Delaware

JEAN CARNAHAN, Missouri

MARK DAYTON, Minnesota

THAD COCHRAN, Mississippi

TED STEVENS, Alaska

SUSAN M. COLLINS, Maine

GEORGE V. VOINOVICH, Ohio

PETE V. DOMENICI, New Mexico

ROBERT F. BENNETT, Utah

RICHARD J. KESSLER, Staff Director

SHERRI STEPHAN, Professional Staff Member

MITCHEL B. KUGLER, Minority Staff Director

ERIC E. DESAUTELS, Minority Professional Staff Member

BRIAN D. RUBENS, Chief Clerk

(III)

C O N T E N T S

Opening statements: Page

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

Senator Thompson ............................................................................................ 4

Senator Akaka .................................................................................................. 5

Senator Collins ................................................................................................. 19

Senator Levin .................................................................................................... 22

Senator Durbin ................................................................................................. 25

Senator Carnahan ............................................................................................ 30

Prepared statement:

Senator Bunning ............................................................................................... 75

WITNESSES

WEDNESDAY, OCTOBER 17, 2001

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

Human Services ................................................................................................... 7

Michael D. Brown, Acting Deputy Director and General Counsel, Federal

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

Hon. Deborah J. Daniels, Assistant Attorney General, Ofice of Justice Programs, U.S. Department of Justice ..................................................................... 37

Henry L. Hinton, Jr., Managing Director, Defense Capabilities and Management, U.S. General Accounting Office ................................................................ 40

Anna Johnson-Winegar, Ph.D., Deputy Assistant to the Secretary of Defense

for Chemical and Biological Defense, U.S. Department of Defense ................. 42

Gary W. McConnell, Director, Georgia Emergency Management Agency, on

behalf of the National Emergency Management Association ........................... 53

Maureen E. Dempsey, M.D., F.A.A.P., Director, Missouri Department of

Health and Senior Services ................................................................................. 58

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

Threat Initiative ................................................................................................... 62

Amy E. Smithson, Ph.D., Director, Chemical and Biological Weapons Nonproliferation Project, The Henry L. Stimson Center ......................................... 66

ALPHABETICAL LIST OF WITNESSES

Brown, Michael D.:

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

Prepared statement .......................................................................................... 89

Daniels, Hon. Deborah J.:

Testimony .......................................................................................................... 37

Prepared statement .......................................................................................... 96

Dempsey, Maureen E., M.D., F.A.A.P.:

Testimony .......................................................................................................... 58

Prepared statement .......................................................................................... 143

Hamburg, Margaret A., M.D.:

Testimony .......................................................................................................... 62

Prepared statement .......................................................................................... 152

Hinton, Henry L., Jr.:

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

Prepared statement .......................................................................................... 107

Johnson-Winegar, Anna, Ph.D.:

Testimony .......................................................................................................... 42

Prepared statement .......................................................................................... 124

Page

IV

McConnell, Gary W.:

Testimony .......................................................................................................... 53

Prepared statement with an attachment ....................................................... 132

Smithson, Amy E., Ph.D.:

Testimony .......................................................................................................... 66

Prepared statement .......................................................................................... 164

Thompson, Hon. Tommy G.:

Testimony .......................................................................................................... 7

Prepared statement .......................................................................................... 77

APPENDIX

Chart submitted by Mr. Hinton entitled ‘‘Examples of Coordination Activities

on Bioterrorism Among Federal Departments and Agencies’’ .......................... 123

Letter from the U.S. Department of Justice responding to question posed

by Senator Akaka to Ms. Daniels, dated June 25, 2002 ................................... 176

Meryl Ness, M.D., prepared statement .................................................................. 178

(1)

FEDERAL EFFORTS TO COORDINATE AND

PREPARE THE UNITED STATES FOR BIOTERRORISM: ARE THEY READY?

WEDNESDAY, OCTOBER 17, 2001

U.S. SENATE,

COMMITTEE ON GOVERNMENTAL AFFAIRS,

AND THE SUBCOMMITTEE ON INTERNATIONAL

SECURITY, PROLIFERATION, AND FEDERAL SERVICES, Washington, DC.

The Committees met jointly, pursuant to notice, at 9:37 a.m., in

room SD–342, Dirksen Senate Office Building, Hon. Joseph I.

Lieberman, Chairman of the Committee, presiding.

Present: Senators Lieberman, Thompson, Akaka, Levin, Dayton,

Carnahan, Durbin, Domenici, and Collins.

OPENING STATEMENT OF CHAIRMAN LIEBERMAN

Chairman LIEBERMAN. The hearing will come to order. I thank

all of you for being here, particularly our witnesses.

This morning, this Committee will try to provide answers to the

urgent question of whether our government at all levels is organized adequately to respond to biological and chemical attacks on

the American homeland. Senator Thompson, who will be here in a

few moments, and I are pleased to hold this hearing in conjunction

with the Subcommittee on International Security, Proliferation,

and Federal Services and its able Chairman and Ranking Member,

Senator Akaka of Hawaii and Senator Cochran of Mississippi.

As we are now painfully and, in this Capitol Hill area, personally

aware, the past week has brought one story after another of anthrax attacks, biological attacks, endangering hundreds of innocent

civilians and actually infecting over a dozen people, and by this

morning’s calculation, actually, a significant number more throughout the United States.

Here on Capitol Hill, a wing of the Hart Building was quarantined. Senators and staff were undergoing testing and mail delivery came to a halt when anthrax was identified in a package delivered to the Majority Leader’s office. We have received word today,

which I presume will be dealt with in an announcement that will

be made this morning, that a number of members of Senator

Daschle’s staff are now known to have been infected by the anthrax

that came to his office and they are being treated appropriately.

These incidents and the countless false alarms and hoaxes people

are experiencing daily have put many Americans into an underVerDate 11-MAY-2000 08:28 Aug 06, 2002 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 76807.TXT SAFFAIRS PsN: SAFFAIRS
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standable state of high anxiety over this threat to our public

health.

This morning, I hope, and am confident, that we can calmly

discuss the facts, offer reassurance to the public that the Federal

Government is on duty and rapidly improving our preparedness to

respond to whatever may come. The sad fact is that we have now

entered an era when the previously theoretical, with regard to

chemical and biological attacks, has become altogether real.

Although it is clear to me that our government still has a lot of

work to do, the reassuring fact is that the response of our Public

Health System over the last 2 weeks is just about what we would

have hoped it would be. There has been quick detection, identification, treatment, and containment of the problem and that has

clearly and thankfully minimized the casualties.

I want particularly to commend our first witness, Secretary of

Health and Human Services Tommy Thompson, for his leadership

in responding to this crisis, in calming a tense Nation, and in urgently acting to improve our response systems to this now very real

threat.

The Governmental Affairs Committee is an oversight committee.

We are charged with the specific mandate to ensure that the Federal Government is organized effectively to fulfill its responsibilities. In today’s hearing, therefore, we are going to focus on the organizational aspect of this new threat, and that is the question of

whether we are organized and coordinated adequately, since there

are scores of Federal bureaus and departments that are involved

and will continue to be involved in responding to bioterrorism or

chemical terrorism.

Ten major agencies and dozens of bureaus, including the Defense

Department and the intelligence agencies, are responsible for,

among other things, threat assessments, surveillance of disease occurrences, surveillance of food and water supplies, developing and

stockpiling vaccines, and assisting State and local governments in

planning, training, and responding.

Secretary Thompson’s Department itself has six different agencies involved in bioterrorism and chemical terrorism, which is why,

Mr. Secretary, I think it made such good sense and was an act of

real leadership for you to appoint a Department coordinator last

July, before the current threats became real.

This morning, we are also going to look at coordination between

the Federal Government and State and local governments and

their public health systems because these are the people on the

front lines of homeland defense and they will be called upon to respond first.

The possibility of a biological or chemical attack poses a completely different kind of threat, requiring a different kind of response, from a different set of responders than the one we witnessed on the dark day of September 11. That day, events were

visibly and immediately seen by, in fact, millions of people on television and the catastrophe required conventional fire, rescue, and

medical capabilities, obviously on a large and huge scale.

On the other hand, a biological or chemical attack might well unfold in a very different way. It might not be immediately visible.

It could emerge slowly in different locations, in neighborhoods, ofVerDate 11-MAY-2000 08:28 Aug 06, 2002 Jkt 000000 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 76807.TXT SAFFAIRS PsN: SAFFAIRS
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fices, workplaces, in mailrooms, doctor’s offices, clinics, emergency

rooms, and public health department laboratories. And a completely different set of people, mostly medical personnel, would be

the first to respond. They would be our first line of defense.

Some biological agents, such as smallpox, are contagious and

would spread rapidly throughout the population. A government exercise simulating a biological attack conducted earlier showed that

such diseases could, in fact, greatly challenge State and local medical capabilities to respond.

But there is some better news here and that is that we do have

systems and equipment in place to respond to an attack of this

sort, and as we are going to hear today, the Federal Government

has really begun to organize the pieces that will be needed to contain biological or chemical attacks that might occur on a large

scale.

The Health and Human Services Department is, for instance, developing an Internet-based surveillance system to gather data on

disease incidents that would allow a real-time analysis. The Pentagon is developing civil support teams within the National Guard

in every State. And State and local officials are increasingly well

trained to deal with these attacks.

But the systems that are in place clearly need to be strengthened. Real preparation for these types of attacks did not even begin

at the Federal level until the late 1990’s, so many agency plans and

programs are still incomplete. There is duplication and overlap because of traditional government stovepipe structures and the inevitable turf battles that accompany this kind of overlap. Add to this

the fact that there does not appear to be one single central executive agency involved and it is hard not to conclude that the Federal

Government has a series of organizational decisions to make, and

quickly.

Federal support for State and local governments and health care

systems must also grow to meet the growing challenge. These are

the agencies that employ the local heroes, the emergency medical

technicians, the police, the fire fighters, and the hospital emergency room workers.

While Federal funding for response to terrorist attacks involving

biological and chemical weapons has increased in the past 3 or 4

years, not enough of that, from what I can see, is reaching the

State and local levels. We need, therefore, to build a robust Public

Health System now, capable of aggressive surveillance programs,

early warning systems to quickly detect the onset of illnesses and

then respond immediately. We need adequate inventories of the appropriate pharmaceuticals and we need better coordination and

support for State and local governments and their health care systems.

It seems to me that, ultimately, only the Federal Government

can ensure that the capabilities to protect our citizens in the event

of biological and chemical attack are in place, and I hope this hearing and, in fact, this Committee can help the Federal Government

do that as quickly as possible.

Senator Thompson.

4

OPENING STATEMENT OF SENATOR THOMPSON

Senator THOMPSON. Thank you very much, Mr. Chairman, and

I thank Secretary Thompson for being with us. I, too, want to commend him for the steadying influence he has had on all of this. It

is a delicate balance that he and others in the administration have

to walk in telling the truth to the American people on the one hand

and not being unduly alarmist on the other, and frankly, I think

you are doing an excellent job of that.

Last Friday, we held a hearing to discuss the structure of the

new Homeland Security Office in the administration. Today, we

look a little closer at some of the more specific challenges that the

Director of that office will face with regard to biological and chemical attacks.

Concerns about these issues are not new. Two months ago, the

International Security, Proliferation, and Federal Services Subcommittee held a hearing to discuss our level of preparedness for

a biological attack. There have been over ten different hearings

held in Congress this year on the biological and chemical threat

and the Federal Government’s response capabilities. Moreover, in

the ‘‘Government at the Brink’’ report I released earlier this year,

I noted that combatting terrorism was an area of potential overlap

and fragmentation, issues that I believe we will be discussing more

today.

While these concerns may not be new, there is a new sense of

urgency. There have been anthrax attacks now in three States, as

well as here in Washington. Our Committee office was shut down

yesterday and again today because of its proximity to Senator

Daschle’s office, and our staff has had to undergo testing. Mr.

Chairman, your own personal office has been shut down.

Clearly, we no longer have the luxury of time to deal with the

bioterrorism threat and our government’s response. The challenge

we have before us is to determine how we can, at the Federal level,

best prepare our country for chemical and biological attacks.

As a Nation, we do have certain priorities in this area. First, ensuring that local officials are prepared for an attack. Especially in

dealing with a biological attack, the first responders on the first

line will be the local medical personnel and community public

health officials. How well trained and ready they are will be the

biggest factor in our success or failure in dealing with these attacks.

Second, the Federal Government must provide proper support to

local first responders in the event of an attack. That support could

come in the form of response teams, pharmaceutical supplies, law

enforcement, as well as other efforts.

And third, the Federal Government can continue to provide research to aid in the surveillance, detection, and treatment for biological and chemical attacks.

The good news is that there are many Federal agencies working

on all of these issues. The bad news is that there are many Federal

agencies working on all of these issues. As GAO recently stated in

a report, coordination of Federal terrorism research preparedness

and response programs is fragmented. Several different agencies

are responsible for various coordination functions, which limits accountability and hinders unity of effort.

5

I think it is probably appropriate to point out that this is not

true just with regard to this issue of terrorism. It is endemic

throughout government. We are just simply following a familiar

pattern.

In our ‘‘Government at the Brink’’ report, we listed examples of

program overlap and fragmentation and we listed and discussed in

some detail with numbers problem areas: Border patrol; combatting terrorism was second; community development; drug control,

prevention and treatment; early childhood development; economic

development; education; environmental programs; Federal land

management; Federal property management; financial regulation;

food safety; foreign relations; homelessness; international trade;

and law enforcement—at least 45 different Federal agencies conduct Federal criminal investigations; military acquisitions; military

health care; nuclear health and safety; people with disabilities, research and development; rural development; satellite control systems; statistical programs; teen pregnancy prevention; and youth

programs. All of these have overlap and duplication problems.

We follow a familiar pattern in our country, it seems. We ignore

for a long time clear and present dangers. We have been having

hearings and being told about these things for at least a decade,

and during all that time, we add program on program on program.

Then we get our attention and we want to go in and do something

fast and we begin to consolidate, but just with regard to that particular area that we are having a problem with at that particular

point. So we are following a particular pattern here.

But other problems exist. The Federal Government tends to

spend most of its resources at the Federal level rather than on the

front lines. As one of our witnesses today, Dr. Smithson, noted in

her book on this subject, just 3.7 percent, or $315 million of the

overall $8.4 billion counter-terrorism budget in 2000 went to the

front lines in the form of training, equipment grants, and planning

assistance. She says, ‘‘Bluntly put, an absurdly small slice of the

funding pie has made its way beyond the beltway.’’ We are spending a great deal of money on this problem and we will need to

make sure it is spent more efficiently.

Also, the large number of Congressional committees asserting jurisdiction in this area has resulted in several different agencies receiving authorization for activities that overlap.

So I look forward to hearing from our witnesses today and I hope

we can discuss not only what problems may exist with regard to

coordination and fragmentation in our fight against biological and

chemical terrorism, but also ways that we can improve the efficiency and effectiveness of the Federal response to such attacks.

Thank you, Mr. Chairman.

Chairman LIEBERMAN. Thank you, Senator Thompson, for that

statement.

I would like to now call on the Chairman of the relevant Subcommittee, Senator Akaka.

OPENING STATEMENT OF SENATOR AKAKA

Senator AKAKA. Thank you very much, Mr. Chairman. I am delighted to be here and I want to thank you for holding this joint

hearing. I want to welcome our Secretary, Mr. Thompson, and add

6

my commendation to what you are doing for bringing better understanding to the problems that we are facing and bringing also a

calming effect on the people of our country and I thank you for

that.

The Subcommittee on International Security, Proliferation, and

Federal Services, which I Chair, has been working on bioterrorism

for a long time. In July, the Subcommittee had a hearing on

FEMA’s role in managing bioterrorist attacks and the impact of

public health concerns on bioterrorism preparedness. Representatives from FEMA and HHS discussed the activities underway by

dedicated Federal employees across the government to prepare our

communities for a biological crisis.

We learned that, contrary to current press reports, the Federal

Government is not unprepared, as evidenced by the rapid response

of the CDC and FBI to the anthrax exposures in Florida and New

York. However, preparedness levels are not uniform or consistent

across the United States. There are considerable and serious problems. While not unprepared, we are clearly under prepared.

Today, I plan to introduce three bills that will deal with some of

these problems. I would welcome any of my colleagues that would

like to join me in these initiatives. We lack the tools to monitor the

air, water, and food supply continuously in order to detect rapidly

the presence of biological agents. One bill will increase our efforts

to develop the necessary tools to minimize the impact of bioterrorism by reducing the number of people exposed and alerting authorities and medical personnel to a threat before symptoms occur.

The second measure addresses a part of the larger question as

to how our health care workers are prepared and trained for bioterrorism or any biological crisis. Senator Rockefeller and I propose

using the existing emergency communications infrastructure, disaster training program, and community partnerships within the

Nation’s 173 VA hospitals to train both VA hospital staff and local

health care providers.

The third piece of legislation addresses a related but distinct set

of concerns, the safety of our agriculture. I will introduce the Biosecurity Agricultural Terrorism Act of 2001. This bill will enhance

Federal efforts to prevent, prepare, plan, respond, and recover from

acts of agricultural terrorism. It would do the same for naturally

occurring agricultural epidemics by prioritizing efforts, authorizing

funding, and establishing new policy guidelines. The measure addresses risks and gaps in our law on foreign biosecurity, agricultural monitoring and surveillance, response and recovery efforts,

vaccine treatment research, and other aspects of biosecurity.

Our proposals address several critical parts of the puzzle we are

to solve. A complex Federal interagency process governs our preparation for bioterrorism and naturally occurring medical crises. The

Nation’s response to current threat must strengthen and augment

existing Federal programs, minimize confusion or duplicity in program efforts, and work to prepare all communities, from the largest

city to the smallest rural town, for biological incidents.

During our hearing in July, Dr. Tara O’Toole of the Johns Hopkins Center for Bio-Defense Studies cautioned that we may have

spent too much time asking who is in charge. Identifying one single

agency that commands all resources is not as essential for respondVerDate 11-MAY-2000 08:28 Aug 06, 2002 Jkt 000000 PO 00000 Frm 00010 Fmt 6633 Sfmt 6633 76807.TXT SAFFAIRS PsN: SAFFAIRS
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1The prepared statement of Mr. Thompson appears in the Appendix on page 77.

ing to deliberate or natural outbreaks where the first line responders practice constantly in their primary responsibility, and that is

caring for patients. We must ensure that these new first line responders, doctors and nurses, have the training, tools, and resources necessary to respond immediately to an incident and the

capacity to cope with the several hours or days it will take before

Federal help can arrive.

Again, I would like to thank our distinguished Chairman for convening today’s hearing and our witnesses for taking the time to be

with us today. Thank you very much.

Chairman LIEBERMAN. Thanks very much, Senator Akaka.

With the indulgence of the Members of the Committee, I would

like to now go to Secretary Thompson. When we go to the first

round of questions, we will add extra time for each Senator so that

the Senator can make an opening statement if he or she wishes before asking questions.

I also will note for my colleagues that I received a note that at

10:30, there is a meeting, a bipartisan caucus for all Senators who

wish to attend regarding the latest developments in this matter

right here on Capitol Hill, particularly in the Hart Building, with

regard to employees of Senator Daschle’s office. But it would be my

current intention to continue, certainly to hear Secretary Thompson’s testimony and to allow Members of the Committee to question

you, and hopefully we can get briefed later on as our colleagues

will be at 10:30.

Secretary Thompson, again, you just seem to me to be the right

man in a tough job at the right time. I appreciate what you have

done and look forward to your testimony and we all look forward

to working with you in the days and months ahead.

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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Mr. THOMPSON. Thank you very much, Mr. Chairman. It is an

honor for me to appear in front of your distinguished Committee.

Senator Thompson and Senator Akaka, it is an honor to appear in

front of this joint Committee and all distinguished Members of this

body.

Thank you very much for inviting me to discuss the role of the

Department of Health and Human Services and the Federal Government’s efforts to coordinate, prepare for, and respond to a biological or chemical terrorist attack.

In the wake of September 11 and the recent anthrax cases in

Florida, New York, and here on the Hill, there are significant questions about our preparedness, our overall coordination within government, and, yes, our ability to respond. Let me make one thing

clear. The administration is absolutely committed to responding to

bioterrorism quickly in a coordinated and effective manner.

Our recent efforts on September 11 demonstrate that commitment. By the end of that painful morning, I had ordered activation

of the entire National Disaster Management System, including notification of all of its 7,000 volunteer health workers and 2,000 hospitals. Those 7,000 volunteer medical personnel are distributed to

8

90 medical teams throughout the United States. We were able to

get 50 tons of medical supplies to New York City in about 7 hours.

Our schedule is 12 hours. We did it in 7 hours, and even with the

airlines shut down. Within a couple of days of the terrorist attack,

we had 700 doctors and specialists on the ground in New York and

Pennsylvania and in the Pentagon.

Let me say how very proud I am of the Department of Health

and Human Services, whose committed health care professionals

and support staff made a decisive difference in bringing help and

healing to so many people in the wake of the attack on America.

So, as I have stated before, the Department of Health and

Human Services is prepared to respond. But as I have also said,

there is more we must do to strengthen our ability to respond. We

need to get stronger. Coordination with our Federal, State, and

local partners is without question an area that I take personally,

very seriously.

At the Federal level, President Bush has made bioterrorism preparedness a priority, first asking Vice President Cheney to develop

a coordinated domestic preparedness plan, and recently creating

the Office of Homeland Security.

Let me outline for you this morning what steps we are already

taking. HHS is the lead Federal agency for the public health response to any biological or chemical attack. We are working vigorously with our Federal partners to coordinate domestic preparedness, the Departments of Defense, Justice, and Veterans’ Affairs,

and, of course, the Federal Emergency Management Administration, commonly referred to as FEMA.

We have also made great progress in utilizing the expertise, the

resources, and the technical support within the Federal Government. For example, HHS works with the VA on purchasing drug

purchases to supplement our Department’s pharmaceutical supply.

Together, HHS and VA are building the stockpile effectively.

And we have partnered with the Department of Defense in creating our National Medical Response Teams, which are specialized

teams capable of treating thousands of individuals exposed to

chemical, biological, radiological, or nuclear attack.

As many of you know, I was particularly concerned about this

issue when I came to Washington. I was told many times that our

bioterrorism efforts needed substantial improvement. I read the

GAO reports that have already been alluded to this morning by

Senator Thompson and regarded them as the measure against

which our efforts could be and should be evaluated. Our work over

the past 9 months had been performed in light of the reports’ recommendations.

I moved our bioterrorism preparedness efforts into my immediate

office upon being selected Secretary of Health and Human Services

and I appointed the gentleman on my right, Dr. Scott Lillibridge

of CDC, one of the Nation’s leading experts on bioterrorism, to

head the Office for National Security and Bioterrorism. His office

is on my floor in the HHS building.

And I went out and assembled a team of experts from throughout

the Department of Health and Human Services, led by Dr.

Lillibridge, that now are working 24 hours a day, 7 days a week,

to coordinate the Department’s activities in responding to public

9

health needs. They are working out of a conference room that we

have remodeled just a few steps from my office so I can be continually updated on the latest developments. They also are coordinating HHS’s communications with the other departments within

the Federal Government to ensure that all of us have the latest information available.

We also have assembled a team from other agencies who are also

spending time in our conference room.

I have announced several weeks ago that I also was creating an

advisory committee to my office headed by Dr. D.A. Henderson,

who is the individual that led the fight to eradicate smallpox, to

advise the Department on bioterrorism activities and State and

local preparedness. And since I have announced him, he has been

in my office every day. I do not know if he has a real job or if this

is his full-time job, but he is there every single day helping us.

I am also reaching out to State and local governments, as well

as public health officials. For example, this past Saturday, I called

together via the teleconference all the States’ public health departments, our experts at CDC, and those in my immediate office to

discuss State and local preparedness for combatting bioterrorism.

Tomorrow, Dr. Jeff Koplan of the CDC and myself will be doing

a simultaneous video conference and webcast with members of the

American Medical Association and the American Hospital Association to be able to answer questions from physicians, nurses, and

other health professionals concerning how to recognize and also

how to treat anthrax.

Then on Friday, I will be speaking to our Nation’s governors, also

by teleconference, and discuss with them how to rapidly improve

our capacity for responding to bioterrorism. And next week, I will

be doing the same with our country’s mayors on the same subject.

Continuing to improve and better coordinate the efforts at the

local, State, and Federal levels is truly the best way to ensure an

effective response, and at the same time reassure the public. We

are also working aggressively to strengthen our readiness and response, but we need your help, Senator and all Members of this

Committee, as well as the entire Congress.

Bioterrorism has not, and I want to underscore this, has not been

a high fiscal priority in the past and we need to move aggressively.

That is why the President is today requesting an additional $1.5

billion to combat terrorism, to strengthen our ability to prevent and

respond to a bioterrorism attack. President Bush’s request will result in more than a six-fold increase above the $300 million Congress appropriated in fiscal year 2001. President Bush has from his

first days in office made a serious commitment to addressing the

issue of bioterrorism, and the President’s fiscal year 2002 budget

provides HHS anti-bioterrorism initiative with $345 million, which

is also a 20 percent increase over the previous year.

But with the events of September 11—none of us could have expected that—the President has called for an additional $1.5 billion

in Federal funding for those areas most critical to our ability to respond to bioterrorist threats. Let me outline the areas in which we

are focusing our efforts.

First, pharmaceuticals. We must accelerate the production of vaccines and antibiotics and we must invest in essential programs to

10

ensure the speedy and the orderly distribution of antibiotics and

other supplies in the event of a biological event. The President’s

proposal includes $1.2 million for this activity and will be used to

prepare for all contingencies. These funds include $643 million to

expand the National Pharmaceutical Stockpile and $509 million to

speed the development and the purchase of smallpox vaccine. The

President’s request also includes funding to make sure the stockpile is ready, for the immediate shipment and the deployment and

use by trained professionals.

We are going to add four more push packs. Each one of the push

packs are now located in eight strategic locations. Each of those

consists of 50 tons of pharmaceutical supply. We want to increase

that by four, and that will add an additional 200 tons of medical

supplies. These push packs include no less than 84 separate types

of supplies. They include things like antibiotics, include Cipro, needles and IVs, a tablet counting machine, oxygen mask, and so on.

Second, let me emphasize again that much of this new money is

also needed to build on our partnership with local and State governments, an issue that all of you on this Committee are passionate about and I thank you from the bottom of my heart for that

passion. For example, the President is calling for $88 million to expand

HHS’s capacity to respond to bioterrorist incidents, including $20

million for CDC’s rapid response and advanced technology and specialty labs, which they badly need, which provide quick identification of suspected agents as well as technical assistance to State

labs.

Also included in this amount is $20 million to support additional

expert epidemiologists and these teams that can be sent to States

and cities to help them respond quickly to infectious diseases. One

of those teams was in the Capitol last night until 2 o’clock this

morning working with the Majority Leader, along with Scott

Lillibridge, and I was in contact with them up until midnight,

when I left contact.

And then respond quickly to infectious diseases, the outbreaks

and other public health risks. I believe every State should have at

least one federally funded epidemiologist who has graduated from

the Epidemic Intelligence Special Service training program at CDC.

The President is also asking for $50 million to strengthen also

the Metropolitan Medical Response System, which will be able to

increase the number of large cities that are able to fully develop

their MMRS units. These are the medical and public safety response units. We have 97 right now. We would like to go to 122

with the extra money. It is imperative that we work closely with

cities to ensure that their MMRS units have the proper equipment

and, yes, proper training.

We are also providing $50 million to assist hospitals and emergency departments in preparing for and responding to incidents requiring mass immunization and treatment, and we are providing

$10 million to augment State and local preparedness by providing

training to State health departments on bioterrorism and emergency response.

The President is also requesting $40 million to support early detection surveillance to identify potential bioterrorism agents, which

11

include web-based disease notification to the health community nationwide, which is so important in order to hook up with the local

communities, local health departments, and the State health departments. This effort will also provide for the expansion of a very

successful health alert network. We have 37 States hooked up right

now. We want to get to all 50, and then we would like to hook up

to the local health departments. It is going to help provide early

detection of disease to 75 percent of the Nation’s 3,000 counties.

We are providing $15 million to support increased capacity in no

less than 78 laboratories in 45 States. This funding will enhance

our ability to identify and detect all critical biological agents, and

we are implementing a new hospital preparedness effort to ensure

that our health facilities have the equipment and training they

need in order to respond to mass casualty incidents.

Third, in addition to purchasing pharmaceuticals, we are committed to the development and the approval of new vaccines and

new therapies. For example, the Food and Drug Administration is

working closely with the manufacturer of ciprofloxacin, commonly

known by the brand name Cipro, to make certain that firm, Bayer,

can safely and rapidly increase its production of that drug, which

is used in the treatment of anthrax victims. I was in contact with

Bayer yesterday and they have announced, as of yesterday, they

will be able to produce 200 million tablets within the next 90 days.

Let me also announce that the FDA is officially approving today

the use of two additional generic antibiotics for the treatment of

anthrax, doxycycline, and penicillin. Because these drugs are available in generic forms and produced by several manufacturers, they

will be relatively inexpensive and readily available. The FDA’s approval will include instructions on what dose to use and how long

to treat the inhalation form of anthrax, and I would like to quickly

point out that we have found that of all the anthrax that we have

received so far and been tested, all of them are sensitive not only

to Cipro, but also to doxycycline and also to penicillin. So let me

again stress that there is no need for anyone to stockpile any

drugs. We have the drugs that we need and they will be available

whenever and wherever they are needed.

The fourth, food safety. The President is also requesting $62 million to enhance the frequency and the quality of imported food, to

order inspections, and be able to modernize the import data system

to enable us to detect tainted food. This funding will also provide

for 410 new FDA inspectors to help ensure that our food is better

protected.

In addition, the administration will be sending to Congress legislation to strengthen our ability to protect the Nation’s food supply.

This measure will require prior notice of imported food shipments,

enhancing our ability to inspect food, allowing for detention of foods

suspected of being tainted, and providing the flexibility for the FDA

to approve drugs and other treatments for dealing with illnesses

resulting from pathogens on our food.

Much of the initial burden for providing the effective medical response to a terrorist attack, of course, rests with local governments.

If the disease outbreak reaches any significant magnitude, however, local resources will be stretched, and very quickly, and the

Federal Government will be required to provide protective and reVerDate 11-MAY-2000 08:28 Aug 06, 2002 Jkt 000000 PO 00000 Frm 00015 Fmt 6633 Sfmt 6633 76807.TXT SAFFAIRS PsN: SAFFAIRS
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sponsive measures for the affected populations. In the testimony I

have submitted to the Committee, Mr. Chairman, I have outlined

the specifics of how the various departments and the agencies are

working together in a coordinated effort.

So, Mr. Chairman, let me again emphasize that the administration is taking aggressive steps to make sure that our country is

well protected from bioterrorism, and let me once again tell the

American people the following: One, anthrax is not contagious.

Two, the government at all levels is responding to bioterrorist

threats and responding well.

Third, our postal system is being monitored very carefully. People should exercise caution, and if something seems suspicious, use

good judgment. But there is no reason not to send and receive letters and packages.

Fourth, be vigilant and cautious, but do not let the terrorists win

by frightening us unduly. Do not let them scare you into not living

your life. That would help our enemies achieve what they are trying to do, and that is terrorize American citizens.

Contemplating bioterrorism is very unpleasant, but it is imperative, and under the leadership of this Committee, this Congress,

and President Bush, we are taking all the steps necessary to keep

America safe in an era when biological and chemical attacks are

as possible as they are unthinkable.

I want to thank you, Mr. Chairman, both Mr. Chairmen and the

Ranking Minority Member and all Members on this Committee for

giving me this opportunity to talk about this subject. Now I will be

more than happy to answer any questions you have.

Chairman LIEBERMAN. Thank you very much, Secretary Thompson, for a reassuring and very helpful statement.

I wonder if I might suggest to my colleagues that Senator

Thompson and I and Senator Akaka have 5 minutes on a first

round of questioning, since we got to give an opening statement,

and we will give every other Member of the Committee, shall I say

at least 8 minutes, and we will go in order of arrival, which would

mean, just for the information of Members, after Senator Akaka,

it will be Senator Domenici, then Senator Levin, Senator Collins,

Senator Dayton, Senator Carnahan, and then Senator Durbin.

Mr. Secretary, just to bring it home, and it really is right here,

I wonder whether you or Dr. Lillibridge have any information you

want to convey to the Committee about what has now been determined as to the infection caused by the anthrax sent to Senator

Daschle’s office.

Mr. THOMPSON. I would be more than happy to, Senator

Lieberman. I believe it has already been publicized—we are waiting for Senator Daschle to make that notice first, but there are

over 20 individuals on the staff that have the anthrax within their

system, that tested preliminarily positive. We have provided at the

present time 1,200 bottles of Cipro. One thousand individuals will

be tested. We are going to have six nurses on hand, two pharmacists, and a doctor, and 750 tests are going to be conducted by

NIH and all this is being done as we speak right now, Mr. Chairman.

Chairman LIEBERMAN. Is it correct to infer that the reason why

such a large number in Senator Daschle’s office were infected, largVerDate 11-MAY-2000 08:28 Aug 06, 2002 Jkt 000000 PO 00000 Frm 00016 Fmt 6633 Sfmt 6633 76807.TXT SAFFAIRS PsN: SAFFAIRS
13

er than in the other instances where anthrax has been mailed to

an office, was because of what we have learned was the pure and

more refined state of the anthrax that was sent to the Daschle office?

Mr. THOMPSON. You certainly can draw that conclusion, but the

tests have not been finalized, so I do not want to speculate, but

there is no question that this is a very serious attempt at anthrax

poisoning.

Chairman LIEBERMAN. And all of the individuals, I presume,

were in the Daschle office or in the vicinity of——

Mr. THOMPSON. I am not sure about that.

Chairman LIEBERMAN. Doctor, do you want to add anything

here?

Dr. LILLIBRIDGE. Sir, let me add two things. One is that I would

like to differentiate between being exposed and being infected.

Chairman LIEBERMAN. OK.

Dr. LILLIBRIDGE. We are telling the American people that these

people were exposed, but they are not currently infected. They are,

indeed, healthy and on medicine to prevent illness or prevent from

becoming infected.

Chairman LIEBERMAN. Say a little more about the distinction so

we understand it.

Dr. LILLIBRIDGE. When we say exposed, that means they were in

an area perhaps where there was dust or a powder or in the vicinity where a letter was opened up. They may have recovered spores

from their clothing or from their nasal passages. But that is a far

cry and that is very different from having a bacteria set up housekeeping and creating infection and illness in the human. They are

not to that stage, and indeed, with medical prophylaxis and a proper environmental follow-up, we do not expect them to move to that

stage.

Chairman LIEBERMAN. That is a very important distinction.

Mr. THOMPSON. Of all the anthrax so far, we have only had four

that have actually become infected.

Chairman LIEBERMAN. Infected.

Mr. THOMPSON. Two in Florida and two in New York.

Chairman LIEBERMAN. That is a very important distinction. So at

this point, as far as the two of you know, none of the individuals

in Senator Daschle’s office——

Mr. THOMPSON. That is correct.

Chairman LIEBERMAN [continuing]. Are actually infected?

Mr. THOMPSON. Absolutely. And it is too early and they are on

the necessary antibiotics and they should not become infected.

Chairman LIEBERMAN. As we learned yesterday in the briefing

that Senators received, it takes a pretty significant number of anthrax spores to actually become infected.

Mr. THOMPSON. Different amounts between the three different

types of anthrax. Cutaneous infection results from a break in the

skin. Ingestion—you have different tainted food from animals that

could get into your system, causing gastrointestinal problems,

which would take less than inhalation. Inhalation anthrax, they

have figured, has to have 10,000 spores enter your system in order

for one to become infected, and that is a lot.

14

Chairman LIEBERMAN. It is very important for people to hear

that, particularly since the number of those exposed is larger than

in any other case that we have had thus far.

Mr. THOMPSON. That is correct.

Chairman LIEBERMAN. I wonder if either of you, and I just want

to use this as a moment to try to help convey information that will

be helpful to us and perhaps the public.

Mr. THOMPSON. That is very good and I appreciate this.

Chairman LIEBERMAN. No, I thank you. I wonder if you have

anything to say about what we can determine about the fact that

this anthrax in Senator Daschle’s office was presumably more pure

and refined than that sent to the other offices. Are there any conclusions we can draw about who was sending it, what was done?

Mr. THOMPSON. That is being completely investigated by the FBI,

Senator. We have no knowledge of that at this point in time. We

are hopeful to be able to have the FBI make some arrests and some

breakthroughs, but at this point in time, it is purely speculation.

And the research in the labs, there is research being done at Fort

Detrick and also research being done at our labs at CDC in Atlanta

and all that research and analysis will be coming forthwith to you

and to other members as soon as we get it.

Chairman LIEBERMAN. A final question on my round for you

about the facts here, and about this, I think there is some uncertainty, too. How difficult is it to obtain anthrax? There have been

times I have heard broadcasts where people have said there are

only three countries in the world that have it, perhaps certainly

the former Soviet Union, the United States has some, I gather, in

laboratories, and there have been allegations of other countries,

including Iraq, possibly having it. But then I have also heard at

different times that it exists in labs around this country in some

numbers and that, therefore, that is another place that somebody

sending these packages could have obtained it. So I wonder if you

can help us understand how the people doing this might have obtained the anthrax.

Mr. THOMPSON. Well, there is a lot of different anthrax. A lot of

it occurs naturally in the blood of animals that, once the animal

dies, gets emitted into the air. It is emitted in culture. There are

laboratories across America that have had anthrax and have done

research and experiments on it. It could be done. There are other

countries that have used anthrax and tried to use it as a weapon.

They are the ones that have manufactured and milled it into a

weapons grade and that, of course, is the most dangerous part.

But this anthrax that we have right now, we are still doing research on it. We do not know the exact strains or where it comes

from.

Chairman LIEBERMAN. Is it fair to say that it is difficult to obtain

the kinds of anthrax that has been sent to people around the country now in the last couple of weeks?

Mr. THOMPSON. It is more difficult for it to be able to be used

as a poison in a letter——

Chairman LIEBERMAN. Right.

Mr. THOMPSON [continuing]. Because it clumps together.

Chairman LIEBERMAN. Right.

15

Mr. THOMPSON. And to be able to allow it to go up into the air

requires some degree of scientific ability.

Chairman LIEBERMAN. So that is what, I presume, was noteworthy about what was sent to Senator Daschle, because the analysis of it suggested that it had been refined to a greater extent

than is normally found.

Dr. LILLIBRIDGE. Mr. Chairman, let me make a few comments.

You asked, where might this organism come from? Where might

you recover anthrax bacteria? It is in the soil. It is a disease of the

animal population. Many labs around the world investigate anthrax as it relates to the safety of herds and other kinds of animal

veterinary activities.

As for the sample in question, there are a number of tests that

are ongoing that will look at the size and the purity and the sensitivity. I can tell you at this time, we are aware that the sensitivity

of this organism that was released in Senator Daschle’s office is

sensitive to ciprofloxacin, doxycycline, and penicillin—the common

drugs that would be used to treat any kind of outbreak of this nature. That is, in itself, reassuring.

The issue of whether it is weaponized or where it came from may

take quite a bit of strain analysis and sophisticated testing. That

is ongoing with the Federal Bureau of Investigation at the lead. It

is our impression from a public health safety standpoint that we

have enough information in terms of its sensitivity and its purity

and isolation to make sure this really is anthrax organism to guide

our investigation both environmentally and make public health recommendations. As soon as that information becomes known, it will

be made public as best it can.

Chairman LIEBERMAN. Fine. Just a final point of clarification. I

assume it is some distance from the naturally occurring anthrax,

that is, anthrax that occurs naturally in the soil or in animals,

from that to the kind of powder that was sent to Senator Daschle’s

office.

Dr. LILLIBRIDGE. Let me just use the short answer for this. I

think it shows there has been some attempt to collect it, perhaps

refine it and make it more concentrated. That seems to be certain.

Chairman LIEBERMAN. OK. Thanks very much to both of you.

Senator Thompson.

Senator THOMPSON. Thank you, Mr. Chairman. Your last statement was with regard to that found in Senator Daschle’s office?

Dr. LILLIBRIDGE. Yes, sir.

Senator THOMPSON. There was apparently some attempt to refine

it?

Dr. LILLIBRIDGE. Well, when you have a collection of anthrax

spores put into a package, that takes some effort to do that. This

organism is in the soil, but getting it into spore form requires some

degree of effort.

Senator THOMPSON. The GAO report of last month that someone

referred to said that processing biological agents into the right particle size and delivering them effectively require expertise in a wide

range of scientific disciplines. Would you agree with that, Doctor?

Dr. LILLIBRIDGE. Yes, sir.

Senator THOMPSON. So if, in fact, we do find that this was more

highly refined in terms of particle size, weaponized, I guess is a

16

good way of putting it, then that would indicate someone had a

wide range of scientific disciplines?

Dr. LILLIBRIDGE. Let me just extrapolate the process as you go

through this. As the investigation unfolds and moves into either

national security or law enforcement arenas, they will begin looking at the strains, the match-up, what effort went into manufacturing it, and see if they can pinpoint a source, either a geographic

location or a specific stockpile or a specific strain that inhabits a

certain part of the world.

Senator THOMPSON. This may be a little bit beyond—— Mr. THOMPSON. Senator Thompson, it has to be a certain size in

order for it to get into the body. If it is smaller than one micron

or larger than ten microns, it is not able to be inhaled properly.

Senator THOMPSON. This is all a little premature, I suppose, but

indulge me with one more question. This may be beyond your purview. I have read that in order to produce especially large quantities of this powder form that would be weapons grade, if you want

to call it that, that it would require substantial infrastructure. I

have seen millions of dollars spent to have that kind of production

capability and facilities. As a general proposition——

Mr. THOMPSON. That is absolutely—— Senator THOMPSON. Is that a correct assumption?

Mr. THOMPSON. That is our understanding, Senator.

Senator THOMPSON. With regard to the—— Mr. THOMPSON. To have a weapons grade, it could possibly have

a country behind it.

Senator THOMPSON. A country would probably be behind the

weapons grade?

Mr. THOMPSON. But we want to make sure that none of this is

a weapons grade.

Senator THOMPSON. You want to make sure that none of it—we

do not know yet with regard to this?

Mr. THOMPSON. Of the past one, it is still being tested.

Senator THOMPSON. Right. With regard to these large stockpiles

that we have developed and are in the process of developing, is this

going to have to be constantly replenished? Are there expiration

dates on all these drugs, as we commonly understand them, and

what budgetary impact will that have in these huge numbers we

are talking about?

Mr. THOMPSON. We have two different systems, Senator. In the

push packages, some of those will have to be replaced. But we also

have a vendor marketing inventory and part of the agreement with

the vendor’s marketers is that their responsibility is to restore

items that have used up their shelf life with new stuff and that is

built right into the contract, so it is an ongoing thing. So there are

some of the more durable things that are in the push package, but

we also have a different system, which is called VMI, and that is

brought up currently on a monthly basis and that is being conducted and supervised by CDC.

Senator THOMPSON. I see.

Mr. THOMPSON. And that is built right into our contract.

Senator THOMPSON. Mr. Secretary, there has been a lot of discussion, as you know, about Governor Ridge’s position, the authority

that he has or should have. With regard to all of these things that

17

you and your Department are doing, how do you see that fitting

within his operation? How do you see your relationship and your

duties and responsibilities and all these things that you are doing

intersecting with what you understand his responsibilities are

going to be? Is that too broad a question to answer?

Mr. THOMPSON. No, it is not.

Senator THOMPSON. Have you given some thought to it?

Mr. THOMPSON. It is a very valid question. I will give you an example. As of 4 o’clock yesterday afternoon, we had a meeting, various departments with Governor Ridge and we worked out some

difficulties. He was the coordinator and we threw out questions and

problems and we just had a roundtable discussion and then he

would delegate, ‘‘Tommy, you take care of this one, and Madam

Secretary, you take care of that problem, sir, you are responsible

for this,’’ and so on.

So his job is to coordinate and make sure that when we have

problems in the public health arena, we can go to somebody like

Tom Ridge and say, ‘‘This is a problem. Can you assist us with the

FBI or with the CIA or with the Department of Defense and help

us along?’’ It has been working out, I think, very effectively so far.

Senator THOMPSON. How do you foresee budget determinations?

Would you expect him to have input in your decisions or would he

make certain decisions in certain areas with regard to your Department? How do you see that playing out? Have you gotten into that

yet?

Mr. THOMPSON. Senator, we put in this request, and I talked to

Governor Ridge and I know that he talked to the President in regards to this, as I did, and we all talked to OMB. I think somebody

from the President’s Office, including Governor Ridge and myself,

talked to OMB, and as a result of that, the request today of about

$1.6 billion is in front of you.

Senator THOMPSON. Thank you. My time is expired. Thank you,

Mr. Chairman.

Chairman LIEBERMAN. Thank you, Senator Thompson. Senator

Akaka.

Senator AKAKA. Thank you very much, Mr. Chairman. Mr. Secretary, I am pleased to hear the President’s request for $40 million

to support the early detection surveillance to identify potential bioterrorism agents. This matches the authorization in my bill.

Mr. THOMPSON. And I thank you for that, Senator.

Senator AKAKA. I look forward to working with you to ensure

these funds are made available.

Senator DOMENICI. Mr. Chairman, could I ask the Senator to

yield for 30 seconds?

Senator AKAKA. Certainly.

Chairman LIEBERMAN. Go right ahead, Senator Domenici.

Senator DOMENICI. Mr. Chairman, we have a complication in

that there is a meeting with reference to a collateral issue at 10:30.

Chairman LIEBERMAN. Correct.

Senator DOMENICI. I will come back, and if you are still here, I

would appreciate the opportunity to inquire. I just wanted you, Mr.

Secretary, to understand why I will not be staying here and thank

you for what you have been doing. You are doing a great job.

Mr. THOMPSON. Thank you, Pete.

18

Chairman LIEBERMAN. Thanks, Senator Domenici. We will be

here and await your return.

Senator AKAKA. Thank you. Mr. Secretary, I believe that the animal health community requires formal coordination with the HHS

and CDC and I am delighted to know you are both on the same

floor and there is much coordination. Currently, their interaction is

on a case-by-case or a need basis. Formal and regular contact will

ensure that animal health and agriculture issues are addressed by

HHS and FEMA disaster preparedness.

Federal efforts should also take advantage of the expertise veterinarians have to offer, such as familiarity with anthrax. In fact,

in a National Public Radio report yesterday morning, two out of the

three anthrax specialists interviewed were animal disease specialists. Veterinarians could also help in detecting unusual biological

events because many emerging diseases appear in animals long before humans. Additionally, animal diagnostic labs have the capacity

to identify and confirm the diseases.

The bill I am introducing today establishes a senior-level official

within HHS who has formal responsibility for regular contact with

the animal health community. Would you please comment on current coordination efforts between HHS and the animal health community and on my proposal.

Mr. THOMPSON. First off, let me just say I like the proposal and

I hope that it gets prompt action in the U.S. Senate.

Second, we are trying to coordinate very closely with the Department of Agriculture on food safety as well as animal safety wherever we possibly can.

The third thing, your analysis that veterinarians may have a tremendous amount of expertise in the disease of anthrax is absolutely correct and we have, of course, several teams of veterinarians that are involved with our Public Health System. In fact, I

think we sent four veterinarian teams to the City of New York to

take care of the search dogs and they were there for several weeks

taking care of the dogs while they were still trying to find people

alive in the rubble and our veterinarians were there to take care

of them.

Five, food safety. I know it is a big concern of yours as well as

my friend Senator Durbin’s, and it is a real priority for me. I know

it is for the Secretary of Agriculture, and I think we have to do a

much better job than we have in the past in this arena and I would

be more than happy to discuss that with you at any time.

Senator AKAKA. In the event of a biological terrorism event, clinical laboratories are likely to be overwhelmed with samples.

Mr. THOMPSON. We are finding that right now, Senator, and we

have so many—we have thousands—I do not know how many, but

we have a lot of false starts in regards to the anthrax scare and

we are trying to deal with them through the Post Office Department, through the FBI, and, of course, a lot of the burden rests

upon our laboratories that we have to take care of.

Senator AKAKA. I commend you on identifying that problem and

also again urge you, as you have been doing, to calm the feelings

of people by giving them the proper information on these samples

and medicines, as well.

19

I believe that many areas should begin developing regional plans

to assist neighboring cities or States in handling surge diagnostic

lab demands.

Mr. THOMPSON. Yes.

Senator AKAKA. However, I am concerned that, geographically,

remote areas like Hawaii will be at risk, and also our territories

that are non-contiguous. We cannot forget that the grounding of all

air traffic during the terrorist attacks on September 11 effectively

isolated both Hawaii and Alaska, and our territories, for several

days. In fact, some U.S. territories beyond Hawaii are having trouble getting their medical samples analyzed because they must be

flown to Honolulu first.

My question is, does Hawaii have the laboratory capacity to absorb a dramatically increased sample load in the event of a biological crisis and what plans are in place to ensure that remote areas

have capacity to detect and identify human diseases and plant and

animal pathogens?

Mr. THOMPSON. Senator, I am not expert enough to talk about

a particular lab, but let me tell you the system, how we have got

it set up and how we are able to respond. We have connected with

Hawaii, with Alaska, and with our labs in CDC in Atlanta and

they are hooked up to the lab and we have put out the notice and

we are putting out information on a regular basis to all the State

health departments asking them to get involved and if they see

something suspicious, they are to get us the tests, the tissues, and

the blood samples as soon as possible so we can make a confirmation of what the preliminary lab may find in Hawaii or in Wisconsin or Alaska or Michigan, wherever the case may be.

And then if we find that there is any type of biological agent, we

are able within hours to fly CDC teams to that particular area to

help put together a State or local plan and to assist them. We have

7,000 medical professionals divided into 90 teams throughout the

United States, one of which is in Hawaii, and they are able to respond very quickly. We have one in D.C. that is able to respond to

the Capitol within 90 minutes. These are individuals that are experts in biological, chemical, and radiological kinds of attacks.

So we are able to respond and we also have medicines that we

can distribute very quickly to any locale in the United States, including Hawaii.

Senator AKAKA. Thank you very much.

Chairman LIEBERMAN. Thank you, Senator Akaka. Senator Collins.

OPENING STATEMENT OF SENATOR COLLINS

Senator COLLINS. Thank you, Mr. Chairman.

Mr. Secretary, I want to begin my comments by thanking you for

your tremendous leadership and strength during this very difficult

time. There is no one in whom I have more confidence than I do

you to guide our Nation and to manage our efforts to deal with bioterrorism.

Mr. THOMPSON. Thank you. Thank you very much, Senator.

Senator COLLINS. In the past, an attack with a biological agent

like smallpox or anthrax seemed highly unlikely. Today, such atVerDate 11-MAY-2000 08:28 Aug 06, 2002 Jkt 000000 PO 00000 Frm 00023 Fmt 6633 Sfmt 6633 76807.TXT SAFFAIRS PsN: SAFFAIRS
20

tacks not only seem frighteningly possible, but rather the question

has changed from ‘‘if’’ to ‘‘when and where.’’ Mr. THOMPSON. Right.

Senator COLLINS. Intellectually, we may understand that more

people die of the flu than of anthrax, but that is of little comfort

because people do not try to deliberately kill us by exposing us to

the flu. It is both disturbing and unsettling to all of us that we

were told yesterday that the staffer who opened the mail in Senator Daschle’s office and discovered the anthrax-tainted letter did

exactly the right things, that she took exactly the right steps, and

yet still more than 20 members of his staff have tested positive for

exposure to anthrax. I think that is very unsettling to us all.

In most parts of the country, the first responders are not likely

to be officials from the CDC or highly-trained epidemiologists who

have the training to recognize anthrax and to trace where the infection has come from. They are much more likely to be the family

doctor or the emergency room nurse or the local police officer. I am

very pleased to hear of your efforts to educate our health care providers and those on the front lines.

Last week, I attended a hearing at which Dr. Henderson, whom

you appointed to head your advisory committee, testified along

with several other public health experts about the Florida response

to the first case of anthrax, and to a person, they testified that they

felt in many ways it was fortuitous that the physician had recognized that this might be a case of anthrax, that there was a lab

nearby that had the capability of identifying anthrax, and that if

this first case had happened in many other parts of the country,

it might not have been detected as anthrax. That is of concern to

me and suggests we need to do more.

I know one of your goals is to make sure that every State has

a federally-trained epidemiologist. Could you tell us how many

States now lack a federally-trained epidemiologist?

Mr. THOMPSON. I think there are 17 that—it is either 13 or 17,

I am not sure. But first, let me thank you for your comments, and

second, let me quickly point out that I think that would be a giant

step forward. Luckily, the individual doctor in Florida had had

training from CDC, as I understand it, and knew exactly what to

look for.

I think it would be a wonderful thing for this Congress to be able

to place in every health department maybe at least one individual

that has EIS training, like Scott Lillibridge does from CDC, and

also the regional areas would be the same, so that we have that

expertise out in the field. It would strengthen the local and State

health departments and Public Health Systems tremendously and

I thank you for your support of that, Senator.

Senator COLLINS. I think that really is absolutely critical because

they are the ones who are on the front lines and are going to have

to make the right decisions before there is likely to be Federal involvement.

The second issue that you brought up in your testimony was your

plan to have additional push packs, and I understand that these

are the collections of medical supplies. I commend you for pushing

for additional packages. I am concerned, however, about how we

know what to put in these push packs because today it may be anVerDate 11-MAY-2000 08:28 Aug 06, 2002 Jkt 000000 PO 00000 Frm 00024 Fmt 6633 Sfmt 6633 76807.TXT SAFFAIRS PsN: SAFFAIRS
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thrax. Tomorrow it may be smallpox. The next day, it may be another kind of chemical rather than biological agent that is being

used to attack our citizens. How do you decide what kinds of pharmaceuticals or supplies to put into these essential push packs that

can be deployed on very short notice?

Mr. THOMPSON. Let me just quickly point out that we have a

panel of experts that explore that. We have two systems. We have

the push packs, in which there are eight strategically located

around the United States, 50 tons in each one. In order to move

them, it takes nine semi-trucks or a C–130 to move them, and our

plan is to move them within 12 hours. In the case of New York,

we were up there within 7 hours.

Then we have a second ancillary system called the VMI system

which is in the process of purchasing. We purchase pharmaceuticals but we do not take delivery of them. We have individuals

that supervise them and keep them current, and that is the VMI

system.

So you have two different systems and you have a panel of experts that analyze on a regular basis what should be in either the

VMI, and those are the ones that would have a shorter shelf life,

and then the ones in the push packages.

And the third thing is that we are continuing upgrading that. As

far as smallpox vaccine, that is a separate thing. That is the third

thing. That is being under supervision of Wyeth and we have 15.4

million doses of vaccine. Right now, we are looking at the smallpox

and seeing whether or not we could cut that 5–1 so that we could

expand from 15.4 to 77 million doses of vaccine for smallpox, and

NIH is doing that analysis.

Right now, the preliminary analysis is that by cutting it down

from—we have tests going from 1–1, 5–1, 10–1, and 100–1, and we

have found that the effective rate is around 95 percent on 5–1, but

that is preliminarily. At 10–1 dilution, it is 70 percent effective,

and 100–1 is 20 percent effective. So we strongly think from the

preliminary analysis with our doctors at NIH and with the consultation of CDC that we could have that reduced from 5–1 and

still be very effective and increase the number of doses for smallpox

vaccine from 15.4 to 77 million doses.

Senator COLLINS. Thank you. I see that my time is running

short. I just want to touch quickly on two other issues.

The first is the vulnerability of our food supply. I held hearings

a couple of years ago that showed that our system for inspecting

imported food was woefully inadequate, that less than 1 percent of

shipments of imported food were inspected, but more troubling,

that it was very easy for unscrupulous shippers to circumvent the

inspection process and to actually reship tainted food that had been

caught through the inspection system. So I want to share with you

the hearings that we held and our findings and recommendations,

some of which were enacted but many of which were not because

of lack of resources, and I look forward to providing you with that

information.

Mr. THOMPSON. I appreciate that very much, Senator, and anything you can help with in regards to improving the food safety, I

would appreciate it very much. Seventy-seven million Americans

last year had food poisoning, one out of four. Three hundred and

22

thirty-two thousand ended up in the hospital and 5,000 died because of food poisoning. So when you look at that and compare that

to only four individuals that have actually been infected from anthrax, you can see that food safety and food pathogens is a much

bigger problem and I thank you.

Senator I wanted to correct something that I guess—somebody

sent me a note. I did not in any way imply that there were countries behind this attack on Senator Daschle and that it is weapons

grade. The tests are still being done. I just said that it is very potent.

Chairman LIEBERMAN. Thanks, Mr. Secretary. I thought you

made that clear—— Mr. THOMPSON. I thought I did, too, but I wanted to—— Chairman LIEBERMAN [continuing]. But I appreciate the extra

clarification.

Mr. THOMPSON. Thank you.

Senator COLLINS. I see my time has expired. Thank you, Mr.

Chairman.

Chairman LIEBERMAN. Thanks, Senator Collins, for some excellent questions. Senator Levin.

OPENING STATEMENT OF SENATOR LEVIN

Senator LEVIN. Thank you. First, let me thank you, Mr. Secretary, for your extraordinarily solid, thoughtful leadership. You

and your agency have made a major contribution to the security of

this Nation and its well-being and, hopefully, its calm consideration

of the threat.

Actually, this last clarification of yours is something I was going

to ask you about and that has to do with the difference between

concentrated anthrax and weapons grade anthrax, if you can tell

us that. You indicated, I believe, that it would take a state to

produce the weaponized variety because there are millions of dollars that might be involved in the infrastructure to produce it.

Would it also be safe to say, however, that a well-financed terrorist

organization, if it had enough millions of dollars to produce the infrastructure, could produce weapons grade anthrax?

Mr. THOMPSON. I think we are all learning and I do not know

if anybody knows for sure, but I think you can make that supposition quite easily. Maybe, Scott, you would like to—— Senator LEVIN. Maybe one word on the difference between concentrated and weapons grade, if you know it.

Dr. LILLIBRIDGE. Let me make two statements on this. First of

all, the issue for health really is not so much whether it is concentrated or weapons grade, if the investment has been made in

dissemination and the process to mill it down and make it distribute easily.

The distinction between concentrated and weapons grade, as we

understand it, is that concentrated is what you do to simply get

spores close together so you can put them in an envelope and mail

them out. There are a number of ways technically to do that, depending on the investment, the time and effort, and the amount of

risk you want to take at your local lab certainly would factor in.

The issue of weaponization or weapons grade is often used in the

literature to evoke large industrial investment in preparing samVerDate 11-MAY-2000 08:28 Aug 06, 2002 Jkt 000000 PO 00000 Frm 00026 Fmt 6633 Sfmt 6633 76807.TXT SAFFAIRS PsN: SAFFAIRS
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ples for dissemination. It includes milling down the spores so they

are easy to disseminate. It involves coating the spores so they stay

in the air a little longer. It involves research into dissemination devices, different ways to move it to the population. We do not have

any of that information on this particular sample at this time.

Senator LEVIN. Thank you. I want to talk about smallpox for a

minute. Our former colleague, Sam Nunn, took part in an exercise

called ‘‘Dark Winter,’’ and I do not know if you have seen the video

tape——

Mr. THOMPSON. Yes, we have.

Senator LEVIN. The major finding of that study was that the Nation was very unprepared for such an attack, and so I want to ask

you about what kind of preparations, in fact, have been or are in

the process of being made. You just discussed the dosage issue and

that is very helpful information.

In addition to seeing whether or not we can divide our 15 million

doses into smaller doses, can you answer or address two issues.

One, are we also attempting to produce more, and if so, what is the

time line for that? And second, whatever number of doses we have,

whether it is 15 million or 75 million or whatever number, what

is the plan prior to any attack? Are we going to start immunizing

people before evidence of an attack, given the very different nature

of smallpox, or what are our plans in that area?

Mr. THOMPSON. Well, thank you very much for the question, Senator Levin. Let me point out first that when Dark Winter was

being conducted, we took that experiment, that example, along

with the GAO report, and when I appointed Scott Lillibridge, I

said, you have got to take all of these things, find out the deficiencies we have and start correcting them, and that is why we

brought Scott Lillibridge and brought in a team into the Secretary’s

office to address those inadequate situations and we are knocking

them down as we go along.

We have accelerated, of course, since September 11 and are doing

a lot more, and even though the terrorist attack was terrible for

America, one good thing that came out of it, the consequence of

that is that we are much better prepared to deal with a bioterrorism attack and we are getting stronger each and every day.

In regards to smallpox, I am happy to report that we are meeting

with a lot of the pharmaceutical companies. In fact, we are going

to be discussing smallpox with four of them very soon, and we have

talked to them in the past. We are going to talk to them again

about purchases. We are looking to expand and purchase 300 million doses of vaccine, Senator Levin. Acambis is the company that

has a contract currently with CDC to produce 40 million doses.

They were not going to start producing until 2005. They now have

accelerated that to 2002.

We have also talked to some other companies and we think that

we will be able to purchase some smallpox vaccine and start manufacturing yet this year, Senator Levin, and we should be able to

have, provided Congress goes along with the appropriation, the

necessary dollars and be able to have the 300 million doses by the

end of next year.

24

Senator LEVIN. Is it safe to say or is it accurate to say that

smallpox, if it could be obtained by a terrorist, would be a more

threatening substance than anthrax?

Mr. THOMPSON. There is no question because it is infectious and

contagious and anthrax is not.

Senator LEVIN. Is it also your plan to begin inoculations prior to

any evidence of attack?

Mr. THOMPSON. That was the second question. I apologize I did

not answer it, Senator. We do not believe at this point in time that

inoculation is the right thing because there are some serious side

effects to inoculation of smallpox. There will be some fatalities,

some inflammation of the brain, some other maladies that will

come as a result of taking a smallpox vaccine.

We may sometime in the future, with consultation with Congress, set aside some of the 300 million doses of vaccine for voluntary vaccination if, in fact, Americans want to do it, but that decision has not been made. But we do want a stockpile of 300 million and that is what we are asking Congress for the appropriation

to do.

Senator LEVIN. Thank you. Having been a governor, which is a

tremendous asset to you, I think, in your work and working with

local and State officials as a governor now is surely going to give

you some really important experience in your current work. But as

a former governor, you have also had knowledge in terms of how

you structure an Executive Branch and I want to follow up on some

of Senator Thompson’s questions relative to that structure. You

commented a bit on it.

There are a number of proposals in front of this Committee. One

is to create a separate agency. One is to create an office in the Executive Branch of the President. I would like to ask what your

ideas are in this area.

Under the present system, as you have begun to work in it, if

there are differences between agencies on who should do what particular function, does Governor Ridge have the power to make a decision? I know he can make a recommendation and I know he can

seek to get some kind of a consensus, but in terms of decisionmaking, if Governor Ridge says, ‘‘It should be done this way,’’ and

you or some other cabinet agency says, ‘‘No, we think it really

should be done that way.’’ Does he have the power to decide or is

it just the power to recommend to the President?

Mr. THOMPSON. I cannot answer that, Senator Levin. I do like

your comments about being governor. I never in my life thought

that being governor, I was taking this job and was going to become

an expert on embryonic stem cells and bioterrorism, but that has

been the two examples that have really been foisted upon me.

In regards to Governor Ridge, I think he has the power. I think

the President has given him that power to make the decisions, beyond just making recommendations.

Senator LEVIN. Beyond, you say?

Mr. THOMPSON. Just making recommendations. I think just the

fact that the President says that he is going to be the coordinator,

I cannot imagine any cabinet officer would be dumb enough to challenge that.

25

Chairman LIEBERMAN. Secretary Thompson, Senator Levin, I

apologize for intervening. I just received a message and request

from Senator Daschle that we recess this hearing for now and that

the two of you come with us to the joint caucus of Senators to be

part of the briefing. I apologize to my colleagues who have not had

a chance to ask questions. I would ask the patience of the witnesses on the second two panels. I will definitely return and we

will continue the hearing at that time.

But for the moment, in response to a request from the Majority

Leader, I am recessing the hearing.

[Recess.]

Chairman LIEBERMAN. This hearing of the Senate Governmental

Affairs Committee will now reconvene.

Secretary Thompson, thanks very much for staying here. I know

you have got other appointments. I do not know if I would say we

negotiated an agreement with Senator Daschle that we would leave

Dr. Lillibridge there and you would come back and complete your

testimony.

Mr. THOMPSON. I think Senator Daschle got the better part of

the deal over you, Senator Lieberman. [Laughter.]

Chairman LIEBERMAN. We are very happy and grateful that you

have returned with us.

Senator Durbin, you were next. Thank you.

OPENING STATEMENT OF SENATOR DURBIN

Senator DURBIN. Mr. Secretary, thank you very much for returning. I really appreciate it under all these circumstances. I want to

ask about two specific areas, one, immunizations, and the second,

food safety. Let me start with immunizations.

I think what you have told us is that you are gathering together

300 million doses of smallpox vaccine, and I would like to ask some

further questions about what your plans are for immunization. It

is my understanding that, unlike anthrax, where exposure can be

treated successfully with antibiotics, that exposure to smallpox is

much more dangerous, much more likely of infection, and, therefore, you virtually have to be vaccinated in advance or you stand

a high risk of being infected with smallpox. So could you tell me

what your vision is in terms of this smallpox vaccine and how it

will be used?

Mr. THOMPSON. Thank you. We are not going to gather. It is

going to be produced and we are in the process right now of negotiating with the companies. There is one from Illinois, by the way,

that is involved in the negotiations. But there are four companies

that would like to get in the business of producing the smallpox

vaccine.

Two, we have accelerated the production from 2005 to 2002 and

I can announce today that we are going to be able to accelerate

even further and we should be able to start producing smallpox

vaccine as early as this year, sometime in November and December, and we will be able to produce 300 million doses of vaccine for

smallpox within 12 months. So by the end of next year, we will

have 300 million doses of vaccine within our inventory to be able

to be used if, in fact, smallpox ever turns up.

26

Three, the shot, vaccine, if you get it within 2 to 5 days, it is still

effective even after you have been exposed to smallpox, but the earlier you can get the vaccination, the better off you are.

Four, what we would do if a smallpox outbreak did occur, we

would go in and would quarantine the area. Then we would give

the vaccination to the first responders and the medical personnel

first, and then we would make a concentric circle and go around

and vaccinate all the individuals in that concentric circle.

Senator DURBIN. But this will not be like my first memory of

public health when I was a grade school kid and learned the name

Jonas Salk and we had a national effort to immunize children

across America. Your idea is not to move forward with immunization unless and until there is evidence of outbreak?

Mr. THOMPSON. That is correct at this point in time. Now, there

may be a decision after we have it in stock that the Congress and

the Public Health System and the President will decide that maybe

we should make some of the 300 million doses available for voluntary vaccination, but I do not believe that you will see mandatory vaccination because of the side effects of vaccination for smallpox. There will be some fatalities, not many, but probably one out

of every million doses, there will be a fatality is what the experts

predict. There will be some inflammation of the brain in some

cases, a few more than fatalities. So there are some adverse side

effects.

So mandatory vaccination, I do not think will take place and it

is not recommended by the specialists that I have talked to. Dr.

D.A. Henderson, who is going to be my science advisor, is really the

father of the eradication of smallpox and he does not advise vaccination at this point in time.

Senator DURBIN. Three hundred million doses will treat how

many people?

Mr. THOMPSON. Three hundred million.

Senator DURBIN. So it is one immunization that is necessary?

Mr. THOMPSON. One, but we have 15.4 million doses right now

of the old vaccine and tests are being conducted on that right now

in regards to diluting that 1–1, 5–1, and 10–1, and the preliminary

analysis is 5–1, which would give us 77 million right now. If a

smallpox epidemic occurred, we would have 77 million because the

experts feel, even though the analysis has not been completed, that

it would be strong enough to protect 95 percent of the American

public.

Senator DURBIN. I would like to make one general observation

about immunization. Since I got into the subject a few years ago

and studied it, I was surprised to learn how many children are not

immunized, do not receive the basic immunizations that we consider important for public health, and I was also surprised to learn

that 3.6 million children currently that have health insurance are

not covered for immunizations, that health insurance does not

cover immunizations for over three million children in our country.

I hope that we can work together on that to extend that umbrella

so that kids in Chicago and Milwaukee and all over can get the

basic—— Mr. THOMPSON. Senator Durbin, you are absolutely correct. Preventative health, that is No. 1. Vaccination is the best way to preVerDate 11-MAY-2000 08:28 Aug 06, 2002 Jkt 000000 PO 00000 Frm 00030 Fmt 6633 Sfmt 6633 76807.TXT SAFFAIRS PsN: SAFFAIRS
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vent some disastrous disease and it saves money for the insurance

company.

Senator DURBIN. Anthrax vaccine, is that being considered, as

well?

Mr. THOMPSON. There is one company that produces anthrax vaccine. It is called Bioport. It is in Michigan. They are closed down

right now for some problems and they are remodeling and reconfiguring their factory to produce anthrax vaccine. They have just applied for us to go in and to inspect it. We got that application as

of last Friday. They are going to complete their renovations within

the next 2 weeks. We will then go in and make the inspection and

if the inspection meets FDA approval, which we think that it will,

hope that it does, they should be able to be in production by November 15.

They have an exclusive contract with the Department of Defense.

The Department of Defense purchases all the anthrax vaccine that

they have. They have approximately 5.2 million doses of anthrax

vaccine in inventory right now. Of that, about 3.3 million of it could

be approved as an IND, a new drug, which means that you could

use it if somebody would sign and say that it has not been completely tested and completely approved.

So there is that 3.3 million. The Department of Defense has some

anthrax vaccine in their inventory, but they, of course, I am sure,

will be using it for the military. And the 3.3 million or the 5.2 million which is in inventory which has not been inspected by FDA

will go to the Department of Defense.

Senator DURBIN. First, let me commend you, because in your

opening statement, you have come to an issue which you have now

talked about several times on food safety. I believe there is a need

here for us to focus on two or three levels. First, what you have

suggested, take a look at the current laws. Where are they inadequate to meet the current need, safety and security?

Second, find more and higher levels of cooperation between the

12 different agencies of government that currently are involved in

this. I think what will evolve from that is my ultimate goal, a single agency. But I am willing to stay on board with you for the first

two steps because they are critically important.

Can you amplify any further your remarks about what we need

to do to make certain that food does not become a vehicle for bioterrorism?

Mr. THOMPSON. Well, first, let me just say, Senator Durbin, I

thank you, because you have been a stalwart in trying to protect

the Nation’s food supply. You have been a passionate advocate and

I applaud you for it. I am hopeful that as a result of these bioterrorism attacks that we have had, that we will address food safety

in America. We have 750 inspectors at FDA to inspect 56,000 establishments in America. Some of those establishments are only

being inspected 1 out of every 4 or 5 years. Those that cause problems are inspected annually. But it still does not give me the sense

of security that I would like nor you would like and we do not—

we have 132 points of entry into America for food coming into

America from other countries and we only have 150 inspectors, and

as you can tell just by the sheer numbers, that is not enough.

28

Agriculture, on the other hand, has reduced the number of ports

of entry down to nine, and I think that this Congress should take

a look at reducing the number of ports of entry, increasing the

number of food inspectors, the laboratory analysis. You and I

talked about this coming over, and I was on the border as of Monday going to a food inspection station in El Paso, Texas, and take

out a sample and then the sample has got to be UPS-ed up to Kansas City where it is analyzed and then the analysis is sent back.

To me, that is not a very effective way to inspect food in America.

Senator DURBIN. Thank you. Thanks, Mr. Chairman.

Chairman LIEBERMAN. Thanks, Senator Durbin.

Secretary Thompson, I just want to ask you a few more questions

and then we will thank you for being here, and this comes back to

the focus of this Committee on organization. As we look at this, we

see, as we mentioned before, literally dozens of Federal agencies

that have some part to play in either preparing for or responding

to a chemical or a biological attack. The Justice Department has

a State assistance program. Federal Emergency Management has

a State assistance program. Your Department has a State assistance program. There are research programs that are relevant in

the Defense Department, the Energy Department, even the Treasury Department.

In your own Department, you have got several subdivisions involved, Food and Drug, the Centers for Disease Control, NIH, Office of Emergency Planning, and again, before I commended you for

asking Dr. Lillibridge to coordinate those programs.

So here is the concern or the criticism that I have heard, which

is that the question remains, who is in charge? In other words, you

have asserted a strong coordinating role, certainly over the relevant agencies that come under you as Secretary of HHS. But is

this not still ultimately a kind of stovepipe situation, where there

may be some coordination, but there is not clearly one person who

is in charge of preparing America for the possibility of a chemical

or biological attack and then coordinating the response to it?

Mr. THOMPSON. I think you are right. I do not think there is one

person. I think there are a lot of different individuals involved. Our

responsibility is the public health and I think we do that quite

well. We are making it much more responsive than it has ever been

before. By appointing one person to be the coordinator, Scott

Lillibridge, we have also put in place a lot of other fine individuals,

representatives from the various agencies on a council working

with Scott Lillibridge and they report directly to me.

Especially during this period of time, we are meeting every

morning, every afternoon about updated intel that is coming in and

our responses. We also talk about the problem areas that we still

see and assign people to try and fix them and report back to us

when they are fixed, or if they cannot be, why not and if they need

more resources.

So we have, I think, a well-coordinated operation in the Department of Health and Human Services, but when you look at the totality of it, I think that is what Governor Ridge has been set up

to accomplish, is to bring us all together, report to him. And yesterday, we had a meeting in the White House, and that meeting went

extremely well, with all the various agencies dealing with bioterVerDate 11-MAY-2000 08:28 Aug 06, 2002 Jkt 000000 PO 00000 Frm 00032 Fmt 6633 Sfmt 6633 76807.TXT SAFFAIRS PsN: SAFFAIRS
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rorism coming in to talk about problem areas as well as common

sense solutions.

Chairman LIEBERMAN. I think in your answer you have just gone

ahead and responded to my next question, which was, should there

be one person to coordinate across the various departments? I take

it you have answered that.

Mr. THOMPSON. Yes.

Chairman LIEBERMAN. At this point, then, I was then going to

ask you, who should it be, and I believe you have said that it

should be Governor Ridge as the head of the new National Homeland Security Agency.

Mr. THOMPSON. That is correct.

Chairman LIEBERMAN. We have an ongoing discussion here and

with the administration about the powers that Governor Ridge

should have. I am going to leave that for another day, but I think

you may know that I feel, ultimately, he needs some kind of budgetary authority to make sure that everybody is working together.

And at some point, and you and he as governors, I think, can appreciate this particularly where we have got a crisis now as urgent

as the threat of chemical and biological attack, you have got to

have somebody who can say, hey, this is it. This is what I decide.

Do it. That is what you did as a governor, that is what he did as

a governor, and that is what I think we need here, but that is another question.

Last year, we had a very troubling, interesting, and educational,

I suppose I would say, experience, beginning in Connecticut, and

going around the country, with the outbreak of West Nile virus. My

staff on the Committee here did an excellent investigation. I was

very proud of them. It helped me to understand it. It took weeks

for the Public Health System to correctly identify the disease. It

had not been seen before in the United States. In fact, at the outset, if I remember correctly, CDC and other health officials

misidentified the disease as St. Louis encephalitis.

I am not saying this to criticize CDC. That was not an easy call.

But I am raising it to show how difficult it can be in a broader case

of a larger scale chemical or biological attack to identify the disease

as it begins to appear in doctors’ offices or hospitals all over the

country.

I wanted to ask you if you have any thoughts about what we

might do at the Federal Government level to improve our ability,

not just on the science, but I guess in one sense to share information as it may begin to pop up in individual offices around the

country or even a separate geographic area before we actually have

a sense that something pretty bad is happening?

Mr. THOMPSON. I think what we need to do, Senator, and you

raise a very valid point. Even though—I am not sure, but I heard

the CDC finally did determine it was——

Chairman LIEBERMAN. They did. They absolutely did. At the outset, they——

Mr. THOMPSON. They made a mistake.

Chairman LIEBERMAN. But again, very understandable because it

had not been seen before.

Mr. THOMPSON. And that is the problem, especially now with anthrax and the hemorrhagic viruses and so on. They are very comVerDate 11-MAY-2000 08:28 Aug 06, 2002 Jkt 000000 PO 00000 Frm 00033 Fmt 6633 Sfmt 6633 76807.TXT SAFFAIRS PsN: SAFFAIRS
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plex and you do not see them every day so you do not have the

knowledge.

Chairman LIEBERMAN. Sure.

Mr. THOMPSON. So there are certain things you have to do. You

have to really educate the emergency doctors and the emergency

individuals that deal with patients so that they have some basic information on what to look for.

Second, we have got to strengthen the local health departments.

Third, we have got to strengthen the State health departments

and we have got to connect them all with CDC, and there has to

be education going from CDC down to all of these various agencies

in order to get a uniformity of instructions and support throughout

the system. And I also think it would be very valuable if individuals that have gone to CDC and have been educated as EIS specialists, as you know, and have them assigned to every State health

department and the larger regional health departments so that

they can help advise, put on these educational programs for the

local and State health departments. I think it would be very beneficial to all of us.

Chairman LIEBERMAN. I appreciate that, and anything you could

do to bring that about, including, and I think is implicit in what

you are saying—I do not have a specific idea, but some kind of realtime information sharing so that people can see that similar cases

are suddenly turning up in a lot of different doctors’ offices.

Mr. THOMPSON. That is why we have set up now a 24-hour hotline at CDC for local health people to call in during this period of

time.

Chairman LIEBERMAN. Right.

Mr. THOMPSON. I can assure you it is being widely used.

Chairman LIEBERMAN. Thank you. Senator Carnahan, welcome

back. I believe you would like to speak and have some questions.

Senator CARNAHAN. Yes, if it is all right, I would like to make

an opening statement.

Chairman LIEBERMAN. Please.

OPENING STATEMENT OF SENATOR CARNAHAN

Senator CARNAHAN. First of all, I would like to compliment the

Secretary for his rapid and comprehensive response. I think your

demeanor, your advice, all have caused the American people to

have a lot more awareness and a lot more confidence and I thank

you for that.

Since September 11, the Senate has focused on responding to attacks on our Nation, and now that the Senate itself is under attack, and I applaud Senator Daschle for responding to this incident

with calm and with resolve. But we are now taking the next necessary steps to protect ourselves against any future attacks. We

must also act with speed to ensure that our Nation is prepared, as

well. Future attacks may affect many more people. They may also

affect livestock and the food and water supply.

Unfortunately, many places in the country do not currently have

the capability to respond as quickly and thoroughly as the United

States Capitol, and that is why we are here today. We must ask

the difficult questions. We must address our vulnerabilities. And

31

we must ensure that we are ready to respond to an attack anywhere in the United States.

Our best weapon, of course, is public awareness. Rumors and

misinformation just play into the hands of the terrorists. They create fear and insecurity. We should arm our citizens with scientific

and accurate information.

Today, I am announcing my introduction of S. 1548, the Bioterrorism Awareness Act. The bill would create an integrated website

containing accurate, scientifically-based information about bioterrorism. The website will serve as the official Federal Government

source of information for the public. Currently, there is information

on bioterrorism on a variety of Federal websites. Since the bioterrorism information on these websites can be very difficult to find,

I think where it would be well for us to select a central location

that the public can go to get accurate bioterrorism information

geared specifically to their needs.

For example, we need to be sure that our doctors know how to

recognize the symptoms of a bioterrorism outbreak. There will be

a section on the website with information geared toward health

care professionals. Another section of the website will be geared to

help farmers and other personnel involved in the Nation’s food supply system to protect themselves, their livestock, and the Nation’s

food supply in the case of an attack.

States are key players in our country’s ability to respond effectively to a bioterrorist attack, and I am pleased that in a later

panel we will have Dr. Maureen Dempsey, Director of the Missouri

Department of Health and Senior Services, here to testify and to

share the State perspective. States need sufficient resources to prepare for, detect, and respond to bioterrorist attacks.

To give States these resources, I have signed on as an original

cosponsor to the State Bioterrorism Preparedness Act sponsored by

Senator Evan Bayh. It will give State Public Health Agencies the

resources to have surveillance systems in place so that they are

equipped to detect any pattern of unusual illness that could indicate a biological attack. This is just one example of what the bill

would support.

In addition, I have asked the Appropriations Committee to provide $2.5 million for the St. Louis University Center for Research

and Education on Bioterrorism and Emerging Infections. The SLU

Center for Research and Education on Bioterrorism is the only

CDC Public Health Preparedness Center devoted to bioterrorism

preparedness, training, and education. Its work is more important

now than ever before. The funding should help the center meet the

increased demands for its considerable expertise.

Certainly, we need to be vigilant in this struggle. Given the resources, I know that our law enforcement officials as well as our

public health authorities can get the job done, but we need to act

quickly and effectively.

Thank you, Mr. Chairman, for calling this very timely and important hearing and I have one question for the Secretary. In the

last month, we have seen what a powerful role the media can play

in relaying information to the public. The media has the ability either to calm our fears or to increase our anxiety. What has HHS

done to educate the media on how to communicate to the public

32

during a bioterrorist attack in such a way that it minimizes people’s fears?

Mr. THOMPSON. Thank you very much, Senator. Let me compliment you on the introduction of your bill. It is badly needed and

I hope that you will get bipartisan support for it and I applaud you

for doing that.

Second, what we did first was we wanted to make sure that we

contacted the State health departments and local health departments. We have what is called the Health Alert Network and we

are hooked up with, at the present time, 37 States. We have just

given out enough grants to have us hooked up to all 50 States. I

would like to be able to expand that in the future so that the HAN,

the Health Alert Network, could be expanded into the counties.

There is money in the appropriation bill for that, and I think that

would be the best way in order to get information.

We also set up a 24-hour hotline in regards to giving information

out and receiving information from local health departments and

doctors, from hospitals and so on who could call up and give us information and ask questions.

Third, Jeff at CDC, Dr. Koplan, and myself spoke to all of the

health departments on a teleconference last Saturday and we answered their questions and we are going to do the same thing tomorrow for the American Medical Association and the American

Hospital Association and get out information through the teleconference. On Friday, I am talking to all the governors on a teleconference about what they can do and how they can report to their

constituents on bioterrorism, and next week, we are going to do the

same thing with the country’s mayors. Those mayors who want to

hook up on a teleconference, we are going to be able to do that, or

through a webpage.

Finally, last night, we had an informational meeting with the

print press in which we had three doctors and myself answer their

questions over the telephone. There were a lot of press on, I do not

know how many, and we have been holding briefing meetings

through my press office with the press about the status and things

like this. But it is very hard to knock down all the rumors. We are

getting thousands of rumors, as you can well imagine, and it is difficult to be able to answer all of those rumors, but we are trying

to do the best job we possibly can.

I would just like to leave you with one thing and that is that we

have to make sure that people understand, even with all of the individual exposures on anthrax, there still are only four cases, two

in Florida and two in New York, and even though you are exposed,

it is not a disease that can be conveyed to another individual. It

is one that can be treated with antibiotics, and I am happy to be

able to report that of all the things that we have seen on anthrax,

all of them have been sensitively proven that antibiotics work, and

it is not only ciprofloxacin, it is doxycycline, it is penicillin. By allowing generic drugs for doxycycline and penicillin, they should be

very reasonably priced so that individuals, if the need be, can purchase it.

I would not in any way encourage people to horde these pharmaceutical drugs because the government has got plenty in supply to

be able to take care. We will have enough right now to handle 2

33

million Americans with Cipro and other antibiotics for 60 days and

we are asking the Congress to allow us to purchase and give us the

money to purchase an additional 10 million for 10 million individuals, enough supply to handle then 12 million individuals in America. We are purchasing vaccine for smallpox and we feel that we

will have enough of that within the year to treat 300 million Americans.

Senator CARNAHAN. That is exactly the message we need to hear

in America today. Thank you very much, Mr. Secretary.

Mr. THOMPSON. Thank you very much.

Chairman LIEBERMAN. Thank you, Senator Carnahan.

Secretary Thompson, thanks very much. You have been not only

cooperative and informative, but really reassuring. Again, I appreciate the fact that you are there, that you are doing the job you are.

I thank you for the specific announcements that you have made

today, the ones that you have just mentioned, that the American

people can be sure that their government is prepared, and insofar

as the Senator first said a while ago, but we may be under-prepared, we are moving rapidly to close that gap.

For our part on this Committee, I hope that we can be supportive

in helping you assert your leadership and making sure that all the

agencies and offices of the Federal Government that have any responsibility or programs for chemical and biological warfare are

well coordinated and directed, and I think you are right that Governor Ridge is now the person to do that.

Anyway, thank you, God bless you, and good luck in your work.

Mr. THOMPSON. Thank you so very much. Thank you for holding

the hearing.

Chairman LIEBERMAN. Thank you.

We will now call the second panel. Michael Brown is the Acting

Deputy Director of the Federal Emergency Management Agency.

Deborah Daniels is Assistant Attorney General, Office of Justice

Programs, U.S. Department of Justice. Henry L. Hinton, Jr., is the

Managing Director of Defense Capabilities and Management, U.S.

General Accounting Office. Anna Johnson-Winegar is Deputy Assistant to the Secretary for Biological and Chemical Defense at the

U.S. Department of Defense.

I wonder if I might also call to take a chair at the end of the

table Gary McConnell, who is the Director of the Georgia Emergency Management Agency, who is testifying on behalf of the National Emergency Management Association. Why do you not pull

right up in that comfortable chair, Mr. McConnell. I gather that

you have got plane pressure. How soon do you have to leave?

Mr. MCCONNELL. Mr. Chairman, I will be here as long as you

need for me to. I just need to get back to Atlanta at my earliest

convenience, but if I can get out of here by 1:30 or 2 o’clock, I will

be fine.

Chairman LIEBERMAN. Oh, you do? OK. If this panel moves,

maybe we will wait and bring you on on the third panel.

Mr. MCCONNELL. OK, sir.

Chairman LIEBERMAN. If not, I will call you earlier.

I thank you all for your patience under these unusual circumstances. The testimony you prepared will be submitted in full

as part of the record. To the extent that you can keep your remarks

34

1The prepared statement of Mr. Brown appears in the Appendix on page 89.

to 5 minutes, I would appreciate it, but if you feel like you have

some more to say and you need to say it, we will not physically remove you from the premises, I assure you. [Laughter.]

Mr. Brown, please proceed.

TESTIMONY OF MICHAEL D. BROWN,1 ACTING DEPUTY DIRECTOR AND GENERAL COUNSEL, FEDERAL EMERGENCY MANAGEMENT AGENCY

Mr. BROWN. Thank you, Mr. Chairman, Members of the Committee. I really appreciate the opportunity to be here today and

speak on behalf of Director Allbaugh and all of the workers in New

York City, the Pentagon, and here at headquarters of the Federal

Emergency Management Agency.

What I would like to do is give you a very broad overview of

FEMA’s preparedness response activities to both natural and manmade disasters and how those programs make FEMA uniquely

fitted to deal with the consequences of terrorism, regardless of the

type of terrorism.

But first, I want to talk about the immediate response to the attacks at the Pentagon and the World Trade Center. On the day of

the attacks, September 11, I was in Big Sky, Montana, preparing

to give a speech about terrorism at 11 o’clock that morning when

I received a phone call that said, ‘‘Turn on your television. We are

under attack.’’ I turned on the television and realized immediately

that I needed to get out of Big Sky, Montana, along with Director

Allbaugh. We jumped a military plane and came back to DC, after

finding a military plane that could get us back there.

But I thought about that speech and the three things that I

wanted to say in that speech on September 11 are equally applicable today, and it is probably a speech that I could give anywhere

else in the country, any other time in the future. Three things.

First, this administration recognizes that the first individuals to

respond to the 911 phone calls are the local and State emergency

managers, the fire departments, emergency medical services, and

law enforcement. Those truly are the first responders. When someone dials 911, they do not call Washington, DC. They call their

local officials.

Second, we rely upon and must rely upon the wisdom and the experience of those at the State and local levels as we prepare and

work toward a national plan that includes the active participation

of all levels of government.

And third, and probably most importantly, the Federal Government must provide a comprehensive national strategy to prepare

for terrorist attacks. Our goal, our strategy must be to provide the

best resources, the best education, the best guidance, and the best

training to the State and local officials to enable them to respond

when, indeed, they are called in that 911 phone call.

I often think of duty honoring country when reflecting on the

events of September 11. The response that day and every day demonstrates the true heroism of all of those who responded, fire fighters, policemen, emergency medical technicians, the emergency

managers, all who placed themselves in danger to respond and help

35

those in need. Many of those heroes tragically lost their lives that

day, rushing to the scene to save lives, rescuing the trapped and

the injured. They were, in fact, being the first responders. Our

hearts hurt with them and for the innocent families who lost loved

ones. Now we must, however, be prepared for long-term recovery

efforts and stand united and ready to assist those who were injured

both physically and emotionally.

The level of cooperation and professionalism by the Federal,

State, and local agencies and emergency responders in responding

to New York and the Pentagon have been absolutely outstanding.

The American people can and should be proud of the work that

they have done in helping the Nation recover from those incidents.

At FEMA, our mission is to reduce the loss of life and to reduce

damage to property, and that mission applies to all hazards, to all

disasters, whether those disasters are manmade or whether they

are natural disasters. When a disaster overwhelms the response capabilities of State and local governments, the President may sign

an emergency or major disaster declaration. On September 11, the

President did that. Declarations were signed immediately and response of the Federal Government was immediate.

As in response to other presidentially declared disasters and

emergencies, FEMA utilized the Federal Response Plan to coordinate the government’s response activities to those disasters. We

use this tool, on average over the past 10 years, 53 times a year

in responding and coordinating the Federal Government’s response

to a disaster. The Federal Response Plan provides the framework

for 26 different Federal departments and agencies, as well as the

American Red Cross, to respond and support the efforts of State

and local governments.

These Federal agencies are organized into interagency functions

based on their authorities and their expertise and the needs of the

counterparts at the State and local government. For example, as

we heard from Secretary Thompson, HHS is the lead support agency for health and medical needs.

Since 1992, the Federal Response Plan has been used exactly

under this mechanism to respond to disasters, regardless of the

cause. To the Members of this Committee, you are familiar with

the response that FEMA has in natural disasters, whether it be

floods in Ohio or fires in New Mexico, tornadoes in Oklahoma,

whatever it is. You are accustomed to how we respond. That is exactly how we responded in New York.

The Federal Response Plan worked in New York City just as it

worked in Oklahoma City in 1995. The effectiveness of the Federal

Response Plan has clearly been demonstrated, and that is why the

Federal Response Plan must be used to identify Federal resources

and response capabilities for the threat of biological terrorism.

Immediately following the attacks on September 11, President

Bush recognized the need to respond quickly and accurately, to

make certain that the Federal Response Plan was working the way

it was supposed to. The President convened three different working

groups to respond to those disasters, a military or foreign policy response group, a protection response group, and the group that he

asked me to chair, the consequence management working group.

36

That group is responsible and is still working today—and, in fact,

Senator, we are meeting this afternoon on another issue—was responsible for identifying those issues, those holes, if you want to

call them that, in the Federal Response Plan and how do we fix

those. We identified those holes and we divided them into three

categories, first, those holes that we needed to fix immediately,

that we had to fix today. Then those holes that we need to fix in

the next 30 or 60 days, and then the long-term fixes that we could

put off and deal with in a longer-term situation.

The result of that consequence management working group you

are seeing today. You are seeing, as Secretary Thompson indicated,

the push packs being increased, the vaccine issue being addressed,

the issue of what we are going to do with the antibodies. All of

those issues were addressed by the working group and briefed to

the President and the President had decision papers directing us

exactly what to do with those issues. That is how the Federal Response Plan is supposed to work, and, indeed, how it did work.

We see Governor Ridge as the President’s spokesman for all

issues regarding terrorism. Yesterday, for example, Governor Ridge

asked FEMA to take the lead in organizing a joint information center to coordinate all of the efforts going on between FEMA, Health

and Human Services, FBI, Department of Justice, all of the agencies, so there can be one centralized location for the administration

to put out the message of what they are doing and what the response should be and how the American public can respond. We intend to put together packets for the American public so they will

have information that is helpful to them in responding to this new

crisis. Clearly, groups such as HHS will be involved in that effort.

The threat of a biological attack presents unique challenges to

this country’s response system. The first responders in a biological

event shift, as I think Senator Collins mentioned earlier, from the

fire fighter and the policeman to the doctors, to the Public Health

Service, to those people that will now need to respond in an emergency situation.

The Department of Health and Human Services is a critical link

between the health and medical community and the larger Federal

response. In all disasters, FEMA works closely with HHS, the Public Health Service, and the Centers for Disease Control to make

certain that we have the assets and the response mechanism that

we need in this type of incident. In New York and in the Pentagon,

that is exactly what occurred.

Again, as the lead agency with responding and coordinating a response to a disaster, whether manmade or natural, we have tasked

HHS to put together to the Federal Response Plan a Bioterrorism

Annex so the Federal Response Plan will have in place for future

agencies, for future people working in those agencies, the response

and coordinated effort that they must have.

Just like Secretary Thompson, Director Allbaugh and I met yesterday with Governor Ridge to provide him with information about

this very response mechanism. In Director Allbaugh’s testimony

yesterday before the Senate Committee on Environment and Public

Works, he stated that he could think of no greater person than

Tom Ridge for the position of the Director of Homeland Security.

37

1The prepared statement of Ms. Daniels appears in the Appendix on page 96.

FEMA is committed to working with Governor Ridge in that respect and will implement the strategy that he asks us to do so.

We kind of see Governor Ridge as the conductor of this great orchestra, telling us what we need to do and how to do it. He has

the power because he speaks on behalf of the President of the

United States. As Director Allbaugh will also serve on the Homeland Security Council, FEMA will support the office to any extent

that the governor asks us.

We believe that FEMA is ready, able, and willing to respond, as

seen in New York. We are ready, willing, and able to respond in

any future incidents and believe we have the mechanism to do so.

Mr. Chairman, thank you for convening this meeting so that we

can discuss about the organizational issues facing the government

at this time.

Chairman LIEBERMAN. Thanks, Mr. Brown. I look forward to the

question and answer period with you.

Ms. Daniels, thank you for being here on behalf of the Department of Justice.

TESTIMONY OF HON. DEBORAH J. DANIELS,1 ASSISTANT ATTORNEY GENERAL, OFFICE OF JUSTICE PROGRAMS, U.S. DEPARTMENT OF JUSTICE

Ms. DANIELS. Thank you, Mr. Chairman and Senator Akaka. I

am pleased to have this opportunity to talk about the Office of Justice Programs’ (OJP) efforts related to bioterrorism and our coordination with the Department of Health and Human Services on this

critical issue.

As you know, since 1998, OJP’s Office for Domestic Preparedness, to which I will refer as ODP for short, has been working to

help State and local public safety personnel acquire the specialized

training and equipment they need to safely respond to and manage

domestic terrorism incidents, particularly those involving weapons

of mass destruction. Of course, these efforts have taken on new urgency in the aftermath of the September 11 attacks.

And as the Senators have suggested this morning, State and

local personnel are on the front lines. They are typically first on

the scene of any emergency and first to respond in the event of a

terrorist attack. ODP is working to ensure that these brave men

and women are well prepared and as well equipped as possible for

these potentially catastrophic events.

Over the past 3 years, ODP has worked to develop and implement a national program to enhance the capacity of State and local

agencies to respond to domestic terrorism incidents. We provide coordinated training, equipment acquisition, technical assistance, and

support for national, State, and local exercises to address a wide

range of potential threats, including chemical, biological, radiological, nuclear, and explosive weapons.

We also support the efforts of the Department of Health and

Human Services, particularly the U.S. Public Health Service and

the Centers for Disease Control, to deliver training and equipment

assistance to the public health and medical communities, and we

have worked with HHS to test the Nation’s bioterrorism response

38

capacity through the use of field exercises. This partnership has

been beneficial to both HHS and to our Office for Domestic Preparedness. Whereas ODP has taken the lead in reaching the public

safety and emergency response community, we have deferred to

HHS to lead the preparedness effort for public health and medical

personnel.

ODP’s domestic preparedness activities are concentrated in the

areas of training and technical assistance, equipment, planning,

and field exercises. We provide over 30 direct training and technical assistance courses and programs to enhance the capacity of

State and local jurisdictions to prepare for and to respond to terrorist attacks on U.S. soil.

Since 1998, we have provided training to over 77,000 emergency

responders in 1,355 jurisdictions in all 50 States and the District

of Columbia. We have also completed over 2,000 deliveries of technical assistance to State and local response agencies, and we are

completing delivery of the Nunn-Lugar-Domenici training program

to the remaining 52 of the Nation’s 120 largest cities that did not

receive all elements of the program from the Department of Defense before the transfer of the program to the Justice Department.

This training will include a biological weapons tabletop exercise

and briefings on the U.S. Public Health Service’s Metropolitan

Medical Response System, to which Secretary Thompson referred.

ODP is also working with all 50 States, the District of Columbia,

and the five U.S. territories to help them develop comprehensive 3-

year domestic preparedness strategies. These strategies are based

on integrated threat, risk, and public health assessments that are

conducted at the local level. They will identify the specific level of

response capability necessary for a jurisdiction to respond effectively to a terrorist incident involving weapons of mass destruction.

Once assembled and analyzed, these plans will present a comprehensive picture of equipment, training, exercise, and technical

assistance needs across the Nation. In addition, they will identify

Federal, State, and local resources within each State that could be

utilized in the event of an attack. We anticipate receiving the majority of these strategies by December 15 of this year. We then will

work with each State and territory to implement assistance specifically tailored to the needs identified in their own plans.

The Attorney General recently wrote to each governor stressing

the urgency of completing these assessments. He has directed ODP

to place the highest priority on analyzing these strategies and helping States to meet the identified needs as quickly as possible.

To give you an idea where we have been in terms of providing

dollar assistance, in fiscal year 1999, States received a total of $54

million in initial planning and equipment funds under the program. They are scheduled to receive an additional $145 million in

fiscal year 2000 and 2001 funds as their plans are completed. In

addition, from 1998 through this year, we have provided a total of

$242 million in equipment grants for 157 local jurisdictions, the 50

States, the District of Columbia, and the five U.S. territories under

the County and Municipal Agency Equipment Program. These

funds are helping to ensure that State and local personnel have the

specialized equipment they need to safely and effectively respond

to biological, chemical, or other hazardous incidents.

39

And as indicated in my written testimony that I have submitted,

OJP, the Office of Justice Programs as a whole, makes available

additional millions to each State in the form of block grants that

can be utilized for law enforcement equipment for first responders.

Finally, Mr. Chairman and Senator Akaka, ODP provides funding and technical assistance to state and local jurisdictions to support local and regional interagency exercises. These exercises test

crisis resistance, identify procedural difficulties, and provide a plan

for corrective action to improve crisis and consequence management response capabilities without the penalties that might be incurred in a real crisis.

In May 2000, we conducted TOPOFF, the largest exercise of its

kind, involving separate locations and a multitude of Federal,

State, and local agencies. TOPOFF simulated simultaneous chemical and biological attacks around the country and provided valuable lessons for the Nation’s emergency response communities.

ODP has begun planning for the Congressionally mandated

TOPOFF 2 exercise, which will be conducted in the spring of 2003,

and we are working with the Department of Energy to establish a

Center for Exercise Excellence at the Nevada test site that will

help to ensure the operational consistency of weapons of mass destruction exercises nationwide.

ODP actively coordinates its programs with other Federal agencies to ensure that the highest quality training and technical assistance is provided to the Nation’s emergency response community

while also eliminating duplication of Federal resources. For example, we helped to establish TRADE, the Training Resources and

Data Exchange working group. TRADE includes representatives

from the National Fire Academy, the FBI, FEMA, the EPA, the Department of Energy, HHS, and specifically the CDC. TRADE is already working on a number of joint initiatives that will enhance

the coordination of training delivery resources in accordance with

State strategies.

These and other joint endeavors will greatly enhance the capacity of the Nation as a whole to respond safely and effectively to incidents of terrorism involving weapons of mass destruction, including biological agents. We are committed to continuing build on the

efforts already underway to ensure that States and local jurisdictions have the training and resources they need as a vital link in

our Nation’s response to terrorism.

Once again, Mr. Chairman, I want to thank you for the opportunity to describe the efforts of the Office for Domestic Preparedness in this vitally important area and, of course, will be pleased

to respond to any questions the Senators have. Thank you.

Chairman LIEBERMAN. Thanks, Ms. Daniels. Let me just take the

liberty to ask you to speak a moment more about the TOPOFF exercise, how it was conducted and, just briefly, what the conclusions

were about our state of preparedness.

Ms. DANIELS. Mr. Chairman, TOPOFF was conducted at multiple

sites. There were multiple exercises so that we could literally test

our preparedness to respond to multiple events, including biological

terrorist attacks.

Chairman LIEBERMAN. So you simulated biological attacks in different regions of the country?

40

1The prepared statement of Mr. Hinton appears in the Appendix on page 107.

Ms. DANIELS. Correct. I believe that in Denver, the biological exercise occurred.

Chairman LIEBERMAN. And chemical exercises elsewhere, was

that——

Ms. DANIELS. Portsmouth, New Hampshire. My experts are behind me. Thank you.

Chairman LIEBERMAN. Right.

Ms. DANIELS. And there has been an analysis that has been conducted that is contributing to the preparation for TOPOFF 2, and

I think some valuable lessons were learned and have been disseminated to those who are responsible for preparing for potential

events in the future.

Chairman LIEBERMAN. To the best of your recollection, would you

say that the conclusion from those TOPOFF exercises simulated attacks was that we were—to use a formulation that we are involved

in here now—adequately prepared, under-prepared, or unprepared?

Ms. DANIELS. My understanding, Mr. Chairman, is that at the

time the TOPOFF 1 exercise took place, I think it clarified some

interesting gaps in our preparedness at that time. There has been

time in the interim, I think, to deal with those gaps and I would

hope that we could say that we are close to at least being adequately prepared for the future.

Chairman LIEBERMAN. But probably for now, we would say we

are under-prepared? We are not unprepared.

Ms. DANIELS. We are not unprepared.

Chairman LIEBERMAN. Right. Thanks.

Mr. Hinton, thank you for being here. We are always glad to see

somebody from GAO. We consider you part of the Governmental

Affairs family.

TESTIMONY OF HENRY L. HINTON, JR.,1 MANAGING DIRECTOR, DEFENSE CAPABILITIES AND MANAGEMENT, U.S. GENERAL ACCOUNTING OFFICE

Mr. HINTON. Thank you, Mr. Chairman and Senator Akaka. I appreciate the opportunity to be here today to discuss GAO’s work on

efforts to prepare for and respond to chemical and biological terrorist attacks. My comments today are based on several of our recently issued reports, including our September 28 report on Federal

research and preparedness activities to counter biological terrorism. My colleague, Dr. Jan Heinrich, who directed that work, is

with me today, sitting right behind me on my left. For this hearing,

we also took a quick look at 50 Federal exercise evaluations to

identify problems associated with chemical and biological terrorism

that needed to be addressed.

I will briefly address three points, Mr. Chairman. First, I will

highlight some of the specific Federal programs and coordination

challenges to prepare for and respond to chemical and biological

agents or weapons. Second, I will point out some of the problems

identified in the evaluations of the preparedness exercises. And finally, I will offer some suggestions for Congress to consider for investing resources in chemical and biological preparedness.

41

1 Chart referred to by Mr. Hinton appears in the Appendix on page 123.

I want to echo a comment you made right at the onset of the

day’s hearing, Mr. Chairman. The body of work that we have done

over the last several years shows that there has been progress on

many fronts. But as you said, and we agree, there is more to be

done.

Let me turn to the programs. The Federal Government has a

variety of programs to prepare for and respond to chemical and biological terrorism. They include response teams, support laboratories, training and equipment programs, and research efforts.

These programs face two coordination challenges, if I could refer

you to the graphic.1

At the program level, our first graphic illustrates the complex relationships among some of the key Federal departments and agencies involved in just biological terrorism research and preparedness

activities. I am not going to go into the details on that, but you can

get the gist of the complex relationships there.

Chairman LIEBERMAN. It looks messy.

Mr. HINTON. At the operational level, our second graphic identifies the Federal response teams available to provide assistance to

State and local first responders, if needed, for chemical and biological terrorism. If you were to add the State and local government

activities to each graphic, the relationships will be more complex

and the coordination challenge that much more extensive. A number of interagency and intergovernmental plans and working

groups are involved in coordinating these activities.

Let me turn to our analysis of exercise evaluations, also known

as after-action reports. We identified a number of problems that require solutions to improve preparedness. The problems and their

solutions fell into two categories.

One category was those problems and solutions that are generally applicable to any type of a terrorist incident, major accident,

or natural disaster. For example, they covered issues involving

command and control, specifically the roles, responsibilities of different agencies. The legal authority to plan and carry out a response to a WMD terrorist incident were not always clear, which

resulted in a delayed and inadequate response. In the communication area, interoperability difficulties exist at the interagency and

intergovernmental level.

Last, in planning and operations, State and local emergency operation plans did not always conform to Federal plans.

The other categories were those problems and solutions that are

applicable to both chemical and biological terrorist events. Those

problems included issues involving public health surveillance, a

topic that has come up this morning. Specifically, the basic capacity

for public health surveillance for biological terrorism and emerging

infectious diseases is an urgent preparedness requirement at the

local level. The detection and identification of chemical and biological agents was another problem frequently raised in exercise evaluations. The capability of first responders and specialized response

teams to rapidly and accurately detect, recognize, and identify

chemical and biological agents and assess associated health risks

can be slow. Equipment and training was another problem. First

42

1The prepared statement of Dr. Johnson-Winegar appears in the Appendix on page 124.

responders often lack specialized personal protective equipment or

chemical or biological detection kits. And finally, problems were

identified in the laboratories. Even a small outbreak of an emerging disease was determined to strain the resources. There is a need

for broadening laboratory capabilities, ensuring adequate staffing

and expertise, and improving the ability to deal with surging and

testing needs.

Let me turn to the resource question, Mr. Chairman. Congress

faces competing demands for spending as it seeks to invest resources to better prepare our Nation for chemical and biological

terrorism. As the Comptroller General recently testified before this

Committee, we believe a risk management approach must be used.

It should include a threat assessment to determine which chemical

and biological agents are of most concern in order to focus finite resources on areas of greatest need.

Our work shows that some of the solutions to improve the response to chemical and biological terrorism have broad applicability

across a variety of contingencies, while other response solutions are

only applicable to a specific type of attack. For example, efforts to

improve public health surveillance would be useful in any disease

outbreak, whereas efforts to provide vaccines for a specific disease

would only be useful if terrorists used that disease in a biological

attack.

Until the results from a risk management approach is available,

Congress may want to initially invest resources in areas with broad

applicability, and as threat information becomes more certain, it

may be more appropriate to invest in efforts applicable to specific

chemical or biological agents.

Mr. Chairman, that completes my statement and we stand ready

to answer any questions.

Chairman LIEBERMAN. Excellent. Thank you.

Dr. Johnson-Winegar.

TESTIMONY OF ANNA JOHNSON-WINEGAR,1 PH.D., DEPUTY ASSISTANT TO THE SECRETARY OF DEFENSE FOR CHEMICAL

AND BIOLOGICAL DEFENSE, U.S. DEPARTMENT OF DEFENSE

Dr. JOHNSON-WINEGAR. Thank you. Mr. Chairman and distinguished Committee Members, I would like to briefly describe for

you the role of the Department of Defense.

As we all know, the tragic events of September 11 and the more

recent anthrax cases have heightened the public’s awareness of the

threat posed by biological terrorism. The Department of Defense

has long considered the use of biological weapons as a possible

means by which State and non-state actors might counter America’s overwhelming conventional war-fighting strength. This is

often referred to as an asymmetric threat.

In response to this threat, Congress indeed directed the Department of Defense to consolidate all our efforts in chemical and biological defense, and since that consolidation in 1994, and with the

continued support of the Congress, I feel that the Department of

Defense has made significant progress in fielding defensive equipment for our war fighters and we stand ready to assist the civilian

43

community through our technology sharing, through technical advice, and as otherwise requested by the appropriate authorities.

In order to meet the challenge of biological warfare across the

spectrum, our program must address the need for both material

improvement and operational concepts to address this threat. In

order to address this more thoroughly, we have indeed documented

gaps and deficiencies through the use of exercises such as TOPOFF

and there will be a continuing relook and refocus of the prioritization of efforts within the Department of Defense.

One of the lessons that we learned from the TOPOFF exercise

was that to work effectively during an actual crisis, various governmental agencies must actually exercise together beforehand or

their cultural differences will possibly overcome the plan. We will

continue to work with the other agencies, including the new Office

of Homeland Security, to ensure good working relationships. One

specific area that we will focus on is to help define what support

the Department of Defense can provide.

As you may know, the Department of Defense does, indeed, have

unique expertise and materiel. However, we are not charged with

lead Federal agent responsibilities as described in the Federal Response Plan. In the area of domestic terrorism medical response,

the Department of Health and Human Services takes charge and

requests support as needed. In my testimony today, I will outline

the ways the Department of Defense can provide materiel support

to other organizations and how we help to coordinate the efforts.

Requests for specific materiel may come to the Department of

Defense from a number of different avenues. These requests are

approved on a case-by-case basis, and indeed, my office has dealt

with a number of requests from other Federal agencies for individual and collective protective equipment and access to vaccine,

while the operational support provided by the Department of Defense is coordinated through the Army. The Department will continue to provide the support within our means and balance this

against our main requirement, which is to provide for the readiness

of our military forces to accomplish their war-fighting mission.

DOD can, indeed, offer many of its systems, either in the field

or otherwise, or expertise that may, indeed, prove useful to the civilians. Our chemical and biological detection equipment, for example, could be applied in many civilian situations, as can many of

the medical countermeasures that we have developed. However, I

caution that the provision of materiel alone does not enhance one’s

capability. It needs to be accompanied by valid operational concepts, training, and maintenance.

The mission of the DOD’s chemical and biological defense program is to provide specific materiel to allow our Armed Forces to

be trained and equipped to conduct their operational mission in an

environment contaminated with chemical or biological agents.

Therefore, our Armed Forces are, indeed, trained primarily for traditional war-fighting requirements. However, we also maintain significant capabilities to support homeland security through such

operational units as the Technical Escort Unit, the WMD Civil

Support Teams, and the Marines’ Chemical and Biological Incident

Response Force.

44

In order to enhance our Nation’s overall capabilities, the Department of Defense participates in many programs to support the

transition of military equipment and concepts to other than DOD

agencies. I would like to name a few of those.

Specifically, we participate as a member of the Technical Support

Working Group, which rapidly prototypes emerging technologies for

high-priority Federal interagency requirements. We participate in

the Interagency Board for Equipment Standardization and Interoperability, known as the IAB, which is a partnership with Federal, State, and local agencies focused on the capabilities necessary

for local responders, that is fire, medical, and law enforcement, in

order to be able to cope with WMD terrorism. We also participate

in the Domestic Preparedness Program mandated under the 1997

Nunn-Lugar-Domenici legislation, and indeed help to train and

equip many municipalities and have subsequently transferred that

program to the Department of Justice, as was previously mentioned.

We have a number of interagency agreements with the Department of Justice, Office of State and Local Domestic Preparedness,

to purchase specific equipment. We help provide medical training

programs from our U.S. Army Medical Research Institute for Infectious Diseases, for biological agents, and our Institute for Chemical

Defense for chemical agents. And we also participate in the White

House Office of Science and Technology Policy Program on Weapons of Mass Destruction Research and Development Subgroup.

I think that these efforts represent just a small snapshot of the

Department of Defense efforts to address bioterrorism. As the individual lead Federal agencies assess their needs, DOD anticipates

additional requests for our participation in these groups.

The Department of Defense has established a set of requirements

for the successful completion of military operations in chemical and

biological environments. As you know, we submit an annual report

to the Congress documenting our progress in meeting these requirements. My office additionally continues to coordinate our efforts, and I would particularly like to point out our coordination

with the Department of Energy, Department of Health and Human

Services, and the intelligence community, as is reported in our

Counterproliferation Program Review Committee.

DOD again, in conclusion, I believe, works regularly with the

lead Federal agents to coordinate requirements and development

efforts for biological terrorism. In addition to coordination, there

are a number of other mechanisms for the Defense Department to

provide assistance to other Federal, State, and local agencies. In

light of recent events, the Department certainly anticipates a greater number of requests for assistance. DOD will address these requests on a case-by-case basis to make sure that public safety is

enhanced and that the DOD can still accomplish its war-fighting

mission.

I would like to thank you for the opportunity to speak with you

today and for holding this hearing on what I feel personally is a

very important topic. I will be happy to answer any of your questions.

Chairman LIEBERMAN. Thanks, Doctor. Thanks to all of you. As

I listened to the references to the TOPOFF exercises, and, in fact,

45

as I listened to the reports of what each of the three departments

on this panel have been doing in regard to chemical and biological,

the possibility of chemical and biological attacks, and including

what Secretary Thompson testified to for HHS, there is some comfort here in the sense that we have been hearing, certainly here on

Capitol Hill, for a long time, warnings and concerns. We have all

expressed ourselves, or a lot of us have, about the possibility of

chemical and biological attacks against the United States.

And the good news here is that we, and you, and the Federal

Government together have created a series of programs to prepare

for and help us better respond to those attacks. So I feel very

strongly that we are right when we say America is not unprepared

for chemical and biological attacks. We are under-prepared, and

our fear on this Committee, mine certainly, is that we are also

under-organized, and I take that to be part of what your conclusions, Mr. Hinton, were, GAO’s.

I feel that as I hear the testimony that the three departments

have offered here on this panel, it seems to me that Justice has a

series of programs for State and local governments to receive training and equipment. FEMA has programs to do some of the same.

HHS has programs. DOD has some programs, a little bit different,

but also reaching out to State and local to help train, because those

are the first responders.

So my question, and maybe I will start with you, Mr. Brown, is

who is in charge? Maybe I ought to go about it in a slightly different way. In the best of all worlds, should we be, for instance,

putting all of these various programs under FEMA as the coordinating agency? And I will give you a chance to respond, Ms. Daniels. Why does Justice have this authority? Would that not be better if it came under FEMA as the central response agency in the

Federal Government?

Mr. BROWN. Mr. Chairman, I think maybe the best way to answer that question is to tell you what we have organizationally.

Chairman LIEBERMAN. Go ahead.

Mr. BROWN. Having only been in FEMA now since Director

Allbaugh came on in February, I am amazed at the organizational

structure we have to respond to these types of, or frankly, any kind

of disaster. In our emergency support team operation, we have literally desks and cubicles for every agency that needs to be responding, so that whoever is in the field, if they have cross-cutting issues

that need to be addressed, those can be addressed in the emergency

support team function right here in Washington, DC. We eventually move those out into the field, like we are doing in New York

right now, but there is a mechanism in place to do that coordination in FEMA right now and I think FEMA does it very, very well.

I think what Governor Ridge brings to the table is the ability to

say on a broader scale now, when things are not working and need

to be coordinated, and he made this point to Director Allbaugh just

the other day, training is a very important component that he

wants to work on and he wants to make sure they are all working

together. Because of his authority under the directive of the President, he can now say to all of us, we ought to start combining some

of these programs. We ought to see who is doing it the best and

make sure they are the ones taking the lead on that, and I think

46

that is going to happen. I can just tell that by the way Governor

Ridge is working things right now.

But to go back to my initial point, FEMA has that structure set

up now to coordinate all of those things. The emergency support

functions that all come together in times of disaster and even nondisaster are in place to deal with those cross-cutting issues.

Chairman LIEBERMAN. And FEMA has the authority or the cooperation of the other agencies so that, in fact, you have not had

problems in responding to crises?

Mr. BROWN. Generally, yes.

Chairman LIEBERMAN. OK.

Mr. BROWN. I would say this, that when we have had a problem,

it has taken the sheer willpower of individuals to conquer those

problems. I think now Governor Ridge is in place to help us do

that. And I think the other thing that the administration did to

respond immediately to New York was to create the Domestic Consequences Principals Committee, which did that very thing,

brought together in the White House a group of principals so that

when there were issues that arose in the New York incident, we

could resolve them right there at the table and get them done before they rose to the next level.

Chairman LIEBERMAN. Correct me if I am wrong, but it seems to

me that in response to September 11, I was interested to be reminded that the immediate consequence management responsibility was actually in the Department of Justice, not in FEMA,

where I would have guessed it would be. Is that correct?

Mr. BROWN. Well, no.

Chairman LIEBERMAN. No? OK.

Mr. BROWN. We have the initial response in terms of the consequence management. But in terms of the crisis management, in

terms of the crime scene, that is the Department of Justice.

Chairman LIEBERMAN. So is that a clear enough distinction that

Justice is involved in the law enforcement aspect of it but does not

manage the scene where we want most of all to have rescue and

relief occurring?

Mr. BROWN. I think it works quite well. I will give you an example. I think the Attorney General would like to say something, too.

Chairman LIEBERMAN. Yes.

Mr. BROWN. It is clear to me that, for example, in New York

there was a problem with some communications that DOJ, the FBI

needed to resolve immediately. FEMA was able to step in and resolve that for them. Is that really crisis management or consequence management? It is really a little bit of both, but because

of them working together, we are able to solve those problems.

And we know—I think FEMA is smart enough to know that

when it is a crime scene, it is something the FBI needs to take the

lead on. We back off and let them do that and support them to the

greatest extent that we can.

Chairman LIEBERMAN. Ms. Daniels, why do you not respond

about that, and then to the more general question, devil’s advocate

though it may be, why should not all these programs of training

and assistance to local responders be in FEMA, for instance, because it is going to coordinate the response when a crisis occurs?

47

Ms. DANIELS. Senator, maybe I can back up a little bit and talk

about how we came to be where we are, I suppose. During the

1990’s, there were two Presidential directives that laid out the hierarchy and the delegation of responsibilities in the event of a terrorist incident. Those gave the Attorney General the basic authority to deal with the incident and allowed him to delegate crisis

management to the FBI for the immediacy of the crisis and crisis

management; and delegate the follow-up, or consequence management, to FEMA at the point where the crisis aspect has subsided,

and we have reached the point where we can turn that corner.

And I think that the theory was that that gives us the organizational capability in one official that will enable us to do that

seamlessly. It seemed to work, in fact, very well, as Mr. Brown has

indicated, in New York. I think everyone has been working wonderfully together.

With regard to the larger issue, your first question, I think, was

who is in charge——

Chairman LIEBERMAN. Right.

Ms. DANIELS [continuing]. And I would say that the President is

in charge and Governor Ridge is his spokesman or his agent. And,

frankly, the Department of Justice will do whatever it is that they

determine is the best thing for us to do.

We do have, and we have developed over many years, a very

close working relationship with law enforcement and that has

helped us in our training exercises. But we also not only work collaboratively with the other agencies, including FEMA, but also

defer when it is a public health issue, to HHS. We do not try to

do their job for them, and I think everyone has a piece of this pie

and we are all right now seeking the best way to do that collaboratively.

I liked what Governor Ridge said the day he was sworn in, which

was that the only turf we should be concerned about is the turf we

stand on, and I agree.

Chairman LIEBERMAN. From what you have said, it is clear to me

that you think, and I agree, that we are in a better organizational

structure now that Governor Ridge—that the Office of Homeland

Security has been created and Governor Ridge is in charge. We

may have our discussions and debates about exactly how much authority he has, but it does seem to me that he fills a gap that was

there before. What would you say to that and what you have heard,

Mr. Hinton?

Mr. HINTON. Mr. Chairman, this report that we issued back on

September 20 dealt right square on with that issue.

Chairman LIEBERMAN. Yes.

Mr. HINTON. And based on all the work that we had done over

the last several years, we saw a lot of fragmentation around some

of the key leadership functions in the government, overseeing a national threat and risk assessment, setting priorities for national

strategies, coordinating and monitoring international programs,

providing liaison and assistance to state and local governments.

These were spread throughout the Executive Branch.

We made a recommendation to the President to establish a focal

point within the Executive Office of the President that would rise

48

above the individual agencies and deal with those functions and

bring them together.

Chairman LIEBERMAN. Right.

Mr. HINTON. To refer to your question about the programs,

whether to put them in Justice or FEMA, there are four programs

right now being run by HHS, Justice, and FEMA, all targeted to

basically the same group in the State and local governments that

are dealing with emergency preparedness. Well, if you can rise

above that and have, like Governor Ridge, that may be one of the

targets of opportunity for him to focus on to try to make some rational decisions as to how many programs we exactly need and the

resources.

Chairman LIEBERMAN. In other words, we may not need them

all, or maybe they can be consolidated in one or another department.

Mr. HINTON. Exactly. You asked the question, how much redundancy might be needed and what is enough? Well, I think the

appointment of Governor Ridge in that position was timely with respect to that issue. I think there are some long-term issues that

need to be there.

One goes to the definition of homeland security, everything we

would put in it. How can the coordinator achieve real influence in

the budget and resource allocation process, a question that has

come up this morning, is a very important question that needs to

be addressed. Should the coordinator’s role and responsibilities be

based on specific statutory authority? I think that is another question that the Congress needs to look at over the long term.

Depending on the scope, structure, and organizational location of

this new position, what are the implications for Congress in its

ability to conduct oversight? I think that is another very important

issue—and particularly as GAO’s role in that effort to assist you,

the Congress, in its oversight.

Chairman LIEBERMAN. I agree. Thanks. My time is up. Senator

Akaka.

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

Attorney General, I am concerned, and this has been alluded to,

that there is a cultural divide between how the law enforcement

and public health communities view bioterrorism. The difference is

demonstrated by how the different groups answer the following

question, and the question is, is a bioterrorist event a medical crisis with a law enforcement component or is it a crime scene with

a public health aspect?

Now, this question is for you and anyone else who wants to answer it and to comment on it. So my question is, how would you

answer this?

Ms. DANIELS. Senator Akaka, actually, maybe this will be reassuring to you, coming from the Department of Justice, but I would

say that an incident of biological terrorism is a medical crisis with

a law enforcement component because, as has been discussed of

late with regard to the anthrax situations and other things that

could come up in a biological context, you are not going to necessarily have a crime scene where there is an explosion and something happens and you have to clean up after it. You are going to

have people getting sick and they may be getting sick well after the

49

1Letter from the U.S. Department of Justice responding to question posed by Senator Akaka

to Ms. Daniels, dated June 25, 2002, appears in the Appendix on page 176.

incident that spurred the disease. So, frankly, we do think that is

a medical crisis and that is why we want to work very closely with

HHS.

Senator AKAKA. Thank you. Does anybody wish to comment otherwise?

Let me ask you my second question. Agriculture terrorism presents a serious challenge to our legal system’s ability to protect our

agricultural industry. Currently, terrorism using a weapon of mass

destruction is a very serious offense. However, the application of

this law to agricultural terrorism is problematic because the use of

biological weapons is defined as being directed against a person or

public property of the United States. Therefore, a biological attack

against agricultural land or livestock does not qualify as terrorism

using a weapon of mass destruction.

So my question is, do you feel that the threat of agricultural terrorism warrants amending the U.S. Code to include private property or agriculture in the definition of bioterrorism?

Ms. DANIELS. Senator, I can answer your question, I think, only

partially, and my partial answer is that I absolutely think that we

should have a serious concern about the safety of our livestock and

it has to do with the safety of our entire food supply and everything

else along the line. So I think it is very important.

Having said that, I have been in the Federal Government before

but have not been for several years. Now I am back in and have

been in my current position for all of 3 weeks today, so I have not

yet had a chance to examine the current state of the terrorism law

or what the pending bills that came out of the House and Senate

and, I guess, are ready for conference at this point actually include

in the way of legislation that would protect livestock and the agricultural supply. So with that, I would be happy to get back to you

on that point.

Senator AKAKA. You can provide it for our record, please.1 Thank

you.

Ms. DANIELS. Thank you.

Senator AKAKA. Mr. Brown.

Mr. BROWN. Yes, sir?

Senator AKAKA. FEMA uses the Federal Response Plan to coordinate the government response to disaster or emergency situations,

and we have been alluding now to coordination between agencies.

This plan contains 12 emergency support functions to mobilize Federal resources and conduct activities to augment State and local response efforts. My bill would create an emergency support function

for disasters affecting agricultural production of the food supply,

which currently does not exist.

Could you explain the procedure for creating an emergency support function? The USDA currently leads the response to production agriculture disasters. What agencies do you see filling a support role?

Mr. BROWN. Let me answer it this way, Senator. The first thing

we can do is, if there is somebody else that needs to be a part of

the emergency support team during a disaster or a declaration, we

50

will just add those. I mean, we will rely upon the willingness of

other agencies to come in and help support our response, which we

have seen an overwhelming desire to do that. So if we see a need

that is not being filled that we need some coordination on, I am

certain that the Director can call any of the secretaries or other directors and say, we need that support team here on 24/7 and they

will be there.

In terms of others that we need, I guess the best analogy is the

working group that has been meeting since September 11. We have

brought in different groups at different times based upon the particular issue. There is a group today that is going to meet this

afternoon that we are going to bring in the Department of Energy

and EPA where they were not involved before, but because of some

particular issues we need to address, we are bringing them in.

So I think the way it has been occurring is on an ad hoc basis.

As we need them, they come in, and they do and they support us.

Mr. HINTON. Senator Akaka, could I jump in there for just a second with a comment, and it piggybacks on Senator Lieberman’s

comment, too, and it deals with threat assessments that we have

been seeing in the government that are ongoing. We have some

agencies doing multiple assessments to look at the impact on public

health. We have the FBI looking at what might be the more likely

attack that we are going to have. And then we have a few others

going on.

We also have some other agencies who have not been involved

in some of the discussions about threat, for example, some of the

transportation, agriculture, and the others that you are mentioning

there, and I think that goes right to your question there. Unless

they are an active player, they may not be brought in early on in

that process and I think that is an important step that needs to

get some consideration in this environment that we are in.

Mr. BROWN. Senator, if I could just add, I just spoke to one of

my experts behind me also who tells me that just last week, Emergency Support Function 11, which is the food support function

within FEMA, has asked for the Department of Agriculture and

USDA to come in to deal with some issues that have already arisen

that you have alluded to. So we are already doing that.

Senator AKAKA. Now that you have mentioned them, you did not

mention the Department of Transportation on the list that you just

mentioned and I feel that the importance of transportation restrictions and private industry abiding by those restrictions cannot be

over emphasized.

Mr. BROWN. Right, and the Department of Transportation is already one of our support functions in that group. They already

exist.

Chairman LIEBERMAN. Thanks, sir. Very thoughtful questions,

Senator Akaka.

I just have one additional question for Dr. Johnson-Winegar. Obviously, the Defense Department has spent a lot of time and money

working on these problems with chemical and biological components to war fighting, and now we are at a point where we have

got to begin to think about the same threats here at home. The obvious interest that we have is to make sure that we do not put civilian agencies into a position of reinventing the wheel.

51

I know we are in open session, but I wonder, to the extent that

you can here, Doctor, if you would describe for us some of the types

of technologies and ongoing research that DOD possesses or is

overseeing that would be transferrable or applicable to the civilian

sector, and then what is the process to make sure now that that

happens?

Dr. JOHNSON-WINEGAR. Certainly. Thank you for the opportunity

to describe some of our programs.

As Secretary Thompson mentioned this morning, clearly, the

area of medical countermeasures, both prophylactic and treatment,

for biological agents has been one that the Department of Defense

has invested in for a long time. I am very happy about the collaboration between our two departments on a new anthrax vaccine, for

example. The current vaccine requires six doses for full immunization and we have pooled our resources and expertise to look at recombinant technology to come up with a new product. So that is

clearly an example of one where the Department of Defense and

the civilian community can share in some of the technology that is

ongoing.

Beyond the area of specific medical countermeasures, we could

talk about the detector systems, biological and chemical agent detector systems. And while we have a very well-defined concept of

operations for using those detectors on the battlefield and can, indeed, when the detectors give an alarm or an alert, can order our

military troops to don their protective equipment, the protective

masks and individual clothing, certainly, the technologies that we

have worked on, and again, in conjunction with other work that is

being done in the Department of Energy and other organizations,

can look at those technologies for detection and identification of

chemical and biological agents.

The whole area of protection, collective protection for buildings,

individual protection, I think the Department of Defense has been

the leader in developing a number of those technologies and we are

certainly ready and willing to work with the civilian sector to see

which of those can transfer immediately and which may require

some type of modification to meet the specific needs of the civilian

community.

Chairman LIEBERMAN. Is some of the detection equipment you

described in use now as we respond to this anthrax attack or series

of attacks?

Dr. JOHNSON-WINEGAR. Well, I would like to differentiate between detection equipment and identification equipment.

Chairman LIEBERMAN. Yes.

Dr. JOHNSON-WINEGAR. And specifically, some of the test kits

that are being used for the identification are, indeed, those that

have been developed by Department of Defense funding in our research and development programs and those are some of the little

immunoassay tickets, and our laboratories have been participating

with CDC and other labs in identification using PCR technology

and other technologies.

When I was speaking specifically of detectors, I was referring to

those things, for example, which can continuously collect air samples and then can be periodically analyzed for the presence of a biological agent.

52

Chairman LIEBERMAN. At this point, those are not being distributed throughout the country, but obviously that is one potential if

there began to be concern that there was a biological threat in

some area.

Dr. JOHNSON-WINEGAR. Yes.

Chairman LIEBERMAN. Are you confident that the interaction between the Department of Defense and the civilian agencies is adequate to guarantee that they have a comprehensive idea of what

capacities you have and, therefore, are more able to use them to

confront the threats here at home now?

Dr. JOHNSON-WINEGAR. I certainly think that while I would not

say that we are 100 percent of the way to solving that communication and information exchange, I think that we are in pretty good

shape and that we have made a number of attempts to publicize

the information about what is available, and as I said, it is a matter of making those decisions about which is automatically transferrable and can be used as is, if you will, and those things which

may require some type of adaptation or modification. And an example of that might be the protective masks, and I know there was

a lot of concern amongst the public about the need to purchase individual protective masks and we certainly do not recommend that

from a Department of Defense point of view.

But the technologies and the understanding that we have in how

those work and, for example, we have the specialized laboratories

and expertise where we can do the testing with real chemical and

biological agents where many of our civilian counterpart agencies

do not have those containment laboratories or do not have the personnel who are trained and qualified to work with the real pathogens and the chemical agents to do that testing. And through the

interagency board and a number of the other interdepartmental

groups, that is one of the things that we are bringing to the table,

is our ability to do that type of work.

Chairman LIEBERMAN. Good. Mr. Hinton, did you have a last

word you wanted to offer?

Mr. HINTON. I was just going to say, one of the leadership functions that we recommended be part of the focal point in Governor

Ridge’s office would be the oversight of Federal research and development activities, also.

Chairman LIEBERMAN. Absolutely. It was a good recommendation

and we included it in our bill.

I want to move on so I can let Mr. McConnell testify and then

return safely and in a timely way to Atlanta.

I want to thank all of you for what you are doing and for your

testimony today, which has been very helpful to the Committee,

and I hope reassuring to the public insofar as they are watching.

Thank you.

The final panel this morning—Senator Akaka, thanks for hanging in there with me—Dr. Maureen Dempsey, Director, Missouri

Department of Health and Senior Services; Dr. Margaret Hamburg,

Vice President for Biological Programs, Nuclear Threat Initiative;

and Dr. Amy Smithson, Senior Associate of the Henry L. Stimson

Center.

I thank all of you, and with the permission of the other panelists,

or even without it, for that matter, I am going to call Mr. McConVerDate 11-MAY-2000 08:28 Aug 06, 2002 Jkt 000000 PO 00000 Frm 00056 Fmt 6633 Sfmt 6633 76807.TXT SAFFAIRS PsN: SAFFAIRS
53

1The prepared statement of Mr. McConnell appears in the Appendix on page 132.

nell to testify first. Mr. McConnell is the Director of the Georgia

Emergency Management Agency and is here on behalf of the National Emergency Management Agency.

Again, to pose too simplistically the general question that is before the Committee, in addition to all the expertise all of you bring

to this, we want to know whether the Federal Government, working together with State and local governments, is adequately organized to meet the now-real threat of chemical and biological attack.

Mr. McConnell, thanks for being here.

TESTIMONY OF GARY W. McCONNELL,1 DIRECTOR, GEORGIA

EMERGENCY MANAGEMENT AGENCY, ON BEHALF OF THE

NATIONAL EMERGENCY MANAGEMENT ASSOCIATION

Mr. MCCONNELL. Mr. Chairman, I appreciate the opportunity to

be here, and let me tell you a little bit about where I am coming

from. I am more into the yes and no answers, so let me give myself

a little room to get out of this.

Chairman LIEBERMAN. OK.

Mr. MCCONNELL. I have been the Director of Emergency Management in Georgia for the past 11 years. We have had 16 Presidential disasters. I was also the coordinator for then-Governor Miller to prepare for and respond to and pull off the 1996 games, and

before that, I was a county sheriff for 22 years, so I am more into

the yes or no answers, sir, so please forgive me.

Chairman LIEBERMAN. Yes, Sheriff. All right.

Mr. MCCONNELL. Are we prepared? We are better prepared than

we were 3 years ago. Are we where we should be? Probably not.

There is a lot of Federal agencies doing a lot of good stuff and the

States are very appreciative of that. Most of my comments today

will be from my experience, and you have the written testimony

from NEMA, so please do not hold that against the other group

other than myself.

I certainly hope we do not reinvent the wheel. Justice has some

great programs. FEMA has some good programs. DOD has some

very good programs. But let us not start from ground zero.

Let us understand that when DOD talks about, with all due respect, to having equipment that can tell you when to put on your

mask, the first responders do not have the equipment or the mask,

in most cases. Usually, with the exception of some Justice money,

normally, the first responders, when they get sick, they know there

is something there.

It is certainly important to understand that the States and local

governments want to plan with the Federal Government, but we

ask you all, please do not plan for us. There are a variety of issues

that are different across this country, from the simple issues of

having ports on the ocean waterfront to the State of Kansas that

does not have much interest in port authority issues.

How can we do it better? I think I have heard a lot of questions

this morning about who is in charge, and we heard that a lot in

1996 with the Olympics and I have a different view of that. Who

is responsible? Everybody is in charge. Everybody wants to be in

charge when it is going real well. But who has to stand there and

54

tell those parents or tell the families that their fire fighters or EMS

folks or law enforcement did not come out of the Twin Towers or

did not come out of Centennial Park? That is when you decide who

is responsible, Mr. Chairman.

We think that State and local governments are responsible. I

know if it happens in Atlanta, Georgia, this afternoon, I know who

Governor Barnes is going to hold responsible for it. I do not have

a problem with that. But I do have a problem with everybody being

in charge and nobody being responsible.

The assistance coming from the Federal Government is great. I

have been doing this now for about 30-odd years and some of these

issues we have been talking about for quite some time. Terrorism

is certainly different. It is on the front burner today. But a lot of

the responses, just as the gentleman from the Budget Office mentioned, are also applicable to a number of disasters and emergencies—communications, command and control, unified command.

The last thing we need is 46 or 50 or whatever number you want

to use of State and Federal agencies showing up and having to decide in the parking lot who is responsible for what, and that actually happens, sir.

Chairman LIEBERMAN. You have seen that happen?

Mr. MCCONNELL. I saw a fistfight in downtown Atlanta, Georgia,

in 1996 when we had the Olympic park bombing, between two Federal agencies deciding who was in charge——

Chairman LIEBERMAN. Right.

Mr. MCCONNELL [continuing]. And we decided that I was because

I outweighed both of them. [Laughter.]

That is to the point that we need to get on with it, sir. I am sure

that the new Office of Homeland Security or Homeland Defense is

certainly a step in the right direction, but let me encourage you to

think about three or four things as we move forward.

Chairman LIEBERMAN. Please.

Mr. MCCONNELL. Please do not stovepipe all the Federal resources. Right now, for example, the Department of Energy, Federal Emergency Management, DOD, and two or three others deal

with hazardous materials and biological chemicals. Now we get

money from the Federal Government to do certain things with that,

but we are not allowed to use DOE money, for example, to train

people not on the DOE transportation routes. Even though it is the

same training it would need somewhere else.

Please understand that a simple thing like a background check

to have clearance to find out what is going on from five different

Federal agencies requires five different background checks for me.

It looks to me like DOD, FEMA, the Department of Energy, and

whoever else should do one background check or at least share that

information, not only the cost savings to the Federal Government

but also getting the information to the folks that need to know.

There is an information void. I am not sure whether the information is available or we may not be on a need-to-know list or how

to arrive at—information sharing is a two-way street, Mr. Chairman. A lot of times, the local responders or the State may know

more about what is going on in that local jurisdiction than the Federal authorities, so we certainly need to have a clear path of how

55

to pass that information on and to who. There also needs to be a

clear understanding of how the information is coming back to us.

So very honestly, as an old country sheriff, most all politics is

local and most all disasters and most all terrorism is local. The

Federal Government has a great response capability and it is going

to be there in about 3 days, with no disrespect.

Chairman LIEBERMAN. Understood.

Mr. MCCONNELL. Your local fire, EMS, and your State folks are

going to be there for 2 to 3 days before you get Federal assistance,

and I am not trying to be ugly to the Federal counterparts, please

understand.

One of the things that I did not hear this morning when we were

talking about monitoring disease from Secretary Thompson is looking at the possibility of monitoring 911 calls as they come in as a

faster way of knowing what is going on with diseases. Certainly it

is more accurate to get it from a medical professional, but if you

have a tremendous increase in calls for 911 service in Georgia and

Ohio, there might be some connection for that. So as we gather

that information on biological and chemical weapons and certainly

a variety of diseases, let us look at the possibility of gathering that

from the 911 system.

Chairman LIEBERMAN. That is a good idea.

Mr. MCCONNELL. Also, it is interesting to hear the comments

about agriculture. One of the major concerns, I think, is the spread

of chemical and biological on our agricultural products across this

country. As it stands right now, if there is an agricultural emergency, the communities could not even recover under the Stafford

Act because agriculture is not seen as part of the Federal infrastructure. So the communities, if they had a foot-and-mouth or

hoof-and-mouth disease outbreak right now would not be able to recover any money through the Stafford Act through the FEMA process that is normally taking place. I encourage you to look at that.

And I guess in closing, Mr. Chairman, there is a lot of resources

out here. We need to make better use of those. Some of the things

that are working very good is the National Guard-DOD response

teams, what used to be the raid teams, now the civil support

teams, are outstanding. We have one in Atlanta. In the last 2

weeks, we have used it on an average of once every 8 or 10 hours.

But we have also got to understand that they are spread very

thin. Our particular team in Georgia has eight Southern States. If

I am using it every ten hours, that means Florida and a lot of other

States do not have access to it. We need to enhance that capability.

We certainly need to move forward with the medical packs and a

variety of those things.

But another thing that has not been mentioned that we used

both in New York and several natural disasters is mutual aid.

Each State has a specific or has a lot of capability. We certainly

need to look at how to federally fund that once it is sent from Georgia to New York or New York to California, to better use the State

resources that are out there.

I think we have made tremendous strides in the last 10 years,

but we have got a long way to go, sir. And with that, I will conclude and try to answer any questions you might have, sir.

56

Chairman LIEBERMAN. Thanks, Mr. McConnell. That was excellent.

Maybe I will ask you a question or two and then ask my colleagues if they have any, and I apologize to the other panel members, and let you go and run and catch the plane.

But I thought what you said about the response organization was

critical. We had heard the testimony before that there is a Federal

Response Plan and that, presumably, FEMA is in charge. But my

concern is, and you have illustrated it here, is that when there is

a crisis, it really is not clear who is in charge. So if you had a crisis

of the kind we are talking about now in Georgia, would it be clear

to you who was in charge?

Mr. MCCONNELL. Without a doubt, Senator.

Chairman LIEBERMAN. Who would that be?

Mr. MCCONNELL. It would be my governor and myself.

Chairman LIEBERMAN. Amen. But not——

Mr. MCCONNELL. We look at the Federal response as support to

us.

Chairman LIEBERMAN. Right. They would be, in a sense, working

at your direction. Do they see it that way?

Mr. MCCONNELL. Normally, yes, sir.

Chairman LIEBERMAN. They do?

Mr. MCCONNELL. Not always when it first starts. We have a way

of delivering that message, sir.

Chairman LIEBERMAN. Yes.

Mr. MCCONNELL. But in all seriousness, it has got to be a partnership. They have certain expertise. They bring a lot of resources

to the table. But you have also got to remember that they are going

to get on—locals feel the same way about the State, that once it

is over, they are going to be gone and we are still left there to explain why we did certain things, why it occurred that why and why

it did not occur that way, and the same thing will happen in New

York eventually, just the same as with any other natural disaster.

It has got to be well coordinated between the State, the local, the

Feds certainly play a major role. But I think the ultimate decision

on how to respond to it in a State has got to lie in the governor’s

office, sir.

Chairman LIEBERMAN. I do not want you to name names or

agencies, but just going back to that argument or fistfight that you

described in 1996, was that between people at the Federal level or

was it Federal and State arguing about who was in charge?

Mr. MCCONNELL. Two Federal agencies.

Chairman LIEBERMAN. That is what I was concerned that you

were saying.

A final question, which I think you answered, but I want to make

sure I understand. As I said to the last panel, it struck me that

we have got three or four different Federal agencies with programs

to train and equip local responders, who as we all agree, are where

it is going to happen. These attacks are going to be local and the

response is going to be local.

Is that not a problem for you in terms of even applying for grant

money? I mean, would it not be better if it was concentrated in one

place, because it feels as if you have got to shop around now.

57

Mr. MCCONNELL. It would be better from one aspect if you could

have a broader base to use the funds for. We do not mind chasing

the funds in different agencies, but we do have a problem, for example, if you have Department of Energy money to train first responders on moving hazardous materials from the Savannah River

plant to New Mexico and Arizona for storage, but you also have a

need off of that corridor to train the first responders in the same

thing and you have the expertise and the people on board to do

that with and you are not allowed the flexibility to do that.

If you do not move the money to one place, please try to encourage the flexibility that we can use those resources, if they are sitting there not busy doing their major response, to do DOE, for example, that we have the flexibility to use them somewhere else if

we determine it is necessary, sir.

Chairman LIEBERMAN. Well said. Do either of my colleagues have

any questions specifically for Mr. McConnell?

Senator AKAKA. Yes.

Chairman LIEBERMAN. Senator Akaka.

Senator AKAKA. I like your straightforward comments——

Mr. MCCONNELL. Thank you.

Senator AKAKA [continuing]. About being in charge and who is

responsible. I see you recommend that all Federal programs and

funding should go to the governor’s designated single point of contact.

Mr. MCCONNELL. Yes, sir.

Senator AKAKA. You have been in emergency management for a

while and therefore are very experienced. My question is, how can

we assure—I am thinking of communities—how can we assure

smaller communities that all the Federal funding will not be sent

to one or two large urban areas?

Mr. MCCONNELL. I think there are two or three ways to do that.

One is the Department of Justice now has what is called Byrne

Grant money that has a formula that a certain percentage, and I

am sorry, I do not remember the percentage off the top of my head,

cannot be used for jurisdictions over 30,000 population. It breaks

down how the funding has to be passed on.

The reason I think it ought to go to the governor’s office, Mr.

Chairman, is that way you will have some central point to know

where the resources are in case you do have an emergency or an

event, that now, unless you happen to ask the right person, you

may not know that a particular community in your State has got

a Federal grant to do something with unless you just heard about

it by the grapevine.

But there is already a process in place, I known with the Byrne

Grant money for law enforcement, that breaks it out into populations where you have to put a certain percentage of the money

in certain jurisdictions, or not to certain jurisdictions, but certain

sized jurisdictions, sir.

Senator AKAKA. Thank you, Mr. Chairman.

Chairman LIEBERMAN. Thanks very much.

Mr. McConnell, good luck in catching your plane. Thanks for the

job you do in Georgia and thanks for your testimony today.

Mr. MCCONNELL. Thank you.

58

1The prepared statement of Dr. Dempsey appears in the Appendix on page 143.

Chairman LIEBERMAN. Thanks to the three remaining panelists.

It is too bad, in some ways, that we cannot do this on another day,

because you are each superb witnesses, but we are here and so is

C–SPAN, so there are people who are going to be watching and listening and being affected by it.

Dr. Dempsey, you were previously quite well introduced by Senator Carnahan, so it is nice to have you and I look forward to your

testimony now.

TESTIMONY OF MAUREEN E. DEMPSEY, M.D., F.A.A.P.,1 DIRECTOR, MISSOURI DEPARTMENT OF HEALTH AND SENIOR

SERVICES

Dr. DEMPSEY. Thank you, Mr. Chairman, and good afternoon. I

would like to thank my Missouri Senator, Jean Carnahan, for initiating discussions about my opportunity to testify here today. It is

an honor to be here and I am happy to talk about preparedness.

I would briefly like to discuss the foundation that we have established in Missouri with the Department of Health and Senior Services with regard to bioterrorism preparedness and then use that as

a basis for several issues that I would like to put forth for consideration.

We have been consistently planning over the last decade in Missouri with regard to strengthening the public health infrastructure,

which is now the topic of the day. We wish it could have started

10 years ago in better times and would have addressed, I believe,

our under-preparedness to a great degree.

We have utilized that planning to think strategically about our

workforce, about how we carry out our roles and responsibilities,

and how we plan for the future while taking care of our day-to-day

business. As an outgrowth of that planning, we began to think

about bioterrorism preparedness several years ago as a component

of that planning and began to move our workforce around internally.

Despite that, we felt that we were not able to achieve an adequate focus on bioterrorism preparedness, so in May 2000, we created a bioterrorism preparedness unit within my office and have

staffed it with a medical epidemiologist and an emergency coordinator. Because it is placed in my office, they therefore have the entire resources of the Department at their disposal, which includes

our State epidemiologists and our CDC EIS officer and a host of

other individuals who are responsible for communicable disease

preparedness.

They have been tasked with the oversight of 12 work groups to

look at many of the areas that were highlighted in Denver’s

TOPOFF exercise and our own State preparedness planning for a

pandemic, influenza training that we had several years ago. We

looked at areas such as mass prophylaxis, mass casualties, information systems, training of the media, building those partnerships

and identifying the steps that needed to be put in place in order

to effectively deal with an event should one occur.

We have also participated in the active development of the HAN

Network, the Health Alert Network, and do have a capability to

59

communicate rapidly with all of our 114 local public health agencies, either via E-mail or fax, and are currently working on other

modes of communication should they fail, as they did on September

11.

In addition, since September 11, we have had in place—begun to

put in place an active surveillance system so that we can more rapidly detect unusual events, clusters of diseases, or aberrant trends

in diseases. This is in addition to our usual disease surveillance

systems that have been in place, like many other States have at

their disposal.

We have instituted it currently with over 1,100 providers across

the State, including sentinel hospitals, physicians, federally-qualified health centers, day care centers, schools, and a host of other

sites.

Chairman LIEBERMAN. How does it work?

Dr. DEMPSEY. Currently, we are utilizing a syndromic list of

signs and symptoms that we are tabulating on a three times a

week basis with those sites, active phone calls going from our staff

that we have reassigned to those sentinel locations to tally on a

regular basis what they are actually seeing at those locations so

that we have an ability to have an early warning of any unusual

trend.

If we would see an unusual trend as evaluated by our epidemiologist and analyst, we would then initiate an epidemiologic

investigation to determine whether or not it is a manmade event

or something unusual.

Chairman LIEBERMAN. Please go ahead.

Dr. DEMPSEY. In addition, we have had conversations with the

Missouri Hospital Association and with our hospitals across the

State to tap into the emergency rooms and the urgent care centers

and some of our primary care providers across the State, as well,

in order to achieve the same type of data surveillance on an active

basis. We are looking at ways of doing that rapidly. Currently,

there are resource constraints and personnel constraints in those

hospitals that are somewhat making that a difficulty to rapidly implement, although we are looking at other mechanisms to gather

that data on a very rapid basis and believe within the next several

weeks we can begin to have that data available, as well.

Having said that, I will say that I think there are several areas

within that public health infrastructure that we still need to support. We have heard a lot about State epidemiologists today and

the ability to have CDC-trained individuals available to all States.

We have that luxury in Missouri, and yet I do not believe that capacity will be adequate to meet our needs, or probably any other

State’s needs. We need additional individuals who can do the outbreak investigation. Currently, our folks who are doing the investigations are the same folks who are refining our plans and doing

a host of other activities within the State.

In the flurry of the anthrax threats that have been occurring in

Missouri, as they have elsewhere, those resources are strained and

we need additional individuals who are highly trained, ready to go

in at a moment’s notice to ask specific questions, detailed questions, establish case identification, and then move on to establishing are other people affected and to what extent.

60

We also have a concern about that rapid response, and Chairman

Akaka had a good question about who is in charge when you have

an unusual event and is it a law enforcement or a public health

lead agency at the time of that event, and I would argue that it

is both, and that is true for us in Missouri, as we found out this

last weekend.

There are two issues. One, as long as it is anthrax, I could say

very easily, public health could handle that. But we do not know

at the time the event is unfolding if, indeed, it is anthrax, and

there are several considerations that need to be put in place. If it

is a bioterrorism event, it would require a criminal investigation to

be opened.

We currently, since October 1999, have had a relationship with

the FBI and had a protocol in place in Missouri and have tested

specimens for them during that 2-year period under that protocol.

It has worked very effectively. They establish whether or not there

is a credible threat. We do the testing for them after they have assured us that there is no chemical or radiological event that is unfolding, or if it is a package, that it is not an explosive device. All

of those activities must occur before those specimens can be sent

to the State public health lab, so it must be a dual responsibility

at the outset of the event until the substance or agent or device,

if you will, is properly identified.

As we found out this last weekend, when those resources are

strained, we had to modify our protocol and are now utilizing a

similar protocol for our local law enforcement agencies and are asking them to conduct an initial investigation in concert with public

health, both local and State individuals. We feel that this is critical

in order to protect the folks who are responding as first responders,

as well as to preserve evidence and to assure that any public

health threat outside of anthrax would properly be identified.

In addition to our workforce, equipment, and information systems, we believe that our Federal partners need to be adequately

trained with adequate resources. They are our backup. They are

the individuals we call when we need additional field investigation

or technical assistance, additional expertise and knowledge that

may not be available at the State level.

With regard to the training of emergency personnel, first responders, I would also like to echo other comments from today that

those training dollars need to be coordinated across multiple agencies within the State, and I would often argue that the State agency or the State entities involved in that State responsibility, which

may differ from State to State, should be involved in some capacity

in the planning for those educational dollars.

For example, independent agencies who do not have knowledge

of governmental roles and responsibilities with regard to public

health cannot adequately train our medical providers on what that

response system is unless they understand the response system

and where the authority lies within the State to call up additional

State or Federal resources.

The same is true for our law enforcement individuals. Those dollars often are coming down. I am not aware of them. We are not

involved in that training. And our exercises of this past weekend

and the last few days have shown us that I cannot give certain adVerDate 11-MAY-2000 08:28 Aug 06, 2002 Jkt 000000 PO 00000 Frm 00064 Fmt 6633 Sfmt 6633 76807.TXT SAFFAIRS PsN: SAFFAIRS
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vice to law enforcement agencies, and when we train only within

disciplines, I am missing critical information about how I help

them respond appropriately during an event that I may take as

lead and how they can assist me so that I can do my job more effectively as a public health individual.

A lot more cross-training from the State, Federal, and local level

really needs to occur. Those critical roles and responsibilities are

very difficult to establish in times of confusion and high energy and

high concern. One of the things that having the protocol with the

FBI in advance allowed us to fix our situation in Missouri very rapidly because our roles and responsibilities had been clearly defined.

We also believe that we need responsive teams available 24

hours a day, 7 days a week. We have a system available to do that.

Many States do not. Many of our local public health agencies do

not. But those teams need to be broad-based and supported.

We have inadequate resources for mass casualties in our State.

Most of our hospitals have an inventory that is ‘‘just in time.’’ They

can barely meet their daily needs and will not be able to gear up

for a large influx of ill or injured individuals.

Mental health capacity and funding for dealing with the immediate and long-term consequences of a catastrophic or terroristic

event are currently unknown and untapped, I believe.

Our laboratories need to be increased in capacity. We need highly-trained individuals and they need to be staffed. We say at the

public health level, I do not have reserves to call up. I do not have

a Public Health Guard. We do not have time to train highly-skilled

individuals in a very short time and need to assure that we are

prepared in advance and adequately staffed.

With regard to dealing with the public, we would like to be able

to speak with one voice and assure that we have adequate

educational campaigns to address the public. They need to be comfortable with our credibility and know that our information is accurate and timely. If there were an event that we would need to assure there was no secondary transmission or quarantine and evacuate, we would need them to trust us and to listen to us immediately and respond. We believe that needs to be established in advance.

I have one final area that I would like to address that goes well

beyond the vaccine for smallpox and anthrax and I think that we

have a national tragedy in that we can currently not protect our

population against many usual diseases that are not of terroristic

origin. Influenza is a prime example. We currently also have a

shortage of tetanus vaccine. Most of our current supply in Missouri

was sent to New York and we have not been routinely administering the boosters to adolescents for several months, not only in

Missouri, but across the country. We have recently been notified

there may be shortages of childhood vaccines.

It is impossible to adequately protect our populations currently,

and our vaccine supply and distribution system really needs to be

examined and perhaps overhauled. We would request that we could

have a rational national vaccine policy to help us deal with this

issue and protect our population so they are not vulnerable to manmade or natural threats. Thank you.

62

1The prepared statement of Dr. Hamburg appears in the Appendix on page 152.

Chairman LIEBERMAN. Thank you, Dr. Dempsey. Excellent testimony. Your State is lucky to have you. I would guess that some

of the programs you described do not exist in many other States,

certainly the preparedness for bioterrorism. Am I correct in that?

Dr. DEMPSEY. I do not know the extent of that preparedness. I

know that the degree of preparedness is fairly high in Missouri and

many other States are enacting very similar types of activities and

units.

Chairman LIEBERMAN. Excellent. Thanks.

Dr. Hamburg, thanks for being here. It is good to see you again.

TESTIMONY OF MARGARET A. HAMBURG,1 M.D., VICE PRESIDENT FOR BIOLOGICAL PROGRAMS, NUCLEAR THREAT INITIATIVE

Dr. HAMBURG. Thank you very much for your leadership on this

important issue. It could not come at a more important time. I

think today we are all painfully aware of our Nation’s vulnerability

to terrorism, including bioterrorism, and whether it is an unsophisticated delivery system with a limited number of exposures, as we

have been seeing in recent days with the anthrax situation, or the

potential of a more high-tech mass casualty attack, the prospects

are certainly frightening, and today, no one is complacent any

longer about this biological threat.

While there are many challenges, we do know a great deal about

what needs to be done and how to do it. Improving the national response to bioterrorism must involve a comprehensive and coordinated plan. From a public health and medical perspective, several

key elements must be strongly present, and you just heard a good

recitation.

But perhaps first and foremost is prevention, efforts to reduce

the likelihood that dangerous pathogens will be acquired or used

by those who want to do harm.

Second, strengthening the public health infrastructure, our ability to rapidly detect, investigate, and respond to outbreaks of disease, enhancing medical care capacity to be able to surge in response to a large-scale event.

The National Pharmaceutical Stockpile that Secretary Thompson

talked about this morning is essential to ensure that necessary

drugs or vaccines can rapidly get where they are needed.

And we also need research, perhaps right now most urgently to

improve detectors and diagnostics, along with better vaccines and

new medications, and we also need to make sure that we bring to

bear all available scientific knowledge and technology on the problems before us, that we translate what we know into action, and

whether it is the development of the second generation anthrax

vaccine or the implementation of new standards for ventilation systems, we still have opportunities to actually put in place a number

of things that we know.

There are programs across the domains I just talked about that

have been initiated in recent years. The bioterrorism preparedness

activities are not just in Missouri. CDC has sponsored programs

across the 50 States, but many of those programs need to be

63

strengthened, need to be extended, and there are still many programs and policies that need to be developed and implemented.

And really, until recently, the importance of these kinds of programs in our overall efforts to protect national security and prepare against the threat of terrorism have been under-appreciated

and under-funded and I think we really have an important opportunity at this moment to change that situation in positive ways.

So how big is the gap between the threat and our ability to respond? I was asked by your staff to briefly discuss the Dark Winter

exercise, a recent bioterrorism war game involving the intentional

release of smallpox. Although a simulation of a worst-case scenario,

it powerfully conveyed the distinctive and sobering features of a potential bioterrorist attack and helped, I think, to spotlight vulnerabilities that we must urgently address.

Chairman LIEBERMAN. For the record, why do you not indicate

under whose auspices Dark Winter occurred.

Dr. HAMBURG. OK. It was created by the Johns Hopkins Center

for Civilian Bio Defense, along with the Answer Institute for Homeland Security and CSIS, the Center for Strategic and International

Studies. It was played out at Andrews Air Force Base in late June

of this year and it involved a simulation of a series of National Security Council meetings and the participants were all individuals

who had served in government, many in cabinet or sub-cabinet

roles, and I played the Secretary of Health and Human Services.

Over a 24-hour period, this game went forward, but it actually

represented a 3-week simulation of a bioterrorist event. In the

opening minutes of the exercise, we learned that cases of smallpox

had just been diagnosed by the Federal Centers for Disease Control. Given the propensity of this disease to spread person-to-person, its 30 percent fatality rate, and the limited supply of smallpox

vaccine, it was not surprising that we were soon dealing with an

epidemic of devastating, if not catastrophic potential.

Smallpox has an incubation period of 7 to 21 days, and as the

exercise began, we did not know when the attack had occurred or

where. We had no way to understand the full scope of the crisis we

were facing. How many cases were there? How many more cases

could we expect? When and where did the first infections take

place? Who released it? Did we have enough vaccine and could we

obtain more?

We did not know it at the time, but there actually were three simultaneous attacks that had taken place 9 days earlier. Terrorists

had silently released smallpox in three shopping malls at the start

of the Christmas shopping season, and although the releases were

variably effective, some 3,000 people turned out to have been infected by these initial exposures.

To contain a smallpox epidemic, there are two primary tools: Isolation of cases and protective vaccination of those exposed. Most of

the available vaccine was distributed early on in an effort to protect key health care workers and other critical responders, to protect a fraction of our military, and most importantly, to try and put

a ring of immunity around the smallpox cases that were being reported, and as you heard this morning, we only, as a Nation, have

enough smallpox vaccine for about 1 in 23 Americans.

64

But from the beginning, the strategy for smallpox control was

limited because of the large numbers of people initially infected,

the contagiousness of smallpox, and our limitations on vaccine supplies. Accelerated production of new vaccine was ordered by the

President, and the Secretary of State was asked to try to find surplus stocks from other countries, but this was doubtful in the face

of a smallpox epidemic that was likely to quickly become global in

nature.

Over the course of days, vaccine started to run out and we had

to contemplate measures considered draconian by modern standards, including enforced isolation of contact and restrictions on

travel. We also had to address logistical concerns, such as getting

food and other essential supplies to affected areas in the face of

these restrictions. And these problems were exacerbated by the fact

that, by this point, we could no longer provide vaccine to essential

providers.

As the exercise progressed, we started to see what appeared to

be secondary infections, although we could not be 100 percent certain that we were simply seeing secondary cases or if we were seeing a subsequent attack. Because of the person-to-person spread,

epidemiologic models predicted that without effective intervention,

every 2 to 3 weeks, the number of cases would increase roughly 10-

fold. So we were looking at three million cases in 2 months if we

did not stop the waves of follow-on infections.

At the conclusion of the exercise, the epidemic had spread to 25

States and 10 foreign countries. Civil disorder was erupting sporadically around the Nation. Interstate commerce had ceased in

large areas of the country. Financial markets had suspended trading. We were out of vaccine and we were using isolation as the primary means of disease control.

So you can see, for the participants, this exercise was filled with

many difficult dilemmas and unpleasant insights. I want to stress

again that this is, of course, a worst case scenario and it was really

designed to help surface some of the critical issues in terms of how

we think about a bioterrorist threat, how we organize systems to

respond, and what are some of the critical gaps that we need as

a Nation to address.

So some of the key lessons learned included, first, that we really

need to focus more attention, concern, and resources on the specific

threat of bioterrorism, understanding that it is different from the

other threats we face, that it will unfold as a disease epidemic over

time, potentially with waves of infection and disease as opposed to

the kind of attack we saw on September 11, where, while devastating, it was confined in both time and geography.

Critically, we need to recognize the central role of public health

and medicine in this effort and engage them fully as true partners.

We must act on the understanding that public health is an important pillar of our national security framework.

Public health takes place, of course, at the local, State, and national level, and we have to recognize that and support capacity at

all those levels, as well as integration. We need to increase the core

capacities of our Public Health System to detect, track, and contain

epidemics by providing resources for effective surveillance systems,

65

including the kind of real-time data collection and analysis strategies that were mentioned by Dr. Dempsey and by Mr. McConnell.

We need diagnostic laboratory facilities to support these efforts

and effective communication links to other elements of the response. This must include a reexamination and modernization of

the legal framework for epidemic control measures, and we must

recognize the need to fully bring in and work with new partners,

both within health, veterinary medicine, and agriculture, as we

heard earlier, and also the importance of law enforcement in this

kind of a context.

We also need to develop plans for a surge of patients in the Nation’s hospitals. This will require careful advance planning, since

most hospitals are operating at or near capacity now.

Mr. McConnell mentioned the Stafford Act as it related to agriculture, and I also think that if you are looking into that, some of

those same uncertainties about reimbursement exist for voluntary

and private hospitals in the event of response to a national disaster.

Related to this is the National Pharmaceutical Stockpile, which

should be built to capacity, including extra production capability

for drugs and vaccines with heightened security at the various storage and dispersal sites. It will also be necessary to increase funding for biomedical research to develop new vaccines, new therapeutic drugs, and new rapid diagnostic tests for bioweapon agents.

In a broader sense, we need to identify and put into practice the

mechanisms by which all levels of government and all relevant

agencies in government will interact and work together. These responses, as just mentioned, are cross-disciplinary and must cross

agency lines. We must understand our differing roles, responsibilities, capabilities, and authorities and continue to plan and practice

how to work together before an act of terrorism occurs.

We should also build on systems that are used routinely to the

greatest degree possible so that we are not trying things out for the

first time in the event of a crisis, whether it is HAZMAT teams

that will be relevant in case of a chemical attack or disease surveillance and public health systems for a bioterrorism attack.

Similarly, there should be a clear plan for providing the news

media with timely and accurate information to help save lives and

prevent panic, and I think we have seen the importance of that in

recent days.

Finally, measures that will deter or prevent bioterrorism will be

the most beneficial means to counter these threats to public health

and social order. We need to prevent the proliferation of biological

weapons, in part by strengthening intelligence gathering about

such threats, but also by providing peaceful research options to

former bioweapons scientists in the former Soviet Union and securing their biologic materials. In addition, we need to encourage the

scientific community to confront the potential misapplication of

modern biological research and help them devise systems and practices that ensure secure access to dangerous pathogens for legitimate use only.

So in conclusion, let me reemphasize that a sound strategy for

addressing bioterrorism will need to be quite different from those

that target other terrorist acts. While a larger-scale event likely reVerDate 11-MAY-2000 08:28 Aug 06, 2002 Jkt 000000 PO 00000 Frm 00069 Fmt 6633 Sfmt 6633 76807.TXT SAFFAIRS PsN: SAFFAIRS
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1The prepared statement of Ms. Smithson appears in the Appendix on page 164.

mains a low probability, the high consequence implications of bioterrorism place it in a special category that requires immediate and

comprehensive action.

Yet as we move forward to address this disturbing new threat,

it is heartening to recognize that the investments we make to

strengthen the public health infrastructure, to develop new drugs

and vaccines and assure their availability, to improve medical consequence management, and to support fundamental and applied research will also benefit our efforts to protect the health and safety

of the public from naturally occurring disease, be it flu or food poisoning.

So again, I appreciate your efforts on these important topics and

would be happy to answer any questions you may have.

Chairman LIEBERMAN. Thanks. That is a very good point at the

end, also, about the connection to more traditional public health

threats.

Dr. Smithson, nice to see you here in person. I have seen you a

few times on television in recent weeks.

Ms. SMITHSON. That is not my normal shtick, I assure you.

Chairman LIEBERMAN. Well, you do it well.

Ms. SMITHSON. Thank you, sir.

Chairman LIEBERMAN. We will hear your testimony now.

TESTIMONY OF AMY E. SMITHSON,1 PH.D., DIRECTOR, CHEMICAL AND BIOLOGICAL WEAPONS NONPROLIFERATION

PROJECT, THE HENRY L. STIMSON CENTER

Ms. SMITHSON. On September 11, this Nation suffered an unthinkable tragedy, particularly the family and friends of those who

perished. In the aftermath of that horrific attack, a series of incidents involving anthrax have unfolded, including here on Capitol

Hill. One American has died from anthrax, three have the disease,

and several dozen others have been exposed to the agent. Over 280

million Americans are physically unharmed by these isolated anthrax incidents, but a great many of them are fearful of what

might come next.

No matter where one comes out in the debate about whether terrorists can pull off a biological attack or a chemical attack that

causes massive casualties, the debate itself is moot. One need only

consult public health journals to understand that it is only a matter of time before a strain of influenza as virulent as the one that

swept this country in 1918 resurfaces. You can also examine issues

regarding emerging infectious diseases and the rise in the number

of diseases resistant to antibiotic treatment to know that Mother

Nature herself is a very formidable opponent.

The fact that we now live in large population centers and travel

with great frequency, not just in this country but internationally,

will complicate the ability of public health authorities to address

epidemics.

As for the prospects of a large-scale chemical disaster, one needs

to keep in mind what America’s first responders and health care

workers have to deal with on a routine basis. According to the U.S.

Chemical Health and Safety Investigation Board, between 1987

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and 1996, a hazardous chemical incident of some severity took

place in over 95 percent of this Nation’s counties. Every year, over

60,500 accidents and incidents with these chemicals occur at fixed

facilities or in transit.

Thus, there is a need for this Nation’s front-line responders, from

fire fighters, police, and paramedics to doctors, nurses, laboratory

workers, and public health officials, to be prepared to cope with

chemical and biological disasters, regardless of whether or not terrorists turn to these agents in the future in an attempt to cause

mass casualties.

The appointment of Governor Tom Ridge as the Director of the

new Office of Homeland Security would certainly seem to be a constructive step that could put improved coordination and streamlining of the Federal response bureaucracy on a fast track. To aid

Governor Ridge in his efforts, Congress should grant him czar-like

budgetary authority. I will not kid you. Everybody that works inside the beltway knows that the real clout comes with control of

the budgets.

Alone, Governor Ridge will have difficulty taming the Federal bureaucracy, however. When I try to tally the number of Congressional oversight committees on Capitol Hill, I not only run out of

fingers, I run out of toes. A consolidation of Congressional oversight

committees is sorely needed.

Also in order is a reassessment of the true value of politically

popular placebo programs, like the National Guard’s Civil Support

Teams, and my remarks in this regard will differ from what you

have heard from Mr. McConnell. I assure you I have no disrespect

or intend no disrespect for the National Guard as an institution or

for the fine men and women who serve our country in the National

Guard.

But I urge you to consider the evaluation of these teams offered

by public safety and public health officials, including members of

the National Guard, that I interviewed in 33 cities in 25 States.

Their views are presented fully in ‘‘Ataxia,’’ a report that I co-authored with Leslie-Anne Levy and released last October. This report can be found on the World Wide Web at www.stimson.org.cwc.

Briefly, the message from the front line about these Civil Support Teams is unified and clear. They have a minuscule, if not negative, utility in a chemical or a biological disaster, a point that I

would be pleased to elaborate on during Q and A.

To those accustomed to overseeing billion-dollar budgets, the National Guard program in this area might not seem so ill advised,

but please consider how this program’s budget could be put to uses

that could make a real preparedness difference on the front lines.

For example, to begin fixing the glaring lack of decontamination capacity in U.S. hospitals that results in recurrent hospital closures

even after small HAZMAT incidents. In most of the cities that I

surveyed for ‘‘Ataxia,’’ the central game plan for hospitals in the

event of a major chemical catastrophe was to lock down. That

means to shut their doors to incoming patients.

Chairman LIEBERMAN. Why was that?

Ms. SMITHSON. Simply because in order to protect the safety of

the patients that are already in their facility, as well as the safety

of the workers there, physicians, nurses, etc., if they allow someone

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that is contaminated inside the premises, they have to close that

area of the hospital down.

For the cost of standing up one National Guard Civil Support

Team, 2,333 hospitals or fire stations could be outfitted with decontamination capabilities. With the total 1999 budget for this program, 49,800 local rescue and health care facilities could have been

armed for decontamination. Civil Support Team funds, in other

words, could be used to make a genuine preparedness difference

were they applied to overcoming the decontamination bottleneck at

U.S. hospitals.

I am aware that proposals are now circulating for each State to

have its own Civil Support Team. I would encourage you to reconsider those proposals. By all means, leave the resources in the

States, but this is something, again, I would encourage you to reconsider.

If there is no other message that you take away from my testimony today, let it be an understanding that the key to domestic

preparedness lies not in bigger Federal bureaucracy but in getting

taxpayers’ dollars channeled to readiness at the local level, and I

would like to spend a few minutes, with your indulgence—— Chairman LIEBERMAN. Please.

Ms. SMITHSON [continuing]. Explaining a couple of concepts that

I believe will be key to readiness at the local level.

The first of these refers to something that Dr. Hamburg just discussed and that is how can hospitals handle a great surge of patients either in a chemical or a biological disaster? The key here

appears to be a need for regional hospital planning. This is something that used to occur in a lot of our cities but no longer does

because of the way that our health care system currently works.

If the Federal Government provides grants to regions so that

hospitals can get together and have a pre-agreed game plan about

how to share burdens in these circumstances, who is going to remain open for what, for traumas, for maternity, for heart care,

which hospitals would convert to care of infectious disease patients,

these types of arrangements, including plans about how to

prophylax a large population, how to secure emergency supplies,

how to bring in, in the near term, before Federal help can arrive,

reservoirs of health care personnel that might be nearby. All of

these factors are all essential to the ability of hospitals to withstand the flood of patients they are likely to see, such that the local

health care system does not collapse in such an event.

Chairman LIEBERMAN. As far as you know, none of this is happening now?

Ms. SMITHSON. In the survey that I conducted, there were only

a couple of cities across the country—and I was not everywhere,

but 33 is pretty large—that were even beginning to attempt this

type of planning.

Chairman LIEBERMAN. And the Federal Government is not requiring it, as far as you can tell?

Ms. SMITHSON. This is not a requirement of the Federal programs as I currently understand them.

Chairman LIEBERMAN. OK.

Dr. HAMBURG. I think it is part of the MMRS program that Secretary Thompson talked about. They are trying to get cities receivVerDate 11-MAY-2000 08:28 Aug 06, 2002 Jkt 000000 PO 00000 Frm 00072 Fmt 6633 Sfmt 6633 76807.TXT SAFFAIRS PsN: SAFFAIRS
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ing monies to do planning. It is not quite as required or comprehensive as what Amy is suggesting, though.

Chairman LIEBERMAN. Right.

Ms. SMITHSON. She is correct. With the MMRS program, the difficulty has been, and also with the Domestic Preparedness Program, getting hospital administrators and physicians into the planning process because they simply do not have the ability to charge

their time anywhere and their time is needed for other duties.

Another concept that I would like to discuss with you is that of

early warning syndrome surveillance. Disease reporting usually

comes from two sources, physicians who are alert and pick up signs

and symptoms, as well as laboratories that do detailed analyses of

cultures.

Well, if we really want to get a head start on an outbreak, there

are several places across the country that are attempting to institute disease syndrome surveillance. The utility of this is that it

takes data that is already available and creates a historical database. This is a computing and data analysis challenge, and monitoring things like 911 calls and other leading-edge indicators would

allow public health and emergency officials to understand that

something is going wrong in the health of their communities.

They might not know what, but this kind of a technique would

allow them to notify hospitals and laboratories to look hard and

look fast to get more specific about what might be going wrong. It

may make the difference in the ability to get that early notice of

a disease outbreak in time to take lifesaving intervention. The

most advanced system in that regard that I am aware of is in New

York City. They have done path-breaking work.

And with that, I think I will wait for your questions.

Chairman LIEBERMAN. Thank you.

Ms. SMITHSON. Thank you.

Chairman LIEBERMAN. No, thank you. It was very helpful.

Talk just a moment about what the purpose of the Civil Support

Teams of the National Guard was supposed to be.

Ms. SMITHSON. I think I should actually let the National Guard

speak to their purpose because they run the program, but if one

understands the dynamics of a chemical disaster response, this

peaks very quickly. If you look at the situation that occurred in

Tokyo, the victims in that particular instance were at the hospital

within a matter of a couple of hours.

Chairman LIEBERMAN. Right.

Ms. SMITHSON. Now, the National Guard is saying that these

teams will go ‘‘wheels up’’ in 4 hours. In New York City, I believe

that they arrived at the World Trade Towers within 12 hours, perhaps that was 11 hours, and in that particular situation, they

began to monitor for chemical and biological agents. Well, quite

frankly, the New York City officials had begun to do that hours before, as had the Environmental Protection Agency.

There are a number of exercises and incidents that have been related to me from my interviews with regard to how well these

teams have been able to perform, and simply, they have been put

in between a rock and a hard place. They are very well trained, but

unless you have been in the heat of battle, so to speak, it is very

70

difficult to apply a lot of the skills that they have been asked to

master.

In a biological disaster response, for example, the medical component on these teams is four people, and in terms of how much medical manpower would be needed, that is pretty much a drop in the

bucket.

Chairman LIEBERMAN. Right.

Ms. SMITHSON. So, again, these are things we can discuss in

more detail—— Chairman LIEBERMAN. It is well stated and that is a question we

will throw back at those in charge of those programs.

You made a point which has interested me for a while as I have

focused on the current wave of terrorist attacks and concern about

chemical and biological, which is the extent to which changes that

have occurred in our health care system in recent years, decades,

have put us more on a kind of a ‘‘just in time’’ inventory basis. I

am making a manufacturing comparison, but you talked about it

in terms of hospital rooms available.

I want to ask you, Dr. Hamburg, to comment on that from your

background in public health generally. It strikes me that if we

want to be really ready to respond medically to an attack, it does

take government intervention, because it is not going to normally

happen in the health care system as it is operating out there today.

Am I right?

Dr. HAMBURG. You are exactly right. The current pressures in

the health care environment have led to an enormous amount of

downsizing, fewer hospital beds, ‘‘just in time’’ purchase of pharmaceuticals and supplies, and minimal staffing patterns, and that is

fine if you want to save money, but it is not what you need in the

event of a large-scale, potentially catastrophic event with many

casualties.

Clearly, we do not want to encourage our health care system to

add on unnecessary, unutilized beds or services in the event that

a catastrophic attack will occur or a major natural disaster, but I

think that what Amy was saying about regional planning is absolutely the key. We need today to have localities assess what their

assets and capabilities are, not just in terms of the existing health

care system but also ancillary facilities and staffing possibilities

that could be brought to bear in a crisis. Then you need to look at

what are the State programs and assets and the Federal programs

that can be brought to bear to add to the local capabilities in a

staged kind of way, recognizing that, as has already been emphasized, that the initial response is going to be truly local and it has

to build on local capabilities.

It is absolutely key that as monies go out to States and localities

to build new programs of preparedness in this context, I think that

we put a requirement on them to do this kind of planning and

specify the kinds of elements that they need to address in their

plans, because again, this is the kind of thing where you have to

develop a plan, you have to bring all the partners together, you

have to understand the components of that activity, and then you

have to practice it.

Chairman LIEBERMAN. Good idea. Going back to your report on

the exercise, the simulation of Dark Winter, are you beginning to

71

see responses from the government to some of the lessons learned

from Dark Winter?

Dr. HAMBURG. Well, I think it is a combination of Dark Winter

and real world experience, I think has put some of these issues on

the public consciousness in a way that it has never been before and

in the halls of Congress, as well. Frankly, when I used to talk

about public health infrastructure needs and the surveillance, et

cetera, people’s eyes would glaze over and they would find an excuse to leave the room. Now, people that I would never imagine to

be interested and supportive of these issues suddenly are at the

front line in terms of calling for greater investments in these areas.

From the public health perspective, I think it is very exciting and

I think it really is truly the case that these are very sensible investments for the American people because, as Amy eloquently described in her testimony, Mother Nature herself is a very powerful

adversary and we know that we are vulnerable to a whole array

of infectious disease threats. And as I think about the problem of

bioterrorism, it is part of a continuum of infectious disease threats,

but at the farmost extreme end. We have allowed our Public

Health System to be under-funded and inadequately supported and

this is the critical time to turn that situation around.

Chairman LIEBERMAN. I agree. The investments we make now in

reaction to this terrorist crisis will, if we do them right, have the

effect of strengthening our Public Health System for the kinds of

challenges that just face us in a more natural setting than enemy

attack, including the flu epidemic that you referred to.

Dr. Dempsey, if you were taken up to the Federal level and

asked how best to organize the Federal programs that we have

talked about today for preparing for responding to chemical and biological attacks, what would be the overview of what you would do?

Dr. DEMPSEY. With organizing the Federal level?

Chairman LIEBERMAN. Yes.

Dr. DEMPSEY. To assist the States or just for the Federal response?

Chairman LIEBERMAN. Generally, and to assist the States, yes.

Dr. DEMPSEY. Well, I believe that, first, I would have to understand their primary roles and responsibilities and assure that the

interconnections and the collaborative efforts that needed to be established between them were put into place and actually operationalized.

And what we have found on the State level, we have similar

issues about how do we organize these activities at the State level,

is that we are always long on theory and short on application and

it is really hard to operationalize how it finally works until you try

to do it, and I think that takes a different level of planning, a very

deep understanding of the primary roles and responsibilities and

how they relate to the roles and responsibilities.

If you look at the way we are organized now, both federally, at

least the way I view the Federal perspective, is that everybody has

their roles and responsibilities but they are within their discipline

and within their authority, and that plays out in parallel and not

in concert. So you get a lot of response, but it is not coordinated

and perhaps not as effective as it could be.

72

I think a focus on the outcomes of what we are trying to achieve,

if you are going to reorganize or reallocate resources, what are the

outcomes you are trying to achieve and set your programs up or

your organizations up to achieve those outcomes and then assign

back roles and responsibilities. That approach, generally, I think,

would be far more effective than starting from a role and responsibility and trying to figure out how to make the collaboration work

later.

Chairman LIEBERMAN. Thanks. We have just completed our fifth

hour in this room, or yours, anyway, and I do not want to keep you

much longer, but I want to ask you a last question just to bring

it back to what is happening here now, because obviously we left

to go to the meeting with all of the Senators, and there are well

over 20, maybe approaching 30 or just over 30 cases now around

Senator Daschle’s office in which people have been determined to

have been exposed to the anthrax. And, of course, we have had the

other episodes.

I got a note, and I should not be repeating hearsay, but that

there was now a finding of anthrax in Governor Pataki’s New York

City office.

I wanted to ask you, you are experts, you are administrators, you

have been involved in this, you have thought about it, just give me

for a couple of minutes each, what are your reactions to what is

happening now, and if you have any particular counsel here in

terms of the Capitol or generally, I would be happy to hear it.

Dr. DEMPSEY. Actually, I have thought about it a lot because we

have been dealing with it, and I think part of the difficulty that

we are having with resolving the situation is the panic that ensues.

Chairman LIEBERMAN. That is right.

Dr. DEMPSEY. Even the word ‘‘exposure’’ and the unknown quantity for these agents that are being unleashed and what that means

for individuals, you cannot see them, you cannot predict when they

will be out there. And we are seeing a lot of individuals who are

jumping at shadows, very concerned, beginning antibiotic therapy.

We have deep concerns that if we do not manage this public message from a State, Federal, and local level with a united voice, that

we will have more antibiotic resistance in the future, perhaps

against agents that we only have one drug that may be effective

against it now. That is a huge consideration and that is part of the

management of the public.

I think the unified approach really is to assure that we do establish protocols and procedures for both testing, diagnosis, and treatment, and begin to educate people adequately on what those protocols are and then adhere to them.

Part of the difficulty we have had with overloading the system

is that we have no way to manage that. Everybody wants everything evaluated within 24 hours. Everybody wants to be on drugs

and everyone wants someone to come and investigate. Without a

way to truly manage that, to manage the public response and the

official response in a coordinated, concerted, unified effort, I think

that we may miss something that is going on while we are exhausting our resources on something that we do not need to exhaust

them on and that we create undue panic in the public because we

73

have not given them credible information on how to protect themselves.

We have given them good information on what not to do. Do not

buy masks. Do not stockpile. But we have not said, here is something you can do, and I think they are hungry for that. That is why

they are buying the masks.

So I would say that good, credible information, timely coordination, and a unified approach.

Chairman LIEBERMAN. Dr. Hamburg, I would ask you to respond,

and maybe I will focus it a bit because I know you have spent some

time thinking and working in this area. What conclusions do you

draw, and I understand you are dealing with public information

here, about the finding that the anthrax sent to Senator Daschle’s

office was of a more pure variety, and I presume, and again, I am

going beyond my expertise, the fact that so many more people in

his office have been exposed suggests that this anthrax was moving

more widely in the air.

Dr. HAMBURG. Well, I clearly do not know all the facts about the

investigation or the nature of the material identified, but I think

it underscores the importance of really addressing the problem of

access to dangerous pathogens. The fact that it has been described

as of a higher grade and apparently prepared in a way that would

suggest an intent to make it more harmful reminds us that whoever is doing this is intending to do harm and has been able to get

access to materials that will make the harm done more severe.

And so I think that this is the time to really look at the systems

that we have in place to assure that only those who have a legitimate use for this organism and other dangerous pathogens have

them, that we know more about who is using them and why. And

it underscores our need to really improve intelligence in the biological area and I think that public health and the scientific community actually has an opportunity and an obligation to work more

closely with intelligence authorities in those collection efforts because I think we have expertise that can be very helpful in data

collection and analysis.

Chairman LIEBERMAN. That is very interesting. I appreciate that,

because it is not that this stuff is easy to get, but I have learned

over the last couple of days even that there is more of it around

than I would have guessed, so that—and I presume there is not

much intelligence work being done in this area, so you are right.

Without compromising anybody’s independence and etc., the ability

to share information between the research scientific communities

and intelligence agencies or law enforcement now will be critically

important. Thank you.

Dr. Smithson, finally.

Ms. SMITHSON. Well, I think that the scars from September 11

are running deep, but the scars that are being created by the

events that are unfolding now may be even deeper and more difficult to address. I echo Dr. Dempsey’s concerns in that regard

and——

Chairman LIEBERMAN. Unduly, I take it you mean, in other

words, that it is beyond—— Ms. SMITHSON. Yes. A lot of what the American public heard in

the initial media cycles, I think, blew some of this out of proporVerDate 11-MAY-2000 08:28 Aug 06, 2002 Jkt 000000 PO 00000 Frm 00077 Fmt 6633 Sfmt 6633 76807.TXT SAFFAIRS PsN: SAFFAIRS
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tion, so it is very difficult now when they hear messages about

these are isolated incidents, that there are lots and lots of hoaxes

interspersed with these things. What can they do to protect themselves? How can we move forward? I am perhaps here suggesting

a public service information campaign so that the messages get repeated often about how to put this threat into context.

In my initial statements about this, I talked about how someone

was more likely to be the victim of a lightning strike—your odds

there are one in 600,000—than you are to be the victim of a chemical or biological terrorist attack. I have used the reference of how

we learned to buckle our seat belts when we get into the car to reduce the chances that we might be injured in a car wreck, but we

still drive our cars and we still need to open our mail. So we are

going to have to learn to take some new precautions with our mail.

What are those precautions? Some of these messages are getting

out, but they are getting interspersed with a lot of other stuff that,

I think, is confusing for the American public as well as for policy

makers.

Another thing that these incidents illustrate again and again is

that all emergencies are local. I guess what I would advise you to

consider is that there are some roles that the Federal Government

must fulfill, for example, those related to research, development,

and production of emergency medical supplies and the provision of

emergency medical manpower, the provision of mid- to long-term

recovery assistance in the aftermath of a disaster. Some of these—

a lot of these capabilities and resources are already in place.

But there are some roles that are not appropriate for the Federal

Government to undertake. Allow me to illustrate that by pointing

to how training is currently being conducted. The Federal Government is hiring contractors, and according to the GAO statistics

here, training is getting to responders that serve only 22 percent

of our Nation’s population.

Chairman LIEBERMAN. That is right.

Ms. SMITHSON. So we can either go about this the smart way or

we can continue on a costly and inefficient track. The goal here is

to get the entire country prepared in an even and systematic way,

hopefully. It will be tough.

But, for example, on the training front, the solution there is very

clear. Institutionalize the training in fire academies, in police academies. All paramedics ought to have training with regard to this.

This needs to be in our medical schools, in our nursing schools. Our

microbiologists need to have certain training in this regard, as do

our public health officials. Get the Federal Government out of the

way there, and that way, I think we will get the entire country better prepared.

There are several common sense solutions, and if you need anyone out of my Rolodex from 33 cities to convey these messages personally and with much more authority, you are welcome to them.

Chairman LIEBERMAN. Thank you. That is a generous offer.

You have been very helpful and you have got great expertise.

You have shared it with us. And I think to the extent that you

have given statements that are quite balanced and proportionate.

It is very important to do that.

75

Now, obviously there is great anxiety here, as I said long ago at

the beginning of the hearing, and part of it is because we are in

a territory that we have not been before within the United States.

I mean, there have been health epidemics, and in some ways, people have been fearful when that has happened. I watched it on a

relatively small scale about West Nile virus. And, of course, earlier

in our history, terrible losses associated with influenza. I lost my

paternal grandmother, who I never got to know, in the influenza

epidemic of 1918.

But it seems far away from life as we have known it in recent

times and that is part of the anxiety, and I do think we have to

put it in proportion, compare it to other risks that we have, and

then share information and then, and this comes back to the purpose of the hearing, make sure that the government is organized

as effectively as possible to both prepare for crises of this kind and

then respond to them, and if we are, then we will give the public

even greater reason for confidence.

Anyway, you have helped measurably. This has been a long hearing and it has taken at least one unexpected twist, but I think it

has been valuable, certainly to me and the Committee in assisting

us in fulfilling our responsibilities to the public. So I thank you

very much.

Before we recess, I would like to enter into the record a statement from Senator Bunning.

[The prepared statement of Senator Bunning follows:]

PREPARED STATEMENT OF SENATOR BUNNING

Thank you, Mr. Chairman.

The threat of a biological attack has unfortunately been brought home to us during the past couple of weeks.

Understandably, Americans are nervous.

Companies and offices are taking extreme measures when opening mail, hundreds

of employees have been tested for anthrax exposure and many Americans have contacted their doctors about getting prescription drugs.

During this time of confusion and anxiety, the American people are turning to us

for answers.

We have known for some time that we need to be better prepared to respond to

a biological or chemical attack. We have taken some steps in the past to address

these concerns and better prepare our state and local governments.

However, as some of our witnesses will testify today, we have a long way to go

in being able to adequately handle a large-scale biological attack.

This includes making sure our hospital personnel and others on the front line

have the training and equipment they need to make the fastest diagnosis possible,

making sure that we have enough medicine stockpiled to treat those infected, and

making sure that our state and local governments can coordinate and communicate

with the appropriate Federal personnel during and after an attack.

The United States has entered a new era. With the events of September 11 and

the anthrax cases throughout the country, we must become more proactive in addressing all types of terrorist threats.

I want to thank our witnesses for being here today, and taking time out of their

busy schedules to share with us their expertise on this issue.

Thank you, Mr. Chairman.

Chairman LIEBERMAN. The record of the hearing will remain

open for another week for those who may wish to submit statements. At this point, I will recess the hearing.

[Whereupon, at 2:40 p.m., the Committee was adjourned.]

(77)

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